Getting it right first time: what have we learnt?

Getting It Right First Time (GIRFT) is a national programme of improvement to identify and reduce unwarranted variation and non-evidence-based practice in healthcare. It aims to improve patient care, increase productivity and reduce costs. Professor Tim Briggs, an orthopaedic surgeon, began the programme with a pilot review visiting every orthopaedic surgery department in England. He used publicly available data to illuminate variation, and worked with the clinicians and management to develop improvements. The impressive initial report in 2015 led to NHS Improvement investing £60m to expand the programme to 40 medical and surgical specialties. The follow-up Orthopaedic report detailed savings of £696m to the NHS. GIRFT is now sharing its data with the CQC and leading the charge with elective recovery following COVID-19. GIRFT differs from previous programmes of improvement through its peer led, supportive approach to promoting change with early engagement of both clinicians and management. Common themes run through the almost 40 specialty reports published to date: variation in procurement and litigation costs, huge variations in patient treatment options (often with a lack of evidence base) and poor data quality. Successfully applied in orthopaedic surgery, it has been taken on enthusiastically by other specialties. Whether it can deliver its objective of £1.4bn savings whilst improving patient outcomes is yet to be seen, but its approach is changing the culture of the NHS.

Response of ChatGPT for Humanoid Robots Role in Improving Healthcare and Patient Outcomes.

Humanoid robotics is characterized by constant developments, which are supported by several research facilities across the world. Humanoid robots are used in many different industries. In this setting, this letter, written by people, makes use of ChatGPT answers to examine how humanoid robots might be used in the medical industry, particularly in light of the COVID-19 pandemic and in future. Although humanoid robots can help with certain jobs, it is important to recognize the indispensable importance of human healthcare professionals who have knowledge, empathy, and the capacity for critical judgment. Although humanoid robots can complement healthcare initiatives, they shouldn't be viewed as a full-fledged replacement for human care.

A year of COVID-19: Effects of a global pandemic on a hip fracture bundled care protocol.

Introduction: Our aim was to analyse how the coronavirus disease 2019 (COVID-19) pandemic affects a hip fracture bundled care protocol. We hypothesised that key performance indicators, but not short-term outcomes, may be adversely affected. Methods: Patients admitted under a hip fracture bundled care protocol were divided into two arms: 'COVID' group included patients admitted in 2020 during the COVID-19 pandemic and 'PRE-COVID' group included patients admitted in 2019. We retrospectively analysed time to admission, time to surgery, length of stay, discharge disposition, as well as rates of 30-day revision surgery, 30-day readmission and inpatient mortality. Results: There were 307 patients in the PRE-COVID group and 350 patients in the COVID group. There was no significant difference in terms of gender, age and type of hip fracture. The COVID group had a higher proportion of American Society of Anesthesiologists classification III and IV patients (61.4% vs. 50.2% in the PRE-COVID group; P = 0.004). In the COVID group, similar proportion of patients were admitted to the ward within 4 h, but the mean time to surgery was longer (71.8 ± 73.0 h vs. 60.4 ± 72.8 h in the PRE-COVID group; P = 0.046) and few patients underwent operations within 48 h (41.7% vs. 60.3% in the PRE-COVID group; P < 0.001). Mean postoperative length of stay, discharge disposition, as well as rates of inpatient mortality, 30-day revision surgery and 30-day readmission were similar. Conclusion: The volume of hip fractures during the COVID-19 pandemic remained unchanged, although patients admitted during the COVID-19 pandemic appeared to be more deconditioned. Nevertheless, having robust protocols and staff familiar with hip fracture treatment can preserve short-term outcomes for this group of patients, even with strict isolation measures in place during a pandemic.

The impact of the COVID-19 pandemic and stringent social distancing measures on health-related quality of life and COVID-19 infection rates in patients with rheumatic disease: a longitudinal analysis through the pandemic.

