963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit

Abstract Aim Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Method A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

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EP.TH.386Management of acute gallstone-related complications at Great Western Hospital

British Journal of Surgery ◽

10.1093/bjs/znab309.050 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Rute Castelhano ◽

Jessica Bartlett ◽

Harry Wooler ◽

Ahmed Mahmoud ◽

Aris Theofilis ◽

...

Keyword(s):

Service Provision ◽

National Average ◽

Observational Analysis ◽

Surgical Department ◽

Related Disease ◽

Western Hospital ◽

Number Of Patients ◽

The Impact ◽

Current Guidelines ◽

Reason For Admission

Abstract Aim Gallstone-related disease accounts for a third of the admissions to the Surgical Department. In June 2019, an audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted timeframe, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented. Methods A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone-related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission. Only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed. Results Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary related re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year. Conclusions This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.

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Service evaluation for services for younger people with dementia in east locality of north Wales

BJPsych Open ◽

10.1192/bjo.2021.108 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S20-S20

Author(s):

Asha Dhandapani ◽

Sathyan Soundararajan ◽

Sharmi Bhattacharyya

Keyword(s):

Time Frame ◽

Service Evaluation ◽

Young Onset ◽

People With Dementia ◽

North Wales ◽

Number Of Patients ◽

Time To Diagnosis ◽

Working Age ◽

The Impact ◽

Timely Referral

AimsTo evaluate Young-onset dementia (YOD) services in terms of referral, its appropriateness, time to diagnosis and other criteria as per protocol that we have adapted.MethodCase notes of those under 65 referred to Memory service for cognitive assessment between July 2017 and June 2018 were retrospectively reviewed to look at the time to diagnosis, appropriate referrals, post-diagnostic support, etc.ResultCompared to the previous evaluation, the number of patients referred to had increased from 47–48/ year earlier to 63/year. Only 1/3 were appropriate referral over the 10-year period whereas between 2017 and 2018 more than half were appropriate referrals. More than half of them were seen within 12 weeks of referral (35/63 available). Only 132/252 were diagnosed as having some form of dementia in the previous evaluation which was about 13 cases of YOD a year. In contrast, in our new evaluation 19 patients were diagnosed with some form of dementia. Inappropriate referrals had reduced by more than 50%. Appropriateness and timely referral had improved in this time frame.ConclusionDementia is considered ‘young onset’ when it affects people under 65 years of age. It is also referred to as ‘early onset’ or ‘working age’ dementia. However, this is an arbitrary age distinction that is becoming less relevant as increasingly services are realigned to focus on the person and the impact of the condition, not the age. Teaching sessions to educate primary & secondary care clinicians on appropriateness and timely referrals have helped in improving the care for patients with YOD. Services need to be developed further to be able to diagnose & support those with YOD. Repeat evaluations every year would help to inform improvement in quality & appropriateness of referrals.

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The effect of the COVID pandemic lockdown measures on surgical emergencies: experience and lessons learned from a Greek tertiary hospital

World Journal of Emergency Surgery ◽

10.1186/s13017-021-00364-1 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Emmanouil Pikoulis ◽

Nikolaos Koliakos ◽

Dimitrios Papaconstantinou ◽

Nikolaos Pararas ◽

Andreas Pikoulis ◽

...

Keyword(s):

