scholarly journals TP10.2.5Investigating the impact of early COVID-19 policies on Emergency Surgical service at a District General Hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Adam Lunt ◽  
Joseph Hanger ◽  
Alex Bush ◽  
Petros Christopoulos ◽  
Alicia Munro ◽  
...  
Keyword(s):  
Disease Severity ◽  
Royal College ◽  
White Cell Count ◽  
Operative Management ◽  
Outcome Data ◽  
Early Warning Score ◽  
Delayed Presentation ◽  
Laparoscopic Procedures ◽  
Significant Change ◽  
The Impact

Abstract Aims On the 23rd March 2020, the UK introduced measures to curb the spread of coronavirus disease 19 (COVID-19). We aimed to investigate the impact of government and Royal College measures on the acute surgical take. Materials and Methods Retrospective analysis was performed for patients referred to the acute surgical take between 2nd March 2020 and 5th April 2020. Data were analysed in two groups; ‘pre-COVID measures’ cohort (prior to 23rd March 2020) and ‘post-COVID measures’ cohort (on or after 23rd March 2020). Demographics, Early Warning Score (EWS) at referral, blood results, radiological investigations, antibiotic use, diagnosis, operative and outcome data were compared. Results 465 patient referrals were included. Mean admissions per day reduced by 39.9% (p = 0.01) in the post-COVID measures’ cohort compared with the pre-COVID measures cohort. Disease severity increased, with white cell count (WCC) increasing by 14% (p = 0.02) and C-reactive protein (CRP) by 34% (p = 0.04). Laparoscopic procedures decreased by 86.4% (p < 0.01). The proportion of admissions requiring operative management showed no significant change, with 26% in pre-COVID measures verse 23% in post- COVID measures (p = 0.91). Short term morbidity, mortality and length of stay outcomes also demonstrated no significant change. Conclusion Fewer patients were referred following the implementation of government and Royal College guidance, however these patients demonstrated greater disease severity. Guidance likely modified patients help seeking behaviours and delayed presentation time. Surgeons demonstrated good compliance to Royal College guidance by reducing laparoscopic procedures, however operative management rates remained constant.

Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave

2021 ◽  
Author(s):  
Kerstin Saalabian ◽  
Udo Rolle ◽  
Florian Friedmacher
Keyword(s):  
Pediatric Patients ◽  
Health Care Systems ◽  
Adult Population ◽  
Operative Management ◽  
Lessons Learned ◽  
Delayed Presentation ◽  
Relative Paucity ◽  
Care Systems ◽  
Individual Capacity ◽  
The Impact

AbstractThe fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

scholarly journals My Therapist is a Student? The Impact of Therapist Experience and Client Severity on Cognitive Behavioural Therapy Outcomes for People with Anxiety Disorders

2015 ◽  
Vol 44 (2) ◽  
pp. 193-202 ◽  
Author(s):  
Liam Mason ◽  
Nick Grey ◽  
David Veale
Keyword(s):  
Anxiety Disorders ◽  
Behavioural Therapy ◽  
Outcome Data ◽  
Symptom Improvement ◽  
Therapist Experience ◽  
Clinically Significant Change ◽  
Trainee Therapists ◽  
Significant Change ◽  
Clinically Significant ◽  
The Impact

