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1.
JAMA ; 327(3): 237-247, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1669298

ABSTRACT

Importance: Following reductions in US ambulatory care early in the pandemic, it remains unclear whether care consistently returned to expected rates across insurance types and services. Objective: To assess whether patients with Medicaid or Medicare-Medicaid dual eligibility had significantly lower than expected return to use of ambulatory care rates than patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance. Design, Setting, and Participants: In this retrospective cohort study examining ambulatory care service patterns from January 1, 2019, through February 28, 2021, claims data from multiple US payers were combined using the Milliman MedInsight research database. Using a difference-in-differences design, the extent to which utilization during the pandemic differed from expected rates had the pandemic not occurred was estimated. Changes in utilization rates between January and February 2020 and each subsequent 2-month time frame during the pandemic were compared with the changes in the corresponding months from the year prior. Age- and sex-adjusted Poisson regression models of monthly utilization counts were used, offsetting for total patient-months and stratifying by service and insurance type. Exposures: Patients with Medicaid or Medicare-Medicaid dual eligibility compared with patients with commercial, Medicare Advantage, or Medicare fee-for-service insurance, respectively. Main Outcomes and Measures: Utilization rates per 100 people for 6 services: emergency department, office and urgent care, behavioral health, screening colonoscopies, screening mammograms, and contraception counseling or HIV screening. Results: More than 14.5 million US adults were included (mean age, 52.7 years; 54.9% women). In the March-April 2020 time frame, the combined use of 6 ambulatory services declined to 67.0% (95% CI, 66.9%-67.1%) of expected rates, but returned to 96.7% (95% CI, 96.6%-96.8%) of expected rates by the November-December 2020 time frame. During the second COVID-19 wave in the January-February 2021 time frame, overall utilization again declined to 86.2% (95% CI, 86.1%-86.3%) of expected rates, with colonoscopy remaining at 65.0% (95% CI, 64.1%-65.9%) and mammography at 79.2% (95% CI, 78.5%-79.8%) of expected rates. By the January-February 2021 time frame, overall utilization returned to expected rates as follows: patients with Medicaid at 78.4% (95% CI, 78.2%-78.7%), Medicare-Medicaid dual eligibility at 73.3% (95% CI, 72.8%-73.8%), commercial at 90.7% (95% CI, 90.5%-90.9%), Medicare Advantage at 83.2% (95% CI, 81.7%-82.2%), and Medicare fee-for-service at 82.0% (95% CI, 81.7%-82.2%; P < .001; comparing return to expected utilization rates among patients with Medicaid and Medicare-Medicaid dual eligibility, respectively, with each of the other insurance types). Conclusions and Relevance: Between March 2020 and February 2021, aggregate use of 6 ambulatory care services increased after the preceding decrease in utilization that followed the onset of the COVID-19 pandemic. However, the rate of increase in use of these ambulatory care services was significantly lower for participants with Medicaid or Medicare-Medicaid dual eligibility than for those insured by commercial, Medicare Advantage, or Medicare fee-for-service.


Subject(s)
Ambulatory Care/trends , COVID-19/epidemiology , Pandemics , Adult , Aged , Aged, 80 and over , Ambulatory Care/statistics & numerical data , Colonoscopy/statistics & numerical data , Colonoscopy/trends , Databases, Factual , Fee-for-Service Plans/statistics & numerical data , Fee-for-Service Plans/trends , Female , Health Services Needs and Demand/statistics & numerical data , Health Services Needs and Demand/trends , Humans , Insurance, Health/statistics & numerical data , Insurance, Health/trends , Male , Mammography/statistics & numerical data , Mammography/trends , Medicaid/statistics & numerical data , Medicare/statistics & numerical data , Middle Aged , Retrospective Studies , Telemedicine/statistics & numerical data , Telemedicine/trends , Time Factors , United States/epidemiology , Young Adult
3.
Curr Treat Options Oncol ; 22(10): 93, 2021 08 23.
Article in English | MEDLINE | ID: covidwho-1368525

