Maternal outcomes during the COVID-19 Pandemic: A Retrospective analysis of the last 5 years

Aim: Coronavirus disease-2019 has caused a significant health crisis all over the world. This study aimed to compare obstetric and gynecological data during the COVID-19 pandemic period with the previous three years. Material(s) and Method(s): For this purpose, over a 5-year period, from January 2017 to December 2021, patient records from the hospital's electronic data registry were scanned. The extracted data included the number of patients admitted to the outpatient clinic, the number of emergency outpatient visits, the number of patients inserted and removed with an intrauterine device (IUD), abortions, premature rupture of membranes (PROM), intrauterine fetal death (IUFD) and vaginal delivery and cesarean section. Result(s): The number of patients who underwent IUD removal decreased in the last two years. Also, the number of patients who underwent IUD insertion in 2020 was very low compared to other years (p<0.01, for all). It was observed that the number of patients diagnosed with PROM decreased in the last three years (p<0.01, for all). There was a statistically significant decrease in the total number of deliveries in the last two years (p<0.01). Discussion(s): In conclusion, it is seen that the number of outpatients, the number of emergency outpatients, the number of IUDs removed and the total number of deliveries have decreased in the last two years compared to the previous three years. This may be related to the coronavirus infection, which has caused the pandemic for the last two years.Copyright © 2022, Derman Medical Publishing. All rights reserved.

A Retrospective Assessment of the Continuous Health Care Provided to COVID-19 Patients Consulted Via Videoconference

OBJECTIVE: Telemedicine has been defined as a valuable tool in delivering care for COVID-19 patients. However, clinicians and policymakers should be convinced that traditional and new technological methods of clinical management may be equally effective. The purpose of this study was to generate some initial recommendations based on the clinical utility of videoconference consultation in forward triage and follow-up for COVID-19 patients. MATERIAL AND METHODS: This retrospective cross-sectional study evaluated the medical records of 100 COVID-19 patients consulted using a videoconference program (Skype), from September 1, 2020, to February 3, 2021. The data were analyzed on demographic characteristics, disease history, the need for physical examination after videoconference consultation, pre-diagnostics and diagnostics, treatment decisions, number of videoconference consultation sessions in follow-up, duration of sessions, and final outcome. RESULT(S): The male COVID-19 patients constituted 54% of the total sample. The median age was 51 (42-61) years. The median duration of the initial videoconference consultation session was 16 (12-21) minutes. Following the initial videoconference consultation session, 14 patients required follow-up with all face-to-face visits;the remaining patients were primarily followed with videoconference consultation sessions. For 25 patients, it was sufficient to provide only videoconference consultation sessions;they were not required to be in the hospital for physical examination or any subsequent investigation at all. A total of 14 patients were hospitalized. There was no statistically significant difference between the high-risk group and the other patients according to the components of the disease management process via videoconference consultation. CONCLUSION(S): Videoconference consultation enables a holistic assessment regardless of the patient's characteristics and allows for more time to be spent on each patient, particularly during the pandemic period without risk of contagion. It can be used as a forward triage and follow-up tool to identify patients in need of emergency hospitalization and continuous health care.Copyright © Author(s).

Temporal Data Mining in AI-based Patient Navigation Service

The pandemic of COVID-19 reminds us of the basic important principles for prevention of infection: avoid the "Three Cs": closed spaces, crowded places and close contact settings. Outpatient clinics in Japan are typical examples of three Cs, where some kinds of decision support system are required to solve the above situation. This paper proposes data mining based patient navigation support system to prevent the Three Cs. Behind the systems, temporal data mining units plays an important role in providing temporal information to the patients, such as waiting time and human densities in the waiting rooms. It analyzes the data stored in hospital information systems, including patient information, logs of clinical orders. The analysis results show that several aspects of patients' waiting are visualized by temporal data mining. © 2022 IEEE.

Child and Adolescent Mental Health during the COVID-19 Pandemic: Challenges of Psychiatric Outpatient Clinics.

