Identifying candidates for one-night stay robot assisted simple prostatectomy: Single center analysis

Introduction & Objectives: Since COVID-19 global pandemic started, increasing importance was given to same-day discharge (SDD) protocols to minimize viral exposure, reducing healthcare costs without compromising patients' safety. While SDD protocols have been applied for robotic radical prostatectomy, literature is still lacking studies evaluating the feasibility of meeting SSD criteria for patients who underwent RASP. Our aim was to evaluate the feasibility and safety of hospital discharge 24h after surgery. Our secondary endpoint was to assess predictors of successful discharge on 1st postoperative day (POD). Material(s) and Method(s): Patients with allergy to local anesthetics, those scheduled for concomitant surgical procedures and those with severe comorbidities (ASA score 3-4) were excluded from the analysis. Outcomes of this study were: Postoperative Hb drop, 30-day post-surgical readmission, any post-discharge complication, postoperative, time to flatus and consequent regular diet restoration, PSA, flowmetry parameters and validated questionnaires. The SDD criteria included: stable postoperative hemoglobin and vital signs, tolerance of clear liquids, pain control with oral medications and no perioperative complications requiring a prolonged hospitalization (Clavien >1). Result(s): Demographics and baseline values of 63 consecutive patients were reported in Table 1. Perioperative outcomes were shown in table 2. No perioperative complications were reported, median DELTAHb was 2.2 mg/dl, vital signs were stable for every patient. Overall, 55 (87%) patients passed flatus within 24 hours from surgery, and regular diet was restored;7 patients (11%) needed opioids for pain control. Two thirds of patients (n=42, 67%) met the criteria for SDD. At logistic regression analysis, patient's age was the only independent predictor of one night stay (OR 0.89;95% CI 0.80 - 0.98 p=0.02;Table 3). Patients younger than 60 met 24 hours discharge criteria in 90%, while those older than 70 in 50% of cases. Conclusion(s): In a selected cohort of patients with negligible comorbidities profile, discharge within 24h from RASP seems a safe and feasible option in 67% of cases. Patient' age was the only predictor of successful 1 night stay after RASP in our series. [Table presented]Copyright © 2023 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Assessment of the use and Safety of Protection Box for Intubation and Extubation Among Anaesthesiologists During COVID-19 Pandemic- A Cross-sectional Survey.

Introduction: Covid 19 epidemic has affected the people making them undergo emergency procedures requiring intubation. A protective box was innovated at our tertiary care centre to safeguard the HCW during intubation and/or extubation and the study was planned to assess its use and safety among the anaesthesiologists. Methods: A cross sectional, questionnaire base survey was done among anaesthesiologists in various strata of residency. The intubation box was used on the patient for intubation and extubation. The experience of participants was recorded via a Google Form and one response per participant was restricted. Participants were divided into two groups, Group 1(1stand 2nd year junior residents) and Group 2 (Senior resident and 3rd year junior resident). A valid response, was received from 25 anaesthesiologists who were either performing or assisting the intubation. The residents were evaluated based on the ease of use and safety features of the box. Results: There was a significant difference in the time taken to intubate between the two groups (p = 0.048) and it was found that Group 2 with more experience took less time to intubate than Group 1. Also, more respondents in Group 2 found it easier to manoeuvre the hands to handle instruments than Group 1(p = 0.024). Conclusion: We recommend that usage of intubation box during intubation or extubation is a non-harmful and necessary compromise that we must make to protect the /safeguard the well-being of Health Care Worker without affecting patient care in our fight with COVID-19. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03692-7.

COVID-19 pandemic burnout in an Italian sample of anaesthesiologists: coping strategies, resilience and the capability of tolerating the uncertainty as preventing factors.

