scholarly journals 923 How Did the Initial Wave Of COVID-19 Affect CEPOD Waiting Times for Vascular Surgery? A Comparative Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
J Wallace ◽  
J Faiz ◽  
D Lowry ◽  
A Williams ◽  
C Davies
Keyword(s):  
Vascular Surgery ◽  
Surgical Intervention ◽  
Waiting Times ◽  
Initial Wave ◽  
South West ◽  
Significant Difference ◽  
Operating List ◽  
Comparative Audit ◽  
The Impact ◽  
Procedure Type

Abstract Aim Many vascular patients present acutely, relying on emergency theatre availability when surgical intervention is required. The prioritisation of the CEPOD operating list is a challenge, and the additional pressures of the COVID-19 pandemic have necessitated changes to established practice. The purpose of this audit was to review the effects of the pandemic on the CEPOD waiting times for vascular patients at the main centre for the South West Wales Vascular Network. Method The CEPOD waiting times for vascular patients during the initial wave of the COVID-19 pandemic were compared with the same period the previous year. Data was analysed according to booking category and procedure type. Results 98 emergency vascular procedures were performed during the initial wave of the COVID pandemic, compared to 133 in 2019. In 2019, amputations (major and minor) accounted for 47% of cases, which rose to 53% during the pandemic. Median waiting times for category 1 and 2a operations were significantly shorter in 2020, whilst category 3 waiting times rose. There was no significant difference overall in the proportion of patients operated on within the target timescale, regardless of CEPOD booking category. Conclusions Managing the impact of COVID-19 required change to established practice. Although fewer procedures were performed, significant logistical challenges were faced. By adjusting the organisation of CEPOD, the most urgent vascular cases were performed quicker during this time. It is important to identify and promote the positive organisational changes that have arisen as a result of COVID-19, and to continue to review procedures as the pandemic progresses.

scholarly journals The impact of surgical intervention on renal function in cystinuria

2018 ◽  
Vol 40 (3) ◽  
pp. 256-260 ◽  
Author(s):  
Serra Sürmeli Döven ◽  
Ali Delibaş ◽  
Hakan Taşkınlar ◽  
Ali Naycı
Keyword(s):  
Renal Function ◽  
Radionuclide Imaging ◽  
Surgical Intervention ◽  
Renal Scarring ◽  
Urinary Stones ◽  
Surgical Interventions ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

ABSTRACT Introduction: Cystinuria is an autosomal recessive disorder due to intestinal and renal transport defects in cystine and dibasic amino acids, which result in recurrent urolithiasis and surgical interventions. This study aimed to assess the impact of surgical interventions on renal function by analyzing estimated glomerular filtration rates. Methods: Thirteen pediatric patients with cystinuria, who were followed-up in a single tertiary institution between 2004 and 2016, were included in the study. Medical records were reviewed to collect data on clinical presentation of patients, urine parameters, stone formation, medical treatment, surgical intervention, stone recurrence after surgical procedure, stone analysis, ultrasonography, 99m-technetium dimercaptosuccinic acid (99mTc-DMSA) radionuclide imaging results, and follow-up time. Creatinine clearances estimated by modified Schwartz (eGFR) formula before and after surgery were used to assess renal function and compared statistically. Results: Nine patients (69.2%) had renal scarring which were detected with 99mTc-DMSA radionuclide imaging. In ten patients (76.9%), open surgical intervention for stones were needed during follow-up. Significant difference was not detected between eGFR before and after surgical intervention (mean 92 versus 106, p = 0.36). Nine of the patients (69.2%) were stone free in the last ultrasonographic examination. Relapses of stone after surgery were seen in 66.6% of patients who underwent surgical intervention. Conclusions: Surgical interventions for urinary stones are commonly required in patients with cystinuria. Renal scarring is a prevalent finding in cystinuric patients. Surgical interventions have no negative impact on eGFR in patients with cystinuria according to the present study.

