ABSTRACT
Background: The COVID-19 pandemic was declared the greatest challenge the NHS would face since its creation. As a means of combatting the unprecedented strains COVID-19 was expected to force upon hospitals and their staff, NHS England sanctioned the postponement of all non-urgent elective surgery during the first wave of the COVID-19 pandemic. Approximately 70 000 cholecystectomies are performed every year in the UK, with the vast majority of these being elective laparoscopic cholecystectomies (LC). However, in the early stages of the pandemic, both national and international surgical bodies warned of the potential risks of aerosol virus transmission with the use of laparoscopy. Therefore, conservative management for emergency general surgical pathologies was recommended where possible. Delays in performing LC are associated with recurrent cholecystitis, pancreatitis and cholangitis;all of which present as emergencies with significant associated morbidity and mortality. This in turn has an economic impact on the NHS. We aimed to evaluate if patients undergoing emergency LC during the COVID-19 pandemic at our site, had different outcomes compared to those treated prior to the pandemic. Has the COVID-19 pandemic negatively impacted their patient journey? Furthermore, has the pandemic led to increased costs for our site? Methods: A retrospective data collection was performed to identify all patients who had an emergency LC from March 2019 - March 2021. Patients were subsequently categorised into 'pre-COVID-19' and 'during COVID-19' groups. Hospital computer systems were used to review operative admission length of stay (LoS), rate of conversion to open surgery/subtotal cholecystectomy, operative time, post-operative complications/return to theatre and readmission rate. Histopathology reports were analyzed to assess if the 'during COVID-19' cohort had a higher rate of complicated cholecystitis. Finally costs of the operative admission and associated admissions (pre and post-operatively), as well as the tariff for investigations performed for gallstone disease were calculated for each cohort of patients. Result(s): 158 patients were included in the study. A 42% reduction in emergency LC cases was observed during the COVID-19 pandemic compared to pre-pandemic. No statistically significant differences were seen between the two groups when reviewing the rate of conversion to open surgery or the incidence of post-operative complications/need to return to theatre. The rate of subtotal cholecystectomy was higher in the 'during COVID-19' group (12% vs. 3%) and this was found to be statistically significant (p-value 0.024). Operating times were longer during the pandemic (93 vs. 80 mins), as was the LoS for the operative admission (5 vs. 6 days), however these results were not statistically significant. Interestingly, same day emergency care (SDEC) reviews were more frequent in the 'during COVID-19' group (13.1 vs. 29.3%) and this was statistically significant (p-value 0.015). There was no statistically significant difference between the groups in relation to histopathology results. The most prevalent histopathology of both cohorts was chronic cholecystitis (58 vs. 48.28%). Acute on chronic cholecystitis (23 vs. 25.86%) and necrotising/gangranous changes (11 vs. 12.07%) were more prevalent in the 'during COVID-19' group. When reviewing costs between the two groups, no statistically significant differences in LoS, nor investigation tariffs was observed. Conclusion(s): Our study shows that the COVID-19 pandemic has had a negative impact on two clinical aspects of emergency LC - an increase in the rate of subtotal cholecystectomy, as well as SDEC reviews. This could be explained by delays in elective surgery encountered during the pandemic, leading to patients experiencing recurrent infections, or other associated complications of gallstone disease and consequently requiring more frequent clinician/SDEC reviews. These complications can also result in unclear anatomy, diffuse scarring, necrosis and abscess formation, all of which n lead to increasingly complex cases encountered intra-operatively. If surgeons are unable to safely achieve a critical view of safety, guidance recommends subtotal cholecystectomy as a bail out procedure, in order to avoid serious damage to the bile duct or blood vessels. This could justify the statistically significant higher rate of subtotal cholecystectomy in the 'during COVID-19' group. Currently, there are approximately 6 million patients on NHS surgical waiting lists and this issue must be addressed urgently in the COVID-19 recovery phase, so as to prevent adverse outcomes for both patients and the NHS.
