scholarly journals EP.WE.453Impact of COVID 19 pandemic on colorectal rapid access investigations

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
J Maye ◽  
R Sen ◽  
B Sebastian ◽  
N Ward ◽  
T Athisayaraj
Keyword(s):  
Colorectal Cancer ◽  
National Level ◽  
Mortality And Morbidity ◽  
Aerosol Generation ◽  
Referral Service ◽  
Diagnosis Of Cancer ◽  
Delays In Diagnosis ◽  
Outcome Type ◽  
The Impact ◽  
Prospective Database

Abstract Aim The impact of the COVID-19 pandemic on delays in diagnosis of cancer has been highlighted at a national level. Such a delay represents an ongoing source of mortality and morbidity missing from the COVID-19 statistics. This study examines the delay in investigation of patients referred to the urgent colorectal cancer referral service at a single centre. Method Retrospective data was collated from prospective database for all 1,894 referrals to the urgent colorectal cancer referral service for the period 21 January to 24 December 2020. The time to appointment (TTA) was compared by date of referral and outcome type (endoscopy, CT abdomen pelvis (CT-AP), CT colonography (CT-C), clinic appointment). Results Across 2020, fewer than 25% of patients met the NICE recommendation of appointment within 14 days (median TTA 30 days, first quartile 19). TTA increased dramatically in the first months of the pandemic (February median: 19; March: 80.5). TTA remained high, not falling below a median wait of 28 days until November. CT-C tests were particularly delayed (median TTA: 86) due to concerns regarding aerosol generation and COVID-19 transmission. Patients were offered CT-AP tests while awaiting their delayed CT-C, as CT-AP had a significantly better wait of 15 days. Conclusion COVID-19 was a major disruptor of colorectal cancer diagnosis in 2020, with patients waiting more than twice as long as NICE recommends. This will likely continue into 2021, with further research required to assess the impact of this disruption on mortality and morbidity.

SP4.2.12 The impact of COVID 19 on colorectal cancer diagnosis and surgical oncological provision; A national perspective

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Noel Donlon ◽  
Tim Nugent ◽  
Shane Irwin ◽  
SInead Ramjit ◽  
Maria Davern ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
National Level ◽  
Late Presentation ◽  
Cancer Surgery ◽  
Colorectal Cancer Surgery ◽  
Admission Rates ◽  
Cancer Management ◽  
National Quality ◽  
National Perspective ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has interfered with many aspects of cancer management, including delayed diagnoses, stalled screening programmes, limiting treatment and clinical trials. Colorectal cancer is the second commonest cause of cancer death in Ireland. The objective of the current study is to assess the impact of this pandemic on colorectal cancer diagnoses and surgery, at a national level. Methods Data on endoscopy, emergency and elective colorectal operations nationally in Ireland over a three year period (2018-2020) were obtained from the National Quality Assurance Improvement System. Data relating to cancer surgery only were included and patient demographics, type of surgery (open/laparoscopic), length of stay (LOS), mortality, admission to critical care and re-admission rates were collected and analysed. Results 31.33% less cancers have been diagnosed between March and November 2020 inclusive when compared to the same period over the past two years with 22% less rectal cancers identified. There has been a 34% reduction in colorectal cancer surgeries over the same period with a reduction of 42% at the initial wave during the period March-May and of concern, this trend has continued. Laparoscopic right hemicolectomies have reduced by 41%, anterior resections have reduced by 51% with no change in the number of temporary ileostomies over the three year period. Conclusion The impact of COVID-19 on colorectal cancer surgery nationally has been profound. The reduction in diagnoses and cancer surgery is concerning and may result in increased late or incurable stage disease as a consequence of late presentation and diagnosis.

scholarly journals Cancer diagnostic rates during the 2020 ‘lockdown’, due to COVID-19 pandemic, compared with the 2018–2019: an audit study from cellular pathology

