Current debates on end-of-life sedation: an international expert elicitation study

AbstractBackgroundDuring the initial COVID-19 outbreak up to 28.4 million elective operations were cancelled worldwide, in part owing to concerns that it would be unsustainable to maintain elective surgery capacity because of COVID-19-related surgeon absence. Although many hospitals are now recovering, surgical teams need strategies to prepare for future outbreaks. This study aimed to develop a framework to predict elective surgery capacity during future COVID-19 outbreaks.MethodsAn international cross-sectional study determined real-world COVID-19-related absence rates among surgeons. COVID-19-related absences included sickness, self-isolation, shielding, and caring for family. To estimate elective surgical capacity during future outbreaks, an expert elicitation study was undertaken with senior surgeons to determine the minimum surgical staff required to provide surgical services while maintaining a range of elective surgery volumes (0, 25, 50 or 75 per cent).ResultsBased on data from 364 hospitals across 65 countries, the COVID-19-related absence rate during the initial 6 weeks of the outbreak ranged from 20.5 to 24.7 per cent (mean average fortnightly). In weeks 7–12, this decreased to 9.2–13.8 per cent. At all times during the COVID-19 outbreak there was predicted to be sufficient surgical staff available to maintain at least 75 per cent of regular elective surgical volume. Overall, there was predicted capacity for surgeon redeployment to support the wider hospital response to COVID-19.ConclusionThis framework will inform elective surgical service planning during future COVID-19 outbreaks. In most settings, surgeon absence is unlikely to be the factor limiting elective surgery capacity.

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Vulnerability of bridges to scour: insights from an international expert elicitation workshop

Natural Hazards and Earth System Science ◽

10.5194/nhess-17-1393-2017 ◽

2017 ◽

Vol 17 (8) ◽

pp. 1393-1409 ◽

Cited By ~ 11

Author(s):

Rob Lamb ◽

Willy Aspinall ◽

Henry Odbert ◽

Thorsten Wagener

Keyword(s):

Risk Mitigation ◽

Good Practice ◽

Expert Elicitation ◽

Residual Risk ◽

Bridge Scour ◽

International Expert ◽

Quantitative Estimates ◽

Bridge Failure ◽

Expert Workshop ◽

Failure Probabilities

Abstract. Scour (localised erosion) during flood events is one of the most significant threats to bridges over rivers and estuaries, and has been the cause of numerous bridge failures, with damaging consequences. Mitigation of the risk of bridges being damaged by scour is therefore important to many infrastructure owners, and is supported by industry guidance. Even after mitigation, some residual risk remains, though its extent is difficult to quantify because of the uncertainties inherent in the prediction of scour and the assessment of the scour risk. This paper summarises findings from an international expert workshop on bridge scour risk assessment that explores uncertainties about the vulnerability of bridges to scour. Two specialised structured elicitation methods were applied to explore the factors that experts in the field consider important when assessing scour risk and to derive pooled expert judgements of bridge failure probabilities that are conditional on a range of assumed scenarios describing flood event severity, bridge and watercourse types and risk mitigation protocols. The experts' judgements broadly align with industry good practice, but indicate significant uncertainty about quantitative estimates of bridge failure probabilities, reflecting the difficulty in assessing the residual risk of failure. The data and findings presented here could provide a useful context for the development of generic scour fragility models and their associated uncertainties.

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