Objective: The aim was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic and stringent social isolation measures on patients with rheumatic disease (RD) from the beginning of the pandemic (April 2020). Methods: In this UK-based single-centre, prospective, observational cohort study, all RD follow-up patients at our centre were invited by SMS text message in April 2020 to participate in the study. Participants completed questionnaires at four time points between April 2020 and December 2021. We collected demographics, clinically extremely vulnerable (CEV) status, short form 12 mental (MCS) and physical health component scores (PCS) for health-related quality of life, vaccination status, COVID-19 infection rates and incidence of long COVID. Results: We enrolled 1605 patients (female, 69.0%; CEV, 46.5%); 906 of 1605 (56.4%) completed linked responses to our final questionnaire. MCS improved (+0.6, P < 0.05), whereas PCS scores deteriorated (-1.4, P < 0.001) between April 2020 and December 2021. CEV patients had worse mental and physical health scores than non-CEV patients at entry (PCS, 36.7 and 39.3, respectively, P < 0.001; MCS, 40.9 and 43.0, respectively, P < 0.001) and at each time point throughout the study; both mental and physical health outcomes were worse in CEV compared with non-CEV patients (P < 0.001 and P = 0.004, respectively). At study close, 148 of 906 (16.3%) reported COVID infection, with no difference in infection, vaccination or long COVID rates between CEV and non-CEV patients. Conclusions: Mental and physical health in RD patients has changed throughout the pandemic; outcomes for both metrics of health were worse in CEV patients, although there were no differences in infection rates between the groups. These data might assist the understanding and planning of future health-care policy and social restrictions in RD patients. Trial registration: ClinicalTrials.gov, www.clinicaltrials.gov, NCT04542031.

Tracheostomy in Critically Ill COVID-19 Patients on Extracorporeal Membrane Oxygenation: A Single-Center Experience.

OBJECTIVES: Novel coronavirus-19 (COVID-19) has led to over 6 million fatalities globally. An estimated 75% of COVID-19 patients who require critical care admission develop acute respiratory distress syndrome (ARDS) needing invasive mechanical ventilation (IMV) and/or extracorporeal membrane oxygenation (ECMO). Due to prolonged ventilation requirements, these patients often also require tracheostomy. We performed a review of clinical outcomes in COVID-19 patients on ECMO at a high-volume tertiary care center in Hamilton, Ontario, Canada. METHODOLOGY: We performed a retrospective case series, including 24 adult patients diagnosed with COVID-19 who required IMV, veno-venous (ECMO), and tracheostomy. All patients were included from April to December 2021. We extracted demographic and clinical variables pertaining to the tracheostomy procedure and ECMO therapy. We performed descriptive statistical analyses. This study was approved by the Hamilton Integrated Research Ethics Board (14217-C). RESULTS: We included 24 consecutive patients with COVID-19 who required tracheostomy while undergoing ECMO therapy. The mean age was 49.4 years [standard deviation (SD): 7.33], the majority of patients were male (75%), with mean body mass index of 32 (SD: 8.81). Overall mortality rate was 33.3%. Percutaneous tracheostomy was performed most frequently (83.3%) and, similar to open tracheostomy, was associated with a low rate of perioperative bleeding complications. Within surviving patients, the mean time to IMV weaning and decannulation was 60.2 (SD: 24.6) and 49.4 days (SD: 21.8), respectively. CONCLUSION: Percutaneous tracheostomy appears to be safe in COVID-19 patients on ECMO and holding anticoagulation 24 hours prior to and after tracheostomy may limit bleeding events in these patients.

A Scoping Review on COVID-19-Induced Cardiovascular Complications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a type of human coronavirus that resulted in the 2019 coronavirus disease (COVID-19). Although it was generally categorized as a respiratory disease, its involvement in cardiovascular complications was identified from the onset. Elevated cardiac troponin levels (a myocardial injury marker) and echocardiograms, which showed the anomalous performance of the patients' hearts, were noted in the early case reports obtained from Wuhan, China. A couple of mechanisms have been proposed to explain COVID-19-induced cardiovascular complications, with systemic inflammation being the major focus recently. Chest pain and palpitations are among the prevalent symptoms in moderate to severe COVID-19-recovering patients. Cardiac damage potentially occurs due to multifactorial factors, which include cytokine-induced inflammation, direct cardiotoxicity, and disseminated intravascular coagulation (DIC), among others. The cardiovascular manifestations include cardiac arrhythmia, cardiogenic shock, venous thromboembolism, and elevated cardiac biomarkers. Both the long- and short-term effects of these cardiovascular complications remain puzzling to researchers, as substantial evidence is yet to be gathered to reach a consensus on the severity of COVID-19 in the heart. The treatment considerations currently include antiarrhythmic management, ACEI or ARB use, anticoagulation, hemodynamic support, and immunosuppression. This review aimed to outline the pathogenesis of the various cardiac complications due to COVID-19 as well as the available treatment modalities of COVID-19 infection. Both the mechanisms and the treatments have been succinctly explained in a proper manner to ensure understanding. [ABSTRACT FROM AUTHOR] Copyright of COVID is the property of MDPI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Obstetric Outcomes in Women with Rheumatic Disease and COVID-19 in the Context of Vaccination Status.

