998 Utilisation of A “COVID-Free” Hospital in The Independent Sector - Endourology Service Provision and Outcomes During The COVID-19 Pandemic

Abstract Introduction COVID-19 may negatively affect peri-operative outcomes, requiring strategies to allow operating whilst minimising risk. We present our endourology service provision throughout the “lockdown” period. Method Endourological operations 23rd March to 11th May 2020 were designated to the base hospital or independent “green” site by urgency and comorbidity status. Base hospital emergencies underwent surgery in main theatres, whilst elective patients had dedicated “COVID-free” theatres and wards. A portable Holmium laser enabled lasertripsy at the independent site. After 27th April, elective cases required a negative swab and 2-week self-isolation pre-operatively. Results 70 operations were performed: 42 ureteroscopies, 20 stent procedures, 8 PCNLs. Mean age was 57 and 58 at base and independent sites respectively, mean ASA 2.1 and 1.9. 37 operations (53%) occurred at the base hospital, including 14 emergencies (38%). 19 patients received post-operative COVID-19 swabs: 3 positives (8%), all emergencies. 2 patients (5%) died of COVID-19 pneumonia within 35 days; both had negative pre-operative swabs. Of 33 patients at the independent site, 3 (9%) received post-operative swabs, all negative. None had COVID-19 symptoms post-operatively. Conclusions “COVID-free” hospitals, wards and theatres enable elective operating whilst minimising peri-operative virus risk. Further utilisation of independent hospitals would more safely allow operating throughout the pandemic.

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Planned surgery in the COVID-19 pandemic: a prospective cohort study from Nottingham

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02207-8 ◽

2021 ◽

Author(s):

J Catton ◽

A Banerjea ◽

S Gregory ◽

C Hall ◽

CJ Crooks ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Surgical Procedures ◽

Cancer Diagnosis ◽

Prospective Cohort ◽

Post Operative Period ◽

East Midlands ◽

Independent Sector ◽

A Current ◽

Independent Site

Abstract Purpose Globally planned surgical procedures have been deferred during the current COVID-19 pandemic. The study aimed to report the outcomes of planned urgent and cancer cases during the current pandemic using a multi-disciplinary prioritisation group. Methods A prospective cohort study of patients having urgent or cancer surgery at a NHS Trust from 1st March to 30th April 2020 who had been prioritised by a multi-disciplinary COVID Surgery group. Rates of post-operative PCR positive and suspected COVID-19 infections within 30 days, 30-day mortality and any death related to COVID-19 are reported. Results Overall 597 patients underwent surgery with a median age of 65 years (interquartile range (IQR) 54–74 years). Of these, 86.1% (514/597) had a current cancer diagnosis. During the period, 60.8% (363/597) of patients had surgery at the NHS Trust whilst 39.2% (234/597) had surgery at Independent Sector hospitals. The incidence of COVID-19 in the East Midlands was 193.7 per 100,000 population during the study period. In the 30 days following surgery, 1.3% (8/597) of patients tested positive for COVID-19 with all cases at the NHS site. Overall 30-day mortality was 0.7% (4/597). Following a PCR positive COVID-19 diagnosis, mortality was 25.0% (2/8). Including both PCR positive and suspected cases, 3.0% (18/597) developed COVID-19 infection with 1.3% at the independent site compared to 4.1% at the NHS Trust (p=0.047). Conclusions Rates of COVID-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.