BACKGROUND: Worldwide national surveys show a rising mental health burden among children and adolescents (C&A) during COVID-19. The objective of the current study is to verify the expected rise in visits to psychiatric outpatient clinics of C&A, especially of new patients. METHODS: a cross-sectional study focusing on visits as recorded in electronic medical records of eight heterogeneous C&A psychiatric outpatient clinics. The assessment was based on visits held from March to December of 2019 (before the pandemic) in comparison to visits held in 2020 (during the pandemic). RESULTS: The number of visits was similar for both periods. However, in 2020, 17% of the visits used telepsychiatry (N = 9885). Excluding telepsychiatry reveals a monthly decrease in traditional in-person activities between 2020 and 2019 (691.6 ± 370.8 in 2020 vs. 809.1 ± 422.8 in 2019, mean difference = -117.5, t (69) = -4.07, p = 0.0002, Cohen's d = -0.30). Acceptation of new patients declined during 2020, compared to 2019 (50.0 ± 38.2 in 2020 vs. 62.8 ± 42.9 in 2019; Z = -3.12, p = 0.002, r = 0.44). Telepsychiatry was not used for new patients. CONCLUSIONS: The activity of C&A psychiatric outpatient clinics did not rise but was guarded due to the use of telepsychiatry. The decline in visits of new patients was explained by the lack of use of telepsychiatry for these patients. This calls for expanding the use of telepsychiatry, especially for new patients.

Mobile primary healthcare for post-COVID patients in rural areas: a proof-of-concept study.

INTRODUCTION: Post-COVID syndrome is increasingly recognized as a new clinical entity after SARS-CoV-2 infection. Patients living in rural areas may have to travel long with subjectively great effort to be examined using all necessary interdisciplinary tools. This problem could be addressed with mobile outpatient clinics. METHODS: In this prospective observational study, we investigated physical fitness, fatigue, depression, cognitive dysfunction, and dyspnea in patients with post-COVID syndrome in a mobile interdisciplinary post-COVID outpatient clinic. Upon referral from their primary care physician, patients were offered an appointment at a mobile post-COVID outpatient clinic close to their home. RESULTS: We studied 125 patients (female, n = 79; 63.2%) in our mobile unit. All patients reported symptoms lasting for more than 12 weeks after acute infection. 88.3% and 64.1% of patients reported significant impairment in physical and mental quality of life. Patients reported a median of three symptoms. The most frequently reported symptoms were fatigue (86.4%), cognitive dysfunction (85.6%), and dyspnea (37.6%). 56.0% of patients performed at < 2.5th percentile at the 1 min sit-to-stand test compared to age- and sex-matched healthy controls, and 25 patients (20.0%) exhibited a drop in oxygen saturation. A questionnaire given to each patient regarding the mobile unit revealed a very high level of patient satisfaction. CONCLUSION: There is an increasing need for high-quality and locally available care for patients with post-COVID syndrome. A mobile post-COVID outpatient clinic is a new concept that may be particularly suitable for use in rural regions. Patients' satisfaction following visits in such units is very high.

Managing Outpatient Cycle Times in Hospitals Using Integrated Closed-Loop Approaches.

Long waiting times in outpatient clinics have multiple adverse effects on patients and their attendants, staff and hospital management. Several approaches practiced to manage the cycle time have been proposed. The purpose of this study was to evaluate the impact of implementing closed-loop based multiple approaches together. This study was conducted in Aravind Eye Hospital (AEH), Madurai, India where several approaches to manage cycle times have been implemented over the years. Scheduling system was introduced to manage COVID-19 specific norms. We compared the cycle times in general outpatient clinics in a regime in which multiple approaches were practiced together before and after introducing scheduling to regimes in which individual approaches were practiced. We analysed how the cycle time varied by patient load. Cycle time for all patient days when the combined approach was used was 19% lower than baseline, and better than under each of the individual approaches. The outcome sustained even during the COVID-19 pandemic that necessitated additional processes and procedures. Therefore, implementing multiple approaches can be more effective to reduce the cycle time than implementing individual approaches.