The present study aims to explore the prevalence of burnout characteristics and their association with resilience, coping strategies, and the intolerance of uncertainty dimensions. It also aims to explore the predictive effect of these variables on burnout dimensions, separately. Through the SurveyMonkey platform, 1,009 anaesthesiologists completed the Maslach Burnout Inventory (MBI), Resilience Scale, Intolerance of Uncertainty Scale Short Form (IU), and the Coping Inventory for Stressful Situations (CISS). According to the MBI cut-off, 39.7% and 25.8% of participants scored high in Emotional Exhaustion and Depersonalization, respectively, and 44.2% scored low in Personal Accomplishment. Several significant correlations between burnout dimensions and resilience, coping strategies, and the intolerance of uncertainty emerged. Regarding the linear regression models tested, coping strategies, resilience, and age showed a significant predictive effect on all three of the burnout dimensions. In conclusion, the results showed that individual levels of resilience and one's ability to tolerate uncertainty and task-oriented coping strategies represent significant factors for lower burnout levels in Italian anaesthesiologists during COVID-19 pandemic. These findings highlight the importance of intervention aimed at promoting useful coping strategies and enhancing resilience among healthcare workers.

The well-being of physicians during the COVID-pandemic in a Belgian tertiary hospital

Background: COVID-19 has become the largest medical challenge worldwide, affecting the physical and mental well-being of physicians. The aim of this study was to explore the well-being of physicians during the second wave of the COVID-19 outbreak in a Belgian tertiary hospital, with special attention to anaesthesiologists. They were confronted with overcrowded intensive care units, were mentally challenged during several months by an overwhelming workload. Method(s): All physicians of the Antwerp University Hospital (UZA) were invited to participate through an online anonymous questionnaire to objectively evaluate their well-being during the second wave of the COVID-19 outbreak in Belgium. Mental well-being was evaluated by the validated Warwick-Edinburgh Mental Well-being Scale (WEMWBS) summing 14 equally weighted questions (scoring range 1 to 5) about mental well-being. Demographic data such as age, gender, function, COVID exposure was collected. Result(s): Ninety physicians, 42 residents and 48 staff members, completed the questionnaire with an average WEMWBS of 50.6+/-8.0. Participating residents were deployed more on COVID-19 departments compared to participating staff members (p=0.02) and reported a higher workload (p=0.001). Residents scored significantly lower on the WEMBWS compared to staff members (48.1+/-8.2 vs. 52.8+/-7.3, p=0.01). Also, 15 female anaesthesiologists scored significantly lower in the WEMWBS compared to their 12 male colleagues (p=0.03). Conclusion(s): During the second wave of the COVID-19 outbreak in Belgium, residents reported a significantly higher workload due to COVID-19 and reported a significantly lower well-being compared to staff members. Copyright © 2022 ARSMB-KVBMG. All rights reserved.

ESTABLISHING THE SAFETY OF OUTPATIENT RETROPERITONEAL SACROSPINOUS LIGAMENT FIXATION - A RETROSPECTIVE REVIEWAT A LARGE ACADEMIC HEALTHCARE CENTER

Introduction: With the strain placed on the medical system by the ongoing surges of the Covid-19 pandemic, inpatient surgery is often suspended, and same day discharge rates are increasing. Sacrospinous ligament fixation (SSLF) is an apical suspension procedure performed retroperitoneally;retroperitoneal hemorrhage and nerve injury are potential severe complications. Given these risks, providers vary in their preference for same day discharge vs. routine overnight admission after this procedure. Objective: To establish the safety of outpatient SSLF and evaluate the frequency of complications identified during the hospital stay. Methods: This is a retrospective cohort study of women who underwent SSLF by Urogynecologists at our large, academic institution between March 2018 and October 2021. Patients were identified from the Gynecologic Enhanced Recovery Surgical database, which includes all surgical patients in the department of OBGYN. The data was collected from the electronic medical record (EMR) to track compliance and outcomes in real time for quality improvement purposes during implementation of our enhanced recovery protocol. Institutional IRB approval was obtained. Descriptive statistics were performed. Student's t-test and two-sample tests-of-proportions were used, with a p-value <0.05 denoting statistical significance. Results: A total of 165 patients underwent SSLF;23 were outpatient, and 142 were admitted for at least one night. Over 90% of patients in both groups identified as white, non-Hispanic, and English-speaking. The mean BMI for both groups was 28.8 kg/m2. The outpatient group was younger (57.9 years compared to 64.7 years;P = 0.0051);outpatients were more likely to have commercial insurance (P = 0.0143) and inpatients to have Medicare (P = 0.0282). Almost double the proportion of those in the inpatient group had anxiety and depression, but this did not achieve statistical significance. Outpatients were more likely to be never smokers (P = 0.0175) and use narcotics preoperatively (P = 0.0385). They had a lower mean ASA score (P = 0.0067), Charleston Comorbidity Index score (P = 0.0452), total length of surgery (P < 0.001), total length of anesthesia (P < 0.001), and estimated blood loss (P = 0.0142). Those who went home the same day were more likely to have been the first case (P = 0.0123), and same-day discharge rates increased significantly after the onset of the Covid-19 pandemic (P = 0.0039). Both complications that required operative intervention were identified in the post-anesthesia care unit on the day of surgery. Notably, 30-day post-operative complications were proportionally lower in the outpatient group, but this did not achieve significance. Most of the complications were urinary tract infections, including the sole complication identified in the outpatient group. Conclusions: With the ongoing Covid-19 pandemic and rapidly evolving practice patterns, it is important to establish the safety of outpatient surgery. Our study demonstrates that outpatient SSLF is safe for appropriately selected patients after routine post-operative monitoring including serial vital signs and assessment of neuropathic pain. Severe complications requiring reoperation can often be identified immediately after surgery. Thirty-day post-operative complication rates did not significantly differ between patients undergoing outpatient versus inpatient SSLF.

