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Summary : Social work field education has experienced major disruptions due to the COVID-19 pandemic, while also embracing new opportunities to grow. The Transforming the Field Education Landscape research partnership developed a cross-sectional web-based survey with closed- and open-ended questions to understand student perceptions of COVID-19's impacts on social work field education. The survey opened during the first wave of the pandemic from July 8 to 29, 2020 and was completed by 367 Bachelor of Social Work (BSW) and Master of Social Work (MSW) students across Canada. Quantitative and qualitative data were analyzed using descriptive statistics and thematic analysis. Findings : Respondents experienced reduced practicum hours and placements terminating early or moving online. Students were concerned about gaining adequate experience for future job prospects. They were generally positive about academic institutional responses to COVID-19 but described financial challenges with tuition costs and a lack of paid practica. Respondents were mostly satisfied with practicum supervision. They experienced negative impacts of COVID-19 on mental health with isolation and remote learning and described a lack of institutional mental health support. Students were concerned with missing direct practice skills, while some students reported more flexible hours, access to online events beyond their region, and increased research experience. They expressed a need for practicum flexibility and accommodation. Applications : Recommendations include an increase in flexibility and accommodations for practicum students, exchanges of promising and wise field education practices, and accessible postsecondary mental health supports. Professional development opportunities should support graduates who missed learning opportunities in their practicum. © The Author(s) 2023.
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Opportunities for self-determined online professional development (OPD) are emerging, but their potential for increasing adult learners' agency is not yet fully realised. Faced with the problem of successfully designing a self-determined comprehensive evidence-based online numeracy resource for educators who are often time poor and do not engage with online learning unless they are intrinsically motivated, we engaged in design research to conceptualise the Birth to Level 10 Numeracy Guide for educators and families. The Birth to Level 10 Numeracy Guide fosters educators' and adult learners' numeracy capability across numeracy focus areas from birth to level 10 (16-year-olds). This extensive OPD resource incorporates consistent design elements, double-looped learning, nonlinear learning, self-reflection, and metacognition activities to foster educators' pedagogical content knowledge (PCK) through experiential learning. With a section dedicated to families, the resource provides suggestions and advice to parents and carers on everyday, authentic activities to develop children and young people's numeracy understandings at home and in the local community. As education systems continue to grapple with the disruption brought about by the COVID-19 pandemic, the Birth to Level 10 Numeracy Guide is a timely, freely accessed, viable, and scalable option for providing low-cost OPD.
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As both the largest integrated health system and largest provider of telehealth in the country, the Veterans Health Administration (VHA) has a particular interest in understanding how best to implement and utilize virtual care. VHA has long embraced virtual care as part of its mission to "serve all who have served" regardless of their socioeconomic and geographic circumstances. Having begun conducting "virtual care" in the 1960s when doctors first communicated with patient's via TV screens,1 VHA has since provided over 2.6 million episodes of care to more than 900,000 Veterans in 20192 and has distributed over 50,000 data- and video-enabled iPads for Veterans throughout the country.3 Virtual care within VHA includes services such as MyHealtheVet secure messaging, the Home Telehealth program that combines case management principles with remote monitoring to improve access and coordinate care, and the VA Video Connect (VVC) video platform for synchronous visits within both specialty and primary care.4 Increasing Veteran access to care via virtual care has been an integral part of VHA's strategy for improving chronic disease management for a population that is on average older and sicker than their civilian counterparts.5,6 Given the importance that virtual care has for Veteran care even beyond the COVID-19 pandemic, understanding the strengths and limitations associated with synchronous virtual care will be critical in shaping how VHA utilizes virtual care going forward.
