EP.TH.649Identifying Factors Associated with Readmissions after acute biliary admission. Can it help prioritising patients in COVID recovery plans?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Annabelle White ◽  
Andrew Refalo ◽  
Hedda. Widlund ◽  
William Knight ◽  
Husam Ebied
Keyword(s):  
Acute Cholecystitis ◽  
Health Care Services ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Biliary Disease ◽  
Readmission Rates ◽  
Patient Demographics ◽  
Care Services ◽  
Increased Risk ◽  
Biliary Pathology

Abstract Aim We conducted a retrospective analysis of readmissions after Acute admission with biliary pathology managed conservatively under the Surgical Team in a teaching London Hospital from 01/03/2019-29/02/2020 Methods We obtained records of patients admitted with Acute Cholecystitis, Biliary Colic, Cholelithiasis, Choledocholithiasis and Gallstone Pancreatitis from the Audit Department between 01/03/2019-29/02/2020, and analysed these regarding patient demographics, comorbidities, duration of index admission, method of diagnosis and management and identified patients’ readmissions Differences in readmission rates based on before mentioned characteristics were studied. Results 157 patients presented between 01/03/2019-29/02/2020, 76 acute cholecystitis, 22 Biliary Colic, 24 Gallstone Pancreatitis, 6 Ascending Cholangitis and 29 Choledocholithiasis The highest representation rate was for patients with choledocholithiasis (41.3%) followed by Acute Cholecystitis (31.5%), 3 patients required cholecystostomies. Baseline characteristics and differences in these characteristics based on occurrence of readmission were studied. 45-60 age group, increasing comorbidity, and biliary obstruction were all associated with increased risk of readmission. Conclusion Readmissions is a substantial burden on the health care services and patient’s safety and QoL We propose adherence to the NICE/BSG Guidelines for management of Acute Biliary Disease, to alleviate this pressure which is already sometimes challenging due to the logistics and resources and would be more challenging with the COVID situation and limited emergency and elective theatre availability so the group at high risk of readmission should be prioritised in the recovery plans.

scholarly journals P-EGS07 Two years of Acute Biliary Admissions at a tertiary care centre over the Covid-19 pandemic: a closed loop audit with implementation of an acute referral system

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Andrew Refalo ◽  
Annabelle White ◽  
Hedda Widlund ◽  
Husam Ebied
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Acute Cholecystitis ◽  
Patient Outcomes ◽  
Waiting Times ◽  
Tertiary Care ◽  
Referral System ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Tertiary Care Centre ◽  
Readmission Rates

Abstract Background AUGIS recommends patients diagnosed with acute cholecystitis and gallstone pancreatitis to receive a laparoscopy cholecystectomy on the index admission, ideally within 72 hours of presentation. Early laparoscopic cholecystectomy is associated with better patient outcomes and reduced readmission rates. During the Covid-19 pandemic emergency surgery, if possible was avoided. These patients are referred for an elective cholecystectomy, however waiting times can be lengthy with readmissions common prior to surgery.  Methods We performed a closed loop audit on acute biliary admissions to a central London tertiary care centre. We assessed waiting times to laparoscopic cholecystectomy for patients fit for surgery as well as readmissions prior to surgery. The data was collated over a one-year period (01/03/2019 to 29/02/2020), analysed and presented to the senior biliary surgery team. A dedicated e-referral system for patients who did not receive a laparoscopic cholecystectomy on index admission was implemented. Post intervention admissions were re-audited over a second year (01/03/2020- 30/01/2021) and re-analysed to assess the effect of the intervention.   Results A total of 111 patients with acute cholecystitis, 52 with gallstone pancreatitis, 34 with biliary colic, 36 with choledocholithiasis and 10 with ascending cholangitis, were included. Prior to implementation of our referral system average waiting time to laparoscopic cholecystectomy was 98.2 weeks, reduced to 47.7 weeks post referral system implementation. Reduction in waiting times resulted in readmission rates reduced by: 23.3% in Choledocholithiasis; 17.4% in Biliary Colic;   16.7% in Ascending Cholangitis; 12.8% in Acute Cholecystitis and 8.3% in Gallstone pancreatitis.  Conclusions Admissions with acute biliary colic compose a substantial workload. The COVID-19 pandemic has resulted in a preference for elective versus emergency laparoscopic cholecystectomy. However, delay in surgery results in a readmission burden on emergency surgery departments and worse patient outcomes hence laparoscopic cholecystectomy should be performed as soon as possible following initial admission. This audit demonstrates that a dedicated biliary referral system reduced waiting time which translates to a reduction in admission rates. The importance of this referral system is magnified in the recovery phase of the pandemic where we continue to recover waiting times.