Phenotyping patients undergoing colectomy to anticipate clinical trajectory

Background High-risk surgeries account for 12% of the cases performed but represent 80% of the postoperative mortality [1]. The ASA (American Society of Anesthesiology) score, used since 1941, categorizes risk based on patient's comorbidities [2]. Such stratification is of utmost importance, enabling therapeutic decision making, distribution of resources, decision sharing with patients, and billing. By exploiting clinical databases, risk scores could become automatically extracted from medical records, personalized for different populations, and quickly provide insights on several outcomes. By clustering a population with unsupervised artificial intelligence (AI) algorithms, we can create subgroups without specifying how to subdivide them. By identifying discriminative features, the AI creates subgroups from which we extract the typical profile, or phenotype, before describing the associated outcomes [3]. This recent approach identified subgroups among covid-19 and septic patients [3, 4]. The objective of this project is to export this concept for the first time to a surgical population and, considering the democratization of “Enhanced Recovery after Surgery” protocol, to identify phenotypes and associated outcomes in a population undergoing colectomy [5]. Methods Using the patient data warehouse (PDW) from University of California in Los Angeles (UCLA), we retrospectively extracted all surgical cases containing “colectomy” in the procedure name, which occurred between 2013, inception of the database, and November 2021 [6]. Institutional Review Board of UCLA waived the need for patient's consent. We selected 56 relevant variables, including demographic data, comorbidities, and medication. Unsupervised K-means clustering was applied to the data, and the optimal number of phenotypes was determined based on discrimination of significant binary outcomes, including mortality, intensive care unit (ICU) length of stay (LOS) over 10 days, and hospital LOS over 20 days. Continuous data, including age and preoperative vitals were normalized with a min-max algorithm before clustering. A random forest plot algorithm was used to identify the 15 most relevant features linked to mortality and compare the clustering results in a restricted set. Results We identified three major phenotypes in the population (N=2273) based on the major characteristics described in Table 1, with an overall mortality of 0.08%. Despite being younger (average age: 52), phenotype 1 had the highest in-hospital mortality risk with 3.4% (15/437) and had longer ICU LOS (10.1% stayed > 10d), and hospital LOS (26.7% stayed >20d). This subgroup mostly contained patients undergoing urgent surgery (90%) with intestine obstruction (26%). While phenotypes 2 and 3 both were elective and included most cancer cases, mortality and LOS varied significantly between groups (mortality: 0.06% vs 2.1%;ICU>10d: 0.5% vs 7.2%;hospital LOS>20d: 2.4% vs 11.3% ). Phenotype 2 was generally younger (57 vs 62 years old) and presented less comorbidities (see Figure 1). Cases lengths were similar across all groups, and phenotype 3 received more intravenous fluids. In this cohort, phenotype 1 (19.5% of procedures) accounted for 83.3% of deaths, 74,5% of prolonged ICU LOS, and 68,4% of prolonged hospital LOS. Clustering on the restricted feature built after random forest plot algorithm provided similar results. Discussion and conclusion By identifying 3 phenotypes in the colectomy population, we could discriminate patients' outcome and trajectory of care. We confirmed that despite having few comorbidities, the highest risk of complication and prolonged ICU/hospital LOS correlates with urgent surgeries. In other words, urgency seems more correlated to adverse outcomes than comorbidities or ASA score. These results confirm the effectiveness of clustering the surgical population for risk stratification. While these analyses were limited by the low number of deaths, LOS insights were of great interest. Accumulating more data will be interesting to further phenotype patients undergo ng urgent colectomy, or to personalize risk stratification for other surgeries. (Table Presented).