2020 ◽  
pp. jclinpath-2020-206833 ◽  
Author(s):  
Ludovica De Vincentiis ◽  
Richard A Carr ◽  
Maria Paola Mariani ◽  
Gerardo Ferrara
Keyword(s):  
Colorectal Cancer ◽  
Diagnostic Delay ◽  
Family Physicians ◽  
Diagnostic Procedures ◽  
Screening Tests ◽  
Care Hospital ◽  
Diagnosis Of Cancer ◽  
Cellular Pathology ◽  
The Impact ◽  
Corrective Procedures

AimsWe performed an audit to evaluate the impact of the COVID-19 pandemic-related delay in the diagnosis of major cancers at a Pathology Unit of a Secondary Care Hospital Network in Italy.MethodsA comparison was made among the number of first cellular pathological diagnoses of malignancy made from the 11th to the 20th week of the years 2018–2020.ResultsCancer diagnoses fell in 2020 by 39% compared with the average number recorded in 2018 and 2019. Prostate cancer (75%) bladder cancer (66%) and colorectal cancer (CRC; 62%) had the greatest decrease. CRC was identified as carrying a potentially important diagnostic delay.ConclusionsFor CRC corrective procedures (continuing mass screening tests; patient triage by family physicians; diagnostic procedures alternative to colonoscopy; predictive evaluation on biopsy samples) were advised. Our simple audit model is widely applicable to avoid pandemic-related delay in clinical diagnosis of cancer.

scholarly journals TP10.2.7Reintroduction of elective colorectal cancer surgery following the first wave of Covid-19 in the UK – an audit of risk mitigation strategies and review of patient outcome

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Francesca Malcolm ◽  
James Chean Khun Ng ◽  
William Speake
Keyword(s):  
Colorectal Cancer ◽  
Risk Mitigation ◽  
Mitigation Strategies ◽  
Colorectal Cancer Surgery ◽  
Mortality And Morbidity ◽  
Defunctioning Ileostomy ◽  
Operative Strategies ◽  
Risk Mitigation Strategies ◽  
The Uk ◽  
The Impact

Abstract Aim Perioperative acquisition of Covid-19 is associated with high mortality and morbidity. We have analysed the effectiveness of newly designed ‘green’ pathway for elective colorectal cancer (CRC) patients, which aimed to minimise risk of Covid-19. Method Data collected with concurrent implementation of ‘green’ pathway for all patients undergoing CRC surgery over a 6 week period following the ‘first wave’ of the Covid-19 pandemic. The standard audited were appropriately timed pre-operative CT chest, Covid-19 swabs and shielding adherence. The impact of positive pre-operative swabs and post-operative complications were analysed. Additional risk mitigation strategies included dual consultant operating, open operating, and defunctioning ileostomy for high risk anastomoses. Results 49 operations performed of 56 planned. 1 cancelled due to patient being positive for Covid-19, 5 due to progression of cancer on restaging CT, 1 required further medical optimisation. All had a 2 week pre-operative swab and then shielded until the day of the operation. 48/49 had swab 2 days pre-op. CT chest performed in all, 37 (66.7%) were to restage. 4 (8%) had post-operative complication graded as ≥ 2 on Clavien-Dindo score; none of which were Covid related. 1 patient tested positive for Covid-19 post-operatively but remained asymptomatic. All procedures were open and performed by 2 consultants. Conclusion We demonstrate an effective pathway and various operative strategies which can be employed to reduce risk for patients undergoing CRC surgery in the midst of the ongoing global pandemic.

scholarly journals Synthetic indicator of the impact of colorectal cancer screening programmes on incidence rates

Gut ◽  
2019 ◽  
Vol 69 (2) ◽  
pp. 311-316 ◽  
Author(s):  
Manuel Zorzi ◽  
Marco Zappa
Keyword(s):  
Colorectal Cancer ◽  
Screening Programme ◽  
National Level ◽  
Participation Rate ◽  
Target Population ◽  
Incidence Rates ◽  
Advanced Adenoma ◽  
Synthetic Indicator ◽  
Potential Impact ◽  
The Impact

ObjectiveThe impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists’ sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence.DesignWe defined the ‘rate of advanced adenoma on the target population’ (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50–69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50–74 year old subjects and the cumulative AA-TAP.ResultsIn 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013–2014 and those in 2003–2004 (p=0.009).ConclusionThe AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.

scholarly journals Sustainable Public Safety and the Case of Two Epidemics: COVID-19 and Traffic Crashes. Can We Extrapolate from One to the Other?

