The management of adult appendicitis during the COVID-19 pandemic: an interim analysis of a UK cohort study

Abstract Background Acute appendicitis (AA) is the most common general surgical emergency. Early laparoscopic appendicectomy is the gold-standard management. SARS-CoV-2 (COVID-19) brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures: as a consequence, conservative management was advised, and open appendicectomy recommended when surgery was unavoidable. This study describes the impact of the first weeks of the pandemic on the management of AA in the United Kingdom (UK). Methods Patients 18 years or older, diagnosed clinically and/or radiologically with AA were eligible for inclusion in this prospective, multicentre cohort study. Data was collected from 23rd March 2020 (beginning of the UK Government lockdown) to 1st May 2020 and included: patient demographics, COVID status; initial management (operative and conservative); length of stay; and 30-day complications. Analysis was performed on the first 500 cases with 30-day follow-up. Results The patient cohort consisted of 500 patients from 48 sites. The median age of this cohort was 35 [26–49.75] years and 233 (47%) of patients were female. Two hundred and seventy-one (54%) patients were initially treated conservatively; with only 26 (10%) cases progressing to an operation. Operative interventions were performed laparoscopically in 44% (93/211). Median length of hospital stay was significantly reduced in the conservatively managed group (2 [IQR 1–4] days vs. 3 [2–4], p < 0.001). At 30 days, complications were significantly higher in the operative group (p < 0.001), with no deaths in any group. Of the 159 (32%) patients tested for COVID-19 on admission, only 6 (4%) were positive. Conclusion COVID-19 has changed the management of acute appendicitis in the UK, with non-operative management shown to be safe and effective in the short-term. Antibiotics should be considered as the first line during the pandemic and perhaps beyond.

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Conservative Management of Acute Appendicitis In The Era Of COVID 19: A Multicenter prospective observational study at The United Arab Emirates

10.1101/2020.09.30.20204503 ◽

2020 ◽

Author(s):

Fatima Y. AL Hashmi ◽

Abeer Al Zuabi ◽

Ibrahim Y. Hachim ◽

Guido H.H. Mannaerts ◽

Omar Bekdache

Keyword(s):

Health Care ◽

Acute Appendicitis ◽

United Arab Emirates ◽

Health Care Providers ◽

Conservative Management ◽

Length Of Hospital Stay ◽

Operative Management ◽

Care Providers ◽

The Impact

Background Since its emergence in December 2019, the Novel Coronavirus (COVID-19) pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy in the treatment of proven acute appendicitis during COVID19 pandemic. Methods Our study is a prospective multicenter study that includes a cohort of 160 patients admitted to the surgical departments in both Tawam Hospital and Sheikh Shakhbout Medical City, Abu Dhabi, UAE, for the period from February 2020 till July 2020. Results Our results showed that 56 of our patients (35%) were treated conservatively, while the other 104 (65%) underwent operative management. There was a significant decrease in length of hospital stay (LOS) (2.32 days) among the first group compared to the second (2.8 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed any serious complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Follow up was achieved by using telemedicine-based follow-up with the aim of empowering social distancing and reducing risk of viral exposure to patients as well as the health care providers. In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive is a safe and feasible approach that maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.

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Recognizing, reporting and reducing the data curation debt of cohort studies

International Journal of Epidemiology ◽

10.1093/ije/dyaa087 ◽

2020 ◽

Vol 49 (4) ◽

pp. 1067-1074 ◽

Cited By ~ 1

Author(s):

Oliver W Butters ◽

Rebecca C Wilson ◽

Paul R Burton

Keyword(s):

