Correction: Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

[This corrects the article DOI: 10.1371/journal.pone.0288777.].

Impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.

BACKGROUND: Cardiovascular diseases remain the foremost global cause of death. The COVID-19 pandemic has strained health-care systems, leading to delays in essential medical services, including treatment for cardiovascular diseases. We aimed to examine the impact of the pandemic on delayed cardiovascular care in Europe. METHODS: In this systematic review, we searched PubMed, Embase, and Web of Science for peer-reviewed and published quantitative studies in English from Nov 1, 2019, to Sept 18, 2022, that addressed pandemic-induced delays in cardiovascular disease care for adult patients in Europe. Data appraisal, extraction, and quality assessment were done by two reviewers using the 14-item QualSyst tool checklist. We extracted summary patient-level data from the studies, including around 3·5 million patients. Evaluated outcomes included changes pre-March 2020 and during the COVID-19 pandemic in hospital admissions, mortality rates, medical help-seeking delays post-symptom onset, treatment initiation delays, and treatment procedure counts. The protocol is registered on PROSPERO (CRD42022354443). FINDINGS: Of the 132 included studies (20% from the UK), all were observational retrospective, with 87% focusing on the first wave of the pandemic. Results were categorised into five disease groups: ischaemic heart diseases, cerebrovascular diseases, cardiac arrests, heart failures, and others. Hospital admissions showed significant decreases around the ranges of 12-66% for ischaemic heart diseases, 9-40% for cerebrovascular diseases, 9-66% for heart failures, 27-88% for urgent and elective cardiac procedures, and an increase between 11-56% for cardiac arrests. Mortality rates were significantly higher during the pandemic, ranging between 1-25% (vs 16-22% before the pandemic) for ischaemic heart diseases and 8-70% (vs 8-26% before the pandemic) for cerebrovascular diseases. Only one study ranked low in quality. INTERPRETATION: The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Policymakers and health-care systems should work together on implementing adequate resource allocation strategies and clear guidelines on how to handle care during health crises, reducing diagnosis and treatment initiation delays, and promoting a healthy lifestyle. Future studies should evaluate the long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19. FUNDING: Belgian Science Policy Office.

Evaluating the health and health economic impact of the COVID-19 pandemic on delayed cancer care in Belgium: A Markov model study protocol.

INTRODUCTION: Cancer causes a substantial burden to our society, both from a health and an economic perspective. To improve cancer patient outcomes and lower society expenses, early diagnosis and timely treatment are essential. The recent COVID-19 crisis has disrupted the care trajectory of cancer patients, which may affect their prognosis in a potentially negative way. The purpose of this paper is to present a flexible decision-analytic Markov model methodology allowing the evaluation of the impact of delayed cancer care caused by the COVID-19 pandemic in Belgium which can be used by researchers to respond to diverse research questions in a variety of disruptive events, contexts and settings. METHODS: A decision-analytic Markov model was developed for 4 selected cancer types (i.e. breast, colorectal, lung, and head and neck), comparing the estimated costs and quality-adjusted life year losses between the pre-COVID-19 situation and the COVID-19 pandemic in Belgium. Input parameters were derived from published studies (transition probabilities, utilities and indirect costs) and administrative databases (epidemiological data and direct medical costs). One-way and probabilistic sensitivity analyses are proposed to consider uncertainty in the input parameters and to assess the robustness of the model's results. Scenario analyses are suggested to evaluate methodological and structural assumptions. DISCUSSION: The results that such decision-analytic Markov model can provide are of interest to decision makers because they help them to effectively allocate resources to improve the health outcomes of cancer patients and to reduce the costs of care for both patients and healthcare systems. Our study provides insights into methodological aspects of conducting a health economic evaluation of cancer care and COVID-19 including insights on cancer type selection, the elaboration of a Markov model, data inputs and analysis.

The impact of the COVID-19 pandemic on delayed care of cardiovascular diseases in Europe: a systematic review.

AIMS: Cardiovascular diseases (CVD) are the leading cause of death worldwide. The coronavirus disease 2019 (COVID-19) pandemic has disrupted healthcare systems, causing delays in essential medical services, and potentially impacting CVD treatment. This study aims to estimate the impact of the pandemic on delayed CVD care in Europe by providing a systematic overview of the available evidence. METHODS AND RESULTS: PubMed, Embase, and Web of Science were searched until mid-September 2022 for studies focused on the impact of delayed CVD care due to the pandemic in Europe among adult patients. Outcomes were changes in hospital admissions, mortality rates, delays in seeking medical help after symptom onset, delays in treatment initiation, and change in the number of treatment procedures. We included 132 studies, of which all were observational retrospective. Results were presented in five disease groups: ischaemic heart diseases (IHD), cerebrovascular accidents (CVA), cardiac arrests (CA), heart failures (HF), and others, including broader CVD groups. There were significant decreases in hospital admissions for IHD, CVA, HF and urgent and elective cardiac procedures, and significant increases for CA. Mortality rates were higher for IHD and CVA. CONCLUSION: The pandemic led to reduced acute CVD hospital admissions and increased mortality rates. Delays in seeking medical help were observed, while urgent and elective cardiac procedures decreased. Adequate resource allocation, clear guidelines on how to handle care during health crises, reduced delays, and healthy lifestyle promotion should be implemented. The long-term impact of pandemics on delayed CVD care, and the health-economic impact of COVID-19 should be further evaluated.