Emergency Departments ◽

Hospital Admissions ◽

Motor Vehicle ◽

Perianal Abscess ◽

Lessons Learned ◽

University Hospital ◽

Tertiary Referral Center ◽

Surgical Department ◽

Number Of Patients ◽

The Impact

Abstract Background The COVID-19 pandemic caused a rise in healthcare demands leading to significant restructuring of hospital emergency departments worldwide. The aim of the present study is twofold: firstly, to discern any differences in regard to reason for surgical emergency department (SED) attendance and hospital admission during the pandemic and pre-pandemic eras in Greece, and secondly, to assess the impact of the lockdown measures implemented during the pandemic on SED patient attendance. Methods Since the beginning of the COVID-19 pandemic in Greece (1 March 2020) and up to 15 December 2020, the charts of all adult patients arriving at the SED of the third surgical department of the “Attikon” University Hospital (a tertiary referral center for surgical and COVID-19 cases) were retrospectively reviewed and broken down in four periods reflecting two nationwide lockdown (period A 1/3/2020 to 30/4/2020 and period D 16/10/2020 to 15/12/2020) and two interim (period B 1/5/2020 to 15/6/2020 and period C 15/9/2020 to 30/10/2020) periods. Demographic and clinical data were compared to those obtained from the same time periods of the year 2019. Results The total number of patients attending the SED decreased by 35.9% during the pandemic (from 2839 total patients in 2019 to 1819 in 2020). During the first lockdown, there was statistically significant reduction of motor vehicle accidents (p=0.04) and torso injuries (p=0.01). Contrarily, the rate of head injuries (p<0.001) and abdominal pain (p=0.04) were significantly increased. The same effect was observed regarding the rate of hospital admissions (p=0.002), although in terms of absolute numbers, admissions remained unchanged. During the second lockdown, there was a reduction in the number of perianal abscess cases (p=0.04) and hernia-related problems (p=0.001). An increase in the rate of fall injuries was also demonstrable (p=0.02). Overall, application of the lockdown led to a significant decrease in minor (p<0.001) and torso (p=0.001) injuries. Conclusion The burden of the new COVID-19 disease has left a noticeable imprint in the function of emergency departments worldwide. In Greece, SED attendance was significantly reduced during the pandemic, an effect that was even more pronounced during the lockdown implementation; nevertheless, the overall rate of hospital admissions remained the same, denoting that patient care was not altered.

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Impact of COVID-19 on Presentation of Sudden Sensorineural Hearing Loss at a Single Institution

Otolaryngology ◽

10.1177/0194599820974685 ◽

2020 ◽

pp. 019459982097468

Author(s):

Divya A. Chari ◽

Ayush Parikh ◽

Elliott D. Kozin ◽

Meaghan Reed ◽

David H. Jung

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Time Frame ◽

Absolute Number ◽

Sudden Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Academic Center ◽

Number Of Patients ◽

Increased Risk ◽

The Impact

The coronavirus disease 2019 (COVID-19) pandemic resulted in widespread unprecedented changes to the health care system. Herein, we sought to assess the impact of the viral outbreak on clinical presentations of sudden sensorineural hearing loss (SSNHL) at a single academic center. Our results demonstrate a decrease in the absolute number of patients presenting with SSNHL to our institution during the initial onset of the COVID-19 pandemic compared to an analogous time frame 1 year prior. However, the ratio of patients with SSNHL compared to total patients evaluated was largely similar during the 2 time periods. Based on data from our institution, the COVID-19 virus does not appear to confer a significantly increased risk for the development of SSNHL.

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The Impact of the Covid-19 Pandemic with Hidradenitis suppurativa Being Treated with Adalimumab: Evidence from Real-World Data

Clinical Dermatology Open Access Journal ◽

10.23880/cdoaj-16000222 ◽

2020 ◽

Vol 5 (4) ◽

Author(s):

Turkmen M

Keyword(s):

Real World ◽

Hidradenitis Suppurativa ◽

Real World Data ◽

Observational Analysis ◽

World Data ◽

Related Disease ◽

Number Of Patients ◽

Adalimumab Therapy ◽

Study Population ◽

The Impact

Background: There is uncertainty concerning the outcome of coronavirus disease-19 (COVID-19) infections in patients who are receiving adalimumab for hidradenitis suppurativa (HS) treatment. Objectives: This study aims to investigate the effect of adalimumab in HS patients during COVID 19 outbreak. Methods: We performed a retrospective observational analysis of the moderate-to-severe HS patients under adalimumab therapy, with reporting the number of patients hospitalized or who died from COVID 19 infection between 13 March 2020 and 31 July 2020. Results: Eighty nine patients who continued their therapy during pandemic were evaluated retrospectively. There were no cases of death from COVID-related disease in our study population or patients hospitalized for COVID-related disease. Conclusions: We suggest continuing the treatment of ADA in HS patients, under COVID-19 pandemic.

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The impact of the COVID-19 pandemic on cardiology services

Open Heart ◽

10.1136/openhrt-2020-001359 ◽

2020 ◽

Vol 7 (2) ◽

pp. e001359 ◽

Cited By ~ 1

Author(s):

Omar Fersia ◽

Sue Bryant ◽

Rachael Nicholson ◽

Karen McMeeken ◽

Carolyn Brown ◽

...