COVID-19 in the Emergency Department of the Primary Healthcare Centre Banja Luka

Background / Aim: COVID-19 is acute virus disease caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS–CoV-2). It was proclaimed as pandemic starting from March 2020 and is still ongoing. COVID-19 pandemic forced all segments of the society, particularly the health sector, to function in changed and aggravating circumstances and because of the transmission and new strains of the virus it resulted in the change of the number of infected people with peaks and oscillations. Aim of this study was to make analysis of the data related to COVID-19 positive/suspect patients examined in the Primary Healthcare Centre Banja Luka in the period 15 March 2020 – 15 March 2021, which refers to the incidence of the infected persons, sex and age representation, laboratory diag-nostics and clinical parameters, applied therapy, as well as the number of patients sent for the hospital treatment. Methods: Data for the analysis were obtained by the retrospective analysis of the statistical data from the electronic medical record of the examined COVID-19 positive/suspect patients in the Outpatient Clinic for Acute Respiratory Infections (ARI) and in the field. Pearson’s χ2 test of contingency was used for the comparison of differences of the observed characteristics of the examined groups. Results: Personnel of the Emergency Department (ED) of the Primary Health-care Centre Banja Luka, in the period 15 March 2020 – 15 March 2021, examined the total of 3,937 COVID-19 positive patients and patients suspect of COVID-19. Out of that number, 3,601 patients were examined in the ED – ARI and 336 patients were examined in the field. The biggest number of patients was registered in November 2020 (768). Male sex prevailed (55.50 %) and patients of 20-50 years of age were most represented. There were 3.10 % of those highly febrile patients and 2.5 % of those with low SpO2 of under 90 %. 14.90 % of patients had higher values of troponin T and 45.50 % of them had higher values of D-dimer. In the field, 69.60 % of patients had pathological changes on lungs and 33.30 % had pathological ECG report. The number of patients sent from the ARI for further diagnostic procedure or hospitalisation to the Clinic for Infectious Diseases of the University Clinical Centre of Banja Luka was 1,191 and 258 patients were sent from the field. Conclusion: For the purpose of preventing the spread of epidemics, the ED reor-ganised the existing space by introducing temporary clinics – containers for the patients with acute respiratory infections and febrile status, COVID-19 suspects. Clinical parameters changed depending on the new virus strains, as well as on age distribution and infection complications. © 2022 Banjac et al.

The Supportive Care Clinic: A Novel Model of Embedded Pediatric Palliative Oncology Care.

CONTEXT: Pediatric palliative care (PPC) improves quality of life and end-of-life outcomes for children with cancer, but often occurs late in the disease course. The Supportive Care Clinic (SCC) was launched in 2017 to expand outpatient PPC access. OBJECTIVES: To describe the inaugural four years (2017-2021) of an academic, consultative, embedded SCC within pediatric oncology. METHODS: Descriptive statistics (demographic, disease, treatment, visit, and end-of-life) and change over time were calculated. RESULTS: During the first four years, 248 patients (51.6% male; 58.1% White; 35.5% Black; 13.7% Hispanic/Latino) were seen in SCC, totaling 1,143 clinic visits (median 4, IQR 2,6), including 248 consultations and 895 follow-up visits. Clinic visits grew nearly 300% from year one to four. Primary diagnoses were central nervous system tumor (41.9%), solid tumor (37.5%), and leukemia/lymphoma (17.3%). The first point of PPC contact became SCC (70.6%) for most referred patients. Among the 136 deceased patients (54.8%), 77.9% had a do-not-resuscitate or Physician Orders for Life Sustaining Treatment in place, and 72.8% received hospice care. When known (n = 112), 89.3% died in their preferred location. The time from SCC consultation to death increased from 74 to 226 days over the four years (P < 0.0001). The proportion of SCC consultations that occurred greater than 90 days from death increased from 39.1% in year one to 85.0% in year four. CONCLUSION: Embedded SCC clinics can be successful, achieve steady growth, improve referrals and timing of PPC, and enhance end-of-life care for children with cancer. Large pediatric cancer centers should include SCC outpatient services.

