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1.
CMAJ Open ; 9(4): E1205-E1212, 2021.
Article in English | MEDLINE | ID: covidwho-1592340

ABSTRACT

BACKGROUND: Breast cancer screening in Ontario, Canada, was deferred during the first wave of the COVID-19 pandemic, and a prioritization framework to resume services according to breast cancer risk was developed. The purpose of this study was to assess the impact of the pandemic within the Ontario Breast Screening Program (OBSP) by comparing total volumes of screening mammographic examinations and volumes of screening mammographic examinations with abnormal results before and during the pandemic, and to assess backlogs on the basis of adherence to the prioritization framework. METHODS: A descriptive study was conducted among women aged 50 to 74 years at average risk and women aged 30 to 69 years at high risk, who participated in the OBSP. Percentage change was calculated by comparing observed monthly volumes of mammographic examinations from March 2020 to March 2021 with 2019 volumes and proportions by risk group. We plotted estimates of backlog volumes of mammographic examinations by risk group, comparing pandemic with prepandemic screening practices. Volumes of mammographic examinations with abnormal results were plotted by risk group. RESULTS: Volumes of mammographic examinations in the OBSP showed the largest declines in April and May 2020 (> 99% decrease) and returned to prepandemic levels as of March 2021, with an accumulated backlog of 340 876 examinations. As of March 2021, prioritization had reduced the backlog volumes of screens for participants at high risk for breast cancer by 96.5% (186 v. 5469 expected) and annual rescreens for participants at average risk for breast cancer by 13.5% (62 432 v. 72 202 expected); there was a minimal decline for initial screens. Conversely, the backlog increased by 7.6% for biennial rescreens (221 674 v. 206 079 expected). More than half (59.4%) of mammographic examinations with abnormal results were for participants in the higher risk groups. INTERPRETATION: Prioritizing screening for those at higher risk for breast cancer may increase diagnostic yield and redirect resources to minimize potential long-term harms caused by the pandemic. This further supports the clinical utility of risk-stratified cancer screening.


Subject(s)
Breast Neoplasms/diagnosis , COVID-19/epidemiology , Early Detection of Cancer , Guideline Adherence/statistics & numerical data , Mammography , Aged , Early Detection of Cancer/methods , Early Detection of Cancer/standards , Early Detection of Cancer/statistics & numerical data , Female , Health Priorities/standards , Health Priorities/statistics & numerical data , Humans , Mammography/standards , Mammography/statistics & numerical data , Middle Aged , Ontario/epidemiology , Risk Factors
2.
Ann R Coll Surg Engl ; 103(6): 390-394, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1223791

ABSTRACT

The COVID-19 pandemic is the most serious health crisis of our time. Global public measures have been enacted to try to prevent healthcare systems from being overwhelmed. The trauma and orthopaedic (T&O) community has overcome challenges in order to continue to deliver acute trauma care to patients and plan for challenges ahead. This review explores the lessons learnt, the priorities and the controversies that the T&O community has faced during the crisis. Historically, the experience of major incidents in T&O has focused on mass casualty events. The current pandemic requires a different approach to resource management in order to create a long-term, system-sustaining model of care alongside a move towards resource balancing and facilitation. Significant limitations in theatre access, anaesthetists and bed capacity have necessitated adaptation. Strategic changes to trauma networks and risk mitigation allowed for ongoing surgical treatment of trauma. Outpatient care was reformed with the uptake of technology. The return to elective surgery requires careful planning, restructuring of elective pathways and risk management. Despite the hope that mass vaccination will lift the pressure on bed capacity and on bleak economic forecasts, the orthopaedic community must readjust its focus to meet the challenge of huge backlogs in elective caseloads before looking to the future with a robust strategy of integrated resilient pathways. The pandemic will provide the impetus for research that defines essential interventions and facilitates the implementation of strategies to overcome current barriers and to prepare for future crises.


Subject(s)
COVID-19/epidemiology , Health Priorities , Orthopedic Procedures , Wounds and Injuries/surgery , Ambulatory Surgical Procedures , Delivery of Health Care/organization & administration , Delivery of Health Care/statistics & numerical data , Health Priorities/organization & administration , Health Priorities/standards , Humans , Orthopedic Procedures/statistics & numerical data , Traumatology/organization & administration , Traumatology/standards
4.
Endocrine ; 71(1): 20-25, 2021 01.
Article in English | MEDLINE | ID: covidwho-962158

