scholarly journals Instituting a Green Zone for Elective Surgery During the Second Wave of COVID-19

Cureus ◽  
2021 ◽  
Author(s):  
Muhammad Rafaih Iqbal ◽  
Subiksha Subramonian ◽  
Kabir Matwala ◽  
Catherine Morrison ◽  
Stavros Karamanakos ◽  
...  
Keyword(s):  
Elective Surgery ◽  
Green Zone ◽  
Second Wave

scholarly journals 755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Fisher ◽  
C Hadjittofi ◽  
Z Ali ◽  
P Antonas ◽  
K Parekh ◽  
...  
Keyword(s):  
Pain Management ◽  
Oral Surgery ◽  
Elective Surgery ◽  
University Hospital ◽  
Single Centre ◽  
Median Length ◽  
Microsoft Excel ◽  
Single Centre Study ◽  
Green Zone

Abstract Introduction The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients. Method A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel. Results One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%). Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (>Clavien-Dindo IIIa) or 90-day mortality. Conclusions Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.

scholarly journals The myth of pre-operative isolation during the COVID-19 pandemic

2021 ◽  
Vol 104 (3) ◽  
pp. 003685042110261
Author(s):  
Filip Mijovic ◽  
Stuart James ◽  
Bindhiya Thomas ◽  
Mohit Bhatia ◽  
Guillaume Lafaurie ◽  
...  
Keyword(s):  
Mental Health ◽  
Adverse Effect ◽  
Patient Satisfaction ◽  
National Health Service ◽  
Patient Adherence ◽  
Elective Surgery ◽  
University Hospital ◽  
Evidence Based ◽  
Retrospective Data ◽  
Second Wave

The SARS-CoV-2 (COVID-19) pandemic called for the restructuring of National Health Service (NHS) surgical departments across the country. Initial guidance advised that patients undergoing elective surgery isolate for 14 days prior to their operation. As we learnt more about COVID-19 and its incubation period, at the Princess Royal University Hospital this guidance has been decreased to 72 h. We collected retrospective data for two patient cohorts that underwent elective surgery in June and September 2020, isolating for 14 days and 72 h, respectively. We followed-up these patients with several questions allowing us to categorise the cohorts into three groups based on their compliance with isolation measures and also to assess their satisfaction with the isolation process. Our data shows that only 16% of the June cohort and 53% of the September cohort isolated in accordance with the guidelines whilst patient satisfaction was 16% and 64% respectively. These results highlight a suboptimal compliance to pre-operative guidelines as well as an adverse effect on patient mental health and raise the issue of both patient and NHS staff safety. With the possibility of a COVID-19 second wave and for future pandemics, a clear evidence-based plan for pre-operative isolation is vital. Furthermore, consideration of patient adherence and satisfaction is key in deciding which guideline will be most effective.

scholarly journals COVID ‐19 Risk in Elective Surgery during a Second Wave: a Prospective Cohort Study

2020 ◽  
Author(s):  
Paul S Myles ◽  
Sophie Wallace ◽  
David A Story ◽  
Wendy Brown ◽  
Allen C Cheng ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Elective Surgery ◽  
Second Wave

scholarly journals SP4.2.4 Single centre experience of ‘Green Zone’ elective general surgery after the first wave of COVID-19

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Muhammad Rafaih Iqbal ◽  
Subiksha Subramonian ◽  
Kabir Matwala ◽  
Catherine Morrison ◽  
Aaliya Uddin ◽  
...  
Keyword(s):  
General Surgery ◽  
Primary Outcome ◽  
Elective Surgery ◽  
General Anaesthetic ◽  
Single Centre ◽  
Prospective Data ◽  
Single Centre Experience ◽  
Assessment Approach ◽  
Green Zone ◽  
Free Environment

Abstract Introduction Elective surgery came to a halt during the first wave of COVID-19. The safe resumption of elective surgery with COVID-19 prevalent in the community, remains a significant challenge. The aim of this study was to look into the outcomes of elective general surgery in a dedicated ‘Green Zone’ following the first wave of COVID-19. Methods A ‘Green Zone’ pathway was drafted which was meant to provide a COVID-free environment for patients. Prospective data was collected on consecutive patients who underwent elective general surgical procedure at a single NHS trust over a 10-week period (1st Sept 2020 - 10th Nov 2020). The primary outcome was 30-day COVID-19 mortality. Secondary outcomes included 30-day nonCOVID-19 mortality, readmissions and complications. Results The study included 185 patients with a median age 55 years (IQR 41-67); 96 (52%) were females. Majority of the patients were ASA 2 (n = 98, 53%) followed by equal number of ASA 1 and ASA 3 (n = 42, 23%). 33 patients (18%) had been shielding earlier in the year. 96% underwent general anaesthetic. Most of the cases were day cases (n = 131, 71%). There was no 30-day COVID-19 or nonCOVID-19 mortality. One patient developed COVID-19 three weeks after the index operation. 30-day readmission and complication rate were 5% (n = 10) and 10% (n = 18). Most of the complications were Clavien-Dindo grade 1(n = 8, 4%) and 2(n = 8, 4%). Conclusion This study has shown that dedicated ‘Green Zone’ elective operating pathway is safe provided a balanced risk assessment approach is adopted.