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Background and Aims: Substantial practice variation exists in both the diagnostic criteria for and the post-diagnosis monitoring of celiac disease (CeD). Differences include standards for serological diagnosis, endoscopic practices, models of care, and long-term clinical monitoring, all confounded by the COVID-19 pandemic. With the exponential rise of gluten-related disorders, revised ESPGHAN guidelines and new healthcare barriers, it is helpful to explore practice patterns to inform updates to clinical guidelines and future research endeavors. The purpose of this survey was to understand the expertise and practice parameters of pediatric gastroenterology (GI) clinicians across North America for the diagnosis and management of children with celiac disease. Method(s): A 23-item survey designed by a working committee of the NASPGHAN Celiac Disease Special Interest Group was distributed electronically to NASPGHAN members, including attending physicians, fellows, and advanced practice providers from September to December 2021. Four themes were explored: 1) screening and diagnosis;2) monitoring;3) impact of the COVID-19 pandemic;and 4) education and training. The implementaion of the ESPGHAN non-biopsy serologic diagnosis (based on the 2020 guidelines: tissue transglutaminase IgA (TTG-IgA) 10x upper limit of normal and a second sample with a positive endomysial antibody) by providers was explored. Descriptive statistics were tabulated by region, clinical role and those who identified as working at a celiac center. Result(s): A total of 284 surveys were completed with a response rate of 11.1% (264/2552). The majority of respondents were from the United States (89%, n=235) and Canada (8%, n=22) with 2% (n=5) from Mexico. Serology-based diagnosis as per ESPGHAN 2020 guidelines was accepted by 54.5% (n=12/22) of Canadian respondents and 39.6% (n=93/235) from the U.S (p=0.17). Since the COVID-19 pandemic, 36% of respondents have increased their application of non-biopsy diagnosis. Canadian respondents reported offering the ESPGHAN non-biopsy approach to diagnosis more often during the COVID-19 pandemic (Canada 74% vs US 33%, <0.0001). A higher precentage of patients who lived in Canada (52%) with positive celiac serologies waited >1 month to be evaluated by GI than the US (30%);p=0.03. There was also a significant difference between access to endoscopy within a month between patients who lived in Canada and the US patients (Canada 77% >1 month, US 20% >1 month;p=<0.001). Investigations at follow-up which were completed most frequently by those who identified as working at a celiac center (n=108) included complete blood count, thyroid function tests, liver enzymes, iron profile, Vitamin D and TTG-IgA (Figure 1). Among these respondents, 49.1% (n=53/108) repeat family screening ranging every 1-5 years. Specialty training in CeD remains limited as only 25.7% (n=61/237) staff pediatric gastroenterologists had celiac-focused didactic lectures, and 23.3% (n=55/237) participated in a CeD specialty clinic during their fellowship. Conclusion(s): This survey revealed heterogeneity in current practices for the diagnosis and management of CeD in North America and the influence of the COVID-19 pandemic in increasing the use of the ESPGHAN no-biopsy approach to diagnosis. An education gap was identified for CeD in pediatric GI fellowship training. Further studies are needed to understand the impact of these variable practices and future research priorities and clinical guidelines should take this variation into consideration. (Figure Presented).
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BACKGROUND: Electronic health record systems (EHRs) represent one of the most widely adopted digital healthcare technologies in the past decade. Among the potential benefits of EHRs has been the quantification of individual physician time spent performing key components of clinical workload. Epic EHR is a global system with the majority market share in North American acute care and ambulatory arenas and may offer a means to quantify the clinical workload of pediatric gastroenterology, as a subspecialty field of medicine. OBJECTIVE(S): To quantify clinical workload of pediatric gastroenterology across Epic EHR systems. METHOD(S): From