For the study, data were utilized from patients having hematologic neoplasms who had received a minimum of one systemic treatment regimen between March 1st, 2016 and February 28th, 2021. prognosis biomarker The treatment options were categorized as oral therapy, outpatient infusions, and inpatient infusions. Data collection for the study's analyses ended on April 30, 2021.
Monthly visit rates were established through the calculation of documented visits (both telemedicine and in-person) per active patient during a 30-day timeframe. Our time-series forecasting approach, applied to pre-pandemic data (March 2016 to February 2020), estimated the expected rates for the period between March 1, 2020, and February 28, 2021, assuming no pandemic disruption.
This study utilized data from 24,261 patients, who had a median age of 68 years, with an interquartile range between 60 and 75 years. Considering the total number of patients treated, 6737 patients received oral therapy, 15314 received outpatient infusions, and 8316 received inpatient infusions. Over half of the patients identified as men (14370, 58%) and were additionally classified as non-Hispanic White (16309, 66%). The pandemic's early months (March to May 2020) showcased a significant 21% reduction (95% prediction interval, 12%-27%) in the average number of in-person visits for both oral therapy and outpatient infusions. In-person visits for multiple myeloma treatments decreased significantly: oral therapy (29% reduction; 95% CI 21-36%; p = .001), outpatient infusions (11% reduction; 95% CI 4-17%; p = .002), and inpatient infusions (55% reduction; 95% CI 27-67%; p = .005). Oral therapy for chronic lymphocytic leukemia (28% reduction; 95% CI 12-39%; p = .003), outpatient infusions for mantle cell lymphoma (38% reduction; 95% CI 6-54%; p = .003), and outpatient infusions for chronic lymphocytic leukemia (20% reduction; 95% CI 6-31%; p = .002) also saw substantial reductions. Telemedicine appointments for patients receiving oral therapy were most frequent during the earliest months of the pandemic, diminishing subsequently.
Observed in this cohort study of patients with hematologic neoplasms, receiving oral treatments or outpatient infusions, there was a considerable dip in documented in-person visits during the initial stages of the pandemic, but this was followed by a return to near-projected visit rates in the latter half of the year 2020. No statistically substantial decrease was found in the rate of in-person visits by patients undergoing inpatient infusion treatments. The initial pandemic months demonstrated a greater reliance on telemedicine, which lessened, but persistent telemedicine use continued in the latter half of 2020. To determine the connection between the COVID-19 pandemic and subsequent cancer outcomes, and the trajectory of telemedicine's role in healthcare delivery, more research is required.
This cohort study of patients with hematologic neoplasms, treated with oral therapy and outpatient infusions, observed a notable decrease in in-person visit rates during the initial pandemic months. However, these rates rebounded to levels close to projections by the latter half of 2020. Patients receiving inpatient infusions did not demonstrate statistically significant decreases in their overall in-person visit rate. The early stages of the pandemic witnessed a substantial increase in telemedicine utilization, followed by a subsequent downturn, although significant usage continued into the second half of 2020. c-Met chemical The evolving use of telemedicine for care delivery and the potential associations between COVID-19 and cancer outcomes necessitate further research.
Outcomes for Medicare patients following the 2018 removal of total knee replacement (TKR) from the Medicare inpatient-only (IPO) list remain a largely unexplored area.
To assess the influence of patient characteristics on outpatient total knee replacement (TKR) utilization and to determine if the implementation of the IPO policy impacted postoperative outcomes in TKR procedures.
Data sourced from the New York Statewide Planning and Research Cooperative System's administrative claims formed the basis of this cohort study. New York State Medicare fee-for-service beneficiaries who underwent total knee replacements (TKRs) or total hip replacements (THRs) from 2016 through 2019 formed the group of patients considered in this investigation. Multivariable generalized linear mixed models, coupled with a difference-in-differences approach, were employed to discern patient factors influencing outpatient TKR use and to determine the impact of the IPO policy on post-TKR outcomes, relative to post-THR outcomes in Medicare beneficiaries. Water microbiological analysis Data analysis activities were carried out during the years 2021 and 2022.
IPO policy implementation during the year 2018.
Evaluating the use of outpatient or inpatient total knee replacements (TKRs); secondary results included post-operative readmissions (30 and 90 days), emergency department visits (30 and 90 days), non-home discharges, and the total expenses of the surgical instances.
