ABSTRACT
Keywords: Virtual;Pain;Covid-19 Purpose: Due to the Covid-19 crisis, face-to-face groups were cancelled in the fife pain management service (FPMS) for an indefinite period. This resulted in a group of patients, waiting to attend a face-to-face physiotherapy led education and exercise group, requiring an alternative format. Therefore, the need for a virtual alternative was established. The primary aim of the project was to develop and evaluate a patient self-learning resource that may be used on an individual basis, with virtual clinician support, or as part of a virtual group. The secondary aim was to develop and implement the use of this learning resource with patients on the physiotherapy led education and exercise group waiting list in a virtual environment. The tertiary aim of this project was to determine whether this virtual alternative would be an effective means of delivering pain management education during the covid-19 pandemic and beyond. Methods: A working group developed a patient self-management workbook based on the FPMS ‘Self-Management Jigsaw’ tool. An operational procedure was developed and implemented on how the workbook could be used during the pandemic and subsequent restrictions. Patients on the pre-pandemic group waiting list were invited to participate in the programme. The patients had a choice of (1) a telephone supported programme or (2) a video group programme. Due to the limitations of the service at the time, the telephone programme commenced first. The working group implemented the telephone programme operational procedure and collected patient and staff quantitative and qualitative feedback to determine the effectiveness of the intervention. Once feedback was analysed, the group made minor changes to the workbook and developed an operational procedure for a virtual video group programme. This programme was piloted and qualitative and quantitative data was collected, analysed and compared to the telephone pilot group. Results: This project demonstrated the usefulness of a workbook to support pain education virtually. The workbook was better received in the video group (9.75/10) to the telephone cohort (7.5/10). Due to limitations within this pilot project, we are unable to ascertain the reason for this. The telephone support was equally effective and valuable in both pilot groups from both quantitative and qualitative data. Both groups reported high satisfaction rates with an average of 9.5/10, with multiple positive qualitative feedback. This data suggest the user led video approach supported engagement within the group based on the comparison of retention rates. Conclusion(s): The project demonstrates that these programmes have the potential to be an effective means of delivering pain education and have a place within the service post Covid-19. However, they are very much in their infancy and further virtual programmes within the FPMS are required to determine longer term effectiveness and efficiency. Impact: Further research is required to determine whether the delivery of virtual physiotherapy led pain education and exercise groups are effective and offer comparable results to face-to-face groups. Additionally, research is required to establish which factors enable service users to engage effectively with virtual physiotherapy led pain education and exercise programmes. Funding acknowledgements: This work was not funded.
ABSTRACT
Purpose Covid-19 has impacted on the ability of hospital systems worldwide to provide access to elective and scheduled surgical care. Concerns for patient safety in the setting of a global pandemic influenced timing of colorectal surgery. The primary aim of this study was to examine the impact of COVID-19 on surgical work A second aim was to examine the rate of peri-operative COVID19 infection in a cohort of patients undergoing elective and time sensitive colorectal resection. Methods: A retrospective review of all major colorectal surgeries in a tertiary referral centre from January 2020 to January 2021 was performed. Basic demographic data was collected along with information on type of surgery, pathology involved and Covid-19 status. Results: 2.5 WTE colorectal surgeons are employed in the unit. 123 major resections were identified. Cancer resections accounted for the majority of resections (72%). Males (n = 72) were more likely to undergo cancer resections compared with females (P = 0.46) Anterior resection was the most frequent major resection (48.8%), followed by right hemicolectomy (22%). The second quarter of 2020 showed a reduction in the number of major cases performed (Q1 = 35, Q2 = 19, Q3 = 34, Q4 = 30). Preoperative COVID-19 testing began 01/04/2020. One patient (0.81%) developed Covid-19 during their inpatient stay on POD9 following an anterior resection, though remained asymptomatic. Conclusion: The first wave of Covid-19 in Ireland resulted in a reduction in the volume of major resections being performed in a tertiary referral centre during the second quarter of 2020. No patient tested positive for Covid-19 on their preoperative screening swab.
ABSTRACT
Purpose: Acute appendicitis is the most common cause of an acute abdomen. The COVID-19 pandemic has affected the management of acute appendicitis. Initial guidelines advised the use of laparoscopy only if benefits substantially exceeded the risk of potential viral transmission. The main aim of this study was to evaluate the trends in surgical management of appendicitis in the first year of COVID-19 in a tertiary referral centre in Ireland. Methods: A retrospective review of all appendicectomies in a tertiary hospital from January to December 2020 was performed. Basic demographic data was collected along with information on operative approach, conversion to open, laboratory and radiological investigations and histopathology. Results: 452 appendicectomies were identified. More males were affected, at 52.5%. The mean age was 25 years (range: 3-85 years). Laparoscopic appendicectomy was performed in 97% of cases (n = 438). All appendicectomies in January and February were laparoscopic. 66.6% of all open appendicectomies performed were in March and April (n = 4). Regarding these 4 open appendicectomies, none were perforated and 3 were paediatric patients. Open appendicectomies outside of these months (n = 2) were for complicated appendicitis. A combination of laparoscopic and open technique was required in 9 cases. Conclusion: The first phase of Covid-19 in Ireland resulted in a significant increase in the number of open appendicectomies, when concerns surrounded the potential aerosolisation of the virus during laparoscopic procedures. It was not a result of case complexity. This was not mirrored in Phase 2 of the pandemic in September and October.