Background: Allocation of trainee therapist cases is often performed based on intuition and clinical circumstances, with lack of empirical evidence on the role of severity of presenting problem. This has the potential to be anxiety-provoking for supervisors, trainees and service users themselves. Aims: To determine how therapist experience interacts with symptom severity in predicting client outcomes. Method: An intention-to-treat analysis of annual outcome data for primary and secondary care clients seen by a specialist anxiety disorders service. 196 clients were stratified into mild, moderate and baseline severe symptoms of anxiety (GAD-7) and depression (PHQ-9). We measured percentage change on these measures, as well as number of sessions and therapy dropout. We also examined rates of reliable and clinically significant change on disorder-specific measures. We hypothesized that qualified therapists would achieve better outcomes than trainees, particularly for severe presentations. Results: Overall, outcomes were comparable between trainee and qualified therapists on all measures, and trainees additionally utilized fewer therapy sessions. There was however an interaction between anxiety severity (GAD-7) and therapist group, such that severely anxious clients achieved greater symptom improvement with qualified as compared to trainee therapists. Further, for trainee but not qualified therapists, baseline anxiety was negatively associated with rate of reliable and clinically significant change on disorder-specific measures. Conclusions: These findings indicate generally favourable outcomes for trainee therapists delivering manualized treatments for anxiety disorders. They additionally suggest that trainee therapists may benefit from additional support when working with clients that present with severe anxiety.

ANALISIS RASIO UNTUK MENGUKUR KINERJA KEUANGAN PERUSAHAAN (STUDI KASUS PADA PT MEKAR KARYA PRATAMA)

2019 ◽  
Vol 9 (1B) ◽  
pp. 15
Author(s):  
Rizki Ahmad Fauzi
Keyword(s):  
Financial Performance ◽  
Financial Statements ◽  
Corporate Activity ◽  
Significant Change ◽  
Overall Ratio ◽  
The Impact ◽  
Solvency Ratio

Based on the results of the analysis of the ratio of the financial statements can be seen from liquidity ratio in 2010 can already be said to be liquid and in 2011 occurred very significant increase in this ratio that makes the company's liquidity to be too high. Judging from the solvency ratio, in 2010 the company could not be said solvable because the value of this ratio is still quite high. However, in 2011 this ratio decreased significantly which shows that the company can already be said to be solvable. From the ratio of the activity, in 2010 and 2011 the ratio of corporate activity can already be said to be good. Despite the decrease from 2010 to 2011 on some of these ratios, but the overall ratio of activity of the company is good enough. Judging from the ratio of profitability, in 2010 and 2011 the profitability of the company can not be said to be good because it is still very low and no significant change from the year 2010 to the year 2011 for this ratio.The overall financial performance of PT Mekar Karya Pratama from year 2010 to year 2011 can be said to be good, although there are some things that must be considered and they should be repaired as liquidity is too high which causes the idle funds and the impact on the profitability is low. Keyword:Rasio Analysis

Effects of Quarantine Due to the COVID-19 on Sleep Duration and Quality in Algerians

2020 ◽  
Vol 60 (2) ◽  
pp. 182-193
Author(s):  
Kacem Abdelhadi ◽  
Houar Abdelatif ◽  
Zerf Mohamed ◽  
Bengoua Ali
Keyword(s):  
Statistical Analysis ◽  
Sleep Quality ◽  
Sleep Duration ◽  
Online Survey ◽  
Public Awareness ◽  
Italian Version ◽  
Sleep Timing ◽  
Algerian Population ◽  
Significant Change ◽  
The Impact

SummaryThis study tests the impact of COVID-19 on sleep of Algerian population before and during the COVID-19 quarantine by an estimated online survey, adapted from the PSQI Italian version. Including 1210 participants (age between 18-60 years old). The statistical analysis was carried out using SPSS version 22.0 software. Our results showed a significant change in sleeping quality during quarantine, the sleep timing markedly changed, we also noticed additional use of sleeping medications. Algerian scientists recommend to build public awareness and to provide necessary information regarding Algerian sleep quality, especially for Algerian adults.