OBJECTIVE: To describe obstetric outcomes based on COVID-19 vaccination status, in women with rheumatic and musculoskeletal diseases (RMDs) who developed COVID-19 during pregnancy. METHODS: Data regarding pregnant women entered into the COVID-19 Global Rheumatology Alliance registry from 24 March 2020-25 February 2022 were analysed. Obstetric outcomes were stratified by number of COVID-19 vaccine doses received prior to COVID-19 infection in pregnancy. Descriptive differences between groups were tested using the chi -square or Fisher's exact test. RESULTS: There were 73 pregnancies in 73 women with RMD and COVID-19. Overall, 24.7% (18) of pregnancies were ongoing, while of the 55 completed pregnancies 90.9% (50) of pregnancies resulted in livebirths. At the time of COVID-19 diagnosis, 60.3% (n = 44) of women were unvaccinated, 4.1% (n = 3) had received one vaccine dose while 35.6% (n = 26) had two or more doses. Although 83.6% (n = 61) of women required no treatment for COVID-19, 20.5% (n = 15) required hospital admission. COVID-19 resulted in delivery in 6.8% (n = 3) of unvaccinated women and 3.8% (n = 1) of fully vaccinated women. There was a greater number of preterm births (PTB) in unvaccinated women compared with fully vaccinated 29.5% (n = 13) vs 18.2%(n = 2). CONCLUSION: In this descriptive study, unvaccinated pregnant women with RMD and COVID-19 had a greater number of PTB compared with those fully vaccinated against COVID-19. Additionally, the need for COVID-19 pharmacological treatment was uncommon in pregnant women with RMD regardless of vaccination status. These results support active promotion of COVID-19 vaccination in women with RMD who are pregnant or planning a pregnancy.

Compassionate, collective or transformational nursing leadership to ensure fundamentals of care are achieved: A new challenge or non-sequitur?

AIMS: This discursive paper draws on three key leadership theories with the aim of outlining how styles of leadership impact the provision of fundamentals of care. DESIGN: Discussion paper. DATA SOURCES: key leadership theories, leadership and fundamentals of care literature. IMPLICATIONS FOR NURSING: The conceptualization of fundamentals of care is viewed through the lens of nursing leadership, and collective, compassionate and transformational leadership theory. The cognitive dissonance that nursing leaders encounter when trying to reconcile organizational, patient and nurses' needs is considered, and the pressure to deliver high-quality fundamentals of care presents a challenge to nurse leaders. CONCLUSION: Leaders must align nursing and patient outcome data to drive forward and prioritize fundamental care. Focusing on key elements of relational leadership styles will ensure a workforce fit to provide fundamental care, which in the current climate must be an organizational and global nursing priority. IMPACT: This discussion attempts to draw together overlapping leadership theories, emphasizes the importance of relational leadership in ensuring the provision of the fundamentals of care and acknowledged the impact of the COVID-19 pandemic on nurses and nursing care, with leadership implications outlined, such as a need for role-modelling, understanding shared values and giving nurses a voice. It will have an impact on nurse leaders, but also on those nurses providing direct care by issuing a challenge for them to confront their own nurse leaders, and to ask that they better resolve competing needs of both the nursing workforce and patients.

Impact of COVID-19 on the management and outcomes of ureteric stones in the UK: a multicentre retrospective study.