scholarly journals Using panel data to examine pregnancy attitudes over time

2015 ◽  
Vol 1 (1) ◽  
Author(s):  
Heini Väisänen ◽  
Rachel K. Jones
Keyword(s):  
Romantic Relationship ◽  
Health Care Services ◽  
Adult Women ◽  
Multinomial Regression ◽  
Pregnancy Intentions ◽  
Care Services ◽  
Increased Risk ◽  
Women's Lives ◽  
Race Ethnicity ◽  
Pregnancy Avoidance

There is a lack of research examining changes in women’s fertility attitudes over relatively short periods of time. The aim of this study was to determine whether and how women’s attempts to get pregnant and their desire to avoid pregnancy changed over six months’ time as well as which characteristics and circumstances were associated with these changes. Using multinomial regression, we analyzed two panels of data from a sample of approximately 3,000 U.S. adult women gathered within six months apart. Only 4% of the women were trying to get pregnant at both time points, but six percent went from trying to not or vice versa. Two-thirds reported a strong desire to avoid pregnancy at both points, but 9% transitioned from strong to not strong and an additional 7% transitioned from not strong to strong. Women who transitioned to a more serious romantic relationship were at increased risk of transitioning to trying to become pregnant and, not surprisingly, to a weaker pregnancy avoidance. Some of the variables we tested, including changes in employment status and race/ethnicity, were asso-ciated with one outcome but not the other. The results highlight the importance of taking a ho-listic perspective of women’s lives when studying pregnancy intentions and in reproductive health care services such as contraceptive counseling. Context matters and it may change rapidly.

Patient Demographics and Utilization of Health Care Services for Molluscum Contagiosum

2004 ◽  
Vol 21 (6) ◽  
pp. 628-632 ◽  
Author(s):  
Arlene C. Molino ◽  
Alan B. Fleischer ◽  
Steven R. Feldman
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Molluscum Contagiosum ◽  
Patient Demographics ◽  
Care Services

scholarly journals Healthcare Providers on the Frontline: A Quantitative Investigation of the Stress and Recent Onset Psychological Impact of Delivering Health Care Services During COVID-19 in Kashmir

2020 ◽  
Vol 42 (4) ◽  
pp. 359-367
Author(s):  
Aaliya Khanam ◽  
Shabir Ahmad Dar ◽  
Zaid Ahmad Wani ◽  
Naveed Nazir Shah ◽  
Inaamul Haq ◽  
...  
Keyword(s):  
Health Care Services ◽  
Psychological Impact ◽  
Healthcare Providers ◽  
Impact Of Event Scale ◽  
Event Scale ◽  
Recent Onset ◽  
Care Services ◽  
Increased Risk ◽  
The Impact ◽  
Patient Department

Background: Frontline healthcare workers (FHCWs) are at an increased risk of contracting COVID-19. We aimed to assess the stress and psychological impact of the COVID-19 pandemic among FHCWs. Methods: This was an exploratory hospital-based study. A semistructured e-questionnaire was developed and shared through emails, WhatsApp groups, Facebook, and Twitter. The study instruments used were stress questionnaire and the impact of event scale—revised. Results: We received 133 valid responses. A total of 81 (61.4%) of the respondents were single, 74 (55.6) were male, 70 (52.6%) were between 20 and 29 years of age, and 91 (68.4%) were from urban background. A total of 83 (62.4%) of respondents were doctors and 28 (21.1%) were registered nurses. A total of 36 (27.1%) were posted in emergency and 34 (25.6%) were in the in-patient department. Feeling sad and pessimistic, feeling of being avoided by others, the burden of change in the quality of work, and worrying whether the family will be cared for in their absence were significantly more in nurses as compared to the doctors. Stress due to burden in an increase in the quantity of work was seen more in FHCWs working in the swab collection center as compared to those working in the in-patient department, emergency, or theaters. Severe psychological impact was seen in 81 (60.9%) of FHCWs. The psychological impact was significantly more in males and in those who were married. It was also significantly related to the place of posting. Conclusion: More than half of the FHCWs had a severe psychological impact owing to COVID-19. The psychological impact was more in males and those who were married, and it was related to the place of posting of the FHCWs. Nurses had significantly higher stress as compared to doctors.

scholarly journals Have we forgotten about the Person with Disabilities for COVID 19 Vaccination – A need of the hour!!!