2021 ◽  
Vol 13 (6) ◽  
pp. 3136
Author(s):  
Tsippy Lotan ◽  
David Shinar
Keyword(s):  
Road Safety ◽  
Success Factors ◽  
Ethical Issues ◽  
Systems Approach ◽  
Motor Vehicle ◽  
National Level ◽  
Public Information ◽  
World Health ◽  
Mortality And Morbidity ◽  
The Impact

COVID-19 and motor vehicle crashes (MVC) are both considered epidemics by the U.S. Centers for Disease Control (CDC) and the World Health Organization (WHO), yet their progression, treatment and success in treatment have been very different. In this paper, we propose that the well-established sustainable safety approach to road safety can be applied to the management of COVID-19. We compare COVID-19 and MVC in terms of several defining characteristics, including evolvement and history, definitions and measures of evaluation, main attributes and characteristics, countermeasures, management and coping strategies, and key success factors. Despite stark differences, there are also some similarities between the two epidemics, and these enable insights into how the principles of sustainable road safety can be utilized to cope with and guide the treatment of COVID-19. Major guidelines that can be adopted include an aggressive policy set at the highest national level. The policy should be data- and science-based and would be most effective when relying on a systems approach (such as Sweden’s Vision Zero, the Netherlands’ Sustainable Safety, and the recommended EU Safe System). The policy should be enforceable and supplemented with positive public information and education campaigns (rather than scare tactics). Progression of mortality and morbidity should be tracked continuously to enable adjustments. Ethical issues (such as invasion of privacy) should be addressed to maximize public acceptance. Interestingly, the well-established domain of MVC can also benefit from the knowledge, experience, and strategies used in addressing COVID-19 by raising the urgency of detection and recognition of new risk factors (e.g., cell phone distractions), developing and implementing appropriate policy and countermeasures, and emphasizing the saliency of the impact of MVC on our daily lives.

The impact of the peak (day 2) C-reactive protein (CRP) on the day 3 and day 4 CRP thresholds associated with infective complications following curative surgery in colorectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 595-595
Author(s):  
Michelle Leana Ramanathan ◽  
Paul G. Horgan ◽  
Donald C. Mcmillan
Keyword(s):  
Colorectal Cancer ◽  
C Reactive Protein ◽  
Tumour Site ◽  
Curative Surgery ◽  
Node Negative ◽  
Reactive Protein ◽  
The Impact ◽  
Infective Complications ◽  
Prospective Database ◽  
Colonic Tumours

595 Background: The postoperative systemic inflammatory response, as evidenced by C-reactive protein (CRP) on day 3 (threshold ~170 mg/L) and day 4 (threshold ~130mg/L), have been reported to be associated with the development of infective complications following surgery for colorectal cancer. The aim of the present study was to assess the impact of the peak, day 2 CRP, on CRP concentrations at day 3 and day 4. Methods: Patients with colorectal cancer who were considered to have undergone elective curative resection were recorded in a prospective database (n=396). CRP was measured preoperatively and on days 1 to 4 postoperatively. Correlations between day 2 CRP and other perioperative CRP concentrations were examined. Results: The majority of patients were 65 or older (67%), male (55%), had colonic tumours (66%), had node negative disease (57%) and were from a deprived area (55%). Day 2 CRP was not associated not with age (p=0.055), sex (p=0.185), deprivation (p=0.103), tumour site (p=0.529) or stage (p=0.395). Day 2 CRP was directly associated with day 1 (r2=0.421, p<0.001), day 3 (r2=0.617, p<0.001) and day 4 (r2=0.315, p<0.001) CRP, but not preoperative CRP (r2=0.008, p=0.084). The median day 2 CRP that corresponded with the previously described thresholds (~170mg/L and ~130mg/L at day 3 and 4 respectively) for predicting infective complications was 190mg/L. Similarly, the median day 2 CRP corresponding to the previously described thresholds (~190mg/L and ~140mg/L at day 3 and 4 respectively) for predicting an anastomotic leak was 200mg/L. Conclusions: A day 2 CRP concentration >190 - 200mg/L, was associated with day 3 and 4 CRP concentrations above established CRP thresholds for the development of infective complications. It remains to be determined whether reduction in day 2 CRP concentrations will reduce infective complications following surgery for colorectal cancer.