Day-case transurethral resection of bladder tumour (TURBT): A feasible approach in selected patients

Introduction & Objectives: Day-case Transurethral Resection of Bladder Tumour (TURBT) is currently only performed in 18% cases across the United Kingdom. Concerns exist regarding the quality of TURBT, early recurrence rate and the high-risk patient cohort that makes this approach less popular in some centers. The Primary Outcome was to determine 30-day readmission rate and 30-day morbidity using the Clavien-Dindo classification. The Secondary Outcomes were to determine patient cohort selection, quality of TURBT and early recurrence rate and to report patient feedback following day-case TURBT. Materials & Methods: A retrospective audit of day-case TURBTs in a District General Hospital (DGH) over 3 years pre-COVID19 (January 2017 - March 2020) was performed. We only included patients who underwent a TURBT and excluded any cystoscopy, biopsy or fulguration. A day-case TURBT pathway is in place, for postoperative recovery, instillation of intravesical chemotherapy postoperatively if required and re-admission for trial without catheter when indicated in the hospital. Case notes were reviewed manually. Feedback was obtained from patients who had new tumour TURBT in the last year using hospital patient feedback forms. Results: We included 77 patients who underwent TURBT in the day-case theatre, of these 5 patients required in-patient stay after the surgery. Of the remaining 72 discharged on the same day, 8 were re-admitted (11%) for Clavien-Dindo I complications. The mean age of the patients was 71 years (34-94 years);77% (59/77) were male;reported ASA scores were 3/77 ASA 1 (4%), 43/77 ASA 2 (56%), 28/77 ASA 3 (36%);30% (23/77) patients were on anticoagulants or antiplatelets;the average tumour size was 2cm (1mm – 5cm), 69% (53/77) were papillary in nature and 36/77 were newly diagnosed tumours (47%) and the remainder were recurrences or re-resections. Of the new tumours, 32/36 (89%) received mitomycin C as indicated. On final histology, muscle was present in specimen in 50/77 (65%). The readmission/failed discharge group had a higher rate of older patients, with higher ASA scores and longer operative times, however resection quality and tumour characteristics were not different from the day-case TURBTs. The recurrence rate at first check cystoscopy for the newly diagnosed tumours was 3% (1/36) while 1 patient had residual disease in a bladder diverticulum. All patients reported an overall positive experience. Conclusions: In the first of its kind audit patients reported outcomes after day-case TURBT, though readmission rate was relatively higher than previous reports in the literature, the overall patient experience was favorable and the outcomes of TURBT quality and early recurrence were satisfactory. The data obtained can provide guidance to employ better patient selection to reduce readmission rates. Hence, day-case TURBT can be a feasible option in appropriately selected patients, with a suitable pathway in place.

Psychological distress among healthcare professionals at the frontlines: Anaesthesiologists' perspective

The prevalence of burnout and depression among healthcare practitioners in Malaysia has never been studied during a pandemic prior to this study. In the midst of the COVID-19 pandemic, this question has again been pushed into the forefront, due to concerns with maintaining the physical and mental wellbeing of clinicians handling this pandemic. At the same time, there is also no data on the factors associated with psychological distress among Malaysian medical workers, which is not desirable when planning for preventative strategies in alleviating their psychological distress. To answer these questions, we set forth to capture a snapshot of the situation in Malaysia with regards to burnout and depression among frontline anaesthesiology clinicians working in Sungai Buloh Hospital, the national infectious disease centre of Malaysia and the hospital gazetted to be an exclusive COVID-19 hospital in Malaysia. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Teleconsultation after outpatient total mastectomy