Bat activity in coniferous forest areas and the impact of air pollution

Mammalia ◽  
2004 ◽  
Vol 68 (4) ◽  
Author(s):  
A. Rachwald ◽  
K. Wodecka ◽  
E. Malzahn ◽  
L. Kluziński
Keyword(s):  
Air Pollution ◽  
Coniferous Forest ◽  
Upper Silesia ◽  
Bat Activity ◽  
South West ◽  
Significant Difference ◽  
Line Transects ◽  
The Impact ◽  
Bat Diversity ◽  
Białowieża Primeval Forest

This study concerns comparison of bat activity in five mixed coniferous forest areas, exposed to different degree of air pollution. Forest age at every study plot was 70-100 years. The main census method was the detection of ultrasound signals along line transects. A significant difference was found in bat diversity and activity between these areas. Median flight activity varied between 21 flights/1 control (Biebrza Valley) and 1 flight/1 control (Upper Silesia). The largest bat diversity was found at the less disturbed and less polluted forests in Białowieża Primeval Forest and Biebrza Valley, the lowest was recorded at the Upper Silesia region in South-West Poland, the area of highest impact of heavy industry. The possible reasons for these results are analyzed and discussed.

scholarly journals EP.WE.844Two-week bowel cancer referrals during the COVID pandemic

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Ramez Antakia ◽  
Vladimir Popa-Nimigean ◽  
Thomas Athisayaraj
Keyword(s):  
Waiting Time ◽  
Waiting Times ◽  
Bowel Habit ◽  
Red Flags ◽  
National Guidelines ◽  
Mean Waiting Time ◽  
Significant Difference ◽  
Immunochemical Test ◽  
Red Flag ◽  
The Impact

Abstract Aims The aims were to assess the impact of the COVID-19 pandemic on the waiting times for patients referred via the two-week pathway for suspected colorectal cancer. We also examined the use of Faecal Immunochemical Test (FIT) alongside the presenting complaints in triaging/prioritising patients for further imaging and/or endoscopic investigations appropriately. Methods A list of all patients referred via the two-week pathway to the West Suffolk Hospital for suspected colorectal cancers from 30/01/2020 to 19/07/2020 was compiled. The main four red flag symptoms were change in bowel habit (CIBH), anorectal bleeding, anaemia and weight loss. A subset of 235 patients were closely examined regarding their presenting complaints, FIT, imaging and endoscopy results with analysis of outcomes. Results 127 male versus 108 female patients were included. 59.61% of patients who were eligible for the FIT test received one. Mean waiting time for FIT positive patients was 42.39 (95% CI) versus 61.10 (95% CI) for FIT negative patients. Patients with one or two red flags symptoms had a mean waiting time of 44.81 days (95% CI 35.79-53.82) and 47.91 days (95% CI 38.07-57.75) respectively. Patients with three red flag symptoms had a mean waiting time of 28.2 days (95% CI 17.94-38.39). There was a statistically significant difference in mean waiting time between patients having 1-2 symptoms and patients with three symptoms (p < 0.005). Conclusions Despite delays during the COVID pandemic particularly for endoscopy, high risk and FIT positive patients were prioritised. Waiting times were still higher than advised national guidelines.

The Society of Vascular Surgery International Scholars Program: The First Decade

2019 ◽  
Vol 53 (6) ◽  
pp. 488-491
Author(s):  
Bhavya Narala ◽  
Afsha Aurshina ◽  
Anil Hingorani ◽  
Natalie Marks ◽  
Sareh Rajaee ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Massachusetts General Hospital ◽  
Global Scale ◽  
Medical Society ◽  
Current Status ◽  
Academic Productivity ◽  
For Profit ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

Objective: The Society for Vascular Surgery (SVS) is a not-for-profit medical society, whose goal is to further advance in vascular health on a global scale. With its 10th anniversary in sight, we were interested in analyzing the impact of a specific scholarship given under the SVS, the International Scholars Program. Our goal was to examine the awardees’ characteristics and academic productivity. Materials and Methods: We measured the number of peer-reviewed articles, before and after the program, using PubMed® and Google Scholar® (2008-2018) of the scholarship recipients. Editorials, book chapters, letter to editor, and oral/poster presentations were excluded. A survey was sent out to assess the awardees’ current status. Results: The average number of applicants/year was 15.4 (standard deviation ± 6.69), with 17.5% females and a mean age of 37 ± 3.37 years, with 5.6 ± 2.30 years status post vascular fellowship. Brazil had the highest number of recipients (n = 5; 18.5%) followed by China (n = 4; 14.8%). No significant difference was noted between each country in terms of publications ( P = .45), nor with after the SVS scholarship program compared to before ( P = .14, 1.84 vs 2.76). The survey concluded 33% had attended a subsequent SVS meeting after the program, with 27% having presented their research (n = 15). The recipients noted the program helped adopt new practices in clinical management (n = 13, 87%), learn new procedures (n = 10, 67%), gain local/regional leadership (n = 9, 60%), and improve technical skills (n = 8, 53%). The most visited clinical sites were Massachusetts General Hospital and Mayo Clinic (n = 4, 27%). The program was given a 9.1/10 rating. Conclusion: The program was successful in maintaining academic productivity by continuing to publish research even after the scholarship, while teaching recipients skills to further improve their career goals. The award remains a competitive process that selects highly skilled recipients and still has much growth and progress to look forward to over the next decade.