Pengaruh Budaya Terhadap Akuntansi, Auditing Dan Praktik Akuntansi Internasional

2016 ◽  
Vol 3 (1) ◽  
pp. 78-95
Author(s):  
Priyastiwi Priyastiwi
Keyword(s):  
Cultural Values ◽  
Leadership Style ◽  
Financial Reporting ◽  
National Level ◽  
Deep Understanding ◽  
Cultural Dimensions ◽  
Financial Disclosure ◽  
Cross Cultural Differences ◽  
The Future ◽  
The Impact

The purpose of this article is to provide the basic model of Hofstede and Grays’ cultural values that relates the Hofstede’s cultural dimensions and Gray‘s accounting value. This article reviews some studies that prove the model and develop the research in the future. There are some evidences that link the Hofstede’s cultural values studies with the auditor’s judgment and decisions by developing a framework that categorizes the auditor’s judgments and decisions are most likely influenced by cross-cultural differences. The categories include risk assessment, risk decisions and ethical judgments. Understanding the impact of cultural factors on the practice of accounting and financial disclosure is important to achieve the harmonization of international accounting. Deep understanding about how the local values may affect the accounting practices and their impacts on the financial disclosure are important to ensure the international comparability of financial reporting. Gray’s framework (1988) expects how the culture may affect accounting practices at the national level. One area of the future studies will examine the impact of cultural dimensions to the values of accounting, auditing and decision making. Key word : Motivation, leadership style, job satisfaction, performance

HOME VISITS DURING THE FIRST MONTH OF DELIVERY FOR RECENTLY DELIVERED WOMEN IN UTTAR PRADESH, INDIA

2020 ◽  
Vol 6 (5) ◽  
pp. 1183-1189
Author(s):  
Dr. Tridibesh Tripathy ◽  
Dr. Umakant Prusty ◽  
Dr. Chintamani Nayak ◽  
Dr. Rakesh Dwivedi ◽  
Dr. Mohini Gautam
Keyword(s):  
Large Scale ◽  
National Level ◽  
Uttar Pradesh ◽  
Life Time ◽  
Structured Interview ◽  
The Other ◽  
Registration System ◽  
Action Group ◽  
Current Article ◽  
The Impact