Impact of influenza virus during pregnancy: from disease severity to vaccine efficacy

2020 ◽  
Vol 15 (7) ◽  
pp. 441-453
Author(s):  
Ana Vazquez-Pagan ◽  
Rebekah Honce ◽  
Stacey Schultz-Cherry
Keyword(s):  
Influenza Virus ◽  
Virus Infection ◽  
Immune Responses ◽  
Pregnant Women ◽  
Disease Severity ◽  
Influenza A ◽  
Antiviral Treatment ◽  
Influenza Virus Infection ◽  
Severe Influenza ◽  
The Impact

Pregnant women are among the individuals at the highest risk for severe influenza virus infection. Infection of the mother during pregnancy increases the probability of adverse fetal outcomes such as small for gestational age, preterm birth and fetal death. Animal models of syngeneic and allogeneic mating can recapitulate the increased disease severity observed in pregnant women and are used to define the mechanism(s) of that increased severity. This review focuses on influenza A virus pathogenesis, the unique immunological landscape during pregnancy, the impact of maternal influenza virus infection on the fetus and the immune responses at the maternal–fetal interface. Finally, we summarize the importance of immunization and antiviral treatment in this population and highlight issues that warrant further investigation.

scholarly journals Cost-effectiveness of new MDR-TB regimens: study protocol for the TB-PRACTECAL economic evaluation substudy

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036599
Author(s):  
Sedona Sweeney ◽  
Gabriela Gomez ◽  
Nichola Kitson ◽  
Animesh Sinha ◽  
Natalia Yatskevich ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Best Practice ◽  
Current Treatment ◽  
Outcome Data ◽  
London School ◽  
Main Trial ◽  
Ethical Approval ◽  
Mdr Tb ◽  
The Impact

IntroductionCurrent treatment regimens for multidrug-resistant tuberculosis (MDR-TB) are long, poorly tolerated and have poor outcomes. Furthermore, the costs of treating MDR-TB are much greater than those for treating drug-susceptible TB, both for health service and patient-incurred costs. Urgent action is needed to identify short, effective, tolerable and cheaper treatments for people with both quinolone-susceptible and quinolone-resistant MDR-TB. We present the protocol for an economic evaluation (PRACTECAL-EE substudy) alongside an ongoing clinical trial (TB-PRACTECAL) aiming to assess the costs to patients and providers of new regimens, as well as their cost-effectiveness and impact on participant poverty levels. This substudy is based on data from the three countries participating in the main trial.Methods and analysisPrimary cost data will be collected from the provider and patient perspectives, following economic best practice. We will estimate the probability that new MDR-TB regimens containing bedaquiline, pretomanid and linezolid are cost-effective from a societal perspective as compared with the standard of care for MDR-TB patients in Uzbekistan, South Africa and Belarus. Analysis uses a Markov model populated with primary cost and outcome data collected at each study site. We will also estimate the impact of new regimens on prevalence of catastrophic patient costs due to TB.Ethics and disseminationEthical approval has been obtained from the London School of Hygiene & Tropical Medicine and Médecins Sans Frontières. Local ethical approval will be sought in each study site. The results of the economic evaluation will be shared with the country health authorities and published in a peer-reviewed journal.Trial registration numberClinicalTrials.gov Registry (NCT04207112); Pre-results.

scholarly journals Updated overview on the interplay between obesity and COVID-19

Diagnosis ◽  
2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Diletta Onorato ◽  
Giovanni Carpenè ◽  
Giuseppe Lippi ◽  
Mairi Pucci
Keyword(s):  
Disease Severity ◽  
Clinical Characteristics ◽  
Literature Search ◽  
Scientific Literature ◽  
Population Sample ◽  
Obese Patients ◽  
Health Crisis ◽  
Keywords Obesity ◽  
Negative Prognostic Factor ◽  
The Impact

AbstractThe worldwide spread of coronavirus disease 2019 (COVID-19) has generated a global health crisis and more than a million deaths so far. Epidemiological and clinical characteristics of COVID-19 are increasingly reported, along with its potential relationship with overweight and/or obesity. Therefore, we aim here to review the current scientific literature on the impact of overweight and/or obesity among hospitalized patients who have developed severe or critical forms of COVID-19. Following PRISMA guidelines, our literature search identified over 300 scientific articles using the keywords “obesity” and “COVID-19”, 22 of which were finally selected for reporting useful information on the association between overweight/obesity and disease severity. In particular, in 11 out of the 14 studies (79%) which evaluated the association between obesity and disease severity providing also a risk estimate (i.e., the odd ratio; OR), the OR value was constantly >2. Although the studies were found to be heterogeneous in terms of design, population, sample size and endpoints, in most cases a significant association was found between obesity and the risk of progressing to severe COVID-19 illness, intensive care unit admission and/or death. We can hence conclude that an increased body mass index shall be considered a negative prognostic factor in patients with COVID-19, and more aggressive prevention or treatment shall hence be reserved to overweight and/or obese patients.

