ABSTRACT
The Caribbean economy is highly dependent on the tourism industry and the protection of the natural and cultural attractions on which it depends is critical. To address this concern, this chapter provides a snapshot of the progress that has been made on sustainable tourism development in the Caribbean region. There is now more demand from the traveling public for industries to be environmentally friendly and in order to continue to use tourism as a means of economic advancement, sustainable practices must be adopted. The evidence suggests that there are great economic, sociocultural, and environmental impacts of tourism in the Caribbean region that are both positive and negative. The actions of the accommodations sector are commendable but there is the need for all major stakeholders to better manage the negative impacts of tourism development. The Caribbean Tourism Organization has developed a policy framework which consists of guiding principles and integrated policies regarding sustainable tourism development, The Caribbean Sustainable Tourism Policy and Development Framework. A shock, such as COVID-19, can lead to economic collapse as communities heavily dependent on tourism have no capacity to respond to the loss of their primary revenue source. However, in order to strengthen the resilience of small island tourism development, the Caribbean region is transitioning toward community-driven solutions through innovation, employee training, upgrades, greater digitalization, and environmental sustainability. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.
ABSTRACT
Introduction: The SARS-COV-2 pandemic has led to The redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOp) was proposed. An audit was undertaken to evaluate The SOp, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Method(s): To ascertain key pre-operative steps to include in The checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once The checklist was established The questionnaire was re-sent additionally asking for feedback On its impact On The service and suggestions for improvement. Using these results, The checklist was incorporated as a smart text to EpIC (electronic patient notes). Result(s): The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt The checklist improved The service in all domains, except bed availability and subsequent surgical delay, likely because this depended On HDU bed availability and need for on-the-day prioritisation. Conclusion(s): The CEA surgery checklist is now an established part of The electronic patient record in The form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of The team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message: With The move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by The use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.
ABSTRACT
Introduction: The aim of this prospective study was to evaluate the efficacy and safety of carotid endarterectomy for symptomatic carotid stenosis during the COVID-19 pandemic Method: Re-organisation of stroke services due to the COVID-19 pandemic resulted in carotid endarterectomy for symptomatic disease being performed in two hospitals;Covid-19 free and non-free sites Patients were referred from multiple online regional neurovascular multi-disciplinary team meetings, and managed according to the pre- Covid-19 guidance. All patients referred for carotid endarterectomy between 23 March 2020 and 31 July 2020 were included. Demographic medical history, imaging, peri-operative, complication and follow-up data were collected and analysed prospectively Result: 28 patients were referred for carotid endarterectomy, of whom 21 patients underwent surgery. The mean time to surgery was 11 days (3-35). The technical success rate was 100%. Peri-operatively and within 30-days post-operatively, no patient suffered death or stroke There were 2 minor complications;one non-ST elevation myocardial infarction, and another wound haematoma and infection requiring readmission for antibiotics. No patient developed new COVID-19 infection post-operatively. Of the 7 patients not operated on;2 were medically unfit for surgery, three declined surgery, and two had free floating thrombus that was managed successfully with anti-coagulation Conclusion: During the pandemic, the provision of carotid endarterectomy for symptomatic carotid diseases was carried out safely and within the current recommendations, with several pre-cautionary measures being undertaken. Therefore, symptomatic carotid intervention should still be considered to reduce the risk of stroke provided similar pre-cautionary measures are undertaken Take-home Message: Carotid surgery should continue during successive waves of the COVID-19 pandemic .