The current article of Uttar Pradesh (UP) is about the ASHAs who are the daughters-in-law of a family that resides in the same community that they serve as the grassroots health worker since 2005 when the NRHM was introduced in the Empowered Action Group (EAG) states. UP is one such Empowered Action Group (EAG) state. The current study explores the actual responses of Recently Delivered Women (RDW) on their visits during the first month of their recent delivery. From the catchment area of each of the 250 ASHAs, two RDWs were selected who had a child in the age group of 3 to 6 months during the survey. The response profiles of the RDWs on the post- delivery first month visits are dwelled upon to evolve a picture representing the entire state of UP. The relevance of the study assumes significance as detailed data on the modalities of postnatal visits are available but not exclusively for the first month period of their recent delivery. The details of the post-delivery first month period related visits are not available even in large scale surveys like National Family Health Survey 4 done in 2015-16. The current study gives an insight in to these visits with a five-point approach i.e. type of personnel doing the visit, frequency of the visits, visits done in a particular week from among those four weeks separately for the three visits separately. The current study is basically regarding the summary of this Penta approach for the post- delivery one-month period.     The first month period after each delivery deals with 70% of the time of the postnatal period & the entire neonatal period. Therefore, it does impact the Maternal Mortality Rate & Ratio (MMR) & the Neonatal Mortality Rates (NMR) in India and especially in UP through the unsafe Maternal & Neonatal practices in the first month period after delivery. The current MM Rate of UP is 20.1 & MM Ratio is 216 whereas the MM ratio is 122 in India (SRS, 2019). The Sample Registration System (SRS) report also mentions that the Life Time Risk (LTR) of a woman in pregnancy is 0.7% which is the highest in the nation (SRS, 2019). This means it is very risky to give birth in UP in comparison to other regions in the country (SRS, 2019). This risk is at the peak in the first month period after each delivery. Similarly, the current NMR in India is 23 per 1000 livebirths (UNIGME,2018). As NMR data is not available separately for states, the national level data also hold good for the states and that’s how for the state of UP as well. These mortalities are the impact indicators and such indicators can be reduced through long drawn processes that includes effective and timely visits to RDWs especially in the first month period after delivery. This would help in making their post-natal & neonatal stage safe. This is the area of post-delivery first month visit profile detailing that the current article helps in popping out in relation to the recent delivery of the respondents.   A total of four districts of Uttar Pradesh were selected purposively for the study and the data collection was conducted in the villages of the respective districts with the help of a pre-tested structured interview schedule with both close-ended and open-ended questions.  The current article deals with five close ended questions with options, two for the type of personnel & frequency while the other three are for each of the three visits in the first month after the recent delivery of respondents. In addition, in-depth interviews were also conducted amongst the RDWs and a total 500 respondents had participated in the study.   Among the districts related to this article, the results showed that ASHA was the type of personnel who did the majority of visits in all the four districts. On the other hand, 25-40% of RDWs in all the 4 districts replied that they did not receive any visit within the first month of their recent delivery. Regarding frequency, most of the RDWs in all the 4 districts received 1-2 times visits by ASHAs.   Regarding the first visit, it was found that the ASHAs of Barabanki and Gonda visited less percentage of RDWs in the first week after delivery. Similarly, the second visit revealed that about 1.2% RDWs in Banda district could not recall about the visit. Further on the second visit, the RDWs responded that most of them in 3 districts except Gonda district did receive the second postnatal visit in 7-15 days after their recent delivery. Less than half of RDWs in Barabanki district & just more than half of RDWs in Gonda district received the third visit in 15-21 days period after delivery. For the same period, the majority of RDWs in the rest two districts responded that they had been entertained through a home visit.

Modernisation of Higher Education – Willful Action or Wishful Thinking? The Case of Bulgaria

2020 ◽  
Vol 8 (3) ◽  
pp. 3-17
Author(s):  
Elena Blagoeva
Keyword(s):  
Higher Education ◽  
Economic Crisis ◽  
Negative Impact ◽  
National Level ◽  
Sustainable Growth ◽  
Research Approach ◽  
Case Study Methodology ◽  
The Impact ◽  
The Eu

The impact of the last global economic crisis (2008) on the European economy put a strain on higher education (HE), yet it also pushed the sector towards intensive reforms and improvements. This paper focuses on the “Strategy for the Development of Higher Education in the Republic of Bulgaria 2014-2020”. With a case study methodology, we explore the strategic endeavours of the Bulgarian government to comply with the European directions and to secure sustainable growth for the HE sector. Our research question is ‘How capable is the Bulgarian HE Strategy to overcome the economic and systemic restraints of Bulgarian higher education?’. Because the development of strategies for HE within the EU is highly contextual, a single qualitative case study was chosen as the research approach. HE institutions are not ivory towers, but subjects to a variety of external and internal forces. Within the EU, this is obviated by the fact that Universities obtain their funds from institutions such as governments, students and their families, donors, as well as EU-level programmes. Therefore, to explore how these pressures interact to affect strategic action on national level, the case method is well suited as it enabled us to study the phenomena thoroughly and deeply. The paper suggests the actions proposed within the Strategy have the potential to overcome the delay, the regional isolation and the negative impact of the economic crisis on the country. Nevertheless, the key elements on which the success or failure of this Strategy hinges are the control mechanisms and the approach to implementation. Shortcomings in these two aspects of strategic actions in HE seem to mark the difference between gaining long-term benefits and merely saving face in front of international institutions.

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