January 2020 through April 2022, we evaluated Signal EHR data captured in Epic for all pediatric gastroenterologists (PGI), defined as physicians (MDs) with an Epic specified PGI profile. Signal data provides detailed data on clinician time spent daily (defined by days where a MD was clinically active or logged into the EHR) interfacing with the EHR, including clinical work process data in 4 key areas: In-Basket (including communications with patients and other healthcare providers), Orders, Notes and Letters, and Clinical Review. For our study purposes, clinical workload was characterized by 4 monthly metrics: days with appointments;appointments per scheduled day (data from April-July 2020 during COVID-19 lockdown were not included to accurately reflect current practice);pajama EHR time (5:30 PM to 7 AM);and EHR time outside templated clinic hours. Proportional time spent in different clinical arenas was reported for April 2022 only. Monthly process metrics captured in each of the 4 key areas focused on work volume and time spent. Outcome metrics were reported as average+/-standard deviation (SD) and median (interquartile range (IQR)). All metrics were evaluated for change over time using regression modeling. Statistical significance was set at p<0.05. RESULT(S): Signal data from 993 PGI at 213 institutions were analyzed. 95.8% (n=204) institutions were located in the US. Clinical workload Over the reporting period, PGI had clinical appointments an average of 43+/-3% [median (IQR) = 46% (35%, 57%)] days per month or about 3 days per week. PGI had 7.6+/-0.3 [7.0 (5.8, 8.9)] clinical appointments per scheduled day. On average, PGI spent an additional 23.7+/-1.6 [14.4 (4.6, 30.2)] pajama time minutes and 36.1+/-1.9 [30.3 (15.8, 43.3)] minutes outside scheduled hours interacting with the EHR each day. Clinical workload metrics remained stable over the study period. On average, PGI spent 60% time in the ambulatory arena, 9.7% in inpatient, 0.3% in the emergency department and 30% in other. In-Basket The average time spent in In-Basket by PGI was 23.0+/-1.3 [20.4 (13.2, 26.5)] minutes per day. Average time in In-Basket increased significantly over the study period (p<0.0001). Primary drivers for this change included increases in certain types of In-Basket messages, including results (p=0.01), patient medical advice (p<0.0001), hospital chart completion requests (p<0.0001), prescription authorization requests (p=0.003), and staff messages (p<0.0001). Orders On average, PGI prescribed 1 medication every other appointment, or 0.5+/-0.02 [0.4 (0.3, 0.6)] medications per visit. PGI ordered 2.2+/-0.3 [2 (1.4, 2.8)] tests/evaluations per appointment. Notes and Letters The average note length was 6392+/-193 [6072 (4344, 7696)] characters, equivalent to over 3.5 pages of text. Time spent in notes was 10.2+/-0.4 [9.7 (6.7, 13.1)] minutes per appointment and 46.9+/-2.4 [43.6 (29.9, 56.2)] minutes per day. Length of notes increased significantly over the study period (r=0.51, p=0.01) but time spent in notes did not. Clinical Review PGI spent an average of 17.7+/-1.5 [17 (12.7, 20.3)] minutes per scheduled day in chart review, equivalent to 4+/-0.2 [3.9 (2.7, 5.3)] minutes per appointment. CONCLUSION(S): Quantification of some key components of clinical workload inherent to PGI is possible using EHRs. PGIs routinely spend time outside of work hours performing EHR work. Over the past 2 years, In-Basket time has contributed substantially to PGI workload and has trended towards increasing messages from both external (patients and pharmacies) and internal sources (staff and hospital compliance). Considerable PGI time has also been spent constructing clinical notes of lengths that appear to have increased during the same 2-year period. Limitations to the study include non-standardized, opaque metric definitions and unclear fidelity of provider categorization. We would also note that our results document increasing EHR-related workload burdens on PGIs that can contribute to physician burnout. Through identification of best outcome metrics, quantification of PGI clinical workload using EPIC Signal data may allow quality improvement activities that reduce provider burden while enabling our subspecialty field to benefit from widespread implementation of EHRs.
