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Purpose of Study The COVID-19 pandemic required rapid, global healthcare shifts to prioritize urgent or pandemic-related care and minimize transmission. Little is known about impacts on pediatric orthopedic surgeons during this time. We aimed to investigate COVID-19 related changes in practice, training, and research among pediatric orthopedic surgeons globally. Methods Used An online, cross-sectional survey was administered to orthopedic surgeons with interest in pediatrics in April 2020. The survey captured demographics and selfreported experiences during the pandemic. Surgeons were recruited through web media and email lists of orthopaedic societies over 2 months. Descriptive statistics were used to analyze results. Summary of Results We received 460 responses from 45 countries. 358 (78.5%) respondents reported lockdown measures in their region at time of survey. Most (n=337, 94.4%) reported pausing all elective procedures. Surgeons reported reduction in average number of surgeries per week, from 6.89 (SD=4.61) pre-pandemic to 1.25 (SD=2.26) at time of survey (mean difference= 5.64;95% CI=5.19, 6.10). Average number of elective outpatient appointments per week decreased from 67.89 (SD=45.78) pre-pandemic to 11.79 (SD=15.83) at time of survey (mean difference=56.10, 95% CI: 5.61, 60.58). 177 (39.4%) surgeons reported using virtual modes of outpatient appointments for the first time. Of 290 surgeons with trainees, 223 (84.5%) reported systems to continue training. Of 192 surgeons with research, 149 (82.8%) reported continuing research activities during pandemic. Most reported cessation (n=75, 64.1%) or reduction (n=40, 34.1%) in patient recruitment at time of survey. Conclusions We found significant impacts on pediatric orthopaedic practice with uptake of technology to provide care continuity. Understanding global impacts can inform sustainable practices to provide continuity in future disruptions. We will pursue follow-up surveys to assess longitudinal impacts on surgeons. Epidemiological studies are needed to assess impacts of delayed and virtual care on patient outcomes.
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Purpose/Relevance: Pediatric cases of COVID-19 have increased in the setting of the highly transmissible delta variant which has impacted the care of children by ophthalmologists. Inflammatory ocular manifestations of acute COVID-19 infections have been observed and are important to recognize and expeditiously manage. Further, ocular involvement has been recognized in MIS-C. Finally, new challenges in treating and monitoring patients with non-infectious uveitis (NIU) evolved. Guidance is needed regarding immunosuppression, reducing clinic visits/in-hospital exposures while maintaining disease control, and vaccination. Target Audience: Pediatric ophthalmologists, fellows, residents. Current Practice: Ocular inflammatory manifestations are reported in children during or after symptomatic or asymptomatic COVID-19 infection and may go unrecognized. Guidelines for managing children with NIU on immunosuppressive treatment (IMT) continues to evolve, and updated information is needed. Best Practice: Knowledge of ocular manifestations of acute and post-infectious COVID-19 including Multisystemic Inflammatory Syndrome in Children (MIS-C) will improve clinical care of children. Patients may present with conjunctivitis, optic neuritis, transient myasthenia-like syndrome, acute anterior uveitis, keratitis, pan-uveitis and papilledema. Ophthalmic management often involves systemic work-up and coordination of care amongst a multidisciplinary team. Consensus guidelines for monitoring uveitis and preventing COVID-19 infection in children with NIU on IMT may be applied to clinical practice. Expected Outcomes: Clinicians will develop an understanding of (1) Ophthalmic manifestations of acute and post-infectious COVID-19 infection and MIS-C (2) Challenges and strategies to manage NIU during a pandemic (3) Updates on infection risk and vaccination strategies for children on IMT. Format: Didactic, case presentations, rheumatology, ophthalmology panel discussion with audience participation. Summary: COVID-19-related ocular manifestations such as conjunctivitis, uveitis, pan-uveitis and optic neuritis are rare but are important to recognize. Children with NIU on IMT represent a unique patient population balancing ophthalmic follow-up and control of ocular/systemic disease and preventing infection.Copyright © 2022
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Introduction. The COVID-19 pandemic has had a dramatic impact on the health and social care landscape, both in terms of service provision and citizen need. Responsive, evidence-based research is essential to develop and implement appropriate policies and practices that manage both the pandemic itself, and the impact COVID-19 has on other health and social care issues. To address this, the Wales COVID-19 Evidence Centre (WCEC) was launched in 2021 with the aim of providing the best available, up-to-date, and relevant evidence to inform health and care decision making across Wales. Methods. Funded by the Welsh Government, the WCEC comprises of a core team and several collaborating partner organizations, including Health Technology Wales, Wales Centre for Evidence- Based Care, Specialist Unit for Review Evidence Centre, SAIL Databank, Public Health Wales, Bangor Institute for Health & Medical Research in conjunction with Health and Care Economics Cymru, and the Public Health Wales Observatory. Over the last year, WCEC has developed its rapid review processes and methodology informed by best international practice and aims to provide around 50 reviews each year. WCEC works alongside various stakeholder groups from health and social care across Wales, and they form an integral part of the review process, from scoping to knowledge mobilization. Results. To date, the WCEC has produced reviews on a diverse range of COVID-19 topics, including transmission, vaccination uptake (barriers, facilitators and interventions), mental health and wellbeing, as well as face coverings and other preventative interventions. The topics have also covered a wide range of populations, from general public, to healthcare workers, to children. These reviews have been used to inform policy and decision-making, including the Welsh Government's Chief Medical Officer 21-day COVID-19 reviews. Conclusions. The WCEC has brought together multiple specialist centers with a diverse range of skills to produce timely reviews of the most up-to-date research to support decision makers across health and social care. These reviews have informed policy and decisionmaking across Wales.