OBJECTIVES: To determine if management of ureteric stones in the UK changed during the coronavirus disease 2019 (COVID-19) pandemic and whether this affected patient outcomes. PATIENTS AND METHODS: We conducted a multicentre retrospective study of adults with computed tomography-confirmed ureteric stone disease at 39 UK hospitals during a pre-pandemic period (23/3/2019-22/6/2019) and a period during the pandemic (the 3-month period after the first severe acute respiratory syndrome coronavirus-2 case at individual sites). The primary outcome was success of primary treatment modality, defined as no further treatment required for the index ureteric stone. Our study protocol was published prior to data collection. RESULTS: A total of 3735 patients were included (pre-pandemic 1956 patients; pandemic 1779 patients). Stone size was similar between groups (P > 0.05). During the pandemic, patients had lower hospital admission rates (pre-pandemic 54.0% vs pandemic 46.5%, P < 0.001), shorter mean length of stay (4.1 vs 3.3 days, P = 0.02), and higher rates of use of medical expulsive therapy (17.4% vs 25.4%, P < 0.001). In patients who received interventional management (pre-pandemic 787 vs pandemic 685), rates of extracorporeal shockwave lithotripsy (22.7% vs 34.1%, P < 0.001) and nephrostomy were higher (7.1% vs 10.5%, P = 0.03); and rates of ureteroscopy (57.2% vs 47.5%, P < 0.001), stent insertion (68.4% vs 54.6%, P < 0.001), and general anaesthetic (92.2% vs 76.2%, P < 0.001) were lower. There was no difference in success of primary treatment modality between patient cohorts (pre-pandemic 73.8% vs pandemic 76.1%, P = 0.11), nor when patients were stratified by treatment modality or stone size. Rates of operative complications, 30-day mortality, and re-admission and renal function at 6 months did not differ between the data collection periods. CONCLUSIONS: During the COVID-19 pandemic, there were lower admission rates and fewer invasive procedures performed. Despite this, there were no differences in treatment success or outcomes. Our findings indicate that clinicians can safely adopt management strategies developed during the pandemic to treat more patients conservatively and in the community.

Low Prevalence but High Impact of COVID-19 Positive Status in Adult Trauma Patients: A Multi-institutional Analysis of 28 904 Patients.

BACKGROUND: Few large investigations have addressed the prevalence of COVID-19 infection among trauma patients and impact on providers. The purpose of this study was to quantify the prevalence of COVID-19 infection among trauma patients by timing of diagnosis, assess nosocomial exposure risk, and evaluate the impact of COVID-19 positive status on morbidity and mortality. METHODS: Registry data from adults admitted 4/1/2020-10/31/2020 from 46 level I/II trauma centers were grouped by: timing of first positive status (Day 1, Day 2-6, or Day ≥ 7); overall Positive/Negative status; or Unknown if test results were unavailable. Groups were compared on outcomes (Trauma Quality Improvement Program complications) and mortality using univariate analysis and adjusted logistic regression. RESULTS: There were 28 904 patients (60.7% male, mean age: 56.4, mean injury severity score: 10.5). Of 13 274 (46%) patients with known COVID-19 status, 266 (2%) were Positive Day 1, 119 (1%) Days 2-6, 33 (.2%) Day ≥ 7, and 12 856 (97%) tested Negative. COVID-19 Positive patients had significantly worse outcomes compared to Negative; unadjusted comparisons showed longer hospital length of stay (10.98 vs 7.47;P < .05), higher rates of intensive care unit (57.7% vs 45.7%; P < .05) and ventilation use (22.5% vs 16.9%; P < .05). Adjusted comparisons showed higher rates of acute respiratory distress syndrome (1.7% vs .4%; P < .05) and death (8.1% vs 3.4%; P < .05). CONCLUSIONS: This multicenter study conducted during the early pandemic period revealed few trauma patients tested COVID-19 positive, suggesting relatively low exposure risk to care providers. COVID-19 positive status was associated with significantly higher mortality and specific morbidity. Further analysis is needed with consideration for care guidelines specific to COVID-19 positive trauma patients as the pandemic continues.

