scholarly journals Impact of the SARS-CoV-2 pandemic on emergency surgery services—a multi-national survey among WSES members

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Martin Reichert ◽  
◽  
Massimo Sartelli ◽  
Markus A. Weigand ◽  
Christoph Doppstadt ◽  
...  
Keyword(s):  
Emergency Surgery ◽  
Elective Surgery ◽  
Perforated Appendicitis ◽  
Surgical Patients ◽  
Patient Treatment ◽  
Surgical Patient ◽  
Structural Problems ◽  
Number Of Patients ◽  
Time To Diagnosis ◽  
The Impact

Abstract Background The SARS-CoV-2 pandemic is a major challenge for health care services worldwide. It’s impact on oncologic therapies and elective surgery has been described recently, and the literature provides guidelines regarding appropriate elective patient treatment during the pandemic. However, the impact of SARS-CoV-2 pandemic on emergency surgery services has been poorly investigated up to now. Methods A 17-item web survey had been distributed to emergency surgeons in June 2020 around the world, investigating the impact of SARS-CoV-2 pandemic on patients and septic diseases both requiring emergency surgery and the time-to-intervention in emergency surgery routine, as well as experiences with surgery in COVID-19 patients. Results Ninety-eight collaborators from 31 countries responded to the survey. The majority (65.3%) estimated the impact of the SARS-CoV-2 pandemic on emergency surgical patient care as being strong or very strong. Due to the pandemic, 87.8% reported a decrease in the total number of patients undergoing emergency surgery and approximately 25% estimated a delay of more than 2 h in the time-to-diagnosis and another 2 h in the time-to-intervention. Fifty percent make structural problems with in-hospital logistics (e.g. transport of patients, closed normal wards etc.) mainly responsible for delayed emergency surgery and the frequent need (56.1%) for a triage of emergency surgical patients. 56.1% of the collaborators observed more severe septic abdominal diseases during the pandemic, especially for perforated appendicitis and severe septic cholecystitis (41.8% and 40.2%, respectively). 62.2% had experiences with surgery in COVID-19-infected patients. Conclusions The results of The WSES COVID-19 emergency surgery survey are alarming. The combination of an estimated decrease in numbers of emergency surgical patients and an observed increase in more severe septic diseases may be a result of the fear of patients from infection with COVID-19 and a consecutive delayed hospital admission and diagnosis. A critical delay in time-to-diagnosis and time-to-intervention may be a result of changes in in-hospital logistics and operating room as well as intensive care capacities. Both reflect the potentially harmful impact of SARS-CoV-2 pandemic on emergency surgery services.

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

BJPsych Open ◽  
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.

scholarly journals Intensive diagnostic management of coronavirus disease 2019 (COVID-19) in academic settings in Japan: challenge and future

2020 ◽  
Vol 40 (1) ◽  
Author(s):  
Tokio Hoshina ◽  
Hiroka Aonuma ◽  
Manabu Ote ◽  
Tatsuya Sakurai ◽  
Erisha Saiki ◽  
...  
Keyword(s):  
Diagnostic Testing ◽  
Basic Research ◽  
Diagnostic Value ◽  
Turnaround Time ◽  
Patient Treatment ◽  
Emerging Infections ◽  
University Hospitals ◽  
Number Of Patients ◽  
Academic Settings ◽  
The Impact

Abstract Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), first emerged in Wuhan, China, and has spread globally to most countries. In Japan, the first COVID-19 patient was identified on January 15, 2020. By June 30, the total number of patients diagnosed with COVID-19 reached 18,000. The impact of molecular detection of pathogens is significant in acute-care settings where rapid and accurate diagnostic measures are critical for decisions in patient treatment and outcomes of infectious diseases. Polymerase chain reaction (PCR)-based methods, such as quantitative PCR (qPCR), are the most established gene amplification tools and have a comprehensive range of clinical applications, including detecting a variety of pathogens, even novel agents causing emerging infections. Because SARS-CoV-2 contains a single-stranded RNA genome, reverse-transcription qPCR (RT-qPCR) has been broadly employed for rapid and sensitive quantitative measurements of viral RNA copy numbers. The RT-qPCR method, however, still requires time-consuming reactions with two different enzymes in addition to isolation of RNA from patient samples, limiting the numbers of testing institutions for diagnosing SARS-CoV-2 infection. Japan is known to have performed a relatively small number of PCR tests as well as confirmed cases among developed nations; as of June 30, 2020, approximately 390,000 people in Japan had undergone PCR tests. Given the devastating impact on medical services and the scale of demand for diagnostic testing of COVID-19, it has been proposed that academic settings such as basic research departments in university/college can be engaged in diagnosing, especially in university hospitals or academic medical centers. In collaboration with established diagnostic laboratories, academic facilities can divert their function to detecting virus from patients with suspected COVID-19, adopting existing specialized expertise in virus handling, molecular work, and data analysis. This in-house testing strategy facilitates the rapid diagnosing of thousands of samples per day and reduces sample turnaround time from 1 week to less than 24 h. This review provides an overview of the general principles, diagnostic value, and limitations of COVID-19 diagnosis platforms in Japan, in particular in-house testing at academic settings.