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Background. Cefiderocol (CFDC) is a Gram-negative antibiotic (GNA) with a unique mode of cell entry against carbapenem resistance. This study described the initial use of CFDC in US hospitals since its approval in November 2019. Methods. This was a retrospective study of patients treated with CFDC consecutively for >=3 days in US hospitals, as captured in Premier Healthcare Data from January 2020 to June 2021. This study described the clinical characteristics, CFDC usage, and Post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). For patients with microbiology results, the pathogen, susceptibility and culture site associated with CFDC use were described. Index culture was the culture(s) taken on the day closest to CFDC initiation. Results. Among 313 of 360 in-patients who received >=3 days CFDC, the median age was 58 years (range: 17 - 89 years), and 91% were hospitalized via emergency room, trauma, or urgent admission. The most common conditions were severe sepsis with septic shock, palliative care, and multi-drug resistant infection. Also 34% had a 'do not resuscitate order'. About 64% of patients received mechanical ventilation and 79% had ICU stay. Median length of hospital stay was 27 days (range: 3-310 days). Median days on CFDC was 8 days (range: 3 - 66 days). Over 58% received >=2 other GNAs within 14-days of initiatingCFDC.Among 187 patients withmicrobiology results, 75% had index cultures with one pathogen, and 73% had confirmed carbapenem resistant pathogens. The most common pathogens were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae and Acinetobacter baumannii. The most common index culture site was respiratory. The 14-day and 28-day crude IH-ACM from CFDC initiation was 16.3% (95%CI: 12.2%-20.4%) and 23.6% (95%CI: 18.9 - 28.4%), respectively. Among those with microbiology results, 14-day and 28-day IH-ACMwas 17.1% (95%CI: 11.7% - 22.5%) and 23.5%(95%CI: 17.4-29.6%), respectively. Among patients who died, 83% had severe sepsis with septic shock, 76% were in palliative care, 71% had a 'do not resuscitate order', and 44% had COVID-19. Conclusion. CFDC was used most frequently in critically ill patients. IH-ACM was comparable with other studies.
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Background. Cefiderocol (CFDC) has a broad activity against Gram-negative (GN) pathogens. This study describes the usage of CFDC in US hospitals in patients with microbiology data during the initial phase of commercialization. Methods. This retrospective study included patients with laboratory-confirmed GN infections in US hospitals treated with CFDC consecutively for >=3 days between March 2020 to June 2021, as captured by Premier Healthcare data. This study describes the clinical characteristics, microbiology profile, CFDC usage, and post-CFDC initiation 14-day and 28-day in-hospital all-cause mortality (IH-ACM). Index culture was defined as the last day that culture sample(s) was taken before CFDC initiation or the first day the culture sample(s) was taken after CFDC initiation if no microbiology data before CFDC use was available. Index pathogens were all pathogens identified from the index culture(s). The index culture site was where the index culture was taken. Results. A total 187 in-patients received >=3 days CFDC and had >=1 microbiological result(s). The clinical characteristics of the patients and index culture results are provided in Table 1 and Table 2. About 60% of patients had at least one positive respiratory culture. The most frequent pathogens from the index culture were Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Klebsiella pneumoniae, and Acinetobacter baumannii. Nearly 75% of patients had one index pathogen, and 91% with one culture site. Almost 30% of patients had either one pathogen identified in multiple culture sites, or multiple pathogens from >=1 culture site. Crude 28-day IH-ACM for patients with any A. baumannii was 8.3% (95%CI: 0% -19.4%), any P. aeruginosa was 17.3% (95%CI: 9.9-24.8%), any S. maltophilia was 18.4%, (95%CI: 6.1%-44.0%) and any K. pneumoniae was 26.1% (95%CI: 8.1%-44.0%). Crude 28-day IH-ACM for patients with positive respiratory culture was five times higher in COVID patients than non-COVID patients. Conclusion. During the initial phase of CFDC availability, the most frequent pathogens treated using CFDC were non-fermenters, and the most frequent culture site was respiratory. IH-ACM appears to be affected by infection characteristics, especially COVID-19 status.