Contemporary Practice in Telemedicine through Telecommunication Technology during COVID-19 Pandemic in Taiwan - A Single Center Experience

Background: To evaluate the feasibility, baseline characteristics, and satisfaction of patients receiving telemedicine care during the coronavirus 2019 (COVID-19) pandemic in Taiwan. Methods: We retrospectively analyzed patients during the COVID-19 pandemic between May 2021 and December 2021 in a tertiary medical center in northern Taiwan. Information on the distribution of physician divisions, patients' clinical characteristics, and patterns of prescription use in telemedicine care was analyzed. Data were extracted from both the ordinary outpatient department (OPD) and nursing home systems. Results: A total of 6587 patients (55.8% female, mean age: 57.3 +/- 25.8 years) included in our telemedicine care conducted during the pandemic COVID-19 epidemic. Those who were older, female, and patients of Internal Medicine and Family Medicine utilized telemedicine more frequently than ordinary OPD, with a high refill prescription rate (82.6%) and low mail-back prescription use (35.9%). Patients of Family Medicine comprised the majority (40.3%) of nursing home telemedicine, with lower refill pre-scription use (37.3%). Overall satisfaction was high regarding telemedicine care, physicians profession-alism, and medical problem solving (98.3% and 97.7%, respectively). Conclusion: Older age, female sex, and potentially more health conditions were associated with higher willingness to access telemedicine. We identified medical divisional and disease-based differences in prescription patterns. Copyright (c) 2022, Taiwan Society of Geriatric Emergency & Critical Care Medicine.

Factors Associated With the Utilization of Outpatient Virtual Clinics: Retrospective Observational Study Using Multilevel Analysis.

BACKGROUND: Although the COVID-19 pandemic has accelerated the adoption of telemedicine and virtual consultations worldwide, complex factors that may affect the use of virtual clinics are still unclear. OBJECTIVE: This study aims to identify factors associated with the utilization of virtual clinics in the experience of virtual clinic service implementation in Taiwan. METHODS: We retrospectively analyzed a total of 187,742 outpatient visits (176,815, 94.2%, in-person visits and 10,927, 5.8%, virtual visits) completed at a large general hospital in Taipei City from May 19 to July 31, 2021, after rapid implementation of virtual outpatient clinic visits due to the COVID-19 pandemic. Data of patients' demographic characteristics, disease type, physicians' features, and specialties/departments were collected, and physicians' opinions regarding virtual clinics were surveyed and evaluated using a 5-point Likert scale. Multilevel analysis was conducted to determine the factors associated with the utilization of virtual clinics. RESULTS: Patient-/visit-, physician-, and department-level factors accounted for 67.5%, 11.1%, and 21.4% of the total variance in the utilization of virtual clinics, respectively. Female sex (odds ratio [OR] 1.27, 95% CI 1.22-1.33, P<.001); residing at a greater distance away from the hospital (OR 2.36, 95% CI 2.15-2.58 if distance>50 km, P<.001; OR 3.95, 95% CI 3.11-5.02 if extensive travel required, P<.001); reimbursement by the National Health Insurance (NHI; OR 7.29, 95% CI 5.71-9.30, P<.001); seeking care for a major chronic disease (OR 1.33, 95% CI 1.24-1.42, P<.001); the physician's positive attitude toward virtual clinics (OR 1.50, 95% CI 1.16-1.93, P=.002); and visits within certain departments, including the heart center, psychiatry, and internal medicine (OR 2.55, 95% CI 1.46-4.46, P=.004), were positively associated with the utilization of virtual clinics. The patient's age, the physician's age, and the physician's sex were not associated with the utilization of virtual clinics in our study. CONCLUSIONS: Our results show that in addition to previously demonstrated patient-level factors that may influence telemedicine use, including the patient's sex and distance from the hospital, factors at the visit level (insurance type, disease type), physician level (physician's attitude toward virtual clinics), and department level also contribute to the utilization of virtual clinics. Although there was a more than 300-fold increase in the number of virtual visits during the pandemic compared with the prepandemic period, the majority (176,815/187,742, 94.2%) of the outpatient visits were still in-person visits during the study period. Therefore, it is of great importance to understand the factors impacting the utilization of virtual clinics to accelerate the implementation of telemedicine. The findings of our study may help direct policymaking for expanding the use of virtual clinics, especially in countries struggling with the development and promotion of telemedicine virtual clinic services.