Cohort Study ◽

Cohort Studies ◽

Best Practice ◽

Study Data ◽

Data Curation ◽

Cross Domain ◽

Existential Risk ◽

The Uk ◽

Skills Shortages ◽

The Impact

Abstract Good data curation is integral to cohort studies, but it is not always done to a level necessary to ensure the longevity of the data a study holds. In this opinion paper, we introduce the concept of data curation debt—the data curation equivalent to the software engineering principle of technical debt. Using the context of UK cohort studies, we define data curation debt—describing examples and their potential impact. We highlight that accruing this debt can make it more difficult to use the data in the future. Additionally, the long-running nature of cohort studies means that interest is accrued on this debt and compounded over time—increasing the impact a debt could have on a study and its stakeholders. Primary causes of data curation debt are discussed across three categories: longevity of hardware, software and data formats; funding; and skills shortages. Based on cross-domain best practice, strategies to reduce the debt and preventive measures are proposed—with importance given to the recognition and transparent reporting of data curation debt. Describing the debt in this way, we encapsulate a multi-faceted issue in simple terms understandable by all cohort study stakeholders. Data curation debt is not only confined to the UK, but is an issue the international community must be aware of and address. This paper aims to stimulate a discussion between cohort studies and their stakeholders on how to address the issue of data curation debt. If data curation debt is left unchecked it could become impossible to use highly valued cohort study data, and ultimately represents an existential risk to studies themselves.

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Influence of Weekday of Admission and Level of Distress on Length of Hospital Stay in Patients With Low Back Pain: A Retrospective Cohort Study

10.21203/rs.3.rs-111329/v1 ◽

2020 ◽

Author(s):

Emanuel Brunner ◽

André Meichtry ◽

Davy Vancampfort ◽

Reinhard Imoberdorf ◽

David Gisi ◽

...

Keyword(s):

Primary Care ◽

Cohort Study ◽

Back Pain ◽

Hospital Stay ◽

Linear Model ◽

Length Of Hospital Stay ◽

Complex Problem ◽

Interdisciplinary Management ◽

Prolonged Length ◽

The Impact

Abstract BackgroundLow back pain (LBP) is often a complex problem requiring interdisciplinary management to address patients’ multidimensional needs. The inpatient care for patients with LBP in primary care hospitals is a challenge. In this setting, interdisciplinary LBP management is often unavailable during the weekend. Delays in therapeutic procedures may result in prolonged length of hospital stay (LoS). The impact of delays on LoS might be strongest in patients reporting high levels of psychological distress. Therefore, this study investigates which influence the weekday of admission and distress have on LoS of inpatients with LBP.MethodsRetrospective cohort study conducted between 1 February 2019 and 31 January 2020. ANOVA was used to test the hypothesized difference in mean effects of the weekday of admission on LoS. Further, a linear model was fitted for LoS with distress, categorical weekday of admission (Friday/Saturday vs. Sunday-Thursday), and their interactions.ResultsWe identified 173 patients with LBP. Mean LoS was 7.8 days (SD=5.59). Patients admitted on Friday (mean LoS=10.3) and Saturday (LoS=10.6) had longer stays but not those admitted on Sunday (LoS=7.1). Analysis of the weekday effect (Friday/Saturday vs. Sunday-Thursday) showed that admission on Friday or Saturday was associated with significant increase in LoS compared to admission on other weekdays (t=3.43, p=<0.001). 101 patients (58%) returned questionnaires, and complete data on distress was available from 86 patients (49%). According to a linear model for LoS, the effect of distress on LoS was significantly modified (t=2.51, p=0.014) by dichotomic weekdays of admission (Friday/Saturday vs. Sunday-Thursday).ConclusionsPatients with LBP are hospitalized significantly longer if they have to wait more than two days for interdisciplinary LBP management. This particularly affects patients reporting high distress. Our study provides a platform to further explore whether interdisciplinary LBP management addressing patients’ multidimensional needs reduces LoS in primary care hospitals.

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Reducing pressure ulcers across multiple care settings using a collaborative approach

BMJ Open Quality ◽

10.1136/bmjoq-2018-000409 ◽

2019 ◽

Vol 8 (3) ◽

pp. e000409 ◽

Cited By ~ 2

Author(s):

Julia Wood ◽

Bob Brown ◽

Annette Bartley ◽

Andreia Margarida Batista Custódio Cavaco ◽

Anthony Paul Roberts ◽

...