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Introduction: The COVID-19 pandemic has had a considerable and evolving impact on delivery of surgical care to patients. During the early stages of the pandemic, resource scarcity was experienced by many healthcare systems. This led to the implementation of a surgical moratorium on elective surgeries in New York State between the months of March through June 2020. Certain specialties, specifically those performing elective surgeries, experienced significant strain and transformation. Objective: This study aims to describe perioperative and intraoperative characteristics of patients undergoing hysterectomy for pelvic organ prolapse (POP) with and without concomitant urogynecology procedures between 2019-2021 at a multi-hospital healthcare system that experienced significantly strain and a subsequent moratorium on elective surgery during the first peak of the pandemic. Methods: This is a retrospective cohort analysis of all patients in a multi-hospital healthcare system in New York City who underwent hysterectomy for POP from August 19th, 2019 through August 11th, 2021. Cases were identified using procedural and diagnostic codes for hysterectomy and POP, respectively. Patients were separated into three cohorts based on dates corresponding to phases of the COVID-19 pandemic. The 'early peak' was defined from March through June 2020, coinciding with the New York State moratorium. The primary outcome was the stage of POP for patients undergoing surgery. Secondary outcomes included concomitant urogynecologic procedures, route of surgery, time from indication to procedure, length of inpatient stay, and utilization of pre-operative medical assessment/clearance (POMA). Results: A total of 253 cases were included: 106 (41.90%), 15 (5.93%), and 132 (52.17%) patients in the 'pre-pandemic','early peak pandemic', and 'stable pandemic' groups, respectively. Although not statistically significant, vaginal hysterectomy approach was performed less frequently during the 'early peak pandemic' and 'stable pandemic' cohorts (P = 0.0544). The 'early peak pandemic' cohort had significantly more stage IV POP compared to other cohorts (P = 0.0021). Rates of concomitant urogynecology procedures including slings, anterior or posterior repair, or apical repair did not differ between the cohorts. Further, cystoscopy was utilized intraoperatively more frequently in the 'stable pandemic' cohort (P = 0.0272). Time from surgical indication to operation was also significantly different with patients most frequently waiting at least 3 months in the 'early peak pandemic' group (P = 0.0132). Length of inpatient stay did not demonstrate a significant difference (P = 0.3982). The most frequent postoperative complication was transient voiding dysfunction, and this was observed more commonly in the 'stable pandemic' cohort (P = 0.0236), though overall no cases were complicated by persistent voiding dysfunction or urinary retention requiring surgical intervention in any group. Conclusions: In late spring 2020, when the moratorium was lifted, surgical volume returned to pre-peak numbers. However, time from booking to day of surgery remained significantly longer during and after the 'peak'. There was a statistically significant increase in patients with stage IV POP during the 'early peak' and 'stable' pandemic periods. There was a statistically significant increase in use of precautionary measures peri and intra-operatively during the 'peak' and 'stable pandemic' periods with significant increases in use of POMA performed outpatient by anesthesia and an increased utilization of intraoperative cystoscopy.
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BACKGROUND: The COVID-19 pandemic has dramatically increased the adoption of telehealth, however, the majority of telehealth within the Veterans Health Administration (VHA) has been via phone rather than video. Since video telehealth remains underutilized within the VHA, we conducted a mixed-methods quality improvement (QI) project to increase video telehealth utilization by improving clinic workflow. This work is classified as non research by the Durham VA IRB. METHODS: Primary care visit stop codes for Face to Face (F2F), Phone, and VA Video Connect (VVC) within one clinic in Mid-Atlantic Veterans Integrated Service Network (VISN) 6 from April 2020-December 2021 were pulled from the VHA Clinical Data Warehouse into Power BI software for analysis. Semi-structured qualitative interviews were conducted in January 2021 with key stakeholders to identify barriers and map workflows. An inter professional QI team within the clinic was formed and conducted Plan-Do-Study-Act (PDSA) cycles to increase VVC utilization. VVC utilization was analyzed via a statistical process control chart (SPC). RESULTS: Qualitative interviews identified 6 barriers to VVC use including patient problems with digital connectivity, difficult scheduling workflows, unfamiliarity with software, technical burden on providers, resistance to change, and staff equipment needs. Pre-intervention VVC utilization from April 2020 -January 2021 was 1.1% of all visits. Interventions included staff training, dedicated VVC appointment slots, and standardizing pre-appointment workflow. VVC utilization after project started averaged 4.3% (range 2.8-5.8%). SPC p-chart analysis (Figure 1) shows special cause variation after implementation of dedicated VVC appointment time slots. QI efforts have so far led to ∼560 more VVC visits than otherwise expected had baseline rate continued. CONCLUSIONS: There are many challenges to successfully conducting video telehealth within the VHA. Our experience shows that inter professional QI efforts can improve clinic workflow and increase video telehealth utilization. Future QI efforts are still needed to make video telehealth an efficient part of usual care.
