scholarly journals SP4.1.11 Acute general surgical emergency and COVID-19 is a pandemic challenge for surgeons: a UK based practical experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Md Abu Kamal Nahid ◽  
Sanjida Rahman ◽  
Ankur Shah
Keyword(s):  
Healthcare Workers ◽  
Prospective Observational Study ◽  
Perioperative Period ◽  
Practical Experience ◽  
Secondary Outcome ◽  
Global Challenge ◽  
Surgical Services ◽  
Surgical Emergencies ◽  
Theatre Staff ◽  
Surgical Pathway

Abstract Background Transmission of COVID-19 is a considerable risk during the perioperative period of emergency surgery. We aimed to provide a practical experienced adaptation to reorganize the emergency surgical pathways during the COVID-19 pandemic. Methods A prospective observational study was performed between 30th March 2020 to 30th June 2020 at a large DGH in England. The primary outcome was perioperative COVID-19 related complications and secondary outcome measures included incidence of COVID-19 infections among the surgical doctors and healthcare workers. Data was collected on the number of acute surgical admissions and operations performed. The perioperative COVID-19 status of the patients, doctors and the healthcare workers were recorded. Results 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted with COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors, 11 nurses and theatre staff were confirmed for COVID-19 by swab test. Acute cholecystitis and early appendicitis were managed conservatively. Conclusion High mortality (20%) observed among the patients who contracted COVID-19 perioperatively. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.

scholarly journals Acute General Surgical Emergency and COVID-19 Is a Pandemic Challenge for Surgeons: A United Kingdom-Based Practical Experience

2021 ◽  
Vol 8 ◽  
pp. 237437352199773
Author(s):  
Md Abu Kamal Nahid ◽  
Sanjida Rahman ◽  
Ankur Jyotindra Shah
Keyword(s):  
Prospective Observational Study ◽  
Perioperative Period ◽  
District General Hospital ◽  
Practical Experience ◽  
Surgical Patients ◽  
Secondary Outcome ◽  
Global Challenge ◽  
Surgical Services ◽  
Surgical Emergencies ◽  
Surgical Pathway

Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of emergency surgery. A prospective observational study was performed between March 30, 2020, and June 30, 2020, at a large District General Hospital in England. The primary outcome was perioperative COVID-19-related complications, and secondary outcome measures included incidence of COVID-19 infections among the acute surgical patients, doctors, and healthcare workers. A total of 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors and 11 theater staff were confirmed for COVID-19 by swab test. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge, but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.

scholarly journals 666 Innovations in ENT Surgery During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Aziz ◽  
M Benamer ◽  
S Hany ◽  
Y Sahib
Keyword(s):  
Healthcare Workers ◽  
Sinus Surgery ◽  
Healthcare Team ◽  
Ear Surgery ◽  
The Past ◽  
Ent Surgery ◽  
Global Pandemic ◽  
Theatre Staff ◽  
Reduce Risk ◽  
Nose And Throat

Abstract Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is responsible for the coronavirus disease 2019 (COVID – 19) global pandemic. Similar coronavirus epidemics over the past years affected healthcare workers significantly. Aerosol generating procedures (AGPs) presented a unique risk to ear, nose and throat (ENT) Surgeons. We introduce various methods of reducing risk in ENT AGPs. Recommendations During trachesostomies we advocate the adoption of a specialist checklist based on ENT UK guidelines. We also advise the use of a clear drape to create a clear barrier between the patient and staff. For ear surgery we advise suturing 2 microscope pieces together end-to-end so that a clear drape can sperate the patient from surgeon. During nasal and sinus surgery, we advise attaching a clear drape to the sterile camera drape used in rigid nasal endoscopy to create a barrier between patient and surgeon. Discussion Our recommendations will create an extra barrier between the patient and the rest of healthcare team. This should reduce the risks to theatre staff from AGPs. Conclusions COVID 19 is a serious health issue affecting healthcare workers, especially during AGPs in ENT surgery. We recommend several techniques to reduce risk. These can also be used during future epidemics.

scholarly journals Healthcare Workers Preparedness for COVID-19 Pandemic in the Occupied Palestinian Territory: A Cross-sectional Survey

2020 ◽  
Author(s):  
Osaid Alser ◽  
Heba Alghoul ◽  
Zahra Alkhateeb ◽  
Ayah Hamdan ◽  
Loai Albarqouni ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Gaza Strip ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Occupied Palestinian Territory ◽  
Governmental Institutions ◽  
Palestinian Territory

