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Aims: The COVID-19 pandemic has ledtoa changein working practices in The diagnosis and management of Colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact. Method(s): All patients diagnosed with Colorectal Cancer in The authors' tertiary surgical unit in three 4-month intervals were included. These corresponded to before The pandemic (March-June 2019), during The UK's first wave of COVID-19 (March-June 2020), and during The second wave (December 2020-March 2021). The incidence of stomas was compared between groups. Result(s): In patients undergoing elective Surgery The incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during The first wave and increased to 54% in The second wave. Similar trends were seen in patients undergoing emergency Surgery with 36% having stomas before The pandemic which rose to 50% during both The waves. Conclusion(s): A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned Surgery in The UK, patients requiring stoma reversal adds to The backlog. As The huge task of clearing The backlog begins, surgical teams must be provided with appropriate resources, professional and mental Health support.
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Aim: Annually 9.9 million people undergo elective Surgery in The NHS. The National Institute of Health and Care Excellence (NICE) published guidelines on 'Routine pre-operative tests in elective surgery' in 2016. It aimed to reduce unnecessary testing by taking into account patient comorbidities and The complexity of surgery. Excessive testing can cause significant anxiety in patients, delays in treatment and exposure to COVID caused by unnecessary hospital visits. Additionally, unnecessary blood tests can exacerbate blood bottle shortages. We are auditing The compliance of NICE guidelines when requesting blood tests for elective General surgical patients in pre-operative assessment clinics at Northampton General Hospital (NGH) Method: The audit team at NGH provided details of The first 64 patients undergoing elective General Surgery (categorised into 22 Minor, 23 Intermediate, 19 Major procedures), from May to July 2021. Electronic records were used to determine patient ASA grades and blood tests requested at pre-operative assessment clinics. These were checked against NICE (2016) guidelines. Result(s): Conclusion(s): There is poor compliance with NICE guidelines. NGH Anaesthetic team have implemented changes in November 2021, as part of MyPreop online app, to ensure these guidelines are followed. We will re-audit in February 2022 and consider implementing changes across all surgical specialties.
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Background: Approximately 100,000 hernia repairs are performed in the UK annually, the vast majority in hospital usually under general anaesthetic. Due to increased pressure on hospital facilities especially after the COVID-19 pandemic the waiting times for non-emergency surgery for benign conditions has increased. This study outlines the development and feasibility of a dedicated ambulatory primary care hernia service and examines the outcomes achieved between November 2018 and November 2021. Method(s): We prospectively analysed of records of 212 patients who underwent hernia repair in a primary care centre during the above period. Inclusion criteria were a) BMI<35 b) uncomplicated inguinal or umbilical hernia c) non recurrent hernia. The techniques used were Lichtenstein mesh repair for inguinal hernias and a primary sutured repair for ventral hernias. All procedures were performed as day-cases under local anaesthesia without sedation. All patients were telephoned by a healthcare professional a day after their operation. The primary outcomes of the study were length of stay, immediate complications and the secondary outcome was cost effectiveness. Result(s): The median length of post-operative stay was 26 minutes. Complications were low and seen only in 5 patients and managed conservatively. The cost of hernia repair in primary care in UK is only 1012 when compared to 1800 in an NHS hospital. Conclusion(s): Routine elective abdominal wall hernia repairs can be performed in a primary care setting, safely, with good clinical outcomes and clear economic benefits. However, this depends on the availability of surgeons and adequate funds to establish the service.
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Artificial intelligence has developed in recent years. It is mostly enviable to discover the facility of contemporaneous state-of-the-art techniques and to examine lung nodule features in terms of a large population. Now a days lung plays a major role all over the world in early prevention in disease identification. The latest progress of deep learning sustains the recognition and categorization of medical images of respiratory problems. There are varieties of lung diseases to be analyzed to select the high mortality rate among them. In this paper, we have provided a comprehensive study of several lung ailments, in particular lung cancer, pneumonia, and COVID-19/SARS, Chronic Obstructive Pulmonary Disease. Existing deep learning methodology used to diagnose lung diseases are clearly explained and it will be helpful for the lung disease identify the system. © 2022, IFIP International Federation for Information Processing.
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Background: The Covid 19 was declared a global pandemic that had a sizeable impact on the health care services in the surgical field including the orthopaedic department. There was additionally a decreased accessibility to healthcare personnel and facilities reallocated to manage the Covid patients. The study was mainly conducted to find out the impact of the first wave of COVID-19 on the orthopaedic surgeries. Aim: The main aim of the study is to find out the alteration in the number, type of surgeries, financial implications, duration of hospital stay, delay in surgery during the first wave of the COVID-19 pandemic. Study Design: Retrospective crossectional study. Methods: All the surgeries conducted in the orthopaedic department in the year 2019 and 2020 following first peak in March including pre-op and post-op COVID cases are included in the study. The procedure conducted, date of admission, date of surgery, date of discharge, investigations done and the cost expenses are the various parameters that are taken into consideration. The results are analysed for each year and comparisons are made using statistical methods. Results: The comparative analysis of the data collected from the years 2019 and 2020 showed an increase in the duration of hospital stay, delay in surgery, additional expenditure, back log in the number of elective surgeries done during the Pandemic.
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BACKGROUND: The COVID-19 pandemic and the eventual national lockdown in the UK brought a halt to the face-to-face outpatient appointments at most NHS hospitals. Owing to this, clinicians have had to switch to other means of consultation, to maintain continuity of care. This survey was done to see how surgeons perceive telemedicine as part of their surgical consultations. METHODS: A questionnaire was piloted and re-designed following which an improved questionnaire was circulated among all users of telemedicine in surgical specialties through social media platforms. The results were analysed using smart survey software. RESULTS: Seventy per cent of the respondents had never used telemedicine before the COVID-19 pandemic. Three-quarters of the respondents found difficulty in assessing patients preoperatively. A significant proportion were worried about confidentiality and data security. The other concerns expressed were difficulty in building a rapport and the absence of a legal framework to support the surgeons in the transition. Despite some concerns, most of them were in favour of using telemedicine in the future with some improvements. CONCLUSION: As the pandemic prevented people from attending face-to-face appointments, remote consultations were stepped up to help overcome the difficulties. Screening services were suspended and treatment accumulated. Telemedicine will be a corner-stone service as healthcare systems attempt to tackle this backlog. The already existing software need to be further explored. Future studies must address the use of telemedicine in preoperative consultations. Regulatory bodies must ensure that there is adequate legal framework in place so that clinicians continue to embrace telemedicine.