Background: Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with... Show moreBackground: Inevitably, the emergence of COVID-19 has impacted non-COVID care. Because timely diagnosis and treatment are essential, especially for patients with head and neck cancer (HNC) with fast-growing tumours in a functionally and aesthetically important area, we wished to quantify the impact of the COVID-19 pandemic on HNC care in the Netherlands.Material and Methods: This population-based study covered all, in total 8468, newly diagnosed primary HNC cases in the Netherlands in 2018, 2019 and 2020. We compared incidence, patient and tumour characteristics, primary treatment characteristics, and time-to-treatment in the first COVID-19 year 2020 with corresponding periods in 2018 and 2019 (i.e. pre-COVID).Results: The incidence of HNC was nearly 25% less during the first wave (n = 433) than in 2019 (n = 595) and 2018 (n = 598). In April and May 2020, the incidence of oral cavity and laryngeal carcinomas was significantly lower than in pre-COVID years. There were no shifts in tumour stage or alterations in initial treatment modalities.Regardless of the first treatment modality and specific period, the median number of days between first visit to a HNC centre and start of treatment was significantly shorter during the COVID-19 year (26-28 days) than pre-COVID (31-32 days, p < 0.001).Conclusion: The incidence of HNC during the Netherlands' first COVID-19 wave was significantly lower than expected. The expected increase in incidence during the remainder of 2020 was not observed. Despite the overloaded healthcare system, the standard treatment for HNC patients could be delivered within a shorter time interval. (C) 2021 The Author(s). Published by Elsevier B.V. Show less
Objectives: As the risk of a recurrent neurological event in patients with symptomatic carotid stenosis requiring carotid endarterectomy (CEA) is highest in the early phase after the first... Show moreObjectives: As the risk of a recurrent neurological event in patients with symptomatic carotid stenosis requiring carotid endarterectomy (CEA) is highest in the early phase after the first neurological event, guidelines recommend operating on these patients as soon as possible or at least within 14 days of their initial event. However, in real world practice this is often not met. The aim of this study is to identify factors that cause hospital dependent delay to CEA.Methods: All consecutive patients with symptomatic carotid stenosis undergoing CEA registered in the mandatory Dutch Audit for Carotid Interventions from January 2014 up to and including December 2017 were included in the current analysis. Univariable followed by multivariable logistic regression was used to identify independent factors associated with hospital dependent waiting time, defined as time from the first consultation at any hospital to CEA of more than 14 days.Results: A total of 8620 patients were included. The median time to CEA was 11 days (IQR 8-14). Seventy-eight per cent of patients underwent CEA within 14 days of first hospital consultation. Factors associated with a hospital dependent waiting time longer than 14 days were age (OR 0.99 per year, 95% CI 0.98-0.99), any previous CEA (OR 1.67, 95% CI 1.32-2.09), ocular symptoms as index event (OR 1.31, 95% CI 1.15-1.50), and indirect referral (OR 1.53, 95% CI 1.34-1.73). Hospital surgical volume was not identified as a factor for delay, except for the delay of indirectly referred patients where high volume hospitals reported the shortest delay.Conclusion: This cohort derived from a validated nationwide prospective audit identified younger age, previous CEA, ocular symptoms, and indirect referral as hospital dependent factors for delay. High volume hospitals had a similar hospital dependent waiting time to middle and low volume hospitals. However, high volume hospitals had more indirect referrals, implying that their logistics are more efficiently organised. Show less
Better regulation in the European Union cannot be achieved without serious attention to transposition of EU law into national legislation. As a matter of fact, EU member states breach EU law __... Show moreBetter regulation in the European Union cannot be achieved without serious attention to transposition of EU law into national legislation. As a matter of fact, EU member states breach EU law __ perpetuately. Why do member states miss deadlines when transposing EU internal market directives? What factors determine delays when transposing EU directives? How do these factors influence the timeliness of the national transposition processes? And under what conditions are transpositions of directives delayed? This study analyses the timeliness of national transposition processes across nine member states of the 2004 EU transport acquis. Based on a truly mixed-method approach __ a new quantitative data set with further insights gleaned from four controlled case studies and a concluding fuzzy set analysis - this study shows that the European Union has a serious transposition problem. Almost 70 percent of all national legal measures transposing the transport acquis cause problems, either because they are transposed too late, risking the opening of an infringement proceeding, or because they are too early (gold-plating), risking warping effects on the regulatory environment for business and citizens in the EU alike. Furthermore, this book provides some progress regarding the conditions under which transposition performance of member states could be improved. Seven potential European and national drivers and constrainers for timely transposition can be identified with different effects on the lengths of transposition delays. Distinguishing between three outcomes of transposition process (on time, short and long delay) it is the specific features of European directives that account for short term delays, whereas serious time lags of more than six months are a result of domestic factors. Furthermore, the timing of general elections in a member state and policy sector-related crises retard or rather accelerate national transposition processes just as political priority represents a significant necessary condition for timeliness. Show less