The Effect of Payer Type, Disposition, and Day of Surgery on Resource Consumption following Hip Fracture Care

2017 ◽  
Vol 01 (02) ◽  
pp. 080-086
Author(s):  
Gonzalo Barinaga ◽  
Zain Sayeed ◽  
Afshin Anoushiravani ◽  
Erik Wright ◽  
Mouhanad El-Othmani ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Hospital Cost ◽  
Surgical Intervention ◽  
Home Health ◽  
Resource Consumption ◽  
Second Phase ◽  
Fee For Service ◽  
Significant Difference ◽  
Baseline Characteristics ◽  
The Impact

AbstractAs we shift from a fee-for-service to value-based reimbursement system, it is critical that orthopaedic surgeons assess all characteristics of the patient prior to surgical intervention. The purpose of this study was to evaluate the relationship of payer type and disposition on direct and indirect measures of resource consumption (length-of-stay [LOS], hospital cost, and 30-day readmission). Patients equal to or more than 55 years of age with radiographic evidence of hip fracture necessitating surgical intervention were included. Initially, baseline characteristics, including age, body mass index (BMI), American Society of Anesthesiologist (ASA) score, fracture type, and instrumentation, were reported by payer type (private versus Medicare) and disposition (skilled nursing facility [SNF], home, and home health). In the second phase, the independent effects of payer type and disposition on resource consumption were evaluated. Lastly, the impact of payer type and day of admission on disposition were assessed. A total of 478 patients met the inclusion criteria. Evaluation of baseline characteristics demonstrated that age and ASA scores were significantly higher within the Medicare and SNF cohorts, when compared with private payers and home/home health, respectively. Medicare as a payer type resulted in an increased LOS (5.6 versus 4.5 days) and greater hospital cost (12.1%) than private payers. Moreover, payer type was not predictive of 30-day readmission. Disposition following operative fixation resulted in an average LOS of 5.8, 4.4, and 4 days for patients discharged to SNF, home, and home health, respectively. No significant difference in hospital stay was noted between home and home health patients. Compared with patients discharged home, in-hospital cost was 33.9 and 12.3% greater for the SNF and home heath cohorts, respectively. Finally, 21.6% of patients discharged to a SNF were readmitted within 30 days. Our results indicate Medicare patients and those discharged to a SNF are more likely to have longer LOS and incur greater costs. Additionally, 30-day readmission is significantly higher in patients discharged to SNF. Thus, patients with hip fracture should be rigorously optimized within the preoperative setting to enhance clinical outcomes. Moreover, additional resources should be allocated to the higher risk patients.

scholarly journals Does time to endoscopic sinus surgery impact outcomes in Chronic Rhinosinusitis? Prospective findings from the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis

2015 ◽  
Vol 53 (1) ◽  
pp. 10-17
Author(s):  
C. Hopkins ◽  
J. Rimmer ◽  
V.J. Lund
Keyword(s):  
Chronic Rhinosinusitis ◽  
Nasal Polyposis ◽  
Surgical Intervention ◽  
Elective Surgery ◽  
Symptom Burden ◽  
Sinus Surgery ◽  
Time Points ◽  
Comparative Audit ◽  
The Impact ◽  
Snot 22

Objectives: Patients with chronic rhinosinusitis refractory to medical management undergo elective surgery. The time from initial diagnosis to surgery varies considerably. The impact of this delay on surgical success has never previously been evaluated. Design: First-time patients within the National Comparative Audit of Surgery for Nasal Polyposis and Chronic Rhinosinusitis were grouped based on time to surgery: 1) Early cohort: %lt; 12 months; 2) Mid cohort: 12-60 months; and 3) Late cohort: > 60 months. Co-morbidities and preoperative CT scores were analysed for all patients. Main outcome measures: The 22-item Sino-Nasal Outcome Test scores (SNOT-22) were collected at 0, 3, 12 and 60-months. Absolute and relative SNOT-22 changes from baseline were evaluated. Results: Asthma and allergies were significantly more prevalent in the Late versus the Early and Mid-cohorts. In addition, patients in the Late cohort had greater symptom burden on the SNOT-22 and more extensive preoperative radiographic disease as determined by Lund-Mackay (LM) scores. SNOT-22 scores demonstrated greater percentage improvements in the Early versus the Mid- and Late cohorts, at all time points after surgery. At 12 and 60 months after surgery, significantly more patients in the Early group achieved a clinically important change in SNOT-22 scores compared with the other groups. These differences were maintained when cohorts were matched for preoperative co-morbidities. Conclusion: Patients with asthma and/or allergies are more likely to experience delayed surgical intervention versus other patients. Overall, patients with delayed surgery reported less improvement in SNOT-22 scores than patients treated at earlier time points, regardless of co-morbid status. Delaying surgical intervention may worsen long term clinical outcomes.