2021 ◽  
Vol 33 (1) ◽  
pp. 1-2
Author(s):  
Abhijit Vinodrao Boratne ◽  
Karthikayini Sasinthar
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Face Mask ◽  
Health Care Facilities ◽  
Nursing Facilities ◽  
Persons With Disabilities ◽  
Left Behind ◽  
Care Services ◽  
Increased Risk ◽  
The Times

Persons with disabilities (PwDs) are less likely to access health care facilities, education, and employment in their day-to-day life. They are more likely to experience higher rates of neglect and abuse. The present COVID-19 pandemic situation has further affected the PwDs in terms of physical and social neglect. Moreover, the concept of social distancing, using a face mask, and following cough hygiene, which is fundamental in controlling the spread of COVID 19, is likely to be followed by the person with an intellectual impairment since they are highly dependent on their caretakers for their day to day activities. This scenario is even worse with PwDs who are living in congregate settings like residential camps, nursing facilities, and psychiatric institutions where infectivity is very higher. Thus a pronged approach is needed to assure that PwDs are not left behind during the times of pandemic. This paper argues that PwDs, because of their increased risk for exposure to COVID-19 and its consequences of developing morbidity and even possible deaths, should be prioritized in vaccination strategies. Otherwise, they will be left behind, experiencing disproportionate loss of lives and livelihoods, inaccessible health care services, and disconnection from society.

Rethinking the Spectrum of Biliary Disease: Incipient Cholecystitis, an Intermediate Clinical Entity Between Biliary Colic and Acute Cholecystitis

2017 ◽  
Vol 152 (5) ◽  
pp. S1155
Author(s):  
Sufian J. Sorathia ◽  
Trupti Akella ◽  
Vivek Choksi ◽  
Sameer Shaharyar ◽  
Steven Kaplan ◽  
...  
Keyword(s):  
Acute Cholecystitis ◽  
Clinical Entity ◽  
Biliary Colic ◽  
Biliary Disease

P-BN29 Laparoscopic cholecystectomy during the era of a Covid-19 pandemic; a cohort study

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Sian Davies ◽  
Nadar Ghassemi ◽  
Ning Yi Lo ◽  
Sneha Rathod ◽  
Alex Carney ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Length Of Stay ◽  
Acute Cholecystitis ◽  
Hospital Admissions ◽  
Surgical Intervention ◽  
Gallstone Disease ◽  
Good Practice ◽  
Control Group ◽  
Biliary Disease ◽  
Readmission Rates

Abstract Background The Covid-19 era has created a lot of uncertainty for management of common emergency and elective surgical conditions such as acute cholecystitis and other gallstone disease related emergency admissions. At our centre we continued to provide early operative intervention for patients presenting with biliary disease and acute cholecystitis throughout the Covid-19 era during both the 1st and the 2nd waves, despite a significant local surge in Covid-19 hospital admissions impacting on the available resources. Here we present the outcomes of our experience of managing such patients during the Covid-19 pandemic of 2020 of both 1st and 2nd waves. Methods A retrospective observational study was performed on all patients presenting with acute cholecystitis and biliary disease who underwent elective and emergency surgical intervention at UHNM (University Hospital of North Midlands) during the second wave of the Covid pandemic (2nd CW) between 14/10/2020 and 14/01/2021). These were then compared with patients who presented in the first Covid wave (1st CW) of 1/03/020 – 30/06/2020,) and a control group pre-covid (CG) 1/03/2019 – 30/06/2019, Patients were identified using ICD-10 codes K80 (Cholelithiasis) and K81 (Cholecystitis) and OPCS codes.J18.1 – J18.5. Primary endpoints were length of stay, 30 day readmission rates, mortality and morbidity. Results A total of 146 patients were identified who underwent laparoscopic cholecystectomy during the study time period (2ndCW). In comparison to 104 patients during the first covid wave cohort (1st CW) and the control group (CG) of 217 patients in the preceding non covid year. Length of stay (LOS) was significantly lower in the 2ndCW cohort in comparison to both the previous 1st CW cohort and the CG cohort (p < 0.0001), with readmissions also being statistically lower (5% vs 15% and 12% respectively p = 0.027). There was no statistical difference in outcomes for post-operative complications as per Clavien-Dindo classification. Conclusions Overall our study demonstrates that the recommended good practice of early surgical intervention in both emergency and elective gallstone disease can continue during the pandemic periods without any significant impact on patient care & outcomes. Also during this period length of stay was significantly shorted and lower 30 day readmission rates which are likely to be multifactorial but where lessons could be potentially learnt.