From 2016 through 2019, a total of 37,588 TKR procedures were performed on 18,819 patients. This included 1,684 outpatient TKR procedures between 2018 and 2019. The patients' average age was 73.8 years (standard deviation of 59), with 12,240 (650%) females, 823 Hispanic individuals (44%), 982 non-Hispanic Black individuals (52%), and 15,714 (835%) non-Hispanic White individuals. The probability of undergoing outpatient total knee replacements (TKRs) was decreased for older patients (e.g., age 75 versus 65, adjusted difference -165%; 95% CI, -231% to -99%), Black patients (-144%; 95% CI, -281% to -0.7%), and female patients (-91%; 95% CI, -152% to -29%). Additionally, patients treated in safety-net hospitals (disproportionate share hospital payments quartile 4 -1809%; 95% CI, -3181% to -436%) demonstrated an extremely lower rate of outpatient TKRs. After the IPO policy was implemented in the TKR group, a reduction in 90-day readmissions was noted ( -323%; 95% CI, -404% to -242%; P<.001). The TKR cohort's alterations manifested a distinctive increase in cost ($770 per encounter) over the THR cohort (95% CI: $83 to $1457; P=.03), unlike the unchanged adjustments in the other group.
Our cohort study of patients undergoing total knee replacement (TKR) and total hip replacement (THR) indicated that older, Black, female patients and those treated at safety-net hospitals could potentially be at a disadvantage regarding outpatient TKR access, highlighting the need for further investigation into disparities. Changes in IPO policy did not alter overall healthcare use or outcomes in patients following TKR, besides a $770 increase in costs per encounter.
This cohort study of patients undergoing TKR and THR procedures identified a possible disparity in access to outpatient TKRs for older, Black, and female patients, and those receiving care at safety-net hospitals. Following total knee replacement (TKR), IPO policy exhibited no correlation with alterations in overall healthcare utilization or outcomes, save for a $770 per TKR encounter increment.
Comprehensive datasets about the relationship between COVID-19 and physical activity levels are deficient.
To understand long-term patterns in physical activity, a nationally representative survey conducted between 2009 and 2021 will be thoroughly analyzed.
In South Korea, a repeated cross-sectional study, covering the general populace, was conducted between 2009 and 2021 using the Korea Community Health Survey, a nationally representative source. The 2,748,585 Korean adults involved in a nationwide, large-scale, serial study were tracked from 2009 through 2021, leading to the collection of pertinent data. Analysis of data spanned the interval from December 2022 to January 2023.
The outbreak of the COVID-19 pandemic.
Using the prevalence and average metabolic equivalent of task (MET) score, trends in meeting the World Health Organization's sufficient aerobic physical activity guidelines were assessed, which specify a threshold of 600 MET-min/wk or higher. The cross-sectional survey encompassed details on age, sex, body mass index (BMI), region of residence, educational attainment, income bracket, smoking habits, alcohol consumption frequency, stress levels, physical activity patterns, and a history of diabetes, hypertension, and depression.
The prevalence of sufficient physical activity remained largely consistent among 2,748,585 Korean adults in the pre-pandemic period. This comprised 738,934 individuals aged 50-64 (representing 291% of a reference population), 657,560 aged 65 or older (259% of a reference population), and 1,178,869 males (464% of a reference population). (Difference = 10; 95% Confidence Interval = 0.6 to 1.4). During the pandemic, the percentage of people engaging in sufficient physical activity underwent a marked reduction, dropping from 360% (95% confidence interval, 359% to 361%) in 2017-2019 to 300% (95% CI, 298% to 302%) in 2020, and 297% (95% CI, 295% to 299%) in 2021. The prevalence of adequate physical activity decreased among older adults (65 years and above) and younger adults (19 to 29 years of age) during the pandemic. Older adults saw a decrease of -164 (95% confidence interval, -175 to -153), and younger adults experienced a decrease of -166 (95% confidence interval, -181 to -150). During the pandemic, sufficient physical activity decreased notably in several groups. This included women (difference, -168; 95% CI, -176 to -160), urban dwellers (difference, -212; 95% CI, -222 to -202), healthy individuals (e.g., normal BMI, 185-229 difference, -125; 95% CI, -134 to -117), and individuals with a history of depressive episodes (difference, -137; 95% CI, -191 to -84). Similar to the principal results, the average MET score trend demonstrated a decline; mean MET scores fell from the 2017-2019 period (15791 MET-min/wk; 95% CI, 15675 to 15907 MET-min/wk) to the 2020-2021 period (11919 MET-min/wk; 95% CI, 11824 to 12014 MET-min/wk).
This cross-sectional survey demonstrated a consistent national prevalence of physical activity prior to the pandemic, but a significant drop during the pandemic, especially among healthy individuals and demographic groups at higher risk for adverse outcomes such as seniors, women, those residing in urban areas, and individuals with depressive tendencies.