scholarly journals The Impact of Performance Based Budget (Pbb) on Projects Effectiveness, Quality and Sustainability in Fako and Meme Divisions of the South West Region, Cameroon

2021 ◽  
Vol 9 (8) ◽  
pp. 92-107
Author(s):  
Roland A. Anyingang
Keyword(s):  
Service Providers ◽  
The South ◽  
West Region ◽  
South West ◽  
Ex Post ◽  
Significant Difference ◽  
Before And After ◽  
The Impact ◽  
South West Region

The study examined the impact of performance based budget on projects effectiveness, quality and sustainability in Fako and Meme Divisions of the South West Region, Cameroon. Three specific objectives were formulated to guide this study. The objectives investigated the impact of performance based budget on the effectiveness of projects, the impact of performance based budget on the quality of projects and the impact of performance based budget on the sustainability of projects. Ex-post facto research design was used for this study. The sample of this study was made up 420 respondents comprising of service providers, beneficiaries of the projects and staff of the Regional Delegation of Water and Energy and the Regional Delegation of Public Works in Fako and Meme Divisions. A well validated structured questionnaire was used for data collection. Data collected were analyzed using descriptive statistics and dependent t-test. Findings revealed that there exist a significant difference in the quality of roads, water and electricity projects before and after implementation of performance based budget with the quality of roads higher after the full implementation than before the implementation of PBB. There exist a significant difference in the effectiveness of road, water and electricity projects before and after implementation of water projects, and there exist a significant difference in the sustainability of road, water and electricity projects before and after implementation of performance based budget. The study recommended that the effectiveness of the budgetary system should be improved so that the quality and sustainability of projects will be obtained.  Moreover, good budget begets good results.    

scholarly journals The Impact of the COVID-19 Pandemic on Gastric Cancer Surgery: A Single-Center Study.

2021 ◽  
pp. 879-885
Author(s):  
Afig Gojayev ◽  
Cemil Yuksel ◽  
Ogun Ersen ◽  
Haydar Celasin ◽  
Ali Ekrem Unal ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Waiting Times ◽  
Cancer Surgery ◽  
Morbidity And Mortality ◽  
World Health ◽  
Study Patient ◽  
Gastric Cancer Surgery ◽  
Clinicopathological Findings ◽  
Significant Difference ◽  
The Impact

Introduction: Coronavirus disease 2019 (COVID-19) was declared to be a global pandemic by the World Health Organization on March 11, 2020. The impact on gastric cancer (GC) surgery is unknown. Various reports have shown data indicating that cancer patients with COVID-19 have high morbidity and mortality rates. The choice of surgical procedures and perioperative management of the patients with malignancy has become even more impor¬tant in the COVID-19 pandemic. In this study, we aimed to evaluate the effects of the COVID-19 pandemic on the preopartive, intraoperative, and postoperative findings of patients operated for gastric cancer in our clinic. Materials and Methods: We defined the ‘COVID-19’ period as occurring between 12-03-2020 and 31-08-2020. All the enrolled patients were divided into two groups, pre-COVID-19 group (Pre-CG; 64 cases) and COVID-19 group (CG; 39 cases). A total of 103 patients with gastric cancer were included in this study. Patient characteristics, preoperative, intraoperative, and postoperative clinicopathological findings were compared between groups. Results: The waiting times before admission increased in CG (Pre-CG [6.73±2.85] vs CG [20.61±5.16] ; p<0.001). After admission, the waiting time before surgery was longer in CG (Pre-CG [5.06±3.06] vs CG [6.89±3.32] ; p=0.006). No significant difference was detected between the groups in terms of operation time, surgical procedure, combine organ resection, intraoperative blood transfusion requirment (p values, respectively; p=0.108; p=0.951; p=0.204; p=0.597). Postoperative complications were oesophagojejunostomy leak (3/1) , atelectasis (2/2), duodenal leak (2/2), ileus (3/0), pleural effusion (2/2), and others (1/1), and there was no statistically significant difference between the two groups (p = 0.333). There was no significant difference between the two groups in terms of hospital stay (p = 0.086) and ICU stay (p = 0.989). Conclusion: In this study, it was seen that the COVID-19 pandemic did not affect morbidity and mortality in gastric cancer surgery, but it prolonged admission waiting and operation waiting times. Since there is very little data in the literature regarding the effect of COVID-19 on gastric cancer surgery, our study will guide future studies on this subject. Keywords: COVID-19, Impact, Gastric Cancer, Pandemics, Surgery