433 SAME SPECIALITY, DIFFERENT REALITY?

2021 ◽  
Vol 50 (Supplement_2) ◽  
pp. ii14-ii18
Author(s):  
A Gomez ◽  
A Capon-Saez ◽  
A Gomez-Mosquera ◽  
Y Parada-DeFreitas ◽  
J J Arechaderra-Calderon ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Outcomes ◽  
Health Care Professionals ◽  
Health Care Services ◽  
Prospective Observational Study ◽  
Readmission Rates ◽  
Allied Health Care ◽  
Care Services ◽  
The United Kingdom ◽  
The Uk

Abstract Introduction The United Kingdom and Spain run government-funded social and health care services, free for the user at the point of delivery. Acute Geriatric Units (AGU) carrying out Comprehensive Geriatric Assessments improve the clinical outcomes of older patients. Little is known about the similarities and differences between countries, and how these may impact on clinical outcomes. Methods Prospective observational study of consecutive patients admitted to AGU of 2 hospitals in the UK and 4 hospitals in Spain between the 1st to the 30th of October 2019 and from the 1st to the 29th of February 2020. We followed up the patients for a 90 day period. Conclusions Frailty, multimorbidity and polypharmacy were prevalent in both cohorts. English patients were younger, with shorter hospital stay, mortality and use of antipsychotic medication but higher readmission rates. Involvement from Allied health care professionals was higher in UK hospitals.

scholarly journals Cholecystectomy during COVID-19: A Single-Center Experience

2021 ◽  
Author(s):  
Martin Nnaji ◽  
David Murcott ◽  
Hrishikesh Salgaonkar ◽  
Adebimpe Aladeojebi ◽  
Tejinderjit Athwal ◽  
...  
Keyword(s):  
Health Care ◽  
Laparoscopic Cholecystectomy ◽  
Health Care Services ◽  
Gall Bladder Disease ◽  
Biliary Colic ◽  
Peak Period ◽  
Emergency Admissions ◽  
Bladder Disease ◽  
Care Services ◽  
Single Center Experience

AbstractCOVID-19 pandemic has impacted health care globally with restructuring and prioritization of health care services. We prospectively analyzed 104 patients who underwent laparoscopic cholecystectomy during the peak of COVID-19 in 2020 and compared with 217 patients from the same period in 2019. Emergency admissions constituted majority of cases with no statistical difference between both groups (p = 0.49). Most cholecystectomies were for biliary colic (41.3 vs. 35.5%) and cholecystitis (37.5 vs. 43.8%) without any statistically difference (p = 0.31 and p = 0.29, respectively). This study demonstrates that laparoscopic cholecystectomy was feasible and safe in patients with symptomatic gall bladder disease during the peak period for COVID-19.

HIV epidemic situation in the penitentiary system of the Tyumen region

2021 ◽  
Vol 22 (2) ◽  
pp. 25-28
Author(s):  
S. E. Kondratova ◽  
◽  
A. N. Marchenko ◽  
E. N. Melnikova ◽  
◽  
...  
Keyword(s):  
Hiv Infection ◽  
Health Care Services ◽  
Federal District ◽  
Epidemic Process ◽  
Care Services ◽  
Preventive Actions ◽  
Increased Risk ◽  
Sexual Contacts ◽  
High Level ◽  
Living With Hiv

In the biggest Area of Ural Federal District with the high level of prevalence of HIV one of the leading roles in dynamics of epidemic is played by group of the population in which the consumers of injecting drugs, men having sexual contacts with men are most concentrated, workers of commercial sex is group of prisoners. Despite number of the held preventive actions, by the beginning of 2019 the prevalence HIV-infection among these special squads has reached the maximum indicator. Aims. Revealing the development of the epidemic process of HIV infection in the institution of the Federal Penitentiary Service of the Tyumen Region over a long period. Materials and methods. In work statistical data of GBUZ TO «The center for fight about AIDS» of Tyumen, Department of Rospotrebnadzor for the Tyumen region are used. Results. In the Tyumen region the number living with HIV has exceeded 1% of the population, and the prevalence rate infection was 1129.5 on 100 thousand population. Prisoners in places of detention enter into group of the increased risk of infection of HIV (cumulative share in structure of HIV-positive people – 24.4%). The maximum rate of gain of HIV infection among prisoners was +44.0%, minimum – 27.0%. Places of detention need to be considered as one of the main places with high probability of infection of HIV and its carrying out of limits of penal system. Conclusion. Intensity of epidemic process of HIV infection in places of detention are caused by conditions of restriction of freedom and prevalence of the population that demands optimization of system of preventive actions with participation of bodies of health care, services of execution of the punishment and social departments.

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