Keyword(s):

Performance Indicators ◽

Service Provision ◽

Recovery Phase ◽

Community Services ◽

Outpatient Clinics ◽

Clinical Activity ◽

Single Centre ◽

Number Of Patients ◽

The Uk ◽

The Impact

ObjectiveThe COVID-19 pandemic resulted in prioritisation of National Health Service (NHS) resources to cope with the surge in infected patients. However, there have been no studies in the UK looking at the effect of the COVID-19 work pattern on the provision of cardiology services. We aimed to assess the impact of the pandemic on cardiology services and clinical activity.MethodsWe analysed key performance indicators in cardiology services in a single centre in the UK in the periods prior to and during lockdown to assess reduction or changes in service provision.ResultsThere has been a greater than 50% drop in the number of patients presenting to cardiology and those diagnosed with myocardial infarction. All areas of cardiology service provision sustained significant reductions, which included outpatient clinics, investigations, procedures and cardiology community services such as heart failure and cardiac rehabilitation.ConclusionsAs ischaemic heart disease continues to be the leading cause of death nationally and globally, cardiology services need to prepare for a significant increase in workload in the recovery phase and develop new pathways to urgently help those adversely affected by the changes in service provision.

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Increased Use of Blood Transfusions to Manage Urological Conditions during the COVID-19 Pandemic

Urologia Internationalis ◽

10.1159/000511651 ◽

2020 ◽

Vol 104 (11-12) ◽

pp. 849-852

Author(s):

Paolo Capogrosso ◽

Luigi Candela ◽

Piercarlo Rossi ◽

Cristian Guarasci ◽

Fabio Muttin ◽

...

Keyword(s):

Healthcare System ◽

Negative Impact ◽

Delayed Diagnosis ◽

Time Frame ◽

Blood Transfusions ◽

Transfusion Rate ◽

Deferred Treatment ◽

The North ◽

Number Of Patients ◽

The Impact

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to an extensive reorganization of the healthcare system in Italy, with significant deferment of the treatment of urology patients. We aimed to assess the impact of deferred treatment during the SARS-CoV-2 pandemic on the need for blood transfusions in 3 Italian urology departments. Methods: We reviewed hospital chart data on blood transfusions at the urology units of 3 academic centers in the north of Italy from March to April 2020. Data were compared with values from the same time frame in 2019 (March to April 2019). Results: We observed significant reductions of the number of patients admitted to the urology units from March to April 2020 (373 vs. 119) and the number of performed surgeries (242 vs. 938) compared to 2019. Though, the number of transfused blood units was comparable between the 2 years (182 vs. 252), we found a greater mean number of blood units transfused per admission in 2020 (0.49 vs. 0.22; p < 0.0001). As a whole, the transfusion rate for hematuria was higher in 2020 than in 2019 (36 vs. 7.9%; p < 0.0001). Discussion/Conclusion: The observed increased number of blood transfusions needed throughout the SARS-CoV-2 era could have had a negative impact on both patients and the healthcare system. It is possible to speculate that this is the consequence of a delayed diagnosis and deferred treatment of acute conditions.

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Impact of a structured quality management program on survival of patients with advanced (AOC) and relapsed ovarian cancer (ROC) treated in a dedicated tertiary gynecologic-oncology (GO) center.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e17048 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e17048-e17048

Author(s):

Philipp Harter ◽

Florian Heitz ◽

Beyhan Ataseven ◽

Sonia Prader ◽

Stefanie Schneider ◽

...

Keyword(s):

Ovarian Cancer ◽

Quality Assurance ◽

Quality Management ◽

Gynecologic Oncology ◽

Management Program ◽

Quality Assurance Program ◽

Primary Therapy ◽

Surgical Department ◽

Number Of Patients ◽

The Impact

e17048 Background: Treatment of AOC needs interdisciplinary and specialized skills and structures. We report the impact of a dedicated quality management program over 2 decades from learning curve and specialization process started in 1998-2004 when the surgical department was separated from a general clinic of obstetrics and gynecology. The next period from 2005-2010 covers the data after implementation of the first step of our ovarian cancer quality assurance program. In 2011, a dedicated department of GO was founded. Additionally, we investigated the role of subsequent centralized versus decentralized treatment when patients relapsed after they had primary therapy at our institution. Methods: Descriptive analysis of our prospective tumor registry including all consecutive patients with primary diagnosis of AOC FIGO IIB-IV treated from 1998-2004, 2005-2010 and 2011-2017. All patients having started any therapy outside of our center were excluded. Results: The number of patients with untreated AOC increased from 10 to 147 per year from 1998 to 2017. In total, 1,663 pts were analyzed. The annual percentage of FIGO IV increased from 14% in 1998 to 54-61% in recent years (2013-2017). The complete resection rate of upfront surgery was 50%, 67%, and 69% in the periods 1997-2004, 2005-2010, and 2011-2017, respectively. Correspondingly, median PFS increased from 19 to 21 and 26 months (p < 0.001) and median OS increased from 33 to 42 and 56 months, respectively (p < 0.001). Altogether, 893 pts (53.7%) experienced a relapse. 490/893 pts (54.9% of all ROC pts) were treated again in our center, the remaining 45.1% were treated somewhere else. Median OS calculated from first relapse was 43 months for patients re-treated in our institution versus 32 months for others (p < 0.001). Conclusions: We demonstrate a correlation between specialization and improved outcome in AOC. Focusing and implementing a quality assurance program including structural evolution from a department of general obstetrics/gynecology to a department of GO led to an improvement although systemic primary treatment standards did not change during this period.

