Exploring COVID-19 pandemic potential impacts on students' school travel behavior

This study aims to identify the impacts of the COVID-19 pandemic on school trips using a survey of 1120 students and their households in Cairo, Egypt. We found that students' age, distance to school, and school type (public or private) influence the mode used to school, the majority of parents would prefer to wait for one month or more after the lockdown before sending their children to school, and the pandemic has a significant impact on parents' evaluation of the various schooling options. Based on the responses and using different scenarios, we predicted that the original vehicle-kilometers-traveled would increase by 17% to 34%, with most of the expected modal shift occurring from large occupancy vehicles to smaller vehicles. This shift was attributed to;the distance to school, the father's occupation and education level, parents waiting more time to send children to school, and parents expecting reduced class capacity. © 2023 Informa UK Limited, trading as Taylor & Francis Group.

Safety and efficacy of transurethral resection of bladder tumour comparing spinal anaesthesia to spinal anaesthesia with an obturator nerve block: A systematic review and meta-analysis

INTRODUCTION AND OBJECTIVE: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosol-generating procedures. We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. METHODS: We conducted a comprehensive search of electronic databases (MEDLINE, PUBMED, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar and Web of Science), identifying studies comparing the outcomes of TURBT using spinal anaesthesia versus spinal with an obturator nerve block. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data. RESULTS: Searches of electronic databases resulted in 107 articles, from which four randomised control trials (RCTs) and three cohort studies met the eligibility criteria, enrolling a total of 448 patients. The use of spinal anaesthesia with an obturator nerve block was associated with a significantly reduced risk of obturator reflex (p <0.00001), bladder perforation (p=0.02), incomplete resection (p <0.0001) and 12-month tumour recurrence (p=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity (0/159). CONCLUSIONS: Our meta-analysis suggests that TURBT employing spinal anaesthesia with an obturator nerve block is superior to the use of spinal anaesthesia alone. During the COVID-19 pandemic, where avoidance of aerosol-generating procedures (AGPs) such as a general anaesthesia is paramount, the use of an obturator nerve block with spinal anaesthesia is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade.

Safety and efficacy of transurethral resection of bladder tumour comparing spinal anaesthesia to spinal anaesthesia with an obturator nerve block: A systematic review and meta-analysis

Introduction: To investigate whether spinal anaesthesia with an obturator nerve block (SA+ONB) can be effectively employed for transurethral resection of bladder tumours (TURBT) during the COVID-19 pandemic to improve patient outcomes whilst also avoiding aerosolgenerating procedures (AGPs). We aimed to compare outcomes of TURBT using spinal anaesthesia (SA) alone versus SA+ONB in terms of rates of obturator reflex, bladder perforation, incomplete tumour resection, tumour recurrence and local anaesthetic toxicity. Methods: We conducted a comprehensive search of electronic databases, identifying studies comparing the outcomes of TURBT using SA versus SA+ONB. The Cochrane risk-of-bias tool for RCTs and the Newcastle- Ottawa scale for observational studies were used to assess the studies. Random effects modelling was used to calculate pooled outcome data. Results: Four randomised control trials (RCTs) and three cohort studies were identified, enrolling a total of 448 patients. The use of SA+ONB was associated with a significantly reduced risk of obturator reflex(P<0.00001), bladder perforation(P=0.02), incomplete resection(P<0.0001) and 12-month tumour recurrence(P=0.005). Obturator nerve block was not associated with an increased risk of local anaesthetic toxicity(0/159). Conclusions: Our meta-analysis suggests that TURBT employing SA+ONB is superior to the use of SA alone. During the COVID-19 pandemic, where avoidance of AGPs such as general anaesthesia is paramount, the use of SA+ONB is essential for the safety of both patients and staff without compromising care. Further high-quality RCTs with adequate sample sizes are required to compare the different techniques of obturator nerve block as well as comparing this method to general anaesthesia with complete neuromuscular blockade.