Quantification of the impact of multifaceted improvements in patient safety culture: A case study from academic medical center radiation oncology department.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 205-205
Author(s):  
Bhishamjit S. Chera ◽  
Lukasz Maszur ◽  
Prithima Mosaly ◽  
Marianne Jackson ◽  
Kinely Taylor ◽  
...  
Keyword(s):  
Radiation Oncology ◽  
Peer Review Process ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Safety Culture ◽  
Process Engineering ◽  
Patient Treatment ◽  
Task Load ◽  
Number Of Patients ◽  
The Impact

205 Background: We have systematically been incorporating several safety initiatives (based on process-engineering and Lean methodologies) into our academic radiation oncology clinic. We herein quantify the impact of these initiatives on prospectively collected, clinically meaningful metrics. Methods: The data from five quality improvement initiatives are presented. For each, data was collected prospectively: operational metrics recorded before and after implementation of the initiative were compared using descriptive statistics and unpaired student t-test. Each initiative focused on a specific safety/process concern in our clinic. Results: 1) Workload levels for nurses assisting with brachytherapy were too high (NASA task load index scores >55-60, suggesting, “overwork”). Changes in work flow and procedure room layout reduced workload scores to more acceptable limits (<55). 2) The rate of treatment therapists being interrupted was reduced from a mean of 4 (range 1-11) times per patient treatment to a mean < 1 (range 0-3, p<0.001) after implementing standards for electronic communication and placement of monitors informing patients and staff of the treatment machine status (e.g., delayed, on time). 3) The rates of replans by dosimetrists was reduced from 11% in 2010 to 6% in 2011 though a more systematic pre-treatment peer review process. 4) Standardizing nursing/resident functions reduced patient wait times by ≈ 45% (14 min). 5) Standardizing pre-simulation instructions from the physician within the EMR reduced the number of patients experiencing delays on the simulator (from approximatley >50% to <10%). Conclusions: Process engineering and Lean methodologies can be successfully applied in an academic radiation oncology department to yield measurable improvements in operations likely improving quality/safety.

scholarly journals 489 Assessing the Impact Of COVID-19 On Head and Neck Cancer Treatment and Preparing for The Next Wave

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Daga ◽  
L Argus ◽  
J Goswami
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Elective Surgery ◽  
Standard Of Care ◽  
Tnm Staging ◽  
World Health ◽  
Number Of Patients ◽  
Novel Coronavirus ◽  
The Impact

Abstract Introduction As of 11th of March 2020, the World Health Organization (WHO) declared the novel coronavirus 2019 (COVID-19) a pandemic. It is estimated that urgent cancer referrals have reduced 70-89% across hospitals in England during the COVID-19 pandemic, in addition to reductions in attendance for the different treatment arms. The aim of our investigation is to assess the impact of COVID-19 on MDT outcomes and patients attending/receiving treatment as compared to before for head and neck cancer. Method Data was collected retrospectively over a period of 203 days (7th January to 28th July 2020), including 66 patients prior to COVID-19 being declared a pandemic and 116 patients since, at a regional cancer centre. A total of 182 patients undergoing treatment were identified. These patients were assessed by TNM staging, MDT outcomes and final initial treatment intents, which were compared to pre-COVID outcomes. Results With respect to MDT outcomes, there was an increase in the number of patients decided for surgery from 10.61% to 23.28% (p = 0.78) during the first wave of the pandemic. Patients decided for radiotherapy and chemotherapy increased by 12.49% and 4.31% respectively. Notably, there was a decrease in further investigations and referrals from 37.88% to 18.10%. Moreover, an increase in palliative treatment intent by 10.55% was noted during the pandemic. Conclusions As the UK enters into the next peak of the pandemic, with reduced capacity for elective surgery and outpatient clinics, it is essential to consider its impact on the standard of care delivered to current cancer patients.