Background: In response to regulations related to the COVID 19 pandemic and to patient demand, an outpatient total mastectomy pathway has been implemented at the Léon Bérard Center (CLB). This study evaluates the implementation of this pathway in terms of postoperative complications and patient satisfaction. Materials and Methods: Observational, retrospective, uni-centric study comparing two care pathways: traditional hospitalization versus outpatient care, for a total mastectomy associated or not with an axillary lymph node procedure. In the outpatient care, a teleconsultation by the coordinating nurses (IDEC) was performed the day after the surgery (D1 postoperative). Patient satisfaction in the outpatient care protocol was assessed by means of a satisfaction questionnaire sent by e-mail, in person or by telephone. Results: Between January 2020 and March 2021, 314 total mastectomies, without immediate breast reconstruction, associated or not with an axillary lymph node procedure, were performed at CLB. Thirty-six patients (11.46%) benefited from the outpatient program. We matched them in age and ASA score with 36 patients who underwent total mastectomy in traditional hospitalization during the same period. The complication rate in our cohort was 54.2%, 30.6% of which were lymphoceles. The postoperative complication rate and the revision surgery rate were not significantly different between the 2 groups (p=0.509, p=0.614). Five patients (13.9%) in the outpatient protocol were converted to traditional hospitalization. No patient in the outpatient program was rehospitalized for a surgical complication. In 66.7% of cases, the teleconsultation on D1 post-operation was carried out between the patient, the IDEC and the nurse in the patient's home who was responsible for the rest of the management. The patients in the outpatient protocol responded to the satisfaction questionnaire in 83.3% of cases. The overall satisfaction rate was rated at 4 or 5 out of 5 in 72.2% of cases. Patients would recommend the outpatient program to a relative in 90% of cases. Conclusions: Our study highlights the feasibility of outpatient total mastectomy, with good patient satisfaction. Teleconsultation at D1 post-op facilitates the link between the surgical management center and the city, favoring continuity of care.

Day case greenlight laser photoselective vaporisation of the prostate (Gl-pvp): Evaluation of outcomes from a district general hospital experience of 538 cases

Background and Objective In recent years, GreenLight laser photoselective vaporisation of the prostate (GL-PVP) has emerged as the primary ablative surgical treatment option for symptomatic bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE). Unlike the reference procedure, monopolar-transurethral resection of the prostate (M-TURP), GL-PVP can be performed as a day case. As waiting list pressures continue to burden health boards across the UK, exacerbated by the COVID-19 pandemic, enhanced access to day case surgery to optimise patient flow is now of paramount importance. We evaluated the safety and feasibility of day case GL-PVP at our high-volume UK centre and identified predictors of a postoperative overnight stay. Material and Methods We performed a retrospective observational cohort study of all patients who underwent primary GL-PVP at a single institution between October 2016 and June 2021. All procedures were performed utilising the 180W GreenLight XPS™ laser therapy system. Various clinical, operative and functional data were col-lated, and outcomes were compared between patients who underwent day case surgery and those admitted overnight postoperatively. Results In all, 538 patients underwent GL-PVP during the study period. Median patient age was 72 (interquartile range (IQR) 66–77), and median prostate volume was 62.5cc (IQR 45–90). Five hundred nineteen patients (96.5%) were discharged within 23 hours of admission, and 366 patients (68.0%) were managed as a true day case. Operative and functional outcomes were comparable between patients managed as a day case and those admitted overnight. There was higher patient-reported satisfaction and a lower rate of early hospital readmission in the day-case group. On univariate logistic regression analysis, patients aged ≥80 years (Odds Ratio 2.64 [95% Confidence Interval 1.65– 4.24], p = < 0.001), those with American Society of Anaesthesiologists (ASA) physical status classification score ≥3 (OR 1.92 [95% CI 1.33–2.78], p = < 0.001), those with prostate volume ≥80cc (OR 1.62 [95% CI 1.00–2.61], p = 0.05) and those in whom the operation time ≥60 minutes (OR 1.66 [95% CI 1.10–2.52], p = 0.02) were more likely to be admitted overnight following GL-PVP. On multivariate logistic regression analysis, age ≥80 (OR 2.64 [95% CI 1.47–4.73], p = 0.001) and ASA score ≥3 (OR 2.03 [95% CI 1.28–3.22], p = 0.003) remained predictive variables of an overnight stay. Conclusion From our observations of a large cohort of patients over a study period of almost five years, day case GL-PVP is a feasible concept and does not appear to compromise perioperative outcomes. With appropriate service redesign and optimisation of postoperative patient pathways, day case GL-PVP can be established in other centres and may have a role in alleviating waiting list pressures.