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ENT training and the independent sector

Bulletin of The Royal College of Surgeons of England ◽

10.1308/147363512x13189526440870 ◽

2012 ◽

Vol 94 (4) ◽

pp. 138-139

Author(s):

Amit Parmar ◽

Alexander Armstrong ◽

Andrew Drysdale

Keyword(s):

Service Provision ◽

Recent Literature ◽

Healthcare Policy ◽

Training Opportunity ◽

Department Of Health ◽

Treatment Centre ◽

Independent Sector ◽

The Government ◽

General Reduction

An increase in training numbers and a general reduction in training opportunity have been well documented in the recent literature. Over the last few years the involvement of the independent sector in providing NHS-funded healthcare has steadily increased. Since 2000, the government has implemented the independent sector treatment centre (ISTC) programme, on which £2.7 billion of NHS money has been spent. Current plans in healthcare policy will further increase the role of the independent sector in providing NHS-funded healthcare. To date, the NHS-funded independent sector has been dominated by the ISTCs that were commissioned by the last government. These were commissioned directly from the department of Health, primarily to provide service provision. As a part of the commissioning process, a commitment to training by the ISTCs was also expected.

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Safety and efficacy of Holmium laser enucleation of the prostate (HoLEP) in patients with previous transperineal biopsy (TPB): outcomes from a dual-centre case-control study

BMC Urology ◽

10.1186/s12894-019-0523-z ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 2

Author(s):

Chris Bell ◽

Sacha L. Moore ◽

Amarit Gill ◽

Obinna Obi-Njoku ◽

Stephen F. Hughes ◽

...

Keyword(s):

Holmium Laser ◽

Operative Outcomes ◽

Significant Difference ◽

Laser Enucleation ◽

Baseline Characteristics ◽

Group 2 ◽

Transperineal Biopsy ◽

Holmium Laser Enucleation ◽

Control Study ◽

Group 1

Abstract Background We investigated the surgical feasibility, safety and effectiveness of 50 W (low power) Holmium Laser enucleation of the prostate (HoLEP) in patients who have undergone previous template biopsy of the prostate (TPB). Methods Data encompassing pre-operative baseline characteristics, intra-operative measures and post-operative outcomes was collected for 109 patients undergoing HoLEP across two UK centres. Patients were stratified into two groups; group 1 (n = 24) had undergone previous TPB were compared with ‘controls’ (no previous TPB) in group 2 (n = 85). The primary outcome was successful HoLEP. Results There were no statistically significant differences in either key baseline characteristics or mass of prostate enucleated between groups 1 and 2. There was no statistically significant difference in enucleation or morcellation times parameters between the two groups other than enucleation efficiency in favour of group 1 (p = 0.024). Functional outcomes improved, without any statistically significant difference, in both groups. Conclusions In patients with a previous TPB, HoLEP is surgically feasible, safe and effective. TPB should not be considered a contraindication to HoLEP. Our work provides a strong foundation for further research in this area.

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335 Planned Surgery in the COVID-19 Pandemic: A Prospective Cohort Study from Nottingham

British Journal of Surgery ◽

10.1093/bjs/znab134.054 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

J Catton ◽

A Banerjea ◽

S Gregory ◽

C Hall ◽

C Crooks ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Surgical Procedures ◽

Cancer Diagnosis ◽

Prospective Cohort ◽

Cancer Case ◽

Post Operative Period ◽

East Midlands ◽

Independent Sector ◽

Independent Site

Abstract Introduction Globally planned surgical procedures were deferred during the current COVID-19 pandemic. We aim to report planned urgent and cancer case outcomes during the pandemic using a multi-disciplinary prioritisation group. Method Prospective cohort of patients prioritised by a multi-disciplinary COVID Surgery group undergoing urgent or cancer surgery at a NHS Trust from 1st March-30th April 2020. 30-day post-operative rates of PCR positive and suspected COVID-19 infections, 30-day mortality and COVID-19 related deaths are reported. Results During the period, 597 patients underwent surgery, median age 65-years (interquartile range 54-74) of which 86% (514/597) had a cancer diagnosis. 61% (362/597) had surgery at the NHS Trust whilst 39% (234/597) had surgery at Independent Sector hospitals. The COVID-19 incidence in the East Midlands was 193.7 per 100,000 population. 30-days following surgery, 1.3% (8/597) tested COVID-19 positive with all cases at the NHS site. 30-day mortality was 0.7% (4/597). Mortality following PCR positive COVID-19 diagnosis was 25% (2/8). Including PCR positive and suspected cases 3.0% (18/597) developed COVID-19 infection, 1.3% at the independent site compared to 4.1% at the NHS Trust (p = 0.047). Conclusions Rates of COIVD-19 infection in the post-operative period were low especially in the Independent Sector site. Mortality following a post-operative diagnosis of COVID-19 was high.