A Pilot Study of the Efficacy and Economical Sustainability of Acute Coronavirus Disease 2019 Patient Management in an Outpatient Setting.

Objective: To report a preliminary experience of outpatient management of patients with Coronavirus disease 2019 (COVID-19) through an innovative approach of healthcare delivery. Patients and Methods: Patients evaluated at the Mild-to-Moderate COVID-19 Outpatient clinics (MMCOs) of San Raffaele University Hospital and Luigi Sacco University Hospital in Milan, Italy, from 1 October 2020 to 31 October 2021 were included. Patients were referred by general practitioners (GPs), Emergency Department (ED) physicians or hospital specialists (HS) in case of moderate COVID-19. A classification and regression tree (CART) model predicting ED referral by MMCO physicians was developed to aid GPs identify those deserving immediate ED admission. Cost-effectiveness analysis was also performed. Results: A total of 660 patients were included. The majority (70%) was referred by GPs, 21% by the ED and 9% by HS. Patients referred by GPs had more severe disease as assessed by peripheral oxygen saturation (SpO2), ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2), C-reactive protein (CRP) levels and interstitial involvement at lung ultrasound. Among them, 18% were addressed to the ED following MMCO assessment. CART analysis identified three independent predictors, namely home-measured SpO2, age and body mass index (BMI), that robustly divide patients into risk groups of COVID-19 severity. Home-measured SpO2 < 95% and BMI ≥ 33 Kg/m2 defined the high-risk group. The model yielded an accuracy (95% CI) of 83 (77-88)%. Outpatient management of COVID-19 patients allowed the national healthcare system to spare 1,490,422.05 € when compared with inpatient care. Conclusion: Mild-to-moderate COVID-19 outpatient clinics were effective and sustainable in managing COVID-19 patients and allowed to alleviate pressure on EDs and hospital wards, favoring effort redirection toward non-COVID-19 patients.

Disproportionate reduction in respiratory vs. non-respiratory outpatient clinic visits and antibiotic use in children during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic led to improved hygiene and reduced social encounters. Near elimination of the activity of respiratory syncytial virus and influenza viruses were observed, worldwide. Therefore, we assessed the rates of pediatric outpatient clinic visits and medications prescribed at those visits during the coronavirus disease 2019 (COVID-19) pandemic and pre-COVID-19 period (2016-2019). METHODS: Monthly and annual incidence rates for respiratory and non-respiratory diagnoses and dispensed prescription rates were calculated. Acute gastroenteritis (AGE) visits were analyzed separately since the mode of transmission is influenced by hygiene and social distancing. RESULTS: Overall, 5,588,702 visits were recorded. Respiratory and AGE visits declined by 49.9% and 47.3% comparing the COVID-19 and pre-COVID-19 periods. The respective rate reductions for urinary tract infections, trauma, and skin and soft tissue infections were 18.2%, 19.9%, and 21.8%. Epilepsy visits increased by 8.2%. Overall visits rates declined by 21.6%. Dispensed prescription rates of antibiotics and non-antibiotics respiratory medications declined by 49.3% and 44.4%, respectively. The respective declines for non-respiratory antibiotics and non-antibiotics were 15.1% and 0.2%. Clinic visits and prescription rates reductions were highest in April-May, following the first lockdown in Israel. CONCLUSIONS: COVID-19 pandemic resulted in a substantial reduction in respiratory outpatient clinic visits and dispensed respiratory drugs, with only a mild reduction seen for non-respiratory visits. These trends were probably driven by COVID-19 mitigation measures and by the profound disruption to non-SARS COV-2 respiratory virus activity.