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As more people use social media as a source of news and information, it is important to understand its impact on individual health decisions. This article compares the sentiment expressed in COVID-19 related tweets with national rates for first dose vaccinations as recorded by the Centers for Disease Control and Prevention. To conduct the study, the text from over 570,000 COVID-related tweets from January 2021 to December 2021 was captured. The tweets were segregated by month and Google Cloud's Natural Language API was used determine the sentiment in each tweet, with each post labeled as having positive, negative, or neutral sentiment. Overall, there was greater prevalence of negative sentiment as compared with positive sentiment during the period of review, with 45% of tweets negative, 33% positive and 22% neutral. The number of positive and negative tweets was more balanced in the early months of 2021 (when the vaccine was first available) and became decidedly more negative in the later part of the year, as misinformation about the vaccines spread prolifically on social media. This comparison of the tweet sentiment to first-time vaccine doses in the US shows that misinformation about vaccines on social media appears to have had an impact on behavior. Vaccine adoption declined significantly in the latter half of 2021, even as vaccines and information from public health officials regarding their efficacy became more available to the general public. These findings are validated by subsequent analysis of word usage by month, with positive comments about vaccines and vaccination in January through May coinciding with high vaccination rates, and a negative conversational shift to variants, increased deaths and suspicion about vaccine safety and effectiveness later in the year during a stagnation period in vaccinations. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Cefiderocol is a siderophore cephalosporin that has broad activity against Gram-negative (GN) pathogens including carbapenem resistant isolates through its unique mode of cell entry. This study describes the usage of cefiderocol in US hospitals, in patients with microbiology confirmed respiratory infections, during its first 1.5 years following commercial availability. METHODS: This was a retrospective study of patients with microbiology confirmed GN respiratory infections in US hospitals, treated with cefiderocol consecutively for ≥3 days between January 2020 to June 2021, as captured by the Premier Healthcare database. This study describes the clinical characteristics, microbiology profile, and 14-day and 28-day in-hospital all-cause mortality (IH-ACM) amongst patients treated with cefiderocol. Index culture was defined as the last culture sample(s) obtained before cefiderocol initiation, or the first culture obtained after cefiderocol initiation if no microbiology evaluation was performed prior to cefiderocol use. Index pathogen(s) were the pathogen(s) identified from the index culture(s). RESULTS: Among 113 hospitalized patients who received ≥3 days cefiderocol and had ≥1 positive respiratory culture for GN pathogens, median age was 61 years with interquartile range (IQR) of 48-72 years, 57% were male, and 93% were admitted via emergency room or urgent care. The most common comorbidities were renal disease (37%), diabetes (36%), congestive heart failure (35%), and chronic pulmonary disease (33%). Seventy-seven percent of patients received mechanical ventilation and 89% were treated in an intensive care unit. The most frequent index pathogens were Pseudomonas aeruginosa (56%), Stenotrophomonas maltophilia (24%), Klebsiella pneumoniae (13%), and Acinetobacter baumannii (11%). Also 28% of patients had more than one pathogen from index cultures and over 10% also had positive GN index cultures from other sites such as blood, urine or wound. Among 96 pathogens tested for carbapenems, 87% were resistant. Median time from hospital admission to cefiderocol initiation was 14 days (IQR: 5-25). Median cefiderocol duration was 8 days (IQR: 6-14). Before initiating cefiderocol, 88% of patients received other GN antibiotics. Median length of hospital stay was 28 days (IQR: 16-45). Crude 14-day and 28-day IH-ACM were 21.2% (95%CI: 13.7%-28.8%) and 27.4% (95%CI: 19.2-35.7%), respectively. IH-ACM was higher in COVID patients than non-COVID patient (53.1% vs. 8.6% for 14-day ACM and 65.6% vs. 12.3% for 28-day ACM, respectively). CONCLUSIONS: During the initial phase of availability, the most frequent use of cefiderocol was to treat critically ill patients with non-fermenter pathogen infections.IH-ACM appears to be affected by infection characteristics, especially COVID-19 status. CLINICAL IMPLICATIONS: Real-world data supports that Cefiderocol is effective in treating GN respiratory infections as shown in IH-ACM DISCLOSURES: Employee relationship with Shionogi Inc Please note: 2015 - present Added 06/02/2022 by Bin Cai, value=Salary No relevant relationships by Andrew Cooper Employee relationship with Shionogi, Inc Please note: 3 years Added 06/03/2022 by Stephen Marcella, value=Salary No relevant relationships by Yun Zhou