scholarly journals The impact of the COVID-19 pandemic lockdown on rhegmatogenous retinal detachment services—Experiences from the Tongren eye center in Beijing

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0254751
Author(s):  
Jipeng Li ◽  
Meng Zhao ◽  
Haicheng She ◽  
Aman Chandra
Keyword(s):  
Visual Acuity ◽  
Retinal Detachment ◽  
Hospital Stay ◽  
General Anesthesia ◽  
Rhegmatogenous Retinal Detachment ◽  
Waiting Times ◽  
Length Of Hospital Stay ◽  
Lower Percentage ◽  
Significant Difference ◽  
The Impact

Purpose To investigate the impact on services for rhegmatogenous retinal detachment (RRD) patients during the COVID-19 (2019coronal virus disease) pandemic in one tertiary center in Beijing. Methods A retrospective cohort study. Two reviewed consecutive RRD patients cohorts of the same length were treated during two different periods: the COVID-19 pandemic and the pre-COVID-19 group. The characteristics of patients, surgery, anesthesia methods, length of hospital stay, and the latest follow-up were recorded and analyzed. Results There were 79 patients in the COVID-19 pandemic group with a 55.9% reduction (179). Compared to patients in the pre-COVID-19, patients in the COVID-19 pandemic had a longer presurgical waiting times (28days, 3days, p<0.001), a higher percentage of patients with presurgical poor (less than 0.02) visual acuity (55.7%, 32.4%, p = 0.009), and a higher percentage of patients with presurgical choroidal detachment (34.2%, 19.6%, p = 0.01). There was no significant difference in the severity of presurgical proliferative vitreoretinopathy between the two groups (p = 0.64). Surgeries on pathological myopia patients with macular hole retinal detachment were postponed in the COVID-19 pandemic. There was a lower percentage of scleral buckling (27.8%, 41.3%, p = 0.02) and a lower rate of subretinal fluid drainage (45.4%, 75.7%, p = 0.01) in the COVID-19 pandemic. There was no significant difference in either postoperative visual acuity (p = 0.73) or the rate of single-surgery retinal attachment (p = 1) between the two groups. Patients in the COVID-19 pandemic had a shorter length of hospital stay (3hours, 35 hours, p<0.001), and a lower percentage of patients received general anesthesia (48.1%, 83.2%, p<0.001). None was infected with COVID-19 disease during the pandemic. Conclusion The COVID-19 pandemic lockdown caused prolonged presurgical waiting times, shorter hospital stays, less general anesthesia, and a significant reduction of RRD surgeries. The RD were more complicated, the surgeons were more conservative on procedures and patients selection, while the surgery outcomes were comparable.

Measuring Impact of Stress in Sandwich Generation Caring for Demented Parents

GeroPsych ◽  
2014 ◽  
Vol 27 (4) ◽  
pp. 171-179 ◽  
Author(s):  
Laurence M. Solberg ◽  
Lauren B. Solberg ◽  
Emily N. Peterson
Keyword(s):  
Factor Analysis ◽  
Exploratory Factor Analysis ◽  
Social Worker ◽  
Resource Availability ◽  
Well Being ◽  
Sandwich Generation ◽  
Item Questionnaire ◽  
Significant Difference ◽  
Adult Caregivers ◽  
The Impact

Stress in caregivers may affect the healthcare recipients receive. We examined the impact of stress experienced by 45 adult caregivers of their elderly demented parents. The participants completed a 32-item questionnaire about the impact of experienced stress. The questionnaire also asked about interventions that might help to reduce the impact of stress. After exploratory factor analysis, we reduced the 32-item questionnaire to 13 items. Results indicated that caregivers experienced stress, anxiety, and sadness. Also, emotional, but not financial or professional, well-being was significantly impacted. There was no significant difference between the impact of caregiver stress on members from the sandwich generation and those from the nonsandwich generation. Meeting with a social worker for resource availability was identified most frequently as a potentially helpful intervention for coping with the impact of stress.

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