ABSTRACT

PURPOSE: Nowadays, the clinical management of thyroid nodules needs to be multi-disciplinary. In particular, the crosstalk between endocrinologists and cytopathologists is key. When FNAs are properly requested by endocrinologists for nodules characterised by relevant clinical and ultrasound features, cytopathologists play a pivotal role in the diagnostic work-up. Conversely, improper FNA requests can lead to questionable diagnostic efficiency. Recently, recommendations to delay all non-urgent diagnostic procedures, such as thyroid FNAs, to contain the spread of COVID-19 infection, have made the interplay between endocrinologists and cytopathologists even more essential. The objective of this study was to assess the impact of COVID-19 pandemic on our practice by evaluating the total number of FNAs performed and the distribution of the Bethesda Categories before, during, and after the lockdown. METHODS: We analysed the FNA trends before (1st January 2019 to March 13th 2020), during (March 14th to May 15th), and after (May 16th to July 7th) the lockdown. RESULTS: Although the total number of weekly FNAs dropped from 62.1 to 23.1, our referring endocrinologists managed to prioritise patients with high-risk nodules. In fact, in the post-lockdown, the weekly proportion of benign diagnoses dropped on average by 12% and that of high-risk diagnoses increased by 6%. CONCLUSIONS: The lesson we have learned so far from this pandemic is that by applying safety protocols to avoid contagion and by increasing the threshold for FNA requests for thyroid nodules, we can continue to guarantee our services to high-risk patients even in times of a health crisis.


Subject(s)
COVID-19/epidemiology , Health Services Accessibility , Pandemics , Quarantine , Thyroid Nodule/diagnosis , Adult , Aged , Attitude to Health , Biopsy, Fine-Needle/statistics & numerical data , Biopsy, Fine-Needle/trends , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Communicable Disease Control/standards , Female , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Guideline Adherence/trends , Health Priorities/standards , Health Priorities/statistics & numerical data , Health Priorities/trends , Health Services Accessibility/standards , Health Services Accessibility/trends , History, 21st Century , Humans , Italy/epidemiology , Male , Middle Aged , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Practice Patterns, Physicians'/trends , Quarantine/organization & administration , Quarantine/standards , Referral and Consultation/statistics & numerical data , Referral and Consultation/trends , Thyroid Gland/pathology , Thyroid Nodule/epidemiology , Time Factors , Ultrasonography, Interventional
7.
Anaesth Crit Care Pain Med ; 39(3): 333-339, 2020 06.
Article in English | MEDLINE | ID: covidwho-276489

ABSTRACT

BACKGROUND: Relying on capacity increases and patient transfers to deal with the huge and continuous inflow of COVID-19 critically ill patients is a strategy limited by finite human and logistical resources. RATIONALE: Prioritising both critical care initiation and continuation is paramount to save the greatest number of lives. It enables to allocate scarce resources in priority to those with the highest probability of benefiting from them. It is fully ethical provided it relies on objective and widely shared criteria, thus preventing arbitrary decisions and guaranteeing equity. Prioritisation seeks to fairly allocate treatments, maximise saved lives, gain indirect life benefits from prioritising exposed healthcare and similar workers, give priority to those most penalised as a last resort, and apply similar prioritisation schemes to all patients. PRIORITISATION STRATEGY: Prioritisation schemes and their criteria are adjusted to the level of resource scarcity: strain (level A) or saturation (level B). Prioritisation yields a four level priority for initiation or continuation of critical care: P1-high priority, P2-intermediate priority, P3-not needed, P4-not appropriate. Prioritisation schemes take into account the patient's wishes, clinical frailty, pre-existing chronic condition, along with severity and evolution of acute condition. Initial priority level must be reassessed, at least after 48h once missing decision elements are available, at the typical turning point in the disease's natural history (ICU days 7 to 10 for COVID-19), and each time resource scarcity levels change. For treatments to be withheld or withdrawn, a collegial decision-making process and information of patient and/or next of kin are paramount. PERSPECTIVE: Prioritisation strategy is bound to evolve with new knowledge and with changes within the epidemiological situation.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Critical Care/organization & administration , Critical Illness , Health Priorities/standards , Health Resources/supply & distribution , Intensive Care Units/organization & administration , Pandemics , Pneumonia, Viral/therapy , Triage/standards , COVID-19 , Canada , Caregivers , Continuity of Patient Care/organization & administration , Coronavirus Infections/epidemiology , Critical Care/ethics , Critical Care/standards , France/epidemiology , Health Personnel , Health Priorities/ethics , Health Services Accessibility/ethics , Humans , Intensive Care Units/supply & distribution , Patient Transfer , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Refusal to Treat/ethics , Resource Allocation/ethics , SARS-CoV-2 , Social Justice , Switzerland , Triage/ethics , Triage/organization & administration
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