Abstract Background: The coronavirus disease 19 (COVID-19) pandemic threatens to overwhelm the capacity of a vulnerable healthcare system in the occupied Palestinian territory (oPt). Sufficient training of healthcare workers (HCWs) in managing COVID-19 and the provision of personal protective equipment (PPE) are essential in allowing oPt to mount a credible response to the crisis.Methods: A cross-sectional study was conducted using a validated online questionnaire between March 30, 2020 and April 12, 2020. Primary outcomes were availability of PPE and HCWs preparedness in oPt for COVID-19 pandemic. Secondary outcome was regional and hospital differences in oPt in terms of availability of PPE and HCWs preparedness.Results: Of 138 respondents, only 38 HCWs (27.5%) always had access to facemasks and 15 (10.9%) for isolation gowns. Most HCWs did not find eye protection (n=128, 92.8%), N95 respirators (n=132, 95.7%), and face shields (n=127, 92%) always available. Compared to HCWs in West Bank, those in the Gaza Strip were significantly less likely to have access to alcohol sanitizers (p=0.03) and gloves (p <0.001). On average, governmental hospitals were significantly less likely to have all appropriate PPE than non-governmental institutions (p = 0.001). Only 16 (11.6%) surveyed felt confident in dealing with a potential COVID-19 case, 57 (41.3%) having received any COVID-19-related training, and 57 (41.3%) not having a local hospital protocol. Conclusion: HCWs in oPt are underprepared and severely lacking adequate PPE provision. The lack of PPE provision will exacerbate spread of COVID-19 and deepen the crisis, whilst putting HCWs at risk.

Transoral Dermoid Cyst Excision: A Multicenter Prospective Observational Study

2018 ◽  
Vol 159 (6) ◽  
pp. 981-986 ◽  
Author(s):  
Jin Pyeong Kim ◽  
Dong Kun Lee ◽  
Jeong Hwan Moon ◽  
Jung Je Park ◽  
Seung Hoon Woo
Keyword(s):  
Observational Study ◽  
Oral Cavity ◽  
Dermoid Cyst ◽  
Prospective Observational Study ◽  
University Hospital ◽  
Secondary Outcome ◽  
Transoral Surgery ◽  
Cyst Excision ◽  
Surgery Group ◽  
Multicenter Prospective Observational Study

Objective Transoral surgery is becoming a preferred technique because it does not leave any scar after surgery. However, transoral surgery for a dermoid cyst of the oral cavity is not standardized yet, due to the anatomic complexity of this region. The aim of this study was to evaluate the safety and efficacy of a transoral dermoid cyst excision. Study Design Multicenter prospective observational study. Setting University hospital. Subjects and Methods This study was designed as a 4-year prospective multicenter evaluation of dermoid cyst excisions within the floor of mouth. Clinical outcomes and complications related to procedures were evaluated among patients. The primary outcome was the efficacy of the procedure, and the secondary outcome was cosmetic satisfaction of each procedure. Results Twenty-one patients underwent transoral dermoid cyst excisions, and 22 underwent transcervical excisions. In the transoral surgery group, the mean size of the dermoid cyst was 5.35 cm (95% CI, 4.79-5.91), and in the transcervical surgery group, it was 6.19 cm (95% CI, 5.67-6.71). There was no significant differences with respect to overall demographic characteristics between the groups. However, the duration of the operation was shorter with the transoral group than with the transcervical group ( P = .001), and cosmetic satisfaction was much better in the transoral group ( P < .001). Conclusion Transoral dermoid cyst excision is a potentially safe and effective method that can lead to easy and quick removal of an oral cavity dermoid cyst, with excellent cosmetic outcomes.

Perioperative Medication Errors and Adverse Drug Events

2018 ◽  
pp. 138-142
Keyword(s):  
Observational Study ◽  
Medication Errors ◽  
Prospective Observational Study ◽  
Adverse Drug Events ◽  
Perioperative Period ◽  
Anesthesia Care ◽  
Perioperative Medication

This case focuses on medication errors and adverse drug events occurring during the perioperative period by asking the question: What are the rates, types, severity, and preventability of medication errors (MEs) and adverse drug events (ADEs) in the perioperative setting during anesthesia care? This prospective observational study reported that approximately 1 in 20 perioperative medication administrations, and every second operation, resulted in an ME and/or an ADE. These rates are markedly higher than those reported by prior retrospective surveys. Process- and technology-based solutions may address the root causes of MEs to reduce their incidence.