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BACKGROUND: The rapid shift to telehealth during COVID-19 amplified inequities in video-based healthcare. Reduced use of video visits among historically marginalized populations may exacerbate existing healthcare access disparities. We explored patient and provider insights with primary care video visits. Due to concerns that the promotion of video visits could worsen access to care among marginalized populations, we centered our work on rurald welling African Americans. METHODS: We conducted 4 video-based focus groups (n = 38) with rural VA primary care teams and 24 semi-structured telephone interviews with rural-dwelling African American Veterans purposively sampled by video-visit experience (14 with video visit experience and 12 without). Data collection occurred January -May 2021. Data collection guides were based on the domains from the Fortney et al. 2011 model of access to telehealth. We used a rapid analytic approach to identify themes relevant to access to video-based primary care. RESULTS: Findings clustered within three domains related to video-based care: perceived access to care, satisfaction with care, and attitudes towards care. Perceived access: Some patients noted differential treatment by personal characteristics (eg, race, health condition) within the health care setting though not specifically related to telehealth. Reported barriers to video visits included a lack of proper equipment and comfort with technology. Patients noted that scheduling video-based appointments was easy. Clinicians noted that video visits were inappropriate for new patient encounters or for certain conditions (eg, cognitive impairment, significant sensory impairment, new/non-specific symptoms). Satisfaction: Patients appreciated the lower cost and travel times associated with video visits and some felt video visits were less rushed. However, multiple patients expressed concerns about poor quality care via video. Specifically reported were the impersonal feel of video-based care, distracted providers, and inability to fully assess patient concerns. Providers reported frequently spending significant time managing technical malfunctions and diminished interpersonal connections via video. Attitudes: Despite the logistical convenience, many patients noted a preference for in-person care due to perceived higher quality and general appeal of the ritual of going in-person for care. Patients wanted the choice of in-person vs remote care rather than being told which they would receive. Clinical teams were open to video-based visits but emphasized the importance of considering clinical appropriateness and the need for adaptation of clinic workflow to the needs of virtual care (eg, a pre-visit online check-in). CONCLUSIONS: Optimal and equitable incorporation of virtual modalities into primary care requires an assessment of clinical appropriateness of videobased care as well as patient preference and technological readiness at each visit.
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Intracranial inoculation of susceptible strains of mice with the neuroadapted JHM strain of mouse hepatitis virus (JHMV, a member of the Coronaviridae family of viruses) results in an acute encephalomyelitis characterized by widespread growth of virus in astrocytes, microglia, and oligodendrocytes with relative sparing of neurons. Virus-specific CD4+ and CD8+ T cells infiltrate into the central nervous system in response to infection and control viral replication through secretion of interferon gamma as well as cytolytic activity. Nonetheless, virus persists in white matter tracts, and animals develop an immune-mediated demyelinating disease in which both T cells and macrophages amplify white matter damage. For the past decade, we have explored the therapeutic potential of human neural progenitor cells derived from pluripotent stem cells in promoting clinical recovery associated with remyelination of demyelinated axons following intraspinal transplantation. This chapter highlights recent studies from our laboratories demonstrating that tissue repair is associated with the emergence of regulatory T cells in response to transplantation of NPCs. © 2021 Elsevier Inc. All rights reserved.
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The COVID-19 pandemic has significantly affected all aspects of social work education, including field education. The Transforming the Field Education Landscape (TFEL) partnership conducted two national online surveys to determine the impacts of the pandemic on social work field education. The first survey explored the perspectives of students and received responses from 367 Bachelor of Social Work (BSW) and Master of Social Work (MSW) students. The second survey was designed to gather the perspectives of field instructors, with 73 field instructors completing the survey. The article examines the impacts of the pandemic on social work practice, field supervision, practicum flexibility and accommodations in placement, the shift to remote learning, perceptions of future career prospects and the effects on wellness and mental health. This article contributes to an increased understanding of the strengths and challenges facing social work field education, and informs field planning and responses in a pandemic. The findings will be of interest to social work field education programmes, field education coordinators and directors, field instructors, field agencies and undergraduate and graduate social work students. Recommendations for social work field education are offered. © 2021. All Rights Reserved.