ABSTRACT

OPINION STATEMENT: The COVID-19 pandemic forced us to rapidly and dramatically shift our medical priorities and decision making. With little literature or experience to rely on, the initial priority was to minimize patient exposure to the hospital and to others. It remains unclear whether cancer patients are at higher risk of infection or serious complications, or if it is our traditional therapies that place them to be at higher risk. By far, the greatest negative impact was on screening. Routine colonoscopies were considered elective, and as a result, delays in diagnosis will be felt for years to come. The most positive changes were the incorporation of tele-visits, increased use of oral therapies, alterations in treatment schedules of both chemotherapy and radiation, and an increased emphasis on neoadjuvant therapy. These too will be felt for years to come. The colorectal cancer medical community has responded collaboratively and effectively to maintain treatment and to optimize outcomes for our patients during the COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Colonoscopy/statistics & numerical data , Colorectal Neoplasms/therapy , Early Detection of Cancer/statistics & numerical data , SARS-CoV-2/isolation & purification , Telemedicine/methods , COVID-19/transmission , COVID-19/virology , Colorectal Neoplasms/virology , Disease Management , Humans
5.
Comput Math Methods Med ; 2021: 2485934, 2021.
Article in English | MEDLINE | ID: covidwho-1325174

ABSTRACT

With the continuous improvement of human living standards, dietary habits are constantly changing, which brings various bowel problems. Among them, the morbidity and mortality rates of colorectal cancer have maintained a significant upward trend. In recent years, the application of deep learning in the medical field has become increasingly spread aboard and deep. In a colonoscopy, Artificial Intelligence based on deep learning is mainly used to assist in the detection of colorectal polyps and the classification of colorectal lesions. But when it comes to classification, it can lead to confusion between polyps and other diseases. In order to accurately diagnose various diseases in the intestines and improve the classification accuracy of polyps, this work proposes a multiclassification method for medical colonoscopy images based on deep learning, which mainly classifies the four conditions of polyps, inflammation, tumor, and normal. In view of the relatively small number of data sets, the network firstly trained by transfer learning on ImageNet was used as the pretraining model, and the prior knowledge learned from the source domain learning task was applied to the classification task about intestinal illnesses. Then, we fine-tune the model to make it more suitable for the task of intestinal classification by our data sets. Finally, the model is applied to the multiclassification of medical colonoscopy images. Experimental results show that the method in this work can significantly improve the recognition rate of polyps while ensuring the classification accuracy of other categories, so as to assist the doctor in the diagnosis of surgical resection.


Subject(s)
Colonoscopy/statistics & numerical data , Colorectal Neoplasms/classification , Colorectal Neoplasms/diagnostic imaging , Deep Learning , Artificial Intelligence , Colonic Polyps/classification , Colonic Polyps/diagnostic imaging , Computational Biology , Humans , Image Interpretation, Computer-Assisted/statistics & numerical data , Neural Networks, Computer
6.
Gastroenterol Hepatol ; 45(1): 9-17, 2022 Jan.
Article in English, Spanish | MEDLINE | ID: covidwho-1111615

ABSTRACT

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has had a serious impact on the functioning of gastrointestinal endoscopy Units. The Asociación Española de Gastroenterología (AEG) and the Sociedad Española de Endoscopia Digestiva (SEED) have proposed the EPAGE guidelines for managing postponed colonoscopies. OBJECTIVE: To evaluate the EPAGE guidelines as a management tool compared to the immunologic faecal occult blood test (iFOBT) and compared to risk score (RS) that combines age, sex and the iFOBT for the detection of colorectal cancer (CRC) and significant bowel disease (SBD). METHODS: A prospective, single-centre study enrolling 743 symptomatic patients referred for a diagnostic colonoscopy. Each order was classified according to the EPAGE guidelines as appropriate, indeterminate or inappropriate. Patients underwent an iFOBT and had their RS calculated. RESULTS: The iFOBT (p<0.001), but not the EPAGE guidelines (p = 0.742), was an independent predictive factor of risk of CRC. The ROC AUCs for the EPAGE guidelines, the iFOBT and the RS were 0.61 (95% CI 0.49-0.75), 0.95 (0.93-0.97) and 0.90 (0.87-0.93) for CRC, and 0.55 (0.49-0.61), 0.75 (0.69-0.813) and 0.78 (0.73-0.83) for SBD, respectively. The numbers of colonoscopies needed to detect a case of CRC and a case of SBD were 38 and seven for the EPAGE guidelines, seven and two for the iFOBT, and 19 and four for a RS ≥5 points, respectively. CONCLUSION: The EPAGE guidelines, unlike the iFOBT, is not suitable for screening candidate patients for a diagnostic colonoscopy to detect CRC. The iFOBT, in combination with age and sex, is the most suitable strategy for managing demand for endoscopy in a restricted-access situation.