scholarly journals PREVALENCE OF SURGICAL SITE INFECTION ASSOCIATED RISK FACTORS IN A TERTIARY CARE HOSPITAL OF VEDANTA INSTITUTE OF MEDICAL SCIENCES

2019 ◽  
Vol 3 (10) ◽  
Author(s):  
Dr. Amit Ramesh Churi
Keyword(s):  
Surgical Site Infection ◽  
Emergency Surgery ◽  
Elective Surgery ◽  
Prophylactic Antibiotics ◽  
Surgical Patients ◽  
Care Hospital ◽  
Site Infection ◽  
Deep Incision ◽  
Surgery Group ◽  
Wide Range

Introduction:  Skin is generally colonised by a wide range of microorganisms that could cause infection. Surgical site infection (SSI) requires evidence of clinical signs and symptoms of infection rather than microbiological evidence alone. SSIs generally affect the superficial tissues, but some more serious infections affect the deeper tissues or other parts of the body manipulated during the surgical procedure.About 5% of patients posted for surgery develop surgical site infections (SSIs), which may cause much morbidity and may sometimes mortality. Treatment of SSIs imposes a substantial financial burden on the health care system. Patients who develop SSI are more likely to spend 60% more time in an Intensive care unit (ICU), they are 5 times as likely to be readmitted and their mortality rate is twice of non-infected patient. But to great surprise 40-60% of these infections are preventable. Material and Methods: A total of 500 patients who had undergone surgical procedure at the teaching hospitalwere studied prospectively. A total of 464(92.8%) elective surgical patients and 36(7.2%) emergency surgical patients were included in the study.Patient information gathered from the data chart, treatment chart and from ward rounds in the hospital. All patients were followed up from the time of admission until the time of discharge and 30 days postoperatively to inspect the incidence of SSI. Wound infection was diagnosed. SSI diagnosed was divided into three categories: Superficial incision SSI, Deep incision SSI and Organ/space SSI. SSI is considered if an infection occurred within 30 days after the operation, if no implant is left in place SSI was considered. Results: In the present study 500 patients were included of which 464(92.8%) were elective surgical patients and 36(7.2%) were emergency surgical patients. Total SSI cases were 41 (8.2%) of which 29 (70.7%) were identified in elective surgery cases and 12 (29.3%) were observed in emergency surgery superficial incision SSI was most prevalent 25 (61%) followed by deep incisional SSI 11(26.8%) and then by organ/space SSI 5(12.2%).Mean age in elective surgery group was 52.4±7.48 and in emergency surgery group was 56.2± 6.78. In elective surgery group there were 296 (63.8%) male and 168 (36.2%) female. In emergency group there were 29 (80.6%) male and 7 (19.4%) female. Prophylactic antibiotics were given to 404 (87.1%) in elective surgery group and 30 (83.3%) in emergency surgery group. SSI rate observed in elective surgery group was 29/464 (6.25%) while in emergency surgery group was 12/36 (33.33%).BMI (Body mass index) in elective surgery group was 28.7 ±2.45and in emergency surgery group was 27.6 ± 2.89. Conclusion: higher incidence of SSI with increasing age of the patient.it was observed that to prevent SSI prophylactic antibiotics should be initiated within one hour before surgical incision. Keywords: SSI, Surgery, Superficial incision SSI, Deep incision SSI, Organ/space SSI

scholarly journals Susceptibility to Fraud in Systematic Reviews

2009 ◽  
Vol 111 (6) ◽  
pp. 1279-1289 ◽  
Author(s):  
Emmanuel Marret ◽  
Nadia Elia ◽  
Jørgen B. Dahl ◽  
Henry J. McQuay ◽  
Steen Møiniche ◽  
...  
Keyword(s):  
Systematic Reviews ◽  
Surgical Patients ◽  
Relevant Difference ◽  
Number Of Patients ◽  
Subgroup Analyses ◽  
Current Article ◽  
Web Of Knowledge ◽  
Meta Analyses ◽  
The Impact