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Higher Education is the fifth largest service export sector in the United States, with international students contributing $17.7 billion to the U.S. economy each year. There is a plethora of reasons why students migrate to the U.S. to further their education, including but not limited to: (1) increasing their chances for long-term success and increasing self-efficacy;(2) supporting their family through educational advancement;and (3) gaining access to high quality education. Prior research highlights how international students face challenges linked to federal restrictions and policies that potentially hinder their academic success, all of which were heightened during the COVID-19 pandemic. Information such as this raises concern around the current state of undergraduate international STEM (science, technology, engineering, and mathematics) students in the U.S. and access to resources (i.e. scholarships, fellowships, internships, full-time jobs, etc.), especially compared to their domestic counterparts. This insight is particularly true for individuals seeking to obtain a degree within STEM (science, technology, engineering, and mathematics) as the U.S. serves as an incubator for STEM talent due to the abundance of workforce opportunities present. Therefore, it is important to explore the experiences of undergraduate international STEM students pursuing degrees in the U.S., especially as the COVID-19 pandemic continues to have a lingering effect within higher education. Our target population has an influential impact on the nation's economy, particularly H1-B visa sponsored jobs at top companies within the technology sector driving a large portion of our growth within the STEM workforce. This work in progress focused on qualitative analysis centered on the experience of undergraduate international STEM students. This study includes a literature review that highlights the latest findings around our target populations' experiences during the pandemic. Following that, the methods highlight our proposal to conduct a qualitative analysis including interviews with current students. The methods section closes with a draft of the interview questions which center around their experiences, barriers and challenges they face (past and present) related to the pandemic and information related to access to resources. Lastly, an overview of the proposed impact, implications of this study once complete and overarching conclusions. The goal is to get feedback from the broader ASEE community, finalized the interview protocol, conduct the interviews, analyze, and share results and use the overall findings to propose new directions and future work for the broader community. © American Society for Engineering Education, 2022.
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Context: The UK social care sector has come under increased pressure to combat workforce shortages. With international recruitment of professionals impacted by Brexit and the COVID-19 pandemic, social care is in need of innovations to attract, recruit and retain staff. Objectives: This review aimed to identify (1) innovations to attract, recruit, and retain social workers (professionals working with children and adults to protect them from harm, often as case managers) and the wider social care workforce (workers providing direct practical support to children and adults with their daily activities) and (2) factors influencing staff turnover in the UK context. Method: Pre-defined inclusion criteria were developed using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Searches were conducted across three databases and 32 key United Kingdom third sector and government organisations from 2001. In total, 1,835 citations were retrieved and 40 met the eligibility criteria (13 for social workers and 28 for social care workforce). Thematic analysis was used to explore the data and presented across two evidence maps. Findings: Evaluation evidence was only available for a small portion of innovations identified. Practice learning, fast-track graduate programmes, and apprenticeships may support the retention of social workers, while pre-employment training, national recruitment campaigns, care work ambassadors, and values-based recruitment could help attraction, recruitment, and retention of the wider social care workforce. Limitations: Most of the included studies were conducted pre-pandemic and mainly relied on descriptive and explorative methodologies. Implications: Future policy initiatives should include an evaluation strategy from the outset to develop a more extensive evidence base. Funding bodies should offer schemes supporting research in this area. © 2022 The Author(s).