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American Speech-Language Pathologists' Training and Legislative Knowledge When Working With Immigrant and Refugee Populations: A Qualitative Study

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2019_pers-sig17-2019-0028 ◽

2019 ◽

Vol 4 (5) ◽

pp. 1148-1161

Author(s):

Camilo Maldonado ◽

Alejandro Ashe ◽

Kerri Bubar ◽

Jessica Chapman

Keyword(s):

Qualitative Study ◽

Service Provision ◽

Limited English Proficiency ◽

Linguistic Diversity ◽

Speech Language Pathologists ◽

Federal Mandates ◽

Refugee Families ◽

Provision Of Services ◽

English Speaking ◽

Immigrant And Refugee

Background American educational legislation suggests culturally competent speech and language services should be provided in a child's native language, but the number of multilingual speech-language pathologists (SLPs) is negligible. Consequently, many monolingual English-speaking practitioners are being tasked with providing services to these populations. This requires that SLPs are educated about cultural and linguistic diversity as well as the legislation that concerns service provision to non-English or limited English proficiency speakers. Purpose This qualitative study explored the experiences of monolingual, American, English-speaking SLPs and clinical fellows who have worked with immigrant and refugee families within a preschool context. It investigated what training SLPs received to serve this population and what knowledge these SLPs possessed with regard to federal legislation governing the provision of services to culturally and linguistically diverse (CLD) communities. Method Ten American clinicians with experience treating CLD children of refugee and immigrant families in the context of preschool service provision participated in the study. Semistructured interviews were utilized to better understand the type of training clinicians received prior to and during their service delivery for CLD populations. Additionally, questions were asked to explore the degree to which practitioners understood federal mandates for ethical and effective service provision. The data collected from these interviews were coded and analyzed using the principles of grounded theory. Findings The results of this study revealed that there was a general sense of unpreparedness when working with CLD clients. This lack of training also attributed to a deficiency of knowledge surrounding legislation governing service provision to CLD populations.

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Autism and Neurodiversity: Addressing Concerns and Offering Implications for the School-Based Speech-Language Pathologist

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-20-00188 ◽

2020 ◽

pp. 1-7

Author(s):

Laura S. DeThorne ◽

Kelly Searsmith

Keyword(s):

Service Provision ◽

Individualized Education Program ◽

Institutional Constraints ◽

Individualized Education ◽

Existing Structures ◽

Eligibility Determination ◽

Speech Language Pathologist ◽

School Based ◽

Key Points ◽

C Center

Purpose The purpose of this article is to address some common concerns associated with the neurodiversity paradigm and to offer related implications for service provision to school-age autistic students. In particular, we highlight the need to (a) view first-person autistic perspectives as an integral component of evidence-based practice, (b) use the individualized education plan as a means to actively address environmental contributions to communicative competence, and (c) center intervention around respect for autistic sociality and self-expression. We support these points with cross-disciplinary scholarship and writings from autistic individuals. Conclusions We recognize that school-based speech-language pathologists are bound by institutional constraints, such as eligibility determination and Individualized Education Program processes that are not inherently consistent with the neurodiversity paradigm. Consequently, we offer examples for implementing the neurodiversity paradigm while working within these existing structures. In sum, this article addresses key points of tension related to the neurodiversity paradigm in a way that we hope will directly translate into improved service provision for autistic students. Supplemental Material https://doi.org/10.23641/asha.13345727

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