Barriers to same-day discharge after percutaneous nephrolithotomy

Introduction & Objective: The COVID-19 pandemic has provided an impetus to reconsider traditional urologic practices and adapt to the unprecedented healthcare burden. Reducing length of stay after minimally invasive procedures is now more important than ever. Using percutaneous nephrolithotomy (PCNL) as a model, we sought to evaluate clinical barriers to same-day discharge in order to better understand the feasibility of outpatient surgery. Methods: Prospective data collected from 500 inpatient PCNLs performed at our institution between 2016 and 2020 was analyzed via the Registry for Surgery of the Kidney and Ureter (ReSKU). Preadmissions and aborted procedures were excluded. We analyzed issues and complications that warranted postoperative admission. Major categories included infection, bleeding, and excessive pain, which was defined as either a documented pain complication or administration of intravenous opioids within 24 hours after discharge from the recovery room. Multivariate statistics were used to assess risk factors for each outcome. Results: Excessive pain was the most common postoperative issue (40.9%). ASA score was inversely correlated with odds of having increased pain (OR 0.64, 95% CI 0.42-0.98) and was the only statistically significant predictor in our multivariate model that included dilated tract number, diameter, and location. The postoperative SIRS/sepsis rate within 7 days was 9.7%, and higher ASA score (OR 3.6, 95% CI 1.8-7.6) and incomplete stone clearance (OR 2.7, 95% CI 1.2-6.3) were significant predictors. Age, sex, body mass index (BMI), stone burden, and positive preoperative urine cultures were not associated with overall infection rate. In patients who had a postoperative infection, 34.1% of infections were detected intraoperatively or in the recovery room, and 48.8% were associated with the nephrostomy tube removal process on postoperative day 1. Patients who had a postoperative double-J stent rather than a nephrostomy tube had a lower overall infection rate (1.8%, p = 0.047). Finally, only 1.9% of patients had a bleeding complication, and 1.1% required a blood transfusion. Conclusions: Pain is the major barrier to same-day discharge after PCNL. Bleeding is infrequent and most infections can be recognized perioperatively or avoided with alternative tube management strategies. Rigorous patient selection for same-day discharge does not appear to be necessary. Optimizing pain control may be the key to performing outpatient surgery on a large scale.

Theatre efficiency in COVID-19 pandemic conditions: The collaborative experience of four level 1 major trauma centres in the UK.

AIMS: As the world continues to fight successive waves of COVID-19 variants, we have seen worldwide infections surpass 100 million. London, UK, has been severely affected throughout the pandemic, and the resulting impact on the NHS has been profound. The aim of this study is to evaluate the impact of COVID-19 on theatre productivity across London's four major trauma centres (MTCs), and to assess how the changes to normal protocols and working patterns impacted trauma theatre efficiency. METHODS: This was a collaborative study across London's MTCs. A two-month period was selected from 5 March to 5 May 2020. The same two-month period in 2019 was used to provide baseline data for comparison. Demographic information was collected, as well as surgical speciality, procedure, time to surgery, type of anaesthesia, and various time points throughout the patient journey to theatre. RESULTS: In total, 1,243 theatre visits were analyzed as part of the study. Of these, 834 patients presented in 2019 and 409 in 2020. Fewer open reduction and internal fixations were performed in 2020 (33.5% vs 38.2%), and there was an increase in the number of orthoplastic cases in 2020 (8.3% vs 2.2%), both statistically significant results (p < 0.000). There was a statistically significant increase in median time from 2019 to 2020, between sending for a patient and their arrival to the anaesthetic room (29 vs 35 minutes; p = 0.000). Median time between arrival in the anaesthetic room and commencement of anaesthetic increased (7 to 9 minutes; p = 0.104). CONCLUSION: Changes in working practices necessitated by COVID-19 led to modest delays to all aspects of theatre use, and consequently theatre efficiency. However, the reality is that the major concerns of impact of service did not occur to the levels that were expected. Cite this article: Bone Jt Open 2021;2(10):886-892.

Impact of the COVID-19 pandemic on anesthesiologists in India: A cross-sectional online survey of the practices, preparedness, and mind-set.