Did Dermatological Hospital Referrals and Practice of Dermatologists Change in Between Pre-covid and Covid Era? A Short-term Preliminary Evaluation

Objective: In this descriptive study, we aimed to evaluate features of dermatology referrals before and after Covid-19 pandemic. Materials and Methods: The patients referred to dermatology outpatient clinics of Acibadem Group Hospitals in Istanbul between the time intervals 2019 March 1st and August 31st (Group G1) and 2020 March 1st and August 31st (Group G2) were included in this study. G1 and G2 groups were compared in terms of age, gender, mean duration of complaints, the most common five anatomic regions and the most common five dermatoses. Results: Referral rate after Covid-19 pandemic was decreased by 40%. Face (p=.0013, OR= 1.20, 95% CI=1.07-1.34), scalp (p=.02, OR=1.23, 95% CI=1.02-1.48) and hand (p=.04, 95% OR=1.24, 95% CI=1.00-1.54) were more common locations in 2020 (group G2) than in 2019 (G2 group). The most common five dermatoses were contact dermatitis (8.3%), acne (8,1%), wart (7,0%), seborrheic dermatitis (5,7%) and pyoderma (5,5%) in G1 (2019), while the order was contact dermatitis (10,6%), acne (7,5%), seborrheic dermatitis (6,5%), wart (6,4%) and pyoderma (4,9%) in G2 (2020). Contact dermatitis showed a significant increase after pandemic (p=.0017, OR=1.29, 95% CI=1.10-1.51). In 2020, psoriasis and lichen planus showed a two-fold increases (P <.001, OR=2.00, 95% CI=1.43-2.79 and p=.03, OR=1.92, 95% CI=1.09-3.38, respectively), whereas frequency of molluscum contagiosum decreased significantly (p=.03, OR=0.49, 95% CI=0.26-0.92). Conclusion: Although we found some remarkable results, relatively short-term period design with the limited patient population of this study needs to be verified in more comprehensive studies.

Simulation Study of the Impact of COVID-19 Policies on the Efficiency of a Smart Clinic MRI Service.

The present study examines the impact of the policies against the proliferation of SARS-CoV-2 on outpatient facilities through a direct comparison of the key performance indicators measured in an ordinary and pandemic scenario. The subject of the analysis is a diagnostic imaging department of a Smart Clinic (SC) of Gruppo San Donato (GSD). The operations are virtually replicated through a Discrete-Event Simulation (DES) software called FlexSim Healthcare. Operational and productivity indicators are defined and quantified. As hypothesized, anti-contagious practices affect the normal execution of medical activities and their performance, resulting in an unpleasant scenario compared to the baseline one. A reduction in the number of diagnoses by 19% and a decrease in the utilization rate of the diagnostic machine by 21% are shown. Consequently, the development of strategies that restore balance and improve the execution of outpatient activities in a pandemic setting is necessary.

Orthopedic Telemedicine Outpatient Practice Diagnoses Set during the First COVID-19 Pandemic Lockdown-Individual Observation.