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The COVID-19 pandemic resulted in temporary school closures across the world, increasing pressure on educators to rapidly cultivate new skills. This novel research examines the implementation and impact of remote teaching and learning in early primary contexts in Canada from the perspectives of key stakeholders. There is a particular need to investigate the impacts of the pandemic in early primary contexts, as teaching in the early years is primarily play- and inquiry-based and comes with its own unique challenges. Data collection took place in April–June 2020 and included 45-min semi-structured interviews with educators (n = 25) and parents (n = 11). Data analysis included an emergent thematic approach and resulted in five themes: parent involvement, role of educators and administration, curriculum and pedagogy, focus on formative assessment, and recommendations for improvement. Findings of this research can be used by policy makers and Ministries of Education as they work to address the global education crisis and mitigate educational challenges for those who matter most: the students, parents, and educators. © 2022, The Author(s), under exclusive license to Springer Nature Switzerland AG.
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Utilizing narrative inquiry and thematic analysis, this study followed up with adult students who initially participated in a qualitative project, Understanding How Students Reconnect: A Longitudinal Study (Collom et al., 2021). Five participants shared their experiences as adult students during COVID-19, which included their experiences shifting to virtual learning and the broader effects of the pandemic on their lives. Our findings indicated that while students coped with the transition to virtual learning, the overall perceived quality of education dropped and forced students to make difficult family and employment decisions. Overall, the study illuminated the barriers that exist for adult students who have faced unexpected life-events and demonstrated the need for institutions to build supports for adult students beyond tuition-free college. Our findings highlight the need for supports above tuition for Tennessee Reconnect students. While Tennessee Reconnect has substantially increased adult student enrollment in the state, increased support is essential to realize the full benefits of the policy.
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Multi-decadal datasets for endangered species that track both populations and performance of management interventions are rare. One such dataset is for the critically endangered Spotted handfish, a species which has been used as a conservation model for the most endangered of the marine bony fish families the Brachionichthyidae. We assessed a 23-year, multi-site, time-series of population density surveys for the spotted handfish as well as a conservation intervention, the planting of ∼14,000 artificial spawning habitats (ASH). Data ownership spanned multiple Principal Investigators (PIs) and key data and covariates, such as monitoring and interventions, were often documented within personal files and difficult to access grey literature. We consolidated and curated these data, identifying gaps in the time-series and their causes and isolating confounding factors before we assessed population trends and the effectiveness of ASH planting. Both funding gaps and the 2020 Covid-19 lockdown produced breaks in the time-series. Breeding season observations mostly occurred in the early part of the dataset and there was also a change in method that needed to be considered when interpretating of the time-series. There was an overall decline in fish observed between 1997-2019 but, at least since 2014, there has been stabilisation of the population. Local populations of spotted handfish can either be highly dynamic or relatively stable but population increases were linked to the long-running, conservation intervention of planting ASH. As local populations can be dynamic, the functional life span of the ASH is limited and threats to the species - chronic, stochastic and climate - are ongoing, spotted handfish may be a ‘conservation reliant’ species that require annual site-specific monitoring, insitu interventions and existu captive husbandry.
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Background: In June 2020, dexamethasone use was approved for hospitalised coronavirus (covid-19) patients in the United Kingdom. Hyperglycaemia in this group has been associated with increased mortality, leading to a national guidance in managing it. Aims: To assess variability in managing hyperglycaemia during dexamethasone therapy and glycaemic outcomes post dexamethasone in covid-19 patients. Method: Retrospective data analysis was performed for 150 dexamethasone-treated covid-19 adult, non-pregnant patients admitted between June and December 2020. We looked at baseline clinical characteristics, adherence to guidance in managing hyperglycaemia and insulin requirement on discharge. Results: Of the 150 patients, 117 (78%) were known to have type 2 diabetes. Of the 27 (18%) not known to have diabetes, 24 had a glycated haemoglobin of 42mmol mol-1 or more, suggesting undiagnosed diabetes and the majority (38%) were White. Prior to dexamethasone, 121 (81%) were not on insulin. After the first dose, 82% had a blood glucose check within 12 hours, 79% had a blood glucose of more than 12mmol l-1 within 24 hours and only 50% had the recommended four times daily blood glucose checks. Of the 121 insulin naive patients, only 52% were managed with the recommended twice daily Neutral Protamine Hagedorn insulin, while 27 (22%) needed insulin on discharge. Of those 27 patients, 44% were White, 26% were Asian and 26% had not declared their ethnicity. Conclusions: Our data show a notable variability in managing hyperglycaemia in dexamethasone-treated covid-19 patients. In this cohort, a high proportion of insulin naive patients required insulin on discharge, suggesting a high risk for progression of diabetes.
