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      Versorgungssituation urologischer Patienten in Praxen und Kliniken während der Coronaviruspandemie in Deutschland Translated title: Urological care in practices and clinics during the corona virus pandemic in Germany

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          Abstract

          Die Coronaviruspandemie hat unmittelbare und weitreichende Auswirkungen auf die Versorgung urologischer Patienten. Mittels regelmäßiger Befragungen der Mitglieder konnte der Pandemiemonitor der Deutschen Gesellschaft für Urologie die Einschränkungen der Patientenversorgung in urologischen Praxen und Kliniken erfassen. Insgesamt wurden 689 Antworten zu vier Befragungszeitpunkten berücksichtigt. Im April zeigte sich eine mediane Reduktion der urologischen stationären Patienten auf 44 %. Die verfügbare OP-Kapazität für urologische Patienten lag im April im Median bei 45 %; sie normalisierte sich im Juni auf 90 % und sank im Dezember erneut auf 50 %. Elektive Operationen konnten im April und Dezember in einem Großteil der Krankenhäuser gar nicht oder nur zu einem sehr geringen Teil erfolgen. Während im April dringliche Operationen in >75 % der Kliniken zu 100 % versorgt werden konnten, gaben im Dezember mehr als die Hälfte der Kliniken an, nicht alle Patienten mit dringlicher Operation behandeln zu können. Praxen und Kliniken mussten zu einem Teil (8–19 %) auf eine pandemiebedingte überregionale Vermittlung von Patienten zurückgreifen. Die Reduktion der Patienten in urologischen Praxen auf im Median 50 % im April normalisierte sich im Juni auf 95 % und blieb während der zweiten Welle der Pandemie stabil. Die zu Anfang der Pandemie beobachtete Zunahme an urologischen Notfällen in den Praxen zeigte sich im November und Dezember nicht. Die Coronaviruspandemie hat zu einer deutlichen Einschränkung der Versorgung urologischer Patienten geführt, die sich insbesondere in der zweiten Welle auch auf die Versorgung von Patienten mit dringlicher Operationsindikation auswirkte.

          Translated abstract

          The coronavirus pandemic has had an immediate and far-reaching effect on the care of urological patients. The pandemic monitor of the German Society for Urology was able to record the restrictions on patient care in urological practices and clinics by means of regular surveys of the members. A total of 689 responses at four survey time points were included. In April there was a reduction in urological inpatients to 44% and the number of patients in practices dropped to 50%. Available operating theater capacities for urological patients were 45% in April, normalized to 90% in June and fell again to 50% in December. Elective operations could not be performed at all or only to a very limited extent in most hospitals in April and December. While urgent operations could be treated to 100% in more than 75% of the clinics in April, in December more than half of the clinics stated that they could not treat all patients with urgent indications. To some extent (8–19%) practices and clinics had to resort to a pandemic-related supraregional referral of patients. The reduction of outpatients in urological practices in April normalized to 95% in June and remained stable during the second wave of the pandemic. The increase in urological emergencies in practices observed at the beginning of the pandemic did not show up in November and December. The coronavirus pandemic has led to a significant reduction in the care of urological patients, which in particular in the second wave also affects urgent operations.

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          Most cited references13

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          Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

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            Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review

            The coronavirus disease 2019 (COVID-19) pandemic, due to the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a worldwide sudden and substantial increase in hospitalizations for pneumonia with multiorgan disease. This review discusses current evidence regarding the pathophysiology, transmission, diagnosis, and management of COVID-19.
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              Is Open Access

              Mortality due to cancer treatment delay: systematic review and meta-analysis

              Abstract Objective To quantify the association of cancer treatment delay and mortality for each four week increase in delay to inform cancer treatment pathways. Design Systematic review and meta-analysis. Data sources Published studies in Medline from 1 January 2000 to 10 April 2020. Eligibility criteria for selecting studies Curative, neoadjuvant, and adjuvant indications for surgery, systemic treatment, or radiotherapy for cancers of the bladder, breast, colon, rectum, lung, cervix, and head and neck were included. The main outcome measure was the hazard ratio for overall survival for each four week delay for each indication. Delay was measured from diagnosis to first treatment, or from the completion of one treatment to the start of the next. The primary analysis only included high validity studies controlling for major prognostic factors. Hazard ratios were assumed to be log linear in relation to overall survival and were converted to an effect for each four week delay. Pooled effects were estimated using DerSimonian and Laird random effect models. Results The review included 34 studies for 17 indications (n=1 272 681 patients). No high validity data were found for five of the radiotherapy indications or for cervical cancer surgery. The association between delay and increased mortality was significant (P<0.05) for 13 of 17 indications. Surgery findings were consistent, with a mortality risk for each four week delay of 1.06-1.08 (eg, colectomy 1.06, 95% confidence interval 1.01 to 1.12; breast surgery 1.08, 1.03 to 1.13). Estimates for systemic treatment varied (hazard ratio range 1.01-1.28). Radiotherapy estimates were for radical radiotherapy for head and neck cancer (hazard ratio 1.09, 95% confidence interval 1.05 to 1.14), adjuvant radiotherapy after breast conserving surgery (0.98, 0.88 to 1.09), and cervix cancer adjuvant radiotherapy (1.23, 1.00 to 1.50). A sensitivity analysis of studies that had been excluded because of lack of information on comorbidities or functional status did not change the findings. Conclusions Cancer treatment delay is a problem in health systems worldwide. The impact of delay on mortality can now be quantified for prioritisation and modelling. Even a four week delay of cancer treatment is associated with increased mortality across surgical, systemic treatment, and radiotherapy indications for seven cancers. Policies focused on minimising system level delays to cancer treatment initiation could improve population level survival outcomes.
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                Author and article information

                Contributors
                maximilian.kriegmair@medma.uni-heidelberg.de
                Journal
                Urologe A
                Urologe A
                Der Urologe. Ausg. a
                Springer Medizin (Heidelberg )
                0340-2592
                1433-0563
                9 February 2021
                : 1-11
                Affiliations
                [1 ]GRID grid.7700.0, ISNI 0000 0001 2190 4373, Klinik für Urologie und Urochirurgie, Universitätsmedizin Mannheim, , Universität Heidelberg, ; Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Deutschland
                [2 ]Facharztpraxis für Urologie, Treskowallee 103, 10318 Berlin, Deutschland
                [3 ]Kooperative Belegarztpraxis Urologie-Winsen, Friedrich-Lichtenauer-Allee 1, 21423 Winsen, Deutschland
                [4 ]GRID grid.419824.2, ISNI 0000 0004 0625 3279, Klinik für Urologie, , Klinikum Kassel, ; Kassel, Deutschland
                Article
                1458
                10.1007/s00120-021-01458-z
                7871316
                33559694
                d9732c10-a902-4bec-9dfe-d277429974b1
                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 15 January 2021
                Categories
                Leitthema

                kapazitäten,sars-cov‑2,covid-19,infektionsschutz,krebserkrankungen,capacities,infection transmission,cancer

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