The COVID-19 pandemic has caused a substantial intensification of the telemedicine transformation process in orthopedics since 2020. In the light of the legal regulations introduced in Poland, from the beginning of the SARS-CoV-2 pandemic, physicians, including orthopedic surgeons, have had the opportunity to conduct specialist teleconsultations. Teleconsultations increase epidemiological safety and significantly reduce the exposure of patients and medical staff to direct transmission of the viral vector and the spread of infections. The study aimed to describe diagnoses and clinical aspects of consecutive orthopedic teleconsultations (TC) during the pandemic lockdown. The diagnoses were set according to the International Classification of Diseases (ICD-10). Hybrid teleconsultations used smartphones and obligatory Electronic Health Record (EHR) with supplemental voice, SMS, MMS, Medical images, documents, and video conferencing if necessary. One hundred ninety-eight consecutive orthopedic teleconsultations were served for 615 women and 683 men (mean age 41.82 years ± 11.47 years). The most frequently diagnosed diseases were non-acute orthopedic disorders "M" (65.3%) and injuries "S" (26.3%). Back pain (M54) was the most frequent diagnosis (25.5%). Although virtual orthopedic consultation cannot replace an entire personal visit to a specialist orthopedic surgeon, in many cases, teleconsultation enables medical staff to continue to participate in providing medical services at a sufficiently high medical level to ensure patient and physician. The unified approach to TC diagnoses using ICD-10 or ICD-11 may improve further research on telemedicine-related orthopedics repeatability. Future research directions should address orthopedic teleconsultations' practical aspects and highlight legal, organizational, and technological issues with their implementations.

Effects of Coronavirus Disease-2019 Pandemic and "New Normal" on the Orthopedic Outpatient Clinic Practice

Objective: This study aimed to evaluate the effects of the coronavirus disease-2019 pandemic on the orthopedic outpatient clinic, including an investigation of the number, changes in complaints, and demographics of patients. Materials and Methods: Data of patients who visited the orthopedic outpatient clinic at our hospital within four periods were evaluated. Period 1 was between March and May 2019, period 2 was between June and August 2019, period 3 was between March and May 2020, and period 4 was between June and August 2020. Data of patients were recorded for each period including age, gender, number, and International Classification of Diseases 10th Revision codes for comparative analysis. Results: This study included 7,120 patients who were admitted to the orthopedic outpatient clinic within the four periods. The lowest number of patients (1,119) who visited the outpatient clinic was observed in the three months following the pandemic declaration (period 3), in March 2020, whereas the highest number (2,149) was observed in the three months following the lifting of restrictions, in June 2020 (period 4). No significant difference was observed in the age between the four periods (p=0.945). However, a difference was found between the periods for patients aged ≥65 years. Reasons for admission were also different between the periods. In period 3, admissions due to traumatic reasons were statistically higher compared with the other three periods (p<0.001, p=0.003, p<0.001). Conclusion: It was observed that the number of patients visiting the orthopedic outpatient clinic increased after the restrictions were lifted. Outpatient clinic management must be organized in a way that prevents contamination and preserves efficient outpatient support. (English) [ FROM AUTHOR] Amaç: Bu çalışmanın amacı, koronavirüs hastalığı-2019 pandemisinin ortopedi polikliniği üzerindeki etkilerini değerlendirmek, hasta sayısı, hastaların şikayetlerindeki değişiklikler ve demografik özellikleri araştırmaktır. Gereç ve Yöntem: Hastanemizde ortopedi polikliniğine başvuran hastaların verileri dört dönem için değerlendirildi. Dönem 1 Mart ve Mayıs 2019 arasında;dönem 2 Haziran ve Ağustos 2019 arasında;dönem 3 Mart ve Mayıs 2020 arasında;ve dönem 4 Haziran ve Ağustos 2020 arasındaydı. Karşılaştırmalı analiz için her dönemde başvuran hastaların yaş, cinsiyet, sayı ve Uluslararası Hastalık Sınıflandırması 10. Revizyon kodları verileri kaydedildi. Bulgular: Dört dönem içinde ortopedi polikliniğine başvuran toplam 7.120 hasta çalışmaya dahil edildi. En düşük poliklinik başvuru sayısı (1.119), Mart 2020'de pandeminin ilanını takip eden üç ayda (dönem 3) görülürken, en yüksek sayı (2.149), Haziran 2020'de sınırlandırmaların kaldırılmasını takip eden üç ayda görüldü (dönem 4). Dört dönem arasında hasta yaşları açısından anlamlı bir fark gözlenmedi (p=0,945). Bununla birlikte, 65 yaş ve üzeri hastalar için dönemler arasında fark vardı. Polikliniğe başvuru nedenleri de dönemler arasında farklıydı. 3. dönemde travmatik nedenlerle başvurular diğer üç döneme göre istatistiksel olarak daha yüksekti (p<0,001, p=0,003, p<0,001). Sonuç: Kısıtlamalar kaldırıldıktan sonra ortopedi polikliniğine gelen hasta sayısının arttığı belirlendi. Poliklinik sistemi, kontaminasyonu önleyecek ve hastaların tedavilerinin etkin bir şekilde devam ettirilebileceği şekilde organize edilmelidir. (Turkish) [ FROM AUTHOR] Copyright of Turkish Journal of Osteoporosis / Turk Osteoporoz Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Optimization models to find maximum appointment capacity in a pediatric orthopedic clinic - A COVID experience