scholarly journals Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

2017 ◽  
Vol 25 (4) ◽  
pp. 385-392 ◽  
Author(s):  
Willem van der Veen ◽  
Patricia MLA van den Bemt ◽  
Hans Wouters ◽  
David W Bates ◽  
Jos WR Twisk ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Primary Outcome ◽  
Outcome Measure ◽  
Medication Administration ◽  
Primary Outcome Measure ◽  
Secondary Outcome ◽  
Bar Code ◽  
Implementation Evaluation ◽  
Medication Administration Errors ◽  
Large Numbers

Abstract Objective To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

QRS complex characteristics and patient outcomes in out-of-hospital pulseless electrical activity cardiac arrest

2020 ◽  
Vol 38 (1) ◽  
pp. 53-58
Author(s):  
Jung Ho Kim ◽  
Hyun Wook Ryoo ◽  
Jong-yeon Kim ◽  
Jae Yun Ahn ◽  
Sungbae Moon ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Electrical Activity ◽  
Hospital Discharge ◽  
Neurological Outcome ◽  
Prospective Observational Study ◽  
Pulseless Electrical Activity ◽  
Secondary Outcome ◽  
Qrs Complex ◽  
The Relationship ◽  
Hospital Cardiac Arrest

BackgroundPulseless electrical activity (PEA) is increasingly observed in out-of-hospital cardiac arrest (OHCA), but outcomes are still poor. We aimed to assess the relationship between QRS characteristics and outcomes of patients with OHCA with initial PEA (OHCA-P).MethodsThis prospective observational study included patients aged at least 18 years who developed OHCA-P between 1 January 2016 and 31 December 2018, and were enrolled in the Daegu Emergency Medical Services registry, South Korea. We performed multivariable logistic regression analyses to identify the associations between QRS characteristics and OHCA-P outcomes, in which QRS complexes were considered separately (model 1) and simultaneously (model 2). The primary outcome was survival to hospital discharge and the secondary outcome was a favourable neurological outcome.ResultsOf the 3659 patients with OHCA, 576 were enrolled (median age 73 years; 334 men). A higher QRS amplitude was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (adjusted OR (aOR) 1.077 and 1.106, respectively; 95% CI 1.021 to 0.136 and 1.029 to 1.190, respectively) and model 2 (aOR 1.084 and 1.123, respectively; 95% CI 1.026 to 1.145 and 1.036 to 1.216, respectively). A QRS width of <120 ms was associated with survival to hospital discharge and a favourable neurological outcome in model 1 (aOR 3.371 and 4.634, respectively; 95% CI 1.633 to 6.960 and 1.562 to 13.144, respectively) and model 2 (aOR 3.213 and 5.103, respectively; 95% CI 1.568 to 6.584 and 1.682 to 15.482, respectively). Survival to hospital discharge and neurological outcome were not associated with QRS frequency.ConclusionOHCA-P outcomes were better when the initial QRS complex showed a higher amplitude or narrower width.

scholarly journals Comparison of two bedside evaluation methods of dysphagia in patients with acute stroke

2018 ◽  
Vol 3 (4) ◽  
pp. 237-244 ◽  
Author(s):  
Ting Ye ◽  
Shengyan Huang ◽  
Yi Dong ◽  
Qiang Dong
Keyword(s):  
Acute Stroke ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Tube Feeding ◽  
Predictive Ability ◽  
Secondary Outcome ◽  
Test Results ◽  
Volume Viscosity ◽  
Registration Number ◽  
Positive Results

BackgroundDysphagia is a common complication after stroke. Water swallowing test (WST) is a recognised but limited tool in providing details about dysphagia, including severity and how to adjust the diet based on the test results.MethodsWe performed a prospective observational study of comparing WST and volume–viscosity swallow test (V-VST) in patients with acute stroke within 14 days. All patients had WST and if failed would have a V-VST. The primary outcome was to compare the dysphagia levels assessed by these two test tools. The secondary outcome was to explore the predictive capability in patients who were at high risk of pneumonia by these two swallowing tests.ResultsConsecutively 276 patients with stroke were enrolled in our study, and 197 had normal WST. Among 79 patients who had both WST and V-VST, 20 showed swallowing safety and effectiveness by V-VST. The chance of being on tube feeding was strongly related to the positive results of failed WST (p<0.001). Both tests showed good predictive ability in patients with stroke for pneumonia even some of them were placed on tube feeding (p=0.001 in WST and p<0.001 in V-VST).ConclusionsV-VST performed better as a clinical screening test for dysphagia in patients with acute stroke at the bedside.Trial registration numberChiCTR1800016442.

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