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Background: Delays from the COVID-19 pandemic led to increased surgical wait times. With ongoing bed pressures, we must safely maximize surgical volumes. We prospectively evaluated the feasibility and safety of bariatric surgery without inpatient hospital admission. Methods: We identified patients whose elective bariatric surgery we felt could be safely scheduled without inpatient admission to a surgical ward. Patients recovered in an 'overnight stay' perioperative area. Selection criteria excluded patients with revisional surgery, BMI≥55, insulin-dependent diabetes, or therapeutic anticoagulation. Data were collected on consecutive patients scheduled without admission between April and June 2021. Seven-day emergency department (ED) visits and readmissions were used to establish the safety of this intervention. Results: Of 47 patients scheduled for surgery without admission, 42 (89.4%) underwent Roux-en- Y gastric bypasses and 5 (10.6%) sleeve gastrectomies. Patients stayed between 16 and 23 hours, with a mean and median of just over 20 hours. Only 2 (4.3%) patients required admission to the surgical ward, but both were discharged on postoperative day 1 (POD1). Only 2(4.3%) patients had ED visits within 7 days postoperatively, and neither required admission. There were no complications, reoperations, or deaths. A control group of bariatric surgery patients with planned hospital admission per usual care is being analyzed for comparison. Conclusions: We demonstrated that bariatric surgery can be performed without inpatient hospital admission in select patients. We anticipate our controls will further confirm the safety of this endeavor. Optimizing resource utilization is crucial now, as hospitals recover from the pandemic and prepare for potential future waves.
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We employ a new Keynesian model with random search in the labor market and endogenous selection among heterogeneous workers to investigate the impact of a pandemic-induced recession on the distribution of unemployment across workers. In such a recession, workers whose unemployment spells in normal times are inefficiently frequent and long are disproportionately affected. This remains true even when the pandemic initially causes mass layoffs that affect workers broadly or if many separations represent temporary layoffs. Monetary policy that responds to labor market variables affects unemployment for all workers but does relatively little for the distribution of unemployment across workers types.
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Introduction: The Coronavirus 2019 pandemic prompted Gastroenterology (GI) practices to rapidly implement telehealth-based care in order to improve resource allocation, protect patient and staff wellbeing, and comply with public health measures. In 2020, we surveyed nearly 1,500 patients showing a satisfaction rate with telehealth services of over 80%. This current descriptive, survey-based study aims to assess patient satisfaction with telehealth services in comparison to in-person office visits and to portray the factors impacting the patient experience. Methods: An online survey was distributed to patients of eight community-based GI practices across the United States between January and April, 2021. Responses were recorded on a five-point Likert scale. The net promoter score (NPS), a metric for customer loyalty and satisfaction, was calculated to better assess the patient experience. A score between 0-30 denotes good quality of service with room for growth and improvement. Results: A total of 2928 patients had at least one telehealth visit (68.1% female, 87.1% White, mean age 64.5 years). Reason for visit was most often related to inflammatory bowel disease (18.4%), procedure preparation or follow-up (15.2%), or heartburn/reflux (13.4%). Most patients (54.7%) were likely to continue using telehealth services after the pandemic mainly due to shorter wait and travel times (41.1%), flexibility with personal schedule (30.7%), and ease of scheduling appointments on desired date (26.0%). Approximately 73% of respondents indicated that they received a similar quality of care through telehealth as compared to in-person visits and 61.1% stated that patient-physician interaction was also similar. Overall, the NPS for telehealth services among the participating GI practices was 25. Conclusion: Telehealth has become a valuable component of the healthcare system. Our results add to the existing literature regarding the high rate of patient satisfaction with telehealth and display the fact that the quality of virtual care can be perceived similar to that of in-person care. Furthermore, the calculated NPS confirms this level of satisfaction while signaling the need for continued growth and development of virtual care delivery. Further studies are needed to assess the impact of telehealth services on patient and population health outcomes and evaluate underrepresented..