ABSTRACT
Aim: Remote consultations (RC) were implemented during the COVID-19 pandemic with the aim of preventing transmission of the virus. We conducted a survey to assess patients' and clinicians' satisfaction of RC. Method: Two online surveys were created for patient and clinician feedback, and each recorded a cohorts' opinions on various aspects of RC. The surveys were distributed to Urology, General and Vascular surgery departments at three NHS trusts. Patient feedback was collected over the phone, whilst clinicians completed the survey online. Results: Overall, responses from 99 patients and 22 clinicians were collected. 89.9% of patients were either 'satisfied or very satisfied' with RC, compared to 77.2% of clinicians who practiced RC. 93.9 % of patients felt they were able to discuss all their concerns during their RC. However, outside of the COVID-19 setting 50% of patients and 59.1% of clinicians would prefer face to face consultations. Both cohorts reported adherence to social distancing and convenience as key advantages of RC;furthermore 68.2% of clinicians thought RC were economically beneficial. 100% of clinicians felt the inability to examine patients was a disadvantage of RC and 33.8% of patients agreed with this. Conclusions: The majority of feedback from patients and clinicians was positive for RC. However, in future approximately 55% of both cohorts would prefer face to face consultations. Looking forward, we believe RC can form a part of routine practice in selected groups of patients, where it could potentially save time and money without compromising patient or clinician satisfaction.
ABSTRACT
In this work, we present the combination of near-infrared spectroscopy and chemometrics to distinguish respiratory syncytial virus (RSV) and Sendai virus (SeV), the first study of its kind. Using a low-cost and portable spectrometer, a total of 440 virus spectra were collected over four separate sessions. The spectra were pre-processed by normalisation and baseline removal, and variable elimination was conducted based on the standard deviation. Partial least squares discrimination analysis was used to model the relationship between the spectra and the virus categories, resulting in the accuracy of 0.825 and 0.855 for validation and prediction, respectively. Since the portable spectrometer has simple operation and can provide analytical results in real time, it can be used as a viable tool for rapid, on-site and low-cost virus screening for RSV, SeV and possibly other similar viruses such as SARS-CoV-2.
ABSTRACT
Background: Known risk factors for child maltreatment, including parental unemployment and domestic violence (1, 2), were compounded by social isolation from school closures and restriction of home visitors during the COVID-19 lockdown. Data on the incidence of child maltreatment during the pandemic is limited. Aim: Our study aimed to compare the incidence of and characterize the types of child protection concerns among inpatients during the 2020 lockdown versus the same period in 2019. Methods: We carried out a retrospective chart review of inpatients at Children's Health Ireland (CHI) at Crumlin and CHI at Tallaght assessed for child protection concerns during the lockdown from March 13 to August 31, 2020, and the same timeframe in 2019. Results: Fewer patients with child protection concern were admitted in 2020 (n=86) compared to 2019 (n=163). Total admissions were also less in 2020 (n=4609) compared to 2019 (n=7728). Patients assessed for child protection concerns accounted for a smaller percentage of inpatients in 2020 (1.8% versus 2.1% in 2019 (p=0.35)). In 2020, there was a greater percentage of physical (52.3% versus 11% in 2019 (p<.001)) and emotional (6.9% versus 1.2% in 2019 (p=0.014)) abuse concern cases. There was also a greater percentage of neglect and sexual abuse concern cases and a lower percentage of welfare concern cases in 2020, but these differences were not statistically significant. The cases in 2020 were more complex, with 48.8% involving more than one concern type per case versus 13.4% in 2019 (p<.001). Child protection concerns increased steadily during the lockdown, peaking in July. In 2020, there were more unwitnessed injuries (34.8% versus 17.7% in 2019 (p=.002)) and parental use of physical discipline (6.9% versus 0.6% in 2019 (p=.003)). No statistically significant differences in delayed presentation and domestic violence were observed. Conclusions: While fewer inpatients were assessed for child protection concerns during the 2020 lockdown versus 2019, the 2020 cases were more complex. An increase in physical and emotional abuse concerns, unwitnessed injuries and physical disciplining highlights child protection issues specific to the pandemic.