Social inequalities and long-term health impact of COVID-19 in Belgium: protocol of the HELICON population data linkage.

INTRODUCTION: Data linkage systems have proven to be a powerful tool in support of combating and managing the COVID-19 pandemic. However, the interoperability and the reuse of different data sources may pose a number of technical, administrative and data security challenges. METHODS AND ANALYSIS: This protocol aims to provide a case study for linking highly sensitive individual-level information. We describe the data linkages between health surveillance records and administrative data sources necessary to investigate social health inequalities and the long-term health impact of COVID-19 in Belgium. Data at the national institute for public health, Statistics Belgium and InterMutualistic Agency are used to develop a representative case-cohort study of 1.2 million randomly selected Belgians and 4.5 million Belgians with a confirmed COVID-19 diagnosis (PCR or antigen test), of which 108 211 are COVID-19 hospitalised patients (PCR or antigen test). Yearly updates are scheduled over a period of 4 years. The data set covers inpandemic and postpandemic health information between July 2020 and January 2026, as well as sociodemographic characteristics, socioeconomic indicators, healthcare use and related costs. Two main research questions will be addressed. First, can we identify socioeconomic and sociodemographic risk factors in COVID-19 testing, infection, hospitalisations and mortality? Second, what is the medium-term and long-term health impact of COVID-19 infections and hospitalisations? More specific objectives are (2a) To compare healthcare expenditure during and after a COVID-19 infection or hospitalisation; (2b) To investigate long-term health complications or premature mortality after a COVID-19 infection or hospitalisation; and (2c) To validate the administrative COVID-19 reimbursement nomenclature. The analysis plan includes the calculation of absolute and relative risks using survival analysis methods. ETHICS AND DISSEMINATION: This study involves human participants and was approved by Ghent University hospital ethics committee: reference B.U.N. 1432020000371 and the Belgian Information Security Committee: reference Beraadslaging nr. 22/014 van 11 January 2022, available via https://www.ehealth.fgov.be/ehealthplatform/file/view/AX54CWc4Fbc33iE1rY5a?filename=22-014-n034-HELICON-project.pdf. Dissemination activities include peer-reviewed publications, a webinar series and a project website.The pseudonymised data are derived from administrative and health sources. Acquiring informed consent would require extra information on the subjects. The research team is prohibited from gaining additional knowledge on the study subjects by the Belgian Information Security Committee's interpretation of the Belgian privacy framework.

Determinants of the risk of burnout among nurses during the first wave of the COVID-19 pandemic in Belgium: A cross-sectional study.

AIMS: To estimate the prevalence of burnout risk among nurses during the peak of the first wave of the COVID-19 pandemic in Belgium and to identify risk groups and protective and risk factors. BACKGROUND: Nurses are at high risk of burnout, and this can have negative consequences for them, patients and health care systems. The pandemic may have changed their working conditions and increased their risk of burnout. METHODS: The risk of burnout was assessed through the Maslach Burnout Inventory Scale. Information on socio-demographic and working conditions during the pandemic was also collected. We obtained 4552 respondents through convenience sampling. RESULTS: A high risk of burnout was found in 70% of respondents. The main risk factors of burnout were the lack of personal protective equipment, changes in perceived workload and working with COVID-19 patients. CONCLUSIONS: An uneven workload for nurses is an underlying problem during the COVID-19 pandemic and a significant risk factor for their burnout. The decreased workload is a risk factor for burnout as important as increased workload and repeated exposure to COVID-19. IMPLICATIONS FOR NURSING MANAGEMENT: Burnout prevention and treatment interventions must target the correct risk factors and identify nurses at risk to be cost-effective.

An Antimicrobial Stewardship Curriculum to Incorporate in the South African Bachelor of Pharmacy Degree Program.

Objective. To develop an antimicrobial stewardship curriculum that is suitable for incorporation in the undergraduate pharmacy degree programs offered by South African schools of pharmacy. Methods. A mixed methods approach was employed involving four consecutive study phases: content analysis, academic review, expert consultation, and curriculum development. The curriculum development phase involved collation of the findings of the prior three study phases. Results. The final proposed antimicrobial stewardship curriculum included recommendations for: level of incorporation of the curriculum in the undergraduate degree program, minimum contact hours, pedagogical techniques, and assessment methods. The curriculum content was split into four units: pharmacology for antimicrobial stewardship, microbiology for antimicrobial stewardship, antimicrobial stewardship in practice, and hospital antimicrobial stewardship. Conclusion. An antimicrobial stewardship curriculum that highlights key findings in relation to the role of the pharmacist in antimicrobial stewardship was developed. This was the first such study conducted in South Africa.