Closing the loop: What is the delay in Reversal of Hartmann's procedure?

Reversal of Hartmann's procedure is performed to restore intestinal continuity. There is conflicting literature on the best time for reversal, with little evidence suggesting waiting longer than a year is beneficial. We assessed the experience of our patients. Patients were identified from the local Enhanced Recovery After Surgery (ERAS) database over a 9-year period (2012-2021) at a University Hospital. Data was collected from digitalised hospital notes on patient demographics;timings to reversal of Hartmann's;defunctioning stoma;reasons for delay;length of stay;and complications. Forty-three patients underwent reversal of Hartmann's procedure. Median age was 57 (38-83) years;19 (44%) of patients were female. Surgery was performed laparoscopically in 18 (42%);laparoscopic converted to open 6 (14 %);open in 19 (44%) patients. Average length of stay was 6 days. Indications for primary Hartmann's procedure were diverticular disease (67%), malignancy (21%), and other causes (14%). Median time from the index operation to reversal of Hartmann's was 85.2 weeks (range 19.9-312.4 weeks). Only 9 (21%) patients underwent reversal Hartmann's within 1 year of primary surgery. Of the reasons known for the delay in reversal;15 (35%) were due to patient complications, 6 (14%) were due to administrative reasons, 2 (5%) were due to COVID-19 associated delays and 1 (2%) patient choice. This retrospective analysis highlights the varied patient experience within just one centre, further research incorporating detailed patient experience is needed. It also highlights a paucity of national evidence-based consensus on optimal timing for challenging revisional surgery.

COVID-19 in Pakistan: Challenges and priorities

Abstract: COVID-19 has big health issues which affect worldwide beyond their borders, race, and ethnicity. All the countries faced this pandemic challenge but most of the underdeveloped countries are facing more dangerous situations due to limited financial and health infrastructure to respond against it. Overall, more than 100 million people are affected by the Novel Virus which results in 2.15 million people dying within a small interval of time. The current pandemic has brought unpredicted challenges to societies and also threatened humanity and global resilience. According to the National Command Operation Center, Pakistan, more than 0.534 million people are suffering with COVID-19 with more than 11 thousand deaths across the country. The Government of Pakistan has taken different initiatives like complete and smart lockdown to control the pandemic as much as possible. After the removal of the first lockdown, the high peak was observed across the country and created a panic situation among people and the government again closed all the educational and religious institutions with immediate effect to tackle the second wave of pandemic. Further, the interconnected nature of COVID-19 crises demands an integrated approach and coordination between all stakeholders to handle the pandemic in a significant way. Identifying the best set of policies and guidelines to handle COVID-19 challenges, and align them for the sustainable recovery from pandemic. The basic challenge facing the policy makers of underdeveloped countries is how to utilize limited resources to achieve interconnected goals for managing health recovery, economic crises, and creating environmental sustainability. We present a framework for identifying and prioritizing policy action to address COVID-19 and ensure sustainable recovery. The framework outlines principles and criteria, and shared policy goals, identifying smart strategies, accessing policy compatibility, aligning policy instruments and improving sustainability in short and long term policy decisions. This framework can be helpful for policy makers in the short and long run for mapping policy options and accessing cross-sectoral implementation. This framework is also helpful for policy makers to prioritize policy choice and allocate limited resources in such a way that they are directed toward actions and achieve interconnected solutions of health, economy, and environment.

Impact of perceived brand age on consumer-based brand equity: Post COVID-19 pandemic era

This conceptual paper introduces the concept of perceived brand age into the brand equity literature to better understand value development utilizing brand equity model. The similarity attraction theory is introduced into the brand equity model to explore the underlining mechanism of how consumers perceive the ages of brands in relation to brand value. The research results are helpful in understating how perceived brand age generates value for consumers and how value is generated for consumers and firms through consumers' perception of brand age. This study has implications for both academics in terms of inculcating new knowledge and practitioners in terms of devising strategies in the retail pharmaceutical sector.

Evaluating a diagnostic algorithm for adult appendicitis-a quality improvement project

Introduction: Diagnosing appendicitis remains challenging, despite being the most common surgical emergency. We conducted a single-centre mixed method quality improvement project to assess the validity of a diagnostic algorithm for appendicitis and the diagnostic impact of increasing cross-sectional imaging during the Covid-19 pandemic. Method: Adult histology reports and preoperative imaging data were retrospectively retrieved for patients operated on between 1/7/19-31/ 12/19 ('baseline data') and an appendicitis diagnostic algorithm was developed. Imaging and risk stratification data were prospectively collected, as part of a national audit, between 20/03/30-23/6/20 for all adult appendicitis patients. This data was used to evaluate the efficacy of the proposed diagnostic algorithm. Use of imaging and histological diagnoses was compared between datasets. Results: 194 patients were included across both time periods. The rate of cross-sectional imaging increased from 36.6% to 76% and the normal appendicectomy rate (NAR) decreased from 5.22% to 2.4%. Thirty-six percent of patients in the latter time period were not managed in accordance with the proposed algorithm. The proposed diagnostic algorithm may have prevented up to 87.5% of normal appendicectomies across both time periods. Conclusions: Increasing cross-sectional imaging was associated with a decrease in the NAR. The use of the proposed diagnostic algorithm may have reduced the NAR further.

Impact of perceived brand age on consumer-based brand equity: Post COVID-19 pandemic era

This conceptual paper introduces the concept of perceived brand age into the brand equity literature to better understand value development utilizing Aaker (1991) brand equity model. The similarity attraction theory is introduced into the brand equity model to explore the underlining mechanism of how consumers perceive the ages of brands in relation to brand value. The research results are helpful in understating how perceived brand age generates value for consumers and how value is generated for consumers and firms through consumers' perception of brand age. This study has implications for both academics in terms of inculcating new knowledge and practitioners in terms of devising strategies in the retail mobile sector.

Clinical endodontic management during the COVID-19 pandemic: a literature review and clinical recommendations.

The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in millions of confirmed cases and hundreds of thousands of deaths. Despite all efforts to contain the spread of the disease, the number of infections and deaths continue to rise, particularly in some regions. Given its presence in the salivary secretions of affected patients, and the presence of many reported asymptomatic cases that have tested positive for COVID-19, dental professionals, including Endodontists, are at high risk of becoming infected if they do not take appropriate precautions. As of today, there are no predictable treatments or approved vaccines that can protect the public and healthcare professionals from the virus; however, there is speculation that a vaccine might be available sometime in 2021. Until then, general dentists and Endodontist will need to be able to treat emergency patients in order to relieve pressure on emergency clinics in hospitals or local community hubs. In addition, as the pandemic continues, strategies to manage patients will need to evolve from a palliative to a more permanent/definitive treatment approach. In this article, an update on the treatment considerations for dental care in general is provided, as well as a discussion on the available endodontic guidelines reported in the literature. Recommendations on clinical management of endodontic emergencies are proposed.