scholarly journals Practices and attitudes of bariatric surgeons in Israel during the first phase of the COVID-19 pandemic

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Nahum Beglaibter ◽  
Orly Zelekha ◽  
Lital Keinan-Boker ◽  
Nasser Sakran ◽  
Ahmad Mahajna
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Elective Surgery ◽  
Public Hospitals ◽  
Web Based ◽  
The Public ◽  
Nation Wide Survey ◽  
Almost All ◽  
Guidelines And Recommendations ◽  
Second Wave

Abstract Introduction Israel ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons’ community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic. Methods Anonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package. Results 53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government’s decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%. Conclusions We showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more “personal non-structured” practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.

scholarly journals A seven week observational analysis of clinical activities in a North Italian orthopaedic hospital during the second wave of SARS-CoV-2 pandemic: far from usual volumes, but different from the first wave

2021 ◽  
Author(s):  
Luigi Zagra ◽  
Martina Faraldi ◽  
Mauro Andreata ◽  
Immacolata Ottaiano ◽  
Giuseppe Basile ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Health Service ◽  
Elective Surgery ◽  
Activity Levels ◽  
Hospital Budget ◽  
Observational Analysis ◽  
Orthopaedic Hospital ◽  
Second Wave ◽  
Acute Admissions

Abstract Purpose We previously described the radical changes occurred in an orthopaedic hospital in Milan (Italy) during the first SARS-CoV-2 pandemic outbreak. Currently, during the second wave, the situation is still far from normality. Here we describe the changes that took place, and are still ongoing, in the clinical practice. Methods Number and type of admissions, outpatients activity, ER and urgent procedures in SARS-CoV-2 negative and positive patients have been analyzed over seven weeks (October 26th–December 13th, 2020) and compared with the correspondent period in 2019 and the same timeframe during the first wave (February 24th–April 10th). Results 2019 vs. 2020: Overall admissions decreased by 39.8%; however, while admissions for elective surgery dropped by 42.0%, urgent surgeries increased by 117.0%. Rehabilitation admissions declined by 85.2%. White and green priority ER consultations declined by 41.6% and 52.0%, respectively; yellow and red increased by 766.7% and 400.0%, respectively. Second vs. first wave: Overall admissions increased by 58.6% with a smoother decrement in weekly admissions than during the first wave. Disparity of acute admissions vs. rehabilitation expanded: Acute cases increased by 63.6% while rehabilitation cases decreased by 8.7%. Admissions to triage procedures increased by 72.3%. Conclusions Activity levels are far from normality during the second COVID-19 wave. Elective surgery and outpatients-related activities are still strongly limited compared to 2019 while the number of urgent cases treated increased consistently. SARS-CoV-2 positive emergencies are slightly higher than during the first wave. These important changes are expected to impact on health service and hospital budget for long.

Modeling Within-Person Variance in Reaction Time Data of Older Adults

GeroPsych ◽  
2011 ◽  
Vol 24 (4) ◽  
pp. 169-176 ◽  
Author(s):  
Philippe Rast ◽  
Daniel Zimprich
Keyword(s):  
Reaction Time ◽  
Cognitive Aging ◽  
Reaction Times ◽  
Reaction Time Task ◽  
Reaction Time Data ◽  
Scale Model ◽  
Time Data ◽  
Time Task ◽  
The Mean ◽  
Second Wave

In order to model within-person (WP) variance in a reaction time task, we applied a mixed location scale model using 335 participants from the second wave of the Zurich Longitudinal Study on Cognitive Aging. The age of the respondents and the performance in another reaction time task were used to explain individual differences in the WP variance. To account for larger variances due to slower reaction times, we also used the average of the predicted individual reaction time (RT) as a predictor for the WP variability. Here, the WP variability was a function of the mean. At the same time, older participants were more variable and those with better performance in another RT task were more consistent in their responses.

Systemic Effects of ADP-induced Platelet Aggregation and Their Modification by Aspirin and by Pyridinolcarbamate

1973 ◽  
Vol 30 (01) ◽  
pp. 178-190 ◽  
Author(s):  
Itsuro Kobayashi ◽  
Paul Didisheim
Keyword(s):  
Platelet Aggregation ◽  
Venous Pressure ◽  
Systemic Effects ◽  
Central Venous ◽  
Platelet Aggregates ◽  
Induced Changes ◽  
Second Wave ◽  
Carotid Arterial ◽  
Arterial Po2

SummaryADP, AMP, or ATP was injected rapidly intravenously in rats. ADP injection resulted in the f olio wing transient changes: a drop in platelet count, a rise in central venous pressure, a fall in carotid arterial PO2, bradycardia, arrhythmia, flutter-fibrillation, and arterial hypotension. AMP and ATP produced some of these same effects; but except for hypotension, their frequency and severity Avere much less than those following ADP.Prior intravenous administration of acetylsalicylic acid or pyridinolcarbamate, two inhibitors of the second wave of ADP-induced platelet aggregation in vitro, significantly reduced the frequency and severity of all the above ADP-induced changes except hypotension. These observations suggest that many of the changes (except hypotension) observed to follow ADP injection are produced by platelet aggregates which lodge transiently in various microcirculatory beds then rapidly disaggregate and recirculate.

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