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Imaging intact human organs from the organ to the cellular scale in three dimensions is a goal of biomedical imaging. To meet this challenge, we developed hierarchical phase-contrast tomography (HiP-CT), an X-ray phase propagation technique using the European Synchrotron Radiation Facility (ESRF)'s Extremely Brilliant Source (EBS). The spatial coherence of the ESRF-EBS combined with our beamline equipment, sample preparation and scanning developments enabled us to perform non-destructive, three-dimensional (3D) scans with hierarchically increasing resolution at any location in whole human organs. We applied HiP-CT to image five intact human organ types: brain, lung, heart, kidney and spleen. HiP-CT provided a structural overview of each whole organ followed by multiple higher-resolution volumes of interest, capturing organotypic functional units and certain individual specialized cells within intact human organs. We demonstrate the potential applications of HiP-CT through quantification and morphometry of glomeruli in an intact human kidney and identification of regional changes in the tissue architecture in a lung from a deceased donor with coronavirus disease 2019 (COVID-19).
Subject(s)
COVID-19/pathology , Image Processing, Computer-Assisted/methods , Imaging, Three-Dimensional/methods , Lung/pathology , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Humans , Kidney/anatomy & histology , SynchrotronsABSTRACT
Study Objective The purpose of this study was to evaluate the effect of the COVID-19 pandemic on the ectopic pregnancy surgical volume, both ruptured and stable cases, at a New York City high-volume, tertiary-care center. Design A retrospective chart review of 2 years of ectopic pregnancy surgical case volume. The time period evaluated included March 2019-February 2020 prior to the COVID-19 pandemic in New York City followed by March 2020-February 2021 when hospital services shifted to care of such patients. Setting N/A. Patients or Participants All patients who underwent emergent gynecological surgery for ectopic pregnancies were reviewed by weekly and monthly volume over a 2-year period. Further review of ruptured as compared to unruptured cases was performed, with particular interest regarding hemoperitoneum at time of abdominal entry. Interventions N/A. Measurements and Main Results There was no significant difference (t(21) = 0.52, p = 0.612) between the pre-pandemic year March 2019 – February 2020 with a total of 33 ectopic cases (mean monthly volume 2.75, SD = 1.42) as compared to March 2020 – February 2021 total of 37 ectopic cases (mean monthly volume 3.08, SD = 1.73). There was no significant difference (t(22) = 0.56, p = 0.583) regarding ruptured ectopic case volume between 2019-2020 and 2020-2021 (total of 23 and 27, mean monthly volume 1.92 and 2.25 respectively). Finally, for ruptured ectopic cases, the mean estimated hemoperitoneum encountered upon entry into the abdomen (excluding subsequent operative blood loss) was 184.29 cc pre-pandemic and 244.8 cc during the pandemic with no significant difference between the years (t (44) = 1.18, p = 0.244). Conclusion There were no significant differences in ectopic case volume prior and after the COVID-19 pandemic and no significant differences in hemoperitoneum upon abdominal entry, suggesting that the fear of the pandemic was not a deterrent to care for patients needing emergent ectopic surgery.
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Study Objective This study aims to identify patient characteristics associated with length of delay or not returning for elective benign gynecologic surgical procedures that were canceled due to the COVID-19 pandemic. Design Retrospective review of electronic medical records. Setting Academic, urban, tertiary hospital system. Patients or Participants Between March 15, 2020, and May 15, 2020, all elective surgical procedures were canceled due to resource limitations. Electronic medical records were reviewed through November 15, 2020, to assess whether patients rescheduled or did not come back for surgery within the following six-month period. Interventions N/A. Measurements and Main Results 219 benign gynecologic surgeries were canceled between March 15 and May 15, 2020. 158 (72%) patients returned within the following six months for their procedure, and 61 patients (28%) did not return. Among patients who rescheduled, the length of delay was not correlated with age, race/ethnicity, or route of surgery. There was, however, sufficient data to conclude that length of delay differed by primary indication of surgery (p=.0173). There was an association between not returning for surgery and primary indication of pelvic organ prolapse/ incontinence repair (p=.0203). Conclusion The majority of patients rescheduled their procedure within six months following the peak of the COVID-19 crisis. The primary indication of pelvic organ prolapse and incontinence was associated with a decreased likelihood of returning for surgery within six months.