Background Dr. Scott Reuben allegedly fabricated data. The authors of the current article examined the impact of Reuben reports on conclusions of systematic reviews. Methods The authors searched in ISI Web of Knowledge systematic reviews citing Reuben reports. Systematic reviews were grouped into one of three categories: I, only cited but did not include Reuben reports; II, retrieved and considered, but eventually excluded Reuben reports; III, included Reuben reports. For quantitative systematic reviews (i.e., meta-analyses), a relevant difference was defined as a significant result becoming nonsignificant (or vice versa) by excluding Reuben reports. For qualitative systematic reviews, each author decided independently whether noninclusion of Reuben reports would have changed conclusions. Results Twenty-five systematic reviews (5 category I, 6 category II, 14 category III) cited 27 Reuben reports (published 1994-2007). Most tested analgesics in surgical patients. One of 6 quantitative category III reviews would have reached different conclusions without Reuben reports. In all 6 (30 subgroup analyses involving Reuben reports), exclusion of Reuben reports never made any difference when the number of patients from Reuben reports was less than 30% of all patients included in the analysis. Of 8 qualitative category III reviews, all authors agreed that one would certainly have reached different conclusions without Reuben reports. For another 4, the authors' judgment was not unanimous. Conclusions Carefully performed systematic reviews proved robust against the impact of Reuben reports. Quantitative systematic reviews were vulnerable if the fraudulent data were more than 30% of the total. Qualitative systematic reviews seemed at greater risk than quantitative.

Enhanced recovery programmes in knee arthroplasty: current concepts

2018 ◽  
Vol 3 (5) ◽  
pp. 282-286
Author(s):  
Robert M Middleton ◽  
Alexander G Marfin ◽  
Abtin Alvand ◽  
Andrew J Price
Keyword(s):  
Knee Arthroplasty ◽  
Enhanced Recovery ◽  
Surgical Techniques ◽  
Surgical Patients ◽  
Surgical Patient ◽  
Multimodal Approach ◽  
Postoperative Rehabilitation ◽  
Enhanced Recovery Programme ◽  
Recovery Approach ◽  
The Impact

The concept of a multimodal approach to improve the care of surgical patients was first proposed by Kehlet in the 1990s. Measures to optimise the surgical patient, and minimise perioperative stresses, aimed to improve postoperative outcomes. Although originally introduced in colorectal surgery, these ‘enhanced recovery programmes’ have now seen widespread uptake in multiple surgical specialities, including orthopaedics. Patients undergoing knee arthroplasty are well suited to an enhanced recovery approach. These programmes optimise the patient at each stage of the surgical journey, including preoperative optimisation of fitness, perioperative anaesthetic and surgical techniques and finally postoperative rehabilitation and discharge plans. The available evidence supports a number of improvements after programme introduction, including shorter length of stay, morbidity and economics. However, the impact on other outcomes is less clear. One of the issues in the field is a lack of consensus on what interventions an enhanced recovery programme should contain and the specifics of these interventions. As a result, individual units develop their own programmes, making the interpretation and comparison of their impact difficult. This article discusses interventions that could be considered for inclusion in an enhanced recovery programme for knee arthroplasty.

scholarly journals 579 The Impact of Coronavirus 2 (SARS-CoV-2) in Emergency Surgery. Our experience at the General Surgery Department in Queen Elizabeth Hospital, London

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
M Chatzikonstantinou ◽  
M David ◽  
A Pouncey ◽  
F Aljarad ◽  
P Sorelli
Keyword(s):  
General Surgery ◽  
Emergency Surgery ◽  
Surgical Care ◽  
Emergency Operation ◽  
Queen Elizabeth Hospital ◽  
Local Data ◽  
Number Of Patients ◽  
Few Data ◽  
Surgery Department ◽  
The Impact