Keyword(s):

Pressure Ulcers ◽

Length Of Hospital Stay ◽

Community Services ◽

Care Community ◽

North East ◽

The North ◽

Healthcare Improvement ◽

The Uk ◽

Breakthrough Series Collaborative ◽

The Impact

In the UK, over 700 000 patients are affected by pressure ulcers each year, and 180 000 of those are newly acquired each year. The occurrence of pressure ulcers costs the National Health Service (NHS) more than 3.8 million every day. In 2004, pressure ulcers were estimated to cost the NHS £1.4–£2.4 billion per year, which was 4% of the total NHS expenditure.The impact on patients can be considerable, due to increased pain, length of hospital stay and decreased quality of life. However, it is acknowledged that a significant number of these are avoidable.In early 2015, it was identified that for the North East and North Cumbria region the incidence of pressure ulcers was higher than the national average. Because of this, a 2-year Pressure Ulcer Collaborative was implemented, involving secondary care, community services, care homes and the ambulance service, with the aim of reducing the percentage of pressure ulcers developed by patients within their care.The Breakthrough Series Collaborative Model from the Institute for Healthcare Improvement provided the framework for this Collaborative.In year 1, pressure ulcers were reduced by 36%, and in year 2 by 33%, demonstrating an estimated cost saving during the lifespan of the Collaborative of £513 000, and a reduction in the number of bed days between 220 and 352.

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Undesirable social relations as risk factors for loneliness among 14-year-olds in the UK: Findings from the Millennium Cohort Study

International Journal of Behavioral Development ◽

10.1177/0165025420965737 ◽

2020 ◽

pp. 016502542096573

Author(s):

Keming Yang ◽

Kimberly J. Petersen ◽

Pamela Qualter

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Social Relationships ◽

Social Relations ◽

Study Data ◽

Sample Survey ◽

Millennium Cohort Study ◽

Friendship Relations ◽

Nationally Representative ◽

The Uk

In the current study, data collected from Wave 6 of the Millennium Cohort Study ( n = 11,872), a nationally representative sample survey of youth aged 14 years in the UK, are used to examine the prevalence of loneliness among this age-group, investigate the feelings associated with the experience of loneliness among youth, explore the risk factors for loneliness among young people, and learn how they coped with loneliness. Given recent findings that youth are vulnerable to loneliness, the study assesses the prevalence of loneliness among adolescents across some important sociodemographic characteristics, such as nation of residence, gender, and ethnicity. We also identify the kinds of social experiences that accompany loneliness during adolescence, exploring friendship, relations with parents, social support, and bullying. Our key finding is that, in addition to the absence of desired social relationships, which has been typically identified as the ultimate source of loneliness, the presence of undesirable and even harmful social relationships is a major source of loneliness. This study uniquely brings together psychological and sociological perspectives to understand the experience of youth loneliness.

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The impact of co-morbidities on recovery from colorectal cancer within first 2 years after surgery: Results from the UK Colorectal Wellbeing (CREW) cohort study

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.07.063 ◽

2016 ◽

Vol 42 (11) ◽

pp. S231

Author(s):

Joanne Haviland ◽

Amanda Cummings ◽

Jane Winter ◽

Chloe Grimmett ◽

Lynn Calman ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

The Uk ◽

The Impact

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How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Journal of Neurosurgery ◽

10.3171/2020.2.jns193460 ◽

2020 ◽

pp. 1-9

Author(s):

Ralph T. Schär ◽

Shpend Tashi ◽

Mattia Branca ◽

Nicole Söll ◽

Debora Cipriani ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Elderly Patients ◽

Age Groups ◽

Head Ct ◽

Estimated Blood Loss ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

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Length of Hospital Stay Is Associated with a Decline in Activities of Daily Living in Hemodialysis Patients: A Prospective Cohort Study

10.21203/rs.2.10346/v2 ◽

2019 ◽

Author(s):

Tsukasa Kamitani ◽

Shingo Fukuma ◽

Sayaka Shimizu ◽

Tadao Akizawa ◽

Shunichi Fukuhara

Keyword(s):

Cohort Study ◽

Activities Of Daily Living ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Length Of Hospital Stay ◽