Subject(s)
COVID-19/epidemiology , Colonoscopy/standards , Colorectal Neoplasms/diagnosis , Occult Blood , Pandemics , Practice Guidelines as Topic , Adult , Age Factors , Aged , Analysis of Variance , COVID-19/prevention & control , Colonoscopy/statistics & numerical data , Endoscopy, Gastrointestinal/standards , Female , Gastroenterology/standards , Humans , Intestinal Diseases/diagnosis , Male , Middle Aged , Predictive Value of Tests , Prospective Studies , Risk Factors , Sex Factors , Societies, Medical
7.
Lancet Gastroenterol Hepatol ; 6(3): 199-208, 2021 03.
Article in English | MEDLINE | ID: covidwho-1065697

ABSTRACT

BACKGROUND: There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England. METHODS: Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated. FINDINGS: As compared to the monthly average in 2019, in April, 2020, there was a 63% (95% CI 53-71) reduction (from 36 274 to 13 440) in the monthly number of 2-week referrals for suspected cancer and a 92% (95% CI 89-95) reduction in the number of colonoscopies (from 46 441 to 3484). Numbers had just recovered by October, 2020. This resulted in a 22% (95% CI 8-34) relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% (95% CI 19-42) relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% (95% CI 17-76) relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020. INTERPRETATION: The COVID-19 pandemic has led to a sustained reduction in the number of people referred, diagnosed, and treated for colorectal cancer. By October, 2020, achievement of care pathway targets had returned to 2019 levels, albeit with smaller volumes of patients and with modifications to usual practice. As pressure grows in the NHS due to the second wave of COVID-19, urgent action is needed to address the growing burden of undetected and untreated colorectal cancer in England. FUNDING: Cancer Research UK, the Medical Research Council, Public Health England, Health Data Research UK, NHS Digital, and the National Institute for Health Research Oxford Biomedical Research Centre.


Subject(s)
COVID-19 , Colonoscopy/statistics & numerical data , Colorectal Neoplasms , Colorectal Surgery/statistics & numerical data , Early Detection of Cancer , Patient Care Management , Radiotherapy/statistics & numerical data , COVID-19/epidemiology , COVID-19/prevention & control , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/therapy , Delivery of Health Care/trends , Early Detection of Cancer/methods , Early Detection of Cancer/statistics & numerical data , England/epidemiology , Female , Health Services Needs and Demand , Humans , Male , Middle Aged , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Referral and Consultation/statistics & numerical data , SARS-CoV-2 , State Medicine
10.
Int J Colorectal Dis ; 36(5): 1073-1075, 2021 May.
Article in English | MEDLINE | ID: covidwho-1012209

ABSTRACT

PURPOSE: We hypothesized that the COVID-19 pandemic may have modified dispensing of colonoscopy preparations, a proxy for the number of colonoscopies performed. We therefore studied changes in dispensing of colonoscopy preparations during the pandemic in France. METHODS: Using the French national health data system, we identified colonoscopy preparations dispensed from 2018 to 2020. The expected 2020 dispensations were estimated from 2018 to 2019 dispensations. RESULTS: Dispensing of colonoscopy preparations decreased markedly during the eight weeks of national lockdown: 83,045 colonoscopy preparations were dispensed, i.e., 181,826 (68.6%) fewer than expected. After lockdown, dispensing of colonoscopy preparations gradually returned to expected numbers. Overall, this represents an estimated decrease of roughly 250,000 colonoscopy preparations during the six-month period following onset of the pandemic. This shortfall in the dispensing of colonoscopy preparations was of the same order of magnitude in people under or over 50 years of age, in men and women, and in those in the highest and the lowest quintiles of the deprivation index. CONCLUSION: In conclusion, roughly 250,000 fewer colonoscopy preparations were dispensed during the first six months of the COVID-19 pandemic in France. Deleterious consequences on morbidity and mortality related to gastroenterological diseases, such as colorectal cancer, are to be feared.


Subject(s)
COVID-19 , Cathartics/administration & dosage , Colonoscopy/statistics & numerical data , Pandemics , Communicable Disease Control , Female , France/epidemiology , Humans , Male , Prescriptions
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