Abstract Background The outbreak of the COVID-19 has had global impact on elective and emergency surgical care. So far, we possess few data to understand the effect of the CoViD-19 on emergency surgery. Aim To compare the total number of patients who were referred, admitted, and had an emergency operation under General Surgery (GS) between March and May 2020, to the same period between 2016-19. Method Retrospective analysis of prospectively collected local data from surgical take lists and operative data obtained from the hospital’s Business Intelligence Team. Results A 22.4% reduction was seen in the referrals per day 15.18+/-2.45 vs. 11.77 +/- 4.54 (2016-9 vs. 2020, mean+/-SD) and a 36% reduction in admissions per day 7.40 +/-1.07 vs. 4.69+/- 2.03 (2016-9 vs. 2020, mean+/-SD). A 55% reduction in the total number of emergency operations during the CoViD-19 outbreak was observed 87 (total, 2020) vs. 194+/-35.96 (mean+/-SD, 2016-19). Conclusions CoViD-19 had a significant impact on the number of patients presenting to GS. Interestingly, an even greater reduction in operative treatment was also observed. This may reflect reduction in theatre availability or use of a higher threshold for conservative treatment.

scholarly journals Mitigating the stress response to improve outcomes for older patients undergoing emergency surgery with the addition of beta-adrenergic blockade

2021 ◽  
Author(s):  
Shahin Mohseni ◽  
Bellal Joseph ◽  
Carol Jane Peden
Keyword(s):  
Stress Response ◽  
Emergency Surgery ◽  
Surgical Intervention ◽  
Physiological Stress ◽  
Surgical Patient ◽  
Adrenergic Blockade ◽  
Proactive Management ◽  
Operative Care ◽  
Acute Condition ◽  
The Impact

AbstractAs population age, healthcare systems and providers are likely to experience a substantial increase in the proportion of elderly patients requiring emergency surgery. Emergency surgery, compared with planned surgery, is strongly associated with increased risks of adverse postoperative outcomes due to the short time available for diagnosis, optimization, and intervention in patients presenting with physiological derangement. These patient populations, who are often frail and burdened with a variety of co-morbidities, have lower reserves to deal with the stress of the acute condition and the required emergency surgical intervention. In this review article, we discuss topical areas where mitigation of the physiological stress posed by the acute condition and asociated surgical intervention may be feasible. We consider the impact of the adrenergic response and use of beta blockers for these high-risk patients and discuss common risk factors such as frailty and delirium. A proactive multidisciplinary approach to peri-operative care aimed at mitigation of the stress response and proactive management of common conditions in the older emergency surgical patient could yield more favorable outcomes.

Impact of COVID-19 Pandemic on Ophthalmology Trainees in Southern India - A Prospective Observational Study

2021 ◽  
Vol 8 (22) ◽  
pp. 1786-1791
Author(s):  
Chethana Warad ◽  
Arvind Tenagi ◽  
Arya Wakankar ◽  
Pranitha Satarasi ◽  
Umesh Harakuni ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Elective Surgery ◽  
Psychological Impact ◽  
High Stress ◽  
Severe Depression ◽  
Online Questionnaire ◽  
Number Of Patients ◽  
The Government ◽  
The Impact

BACKGROUND COVID-19, caused by a new strain of corona virus 2019-nCoV led to a global pandemic after first manifesting in humans in December 2019 in Wuhan, China. The government of India ordered a nationwide lockdown for 21 days, which was then extended. Hence, ophthalmology, being a branch which largely deals with elective surgeries, was majorly affected. We need to evaluate the impact of the COVID-19 crisis on ophthalmology trainees during pandemic in India. METHODS A prospective, observational study in which an online questionnaire (on Google forms) was circulated between 9 th September and 15th September 2020 among ophthalmologists in training. RESULTS 260 of the 550 training ophthalmologists who were approached responded. They were given 31 questions to answer. The average age of the respondents was 27.39 ± 1.92 years of which 72.69 % (189 / 260) were females. 68.08 % (177 / 260) of the respondents had been posted on COVID-19 related duties. 76.5 % (198 / 260) of the respondents agreed that the outpatient load had dropped to < 50 patients per day and 100 % (260 / 260) of the respondents stated that there had been a reduction in number of patients posted for elective surgery. As a result, 64.23 % (167 / 260) responded that it had led to a loss of interest in their daily activities. 74.23 % reported different levels of stress, 73.46 % reported anxiety and some 24.23 % even experienced sleep deprivation. CONCLUSIONS This study has demonstrated that majority of the training ophthalmologists were affected psychologically during the COVID-19 pandemic to varying degrees which included both groups of training ophthalmologists who did or did not perform any COVID related duties. The study therefore has highlighted the increased need for psychologists to identify and help these individuals who may suffer from severe depression, insomnia and high stress levels and provide the necessary help. KEYWORDS COVID-19, Pandemic, Psychological Impact, Ophthalmology Trainees

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