scholarly journals Improving the Biocontrol Potential of Bacterial Antagonists with Salicylic Acid against Brown Rot Disease and Impact on Nectarine Fruits Quality

Agronomy ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 209
Author(s):  
Nadia Lyousfi ◽  
Rachid Lahlali ◽  
Chaimaa Letrib ◽  
Zineb Belabess ◽  
Rachida Ouaabou ◽  
...  
Keyword(s):  
Salicylic Acid ◽  
Disease Severity ◽  
Mycelial Growth ◽  
Brown Rot ◽  
Antagonistic Bacteria ◽  
Biological Treatments ◽  
Rot Disease ◽  
The Impact

The main objective of this study was to evaluate the ability of both antagonistic bacteria Bacillus amyloliquefaciens (SF14) and Alcaligenes faecalis (ACBC1) used in combination with salicylic acid (SA) to effectively control brown rot disease caused by Monilinia fructigena. Four concentrations of salicylic acid (0.5%, 2%, 3.5%, and 5%) were tested under in vitro and in vivo conditions. Furthermore, the impact of biological treatments on nectarine fruit parameters’ quality, in particular, weight loss, titratable acidity, and soluble solids content, was evaluated. Regardless of the bacterium, the results indicated that all combined treatments displayed a strong inhibitory effect on the mycelial growth of M. fructigena and disease severity. Interestingly, all SA concentrations significantly improved the biocontrol activity of each antagonist. The mycelial growth inhibition rate ranged from 9.79% to 88.02% with the highest reduction rate recorded for bacterial antagonists in combination with SA at both concentrations of 0.5% and 3.5%. The in vivo results confirmed the in vitro results with a disease severity varying from 0.00% to 51.91%. A significant biocontrol improvement was obtained with both antagonistic bacteria when used in combination with SA at concentrations of 0.5% and 2%. The lowest disease severity observed with ACBC1 compared with SF14 is likely due to a rapid adaptation and increase of antagonistic bacteria population in wounded sites. The impact of all biological treatments revealed moderate significant changes in the fruit quality parameters with weight loss for several treatments. These results suggest that the improved disease control of both antagonistic bacteria was more likely directly linked to both the inhibitory effects of SA on pathogen growth and induced fruit resistance.

scholarly journals Resilience and vulnerability of maternity services in Zimbabwe: a comparative analysis of the effect of Covid-19 and lockdown control measures on maternal and perinatal outcomes, a single-centre cross-sectional study at Mpilo Central Hospital

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Clare Shakespeare ◽  
Handsome Dube ◽  
Sikhangezile Moyo ◽  
Solwayo Ngwenya
Keyword(s):  
Perinatal Outcomes ◽  
Control Measures ◽  
Central Hospital ◽  
Cross Sectional ◽  
Maternity Services ◽  
Before And After ◽  
The Mean ◽  
Significant Change ◽  
The Impact ◽  
Mpilo Central Hospital

Abstract Background On the 27th of March 2020 the Zimbabwean government declared the Covid-19 pandemic a ‘national disaster’. Travel restrictions and emergency regulations have had significant impacts on maternity services, including resource stock-outs, and closure of antenatal clinics during the lockdown period. Estimates of the indirect impact of Covid-19 on maternal and perinatal mortality was expected it to be considerable, but little data was yet available. This study aimed to examine the impact of Covid-19 and lockdown control measures on non-Covid outcomes in a government tertiary level maternity unit in Bulawayo, Zimbabwe, by comparing maternal and perinatal morbidity and mortality before, and after the lockdown was implemented. Methods This was a retrospective, observational study, using a cross-sectional design to compare routine monthly maternal and perinatal statistics three months before and after Covid-19 emergency measures were implemented at Mpilo Central Hospital. Results Between January-March and April-June 2020, the mean monthly deliveries reduced from 747.3 (SD ± 61.3) in the first quarter of 2020 to 681.0 (SD ± 17.6) during lockdown, but this was not statistically significant, p = 0.20. The Caesarean section rates fell from a mean of 29.8% (SD ± 1.7) versus 28.0% (SD ± 1.7), which was also not statistically significant, p = 0.18. During lockdown, the percentage of women delivering at Mpilo Central Hospital who were booked at the hospital fell from a mean of 41.6% (SD ± 1.1) to 35.8% (SD ± 4.3) which was statistically significant, p = 0.03. There was no significant change, however, in maternal mortality or severe maternal morbidity (such as post-partum haemorrhage (PPH), uterine rupture, and severe preeclampsia/eclampsia), stillbirth rate or special care baby unit admission. There was an increase in the mean total number of early neonatal deaths (ENND) (mean 18.7 (SD ± 2.9) versus 24.0 (SD ± 4.6), but this was not statistically significant, p = 0.32. Conclusions Overall, maternity services at Mpilo showed resilience during the lockdown period, with no significant change in maternal and perinatal adverse outcomes, with the same number of man-hours worked before and during the lockdown Maternal and perinatal outcomes should continue to be monitored to assess the impact of Covid-19 and the lockdown measures as the pandemic in Zimbabwe unfolds. Further studies would be beneficial to explore women’s experiences and understand how bookings and deliveries at local clinics changed during this time.

scholarly journals The interplay between environmental exposures and COVID-19 risks in the health of children

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Peter D. Sly ◽  
Brittany A. Trottier ◽  
Catherine M. Bulka ◽  
Stephania A. Cormier ◽  
Julius Fobil ◽  
...  
Keyword(s):  
Air Pollution ◽  
Air Quality ◽  
Disease Severity ◽  
Research Effort ◽  
Severe Disease ◽  
Environmental Exposures ◽  
Research Strategy ◽  
Lessons Learned ◽  
Research Questions ◽  
The Impact

Abstract Background An unusual feature of SARS-Cov-2 infection and the COVID-19 pandemic is that children are less severely affected than adults. This is especially paradoxical given the epidemiological links between poor air quality and increased COVID-19 severity in adults and that children are generally more vulnerable than adults to the adverse consequences of air pollution. Objectives To identify gaps in knowledge about the factors that protect children from severe SARS-Cov-2 infection even in the face of air pollution, and to develop a transdisciplinary research strategy to address these gaps. Methods An international group of researchers interested in children’s environmental health was invited to identify knowledge gaps and to develop research questions to close these gaps. Discussion Key research questions identified include: what are the effects of SAR-Cov-2 infection during pregnancy on the developing fetus and child; what is the impact of age at infection and genetic susceptibility on disease severity; why do some children with COVID-19 infection develop toxic shock and Kawasaki-like symptoms; what are the impacts of toxic environmental exposures including poor air quality, chemical and metal exposures on innate immunity, especially in the respiratory epithelium; what is the possible role of a “dirty” environment in conveying protection – an example of the “hygiene hypothesis”; and what are the long term health effects of SARS-Cov-2 infection in early life. Conclusion A concerted research effort by a multidisciplinary team of scientists is needed to understand the links between environmental exposures, especially air pollution and COVID-19. We call for specific research funding to encourage basic and clinical research to understand if/why exposure to environmental factors is associated with more severe disease, why children appear to be protected, and how innate immune responses may be involved. Lessons learned about SARS-Cov-2 infection in our children will help us to understand and reduce disease severity in adults, the opposite of the usual scenario.

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