BACKGROUND AND AIMS: India is one of the five worst hit countries in the world due to COVID-19, by the fourth week of June 2020. The impact of COVID-19 on the health practices is well-documented but there are no studies assessing its impact on anesthesiologists in India. This study aims at assessment of the impact of COVID-19 on the practices followed, the preparedness, and mindset of anesthesiologists in India. MATERIAL AND METHODS: Using Google forms, a cross-sectional, questionnaire-based survey was conducted between the 5th and 22nd of May, 2020, among trainees and practicing anesthesiologists, in India. The anesthesiologists were invited to participate, using their e-mail addresses and through the social media platforms such as Facebook and WhatsApp. The responses that were generated, were analyzed using SPSS version 23 (IBM, Armonk, NY). RESULTS: Of the 707 anesthesiologists who participated, 68.3% had already worked in a COVID-19 specialty unit. Only 41.7% of the anesthesiologists felt confident that they had sufficient knowledge to deal with COVID-19 infected patients. Fear of catching the infection and infecting loved ones were important causes of anxiety, which was seen in 95% of the participants. Majority of the participants, (64.5%) did not think that elective surgical procedures could be restarted at this point. CONCLUSION: COVID-19 has had grave impact on anesthesiologists, on the professional and personal front, and will possibly cause near-permanent changes in the work culture. Restarting elective surgical procedures, will require meticulous planning. In spite of their self-perceived under-preparedness to combat COVID-19, an overwhelming majority of participating anesthesiologists were prepared to contribute to the management of COVID-19.

A national survey evaluating the effect of COVID-19 pandemic on the teaching and training of anaesthesiology postgraduate students in India.

BACKGROUND AND AIMS: Anaesthesiologists have been in the forefront of managing patients of the novel coronavirus disease 19 (COVID-19) globally. The rearrangement of duties of anaesthesiology professionals and trainees along with the enforced containment measures like cessation of gatherings (for classroom teaching), cancellation of large number of elective cases and restricted number of procedures that are being performed have adversely affected the training of anaesthesiology postgraduate students across the country. METHODS: An electronic survey to assess the effect of the measures taken by hospitals due to COVID-19 on postgraduate teaching was undertaken using a validated questionnaire. We used snowball sampling, and the survey invitation with the web link was shared through freeware WhatsApp. The participation in the survey was voluntary and anonymity was maintained. Data obtained from the responses was collated and analysed. RESULTS: A total of 595 anaesthesiology postgraduate students (males = 298, females = 297) responded to the survey. Majority of the participants reported a steep depreciation (>50%) in the quality and quantity of academic activities (57.47%), major changes or cessation of clinical rotations (73.61%) and inability to conduct thesis-related cases (55.29%). In total, 56.97% of the students reported the rise in usage of online platforms like "Zoom" for conduct of routine academic activities. CONCLUSION: Teaching and training schedules of anaesthesiology postgraduate students have undergone major modifications following the COVID 19 pandemic. Resourcefulness and ingenuity in teaching methods is the need of the hour to sustain the desired standards of training courses and to maintain the quality of the budding anaesthesiologists.

Tough times and Miles to go before we sleep- Corona warriors.

The world has changed due to COVID-19 pandemic. Global spread of COVID-19 has overwhelmed all health systems and has incurred widespread social and economic disruption. The authorities are struggling to ramp up the healthcare systems to overcome it. Anaesthesiologists are facing long duty hours, have fear of bringing disease home to their families, being companion to critically ill patients on long term life support, being on front line of this pandemic crisis, may take toll on all aspects of health of corona warriors- physical, mental, social as well as the emotional.At this juncture, we must pause and ask this question to ourselves, "Buried under stress, are we okay?"

Railway anaesthesiologists and Indian railway COVID-19 management system.

Ever since the outbreak of novel Corona Virus 2019 pandemic, Anaesthesiologists are among the frontline leaders in not only the prevention of and control over the spread of the pandemic but also planning, organizing and coordinating the deployment and utilization of the medical and all other resources effectively and efficiently in order to minimize the losses and sufferings of human lives and recouping the global wellbeing at large. This article briefly highlights the prompt, optimal and effective contributions of the Indian Railways, Indian Railway Health Services and the Railway Association of ISA (RAISA) towards the provision of safe and scientific health services to maximum number of our fellow citizens.