Modelling the extremes of seasonal viruses and hospital congestion: The example of flu in a Swiss hospital

Viruses causing flu or milder coronavirus colds are often referred to as 'seasonal viruses' as they tend to subside in warmer months. In other words, meteorological conditions tend to impact the activity of viruses, and this information can be exploited for the operational management of hospitals. In this study, we use 3 years of daily data from one of the biggest hospitals in Switzerland and focus on modelling the extremes of hospital visits from patients showing flu-like symptoms and the number of positive flu cases. We propose employing a discrete generalized Pareto distribution for the number of positive and negative cases. Our modelling framework allows for the parameters of these distributions to be linked to covariate effects, and for outlying observations to be dealt with via a robust estimation approach. Because meteorological conditions may vary over time, we use meteorological and not calendar variations to explain hospital charge extremes, and our empirical findings highlight their significance. We propose a measure of hospital congestion and a related tool to estimate the resulting CaRe (Charge-at-Risk-estimation) under different meteorological conditions. The relevant numerical computations can be easily carried out using the freely available GJRM R package. The empirical effectiveness of the proposed method is assessed through a simulation study.

Has the COVID-19 outbreak changed the way we are treating prostate cancer? An EAU – YAU prostate cancer working group multi-institutional study

Introduction & Objectives: The COVID-19 outbreak has become the dominant issue throughout the world whilst the governments, nations and health services are trying to deal with its impact. The aim of our study is to assess the impact of COVID-19 on patients treated with Radical Prostatectomy (RP) for Prostate Cancer (PCa) at European referral centers in terms of Surgical Volume (SV), waiting list meant as time from biopsy to surgery (WL) and risk of adverse pathologic findings at RP due to the selection of men with more adverse disease characteristics at final pathology. Materials & Methods: Consecutive patients with histologically proven disease treated with Radical Prostatectomy (RP) were collected between March 11th 2020 (WHO declaration of pandemic) and December 2020. Metastatic patients not eligible to local treatment and patients with recurrent prostate cancer after RP or RT were excluded. Patients treated in the same time span of the year before with comparable inclusion criteria were considered as the control group. Disease characteristics were compared. Multivariable logistic regression analysis tested the impact of the COVID-19 outbreak on the risk of adverse pathologic findings at RP after adjusting for confounders. The percentage change of SV and WL was assessed comparing the months of pandemic with the equivalent timespan of the previous year. Results: A total of 2,574 RP were collected (927 study group and 1647 control group) in 8 European centers. A reduction of MRI for staging and a higher PI-RADS score (p<0.01) was observed in patients managed after the COVID-19 outbreak in comparison to the control group. Multivariable analysis adjusted for age, PSA at diagnosis, cT stage, ISUP at biopsy and PI-RADS score, showed that patients who were treated during the pandemic had higher risk of extra prostatic disease (OR:1.35, 95% CI 1.00-1.81, p=0.047). An average 23% reduction of the SV with the equivalent timespan of the previous year allowed an illusory reduction of the WL after the peak gained during the first wave of COVID-19 (fig1).(Figure Presented) Conclusions: The COVID-19 outbreak induced a stage migration phenomenon in surgically managed PCa patients. Further evaluations are necessary to assess possible implication in the oncologic outcomes of the PCa disease.

Reshaping the diagnostic pathways for investigation of haematuria during and after the COVID-19 pandemic: Diagnostic accuracy of strategies for the detection of bladder cancer from the IDENTIFY cohort study

Background: Haematuria often requires investigation with an imaging test and flexible cystoscopy to rule out urinary tract cancers. With a reduction in diagnostic services due to the COVID-19 pandemic there is a risk of compromise in the care of patients referred with haematuria. We aimed to provide a pragmatic strategy that optimises the use of scarce resources by reducing patient visits to hospital and allocating the appropriate diagnostic tests according to risk of bladder cancer. Methods: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of newly suspected urinary tract cancer. Patients underwent cystoscopy, imaging tests, urine cytology and transurethral resection of bladder tumour (TURBT), where indicated. We developed strategies using combinations of imaging and cytology as triage tests to flexible cystoscopy. These strategies aimed to maximise cancer detection within a pragmatic pathway in a resource-limited environment. Findings: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Amongst all patients, 1474 (18 2%) had bladder cancer;1333 (23 2%) in VH group and 141 (5 94%) in NVH group. Diagnostic test performance was used to determine optimal age cut-offs for each proposed strategy. We recommended proceeding directly to TURBT for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients (threshold of 60-years-old with VH, or 70-years-old with NVH) to capture high risk bladder cancer. Interpretation: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

Reshaping the diagnostic pathways for investigation of haematuria during and after the covid-19 pandemic: Diagnostic accuracy of strategies for detection of bladder cancer from the identify cohort study

Introduction: Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method: The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results: 8112 patients (74 4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70 7%) patients had visible haematuria (VH) and 2375 (29 3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions: We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.

Development of Wellness Programs During the COVID-19 Pandemic Response

Health care workers are on the front lines of the recent pandemic, facing significant challenges to their physical and mental health. This article details the efforts undertaken by a health care system and two academically affiliated hospital systems to provide emotional support to their frontline staff. The multipronged approach describes coordinating efforts to decrease duplication of services and to increase centralization of information. This included enhancing pathways for faculty, staff, and trainees to obtain individual and group treatment and to have access to high-quality self-help resources. Continuous feedback has been elicited to ensure that efforts are consistent with expressed needs and in turn services undergo modifications as needed. This article seeks to provide an overview of how one health system has thus far approached the important issue of staff support as well as the challenges experienced and lessons learned along the way.