During the first few months of the COVID crisis in 2020, a large number of appointments were canceled at many outpatient clinics across the US as a precautionary measure. This cancelation of appointments resulted in a long backlog. As clinics started to slowly open with safety precautions, they were faced with the daunting task of rescheduling these canceled appointments in addition to regular appointments. Administrators were faced with the question - how many appointments can be scheduled in a day without increasing physician and exam-room capacity? In this paper, a combination of mathematical optimization models and best-practice guidelines gleaned from literature were used to arrive at a set of recommendations for a pediatric orthopedic clinic. Recommendations include number of appointments per provider per day, the sequence of appointments by visit type and start-time (appointment time) for each appointment. Implicit in these recommendations is the minimization of length of visit (LOV) by minimizing waiting-time for patients. Exam-room utilization was also simulated to ensure existing exam-rooms will be sufficient for handling the number of appointments recommended by mathematical models. © 2021 IISE Annual Conference and Expo 2021. All rights reserved.

Analysis of a COVID-19 Prescreening Process in an Outpatient Clinic at a University Hospital during the COVID-19 Pandemic.

BACKGROUND: To minimize nosocomial infection against coronavirus disease 2019 (COVID-19), most hospitals conduct a prescreening process to evaluate the patient or guardian of any symptoms suggestive of COVID-19 or exposure to a COVID-19 patient at entrances of hospital buildings. In our hospital, we have implemented a two-level prescreening process in the outpatient clinic: an initial prescreening process at the entrance of the outpatient clinic (PPEO) and a second prescreening process is repeated in each department. If any symptoms or epidemiological history are identified at the second level, an emergency code is announced through the hospital's address system. The patient is then guided outside through a designated aisle. In this study, we analyze the cases missed in the PPEO that caused the emergency code to be applied. METHODS: All cases reported from March 2020 to April 2021 were analyzed retrospectively. We calculated the incidence of cases missed by the PPEO per 1,000 outpatients and compared the incidence between first-time hospital visitors and those visiting for the second time or more; morning and afternoon office hours; and days of the week. RESULTS: During the study period, the emergency code was applied to 449 cases missed by the PPEO. Among those cases, 20.7% were reported in otorhinolaryngology, followed by 11.6% in gastroenterology, 5.8% in urology, and 5.8% in dermatology. Fever was the most common symptom (59.9%), followed by cough (19.8%). The incidence of cases per 1,000 outpatients was significantly higher among first-time visitors than among those visiting for the second time or more (1.77 [confidence interval (CI), 1.44-2.10] vs. 0.59 [CI, 0.52-0.65], respectively) (P < 0.001). CONCLUSION: Fever was the most common symptom missed by the PPEO, and otorhinolaryngology and gastroenterology most frequently reported missed cases. Cases missed by the PPEO were more likely to occur among first-time visitors than returning visitors. The results obtained from this study can provide insights or recommendations to other healthcare facilities in operating prescreening processes during the COVID-19 pandemic.