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Coming-of-Age Cinema in New Zealand

10.3366/edinburgh/9781474429443.001.0001 ◽

2017 ◽

Author(s):

Alistair Fox

Keyword(s):

Coming Of Age ◽

Belief Systems ◽

Time Frame ◽

New Wave ◽

Art Cinema ◽

Literary Sources ◽

French New Wave ◽

Significant Phenomenon ◽

The Impact ◽

New Zealanders

This book investigates the coming-of-age genre as a significant phenomenon in New Zealand’s national cinema, tracing its development from the 1970s to the present day. A preliminary chapter identifies the characteristics of the coming-of-age film as a genre, tracing its evolution and the influence of the French New Wave and European Art Cinema, and speculating on the role of the genre in the output of national cinemas. Through case studies of fifteen significant films, including The God Boy, Sleeping Dogs, The Scarecrow, Vigil, Mauri, An Angel at My Table, Heavenly Creatures, Once Were Warriors, Rain, Whale Rider, In My Father’s Den, 50 Ways of Saying Fabulous, Boy, Mahana, and Hunt for the Wilderpeople, subsequent chapters examine thematic preoccupations of filmmakers such as the impact of repressive belief systems and social codes, the experience of cultural dislocation, the expression of a Māori perspective through an indigenous “Fourth Cinema,” bicultural relationships, and issues of sexual identity, arguing that these films provide a unique insight into the cultural formation of New Zealanders. Given that the majority of films are adaptations of literary sources, the book also explores the dialogue each film conducts with the nation’s literature, showing how the time frame of each film is updated in a way that allows these films to be considered as a register of important cultural shifts that have occurred as New Zealanders have sought to discover their emerging national identity.

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Impact of Michigan’s new opioid prescribing laws on spine surgery patients: analysis of the Michigan Spine Surgery Improvement Collaborative

Journal of Neurosurgery Spine ◽

10.3171/2020.7.spine20729 ◽

2020 ◽

pp. 1-6

Author(s):

Paul Park ◽

Victor Chang ◽

Hsueh-Han Yeh ◽

Jason M. Schwalb ◽

David R. Nerenz ◽

...

Keyword(s):

Spine Surgery ◽

Spinal Surgery ◽

Readmission Rate ◽

Rating Scale ◽

Short Term ◽

Readmission Rates ◽

Opioid Prescribing ◽

Number Of Patients ◽

Before And After ◽

The Impact

OBJECTIVEIn 2017, Michigan passed new legislation designed to reduce opioid abuse. This study evaluated the impact of these new restrictive laws on preoperative narcotic use, short-term outcomes, and readmission rates after spinal surgery.METHODSPatient data from 1 year before and 1 year after initiation of the new opioid laws (beginning July 1, 2018) were queried from the Michigan Spine Surgery Improvement Collaborative database. Before and after implementation of the major elements of the new laws, 12,325 and 11,988 patients, respectively, were treated.RESULTSPatients before and after passage of the opioid laws had generally similar demographic and surgical characteristics. Notably, after passage of the opioid laws, the number of patients taking daily narcotics preoperatively decreased from 3783 (48.7%) to 2698 (39.7%; p < 0.0001). Three months postoperatively, there were no differences in minimum clinically important difference (56.0% vs 58.0%, p = 0.1068), numeric rating scale (NRS) score of back pain (3.5 vs 3.4, p = 0.1156), NRS score of leg pain (2.7 vs 2.7, p = 0.3595), satisfaction (84.4% vs 84.7%, p = 0.6852), or 90-day readmission rate (5.8% vs 6.2%, p = 0.3202) between groups. Although there was no difference in readmission rates, pain as a reason for readmission was marginally more common (0.86% vs 1.22%, p = 0.0323).CONCLUSIONSThere was a meaningful decrease in preoperative narcotic use, but notably there was no apparent negative impact on postoperative recovery, patient satisfaction, or short-term outcomes after spinal surgery despite more restrictive opioid prescribing. Although the readmission rate did not significantly increase, pain as a reason for readmission was marginally more frequently observed.

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