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Systemic disruptions from COVID-19 have transformed the assessment landscape in Canada and across the world. Alongside repeated shifts to emergency remote teaching, large-scale assessments and summative evaluations were cancelled in many jurisdictions, and repeated concerns were raised about ensuring equity and access to quality education. This paper investigates the rapid–and in many cases innovative–responses teachers offered to these challenges at the height of the pandemic. Drawing on prolonged semi-structured interviews with 17 secondary school teachers in Ontario, Canada, the paper provides a detailed account of Ontario’s approach to assessment during COVID-19, exemplified by participants’ lived experiences. Results highlight the notion of emergency remote assessment, the vital role of assessment in stemming widening equity and well-being gaps, and emerging consequences from this period. These data offer critical insights into the future of our forever-changed education landscape, and position classroom assessment as a priority player in this work. © 2022 Informa UK Limited, trading as Taylor & Francis Group.
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AIM: To determine which filtering face piece (FFP3) respirators worn throughout the COVID-19 pandemic are safe for magnetic resonance imaging (MRI). MATERIALS AND METHODS: Three clinical MRI sequences were performed to assess imaging artefacts, grid distortion, and local heating for eight commercially available FFP3 respirators. All examinations were performed at Cardiff University Brain Research Imaging Centre using a 3 T Siemens Magnetom Prisma with a 64-channel head and neck coil. Each FFP3 mask was positioned on a custom-developed three-dimensional (3D) head phantom for testing. RESULTS: Five of the eight FFP3 masks contained ferromagnetic components and were regarded as "MRI unsafe". One mask was considered "MRI conditional" and only two masks were deemed "MRI safe" for both MRI staff and patients. Temperature strips positioned at the nasal bridge of the phantom did not exhibit local heating. A maximum grid distortion of 5 mm was seen in the anterior portion of the head of the ferromagnetic FFP3 masks. CONCLUSION: This study has demonstrated the importance of assessing respiratory FFP3 masks for use in and around MRI machines. Future research involving FFP3 masks can be conducted safely by following the procedures laid out in this study.
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COVID-19 , Artifacts , COVID-19/prevention & control , Humans , Magnetic Resonance Imaging , Masks , Pandemics/prevention & controlABSTRACT
Subgroup discovery is a data mining technique that attempts to find interesting relationships between different instances in a dataset with respect to a property of interest. Cluster analysis is a popular method for extracting homogeneous groups from a heterogeneous population, however, it often yields results that are challenging to interpret and action. In this work, we propose a novel, multi-step clustering methodology based on SHAP (SHapley Additive exPlanation) values and dimensionality reduction, for the purpose of subgroup discovery. Our method produces well-separated clusters that can be readily differentiated by simple decision rules, to yield interpretable subgroups in relation to a target variable. We illustrate our approach using self-reported COVID-19 symptom data across 2,479 participants who tested positive for COVID-19, resulting in the identification of 16 distinct symptom presentations. Future work will investigate common demographic and clinical features exhibited by each cluster cohort, and map clusters to outcomes to better understand the clinical presentation, risk factors and prognosis in COVID-19, as a timely and impactful application of this methodology. © 2021, Springer Nature Switzerland AG.
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Aim: LTHT is the largest acute surgical unit in the UK and has seen an annual 11% increase in attendances with often 90 patients assessed daily. 40% patients present with acute biliary pathology but despite this there has been no dedicated operating list for this cohort of patients. Rapid Access Theatre (RAT) lists were created to manage these patients. We report our early results. Method: In October 2020 the trust appointed four EGS Consultants forming a dedicated acute general surgical service. Emphasis was placed on creating ambulatory pathways and those patients safe to be managed at home but requiring surgical intervention are placed on a day case RAT list. COVID-19 has restricted the broad use of this service for all emergency admissions but biliary pathology continues to be amenable to these pathways. Data was collected retrospectively using in-house coding and electronic patient database systems. Results: 34 day case laparoscopic cholecystectomies were performed in the first 10 weeks. Mean age was 44(17-67) with a male:female ratio of 1:1. Mean wait time from clinical review to theatre was 11(3-23) days. 1 patient required overnight admission but there were no readmissions and no reported complications at 30 days. Conclusion: Despite isolation restrictions resulting from COVID-19, the service has allowed patients to be assessed and treated in a timely, safe fashion. The new service has resulted in significant reductions in bed stays and improved patient experiences. Financial savings have been clearly delineated and as such expansion of the model is underway.