Hemodialysis Patients ◽

Cumulative Length ◽

The Impact

Abstract Background The impact of length of hospital stay on activities of daily living (ADLs) has not specifically been investigated among dialysis patients. Therefore, we attempt to verify the association between the length of hospital stay and the decline in ADLs among hemodialysis patients. Methods This prospective cohort study used data from the Japanese Dialysis Outcomes and Practice Patterns Study (J-DOPPS). We included 2,442 hemodialysis patients aged ³ 40 years from the J-DOPPS phase V (2012–2015) and subsequently excluded those who had already lost basic activities of daily living (BADLs) as demonstrated by dependency in at least three of the five BADLs at baseline and for whom changes in ADLs had been evaluated for less than 90 days. The main exposure was the cumulative length of hospital stay during the follow-up period. The primary outcomes were a decline in at least one of the five BADLs and eight instrumental activities of daily living (IADLs). We compared risk ratios (RRs) for 30-day increments for hospital stays with 10-year increments for age and having diabetes. Results A total of 849 patients were included in the statistical analysis. The cumulative length of hospital stay was significantly associated with a risk of decline in ADLs (adjusted RRs [95% confidence intervals] per 30-day increments: 1.42 [1.15 to 1.75] for BADLs, 1.38 [1.13 to 1.68] for IADLs). The adjusted RRs [95% CI] for 10-year increments in age were 1.20 [0.96 to 1.50] and 1.21 [1.00 to 1.47]. The adjusted RRs [95% CI] for having diabetes were 1.36 [0.97 to 1.91] for BADLs and 1.38 [1.04 to 1.84] for IADLs. Conclusion The impact of a 30-day increment in the cumulative length of hospital stay on the decline in ADLs was comparable to that of a 10-year increase in age and having diabetes.

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Length of Hospital Stay Is Associated with a Decline in Activities of Daily Living in Hemodialysis Patients: A Prospective Cohort Study

10.21203/rs.2.10346/v3 ◽

2020 ◽

Author(s):

Tsukasa Kamitani ◽

Shingo Fukuma ◽

Sayaka Shimizu ◽

Tadao Akizawa ◽

Shunichi Fukuhara

Keyword(s):

Cohort Study ◽

Activities Of Daily Living ◽

Hospital Stay ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Daily Living ◽

Length Of Hospital Stay ◽

Hemodialysis Patients ◽

Cumulative Length ◽

The Impact

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CovidLife: a resource to understand mental health, well-being and behaviour during the COVID-19 pandemic in the UK

Wellcome Open Research ◽

10.12688/wellcomeopenres.16987.1 ◽

2021 ◽

Vol 6 ◽

pp. 176

Author(s):

Chloe Fawns-Ritchie ◽

Drew M. Altschul ◽

Archie Campbell ◽

Charlotte Huggins ◽

Clifford Nangle ◽

...

Keyword(s):

Mental Health ◽

Well Being ◽

Study Data ◽

Future Health ◽

Health Records ◽

Psychological Measures ◽

Health Lifestyle ◽

Generation Scotland ◽

The Uk ◽

The Impact

CovidLife is a longitudinal observational study designed to investigate the impact of the COVID-19 pandemic on mental health, well-being and behaviour in adults living in the UK. In total, 18,518 participants (mean age = 56.43, SD = 14.35) completed the first CovidLife questionnaire (CovidLife1) between April and June 2020. To date, participants have completed two follow-up assessments. CovidLife2 took place between July and August 2020 (n = 11,319), and CovidLife3 took place in February 2021 (n = 10,386). A range of social and psychological measures were administered at each wave including assessments of anxiety, depression, well-being, loneliness and isolation. Information on sociodemographic, health, and economic circumstances was also collected. Questions also assessed information on COVID-19 infections and symptoms, compliance to COVID-19 restrictions, and opinions on the UK and Scottish Governments’ handling of the pandemic. CovidLife includes a subsample of 4,847 participants from the Generation Scotland cohort (N~24,000, collected 2006-2011); a well-characterised cohort of families in Scotland with pre-pandemic data on mental health, physical health, lifestyle, and socioeconomic factors, along with biochemical and genomic data derived from biological samples. These participants also consented to their study data being linked to Scottish health records. CovidLife and Generation Scotland data can be accessed and used by external researchers following approval from the Generation Scotland Access Committee. CovidLife can be used to investigate mental health, well-being and behaviour during COVID-19; how these vary according to sociodemographic, health and economic circumstances; and how these change over time. The Generation Scotland subsample with pre-pandemic data and linkage to health records can be used to investigate the predictors of health and well-being during COVID-19 and the future health consequences of the COVID-19 pandemic.

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