Clinical and Paraclinical Predictors of Mortality in Covid-19 in Mashhad, Iran

Objective: The purpose of this study is to determine the epidemiological, demographic, clinical and paraclinical indicators of suspected, probable and infected cases of covid-19 referred to Imam Reza Hospital (AS) in 2018-2019. Method(s): This cross-sectional study was conducted using patient information between 2018 and 2019 at Imam Reza Hospital. The method of collecting information in this study was by means of a checklist. Patient information was collected through the files of suspected, probable, and infected patients with Covid-19 who were admitted to Imam Reza Hospital during the implementation of this study in 2018-2019. This checklist included the demographic information of the patients including age, gender, underlying disease, patient symptoms, laboratory findings, hospitalization information, prescription drugs, and the status of the patients at discharge (survivor or deceased). Result(s): A total of 305 patients with an average age of 58.03 +/- 17.40 years were included in the study. 126 patients (41.3%) were positive for covid. The most common clinical symptoms were shortness of breath in 182 patients (59.7%), cough in 178 patients (58.4%) and fever in 177 patients (58%), respectively. The most common underlying diseases were high blood pressure (39.0%) and diabetes (33.4%). The amount of WBC (p=0.018), potassium (P=0.037), urea (P=0.001), CRP (P=0.001), PT (P=0.001) and INR (P=0.001) were significantly higher in deceased patients than in surviving patients. However, the amount of platelets (P=0.047), pH (P=0.001) and HCO3 (P=0.017) in the deceased group was significantly lower than the living group. . In the discussion of hospital data, the duration of intubation (P<0.001), the duration of hospitalization (P=0.036), the duration of hospitalization in the ward (P=0.005) and the duration of hospitalization In ICU (P<0.001), it was significantly higher in patients who died than in those who survived. Conclusion(s): Covid patients usually present with fever, shortness of breath and cough;Among the cases of disease, diabetic and hypertensive patients made up a major part, which shows the susceptibility of this group to the disease. However, only the presence of cardiovascular diseases was associated with higher mortality. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Epidemiology and outcomes of culture-positive bloodstream pathogens prior to and during the SARS-CoV-2 pandemic: a multicenter evaluation.

BACKGROUND: Bloodstream infections (BSIs) are an important cause of morbidity and mortality in hospitalized patients. We evaluate incidence of community- and hospital-onset BSI rates and outcomes before and during the SARS-CoV-2 pandemic. METHODS: We conducted a retrospective cohort study evaluating patients who were hospitalized for ≥ 1 day with discharge or death between June 1, 2019, and September 4, 2021, across 271 US health care facilities. Community- and hospital-onset BSI and related outcomes before and during the SARS-CoV-2 pandemic, including intensive care admission rates, and overall and ICU-specific length of stay (LOS) was evaluated. Bivariate correlations were calculated between the pre-pandemic and pandemic periods overall and by SARS-CoV-2 testing status. RESULTS: Of 5,239,692 patient admissions, there were 20,113 community-onset BSIs before the pandemic (11.2/1000 admissions) and 39,740 (11.5/1000 admissions) during the pandemic (P ≤ 0.0062). Corresponding rates of hospital-onset BSI were 2,771 (1.6/1000 admissions) and 6,864 (2.0/1000 admissions; P < 0.0062). Compared to the pre-pandemic period, rates of community-onset BSI were higher in patients who tested negative for SARS-CoV-2 (15.8/1000 admissions), compared with 9.6/1000 BSI admissions among SARS-CoV-2-positive patients. Compared with patients in the pre-pandemic period, SARS-CoV-2-positive patients with community-onset BSI experienced greater ICU admission rates (36.6% vs 32.8%; P < 0.01), greater ventilator use (10.7% vs 4.7%; P < 0.001), and longer LOS (12.2 d vs 9.1 d; P < 0.001). Rates of hospital-onset BSI were higher in the pandemic vs the pre-pandemic period (2.0 vs 1.5/1000; P < 0.001), with rates as high a 7.3/1000 admissions among SARS-CoV-2-positive patients. Compared to the pre-pandemic period, SARS-CoV-2-positive patients with hospital-onset BSI had higher rates of ICU admission (72.9% vs 55.4%; P < 0.001), LOS (34.8 d vs 25.5 d; P < 0.001), and ventilator use (52.9% vs 21.5%; P < 0.001). Enterococcus species, Staphylococcus aureus, Klebsiella pneumoniae, and Candida albicans were more frequently detected in the pandemic period. CONCLUSIONS AND RELEVANCE: This nationally representative study found an increased risk of both community-onset and hospital-onset BSI during the SARS-CoV-2 pandemic period, with the largest increased risk in hospital-onset BSI among SARS-CoV-2-positive patients. SARS-CoV-2 positivity was associated with worse outcomes.

Antecedents and consequences of shared decision making for patients with chronic kidney diseases: A cross-sectional survey.

BACKGROUND: Chronic kidney disease (CKD) has a strong negative impact on patients. Finding ways to improve CKD patients' conditions by shared decision-making is receiving much attention. However, little attention has been paid to influencing antecedents and effects of shared decision-making. Meanwhile, as advanced technologies bring in new communication devices, effects of different types of communications used in shared decision-making need to be addressed. OBJECTIVE: This study proposes a research framework to determine the influencing antecedents of shared decision-making, and to evaluate the effects of shared decision-making on patient outcomes when they are computer-mediated and when the decision-makers communicate face-to-face. METHODS: A cross-section survey was conducted and a total of 48 valid samples were obtained. The participants were CKD Stage III, IV, or V patients who had received medical treatment in a hospital in Taiwan. The collected data were subjected to an independent t-test and partial least squares analysis to validate the research framework. RESULTS: Doctor-patient communication (DPC) and doctor-patient relationship (DPR) have no significant direct impact on patient outcomes. Nevertheless, both DPC and DPR significantly impact shared decision-making which in turn impacts patient outcomes. Moreover, patients who use computer-mediated communication were found to have significantly higher perceptions of shared decision-making than those who did not. CONCLUSIONS: The incidence and prevalence of end-stage renal disease in Taiwan are among the highest in the world. The results of this study can serve as a reference for hospitals to improve CKD patients' outcomes. Meanwhile, during the COVID-19 pandemic, this study suggested hospitals should encourage shared decision-making with computer-mediated communication to ensure that patients receive proper treatment and have the desired outcomes.

MONitoring Knockbacks in EmergencY (MONKEY) - An Audit of Disposition Outcomes in Emergency Patients with Rejected Admission Requests.

Background: Emergency Department (ED) clinicians commonly experience difficulties in referring patients to inpatient teams for hospital admission. There is limited literature reporting on patient outcomes following these complicated referrals, where ED requests for inpatient admission are rejected - which study investigators termed a "knockback". Purpose: To identify disposition outcomes and referral accuracy in ED patients whose admission referral was initially rejected. Secondary objectives were to identify additional patient, clinician and systemic factors associated with knockbacks. Selection and Methodology: Emergency clinicians prospectively nominated a convenience sample of patients identified as having knockbacks over two time periods (Jan-Feb 2020 and Aug 2020 to Jan 2021) at a tertiary Australian ED. Data were analyzed with a mixed-methods approach and subsequent descriptive and thematic analyses were performed. Results: A total of 109 patients were identified as knockbacks. The referrals were warranted, with 89.0% of cases (n = 97) ultimately requiring a hospital admission. In 60.6% (n = 66) of the admissions, patients were admitted under the inpatient team initially referred to by the ED, suggesting referrals were generally accurate. The number of in-hospital units involved in the admission process and ED length of stay were positively correlated (0.409, p < 0.001). Patient factors associated with knockbacks include pre-existing chronic medical conditions and presenting acutely unwell. Analysis of clinicians' perspectives yielded recurring themes of disagreements over admission destination and diagnostic uncertainty. Conclusion: In this patient sample, emergency referrals for admission were mostly warranted and accurate. Knockbacks increase ED length of stay and may adversely affect patient care. Further focused discussion and clearer referral guidelines between ED clinicians and their inpatient colleagues are required.

Social Determinants of Health: Considerations for Athletic Health Care.

Health disparities are prevalent concerns in the United States and a frequent topic of conversation in the public health realm. Causes of health disparities include social inequities and social determinants of health. Although social determinants of health have been suggested to contribute more to individual and population health than the health care provided, this concept in athletic health care has received little attention. Therefore, the purpose of our article was to describe social determinants of health, present examples of social determinants, and discuss actionable steps for the athletic training profession to become more culturally proficient. By increasing the awareness of and acknowledging social determinants of health, athletic trainers will be positioned to improve patient outcomes more readily and contribute to ongoing conversations at the policy level of health care.

Management of pediatric appendicitis during the COVID-19 pandemic: A nationwide multicenter cohort study.

BACKGROUND: The COVID-19 pandemic has impacted timely access to care for children, including patients with appendicitis. This study aimed to evaluate the effect of the COVID-19 pandemic on management of appendicitis and patient outcomes. METHODS: A multicenter retrospective study was performed including 19 children's hospitals from April 2019-October 2020 of children (age≤18 years) diagnosed with appendicitis. Groups were defined by each hospital's city/state stay-at-home orders (SAHO), designating patients as Pre-COVID (Pre-SAHO) or COVID (Post-SAHO). Demographic, treatment, and outcome data were obtained, and univariate and multivariable analysis was performed. RESULTS: Of 6,014 patients, 2,413 (40.1%) presented during the COVID-19 pandemic. More patients were managed non-operatively during the COVID-19 pandemic compared to before the pandemic (147 (6.1%) vs 144 (4.0%), p < 0.001). Despite this change, there was no difference in the proportion of complicated appendicitis between groups (1,247 (34.6%) vs 849 (35.2%), p = 0.12). COVID era non-operative patients received fewer additional procedures, including interventional radiology (IR) drain placements, compared to pre-COVID non-operative patients (29 (19.7%) vs 69 (47.9%), p < 0.001). On adjusted analysis, factors associated with increased odds of receiving non-operative management included: increasing duration of symptoms (OR=1.01, 95% CI: 1.01-1.012), African American race (OR=2.4, 95% CI: 1.3-4.6), and testing positive for COVID-19 (OR=10.8, 95% CI: 5.4-21.6). CONCLUSION: Non-operative management of appendicitis increased during the COVID-19 pandemic. Additionally, fewer COVID era cases required IR procedures. These changes in the management of pediatric appendicitis during the COVID pandemic demonstrates the potential for future utilization of non-operative management.

Trends of in-hospital and ICU mortality in COVID-19 patients over the fourth and fifth COVID-19 surges in Iran: a retrospective cohort study from Iran.

OBJECTIVE: The current study aimed to investigate the temporal trend of in-hospital and intensive care unit (ICU) mortality of coronavirus disease 2019 (COVID-19) patients over 6 months in the spring and summer of 2021 in Iran. DESIGN: We performed an observational retrospective cohort study. SETTING: Qazvin Province- Iran during 6 month from April to September 2021. PARTICIPANTS: All 14355 patients who were hospitalized with confirmed COVID-19 in hospitals of Qazvin Province. INTERVENTION: No intervention. MAIN OUTCOME MEASURES: The trends of overall in-hospital mortality and ICU mortality were the main outcome of interest. We obtained crude and adjusted in-hospital and ICU mortality rates for each month of admission and over surge and lull periods of the disease. RESULTS: The overall in-hospital mortality, early mortality and ICU mortality were 8.8%, 3.2% and 67.6%, respectively. The trend for overall mortality was almost plateau ranging from 6.5% in July to 10.7% in April. The lowest ICU mortality was 60.0% observed in April, whereas it reached a peak in August (ICU mortality = 75.7%). Admission on surge days of COVID-19 was associated with an increased risk of overall mortality (Odds ratio = 1.3, 95% confidence interval = 1.1, 1.5). The comparison of surge and lull status showed that the odds of ICU mortality in the surge of COVID-19 was 1.7 higher than in the lull period (P-value < 0.001). CONCLUSIONS: We found that the risk of both overall in-hospital and ICU mortality increased over the surge period and fourth and fifth waves of severe acute respiratory syndrome coronavirus 2 infection in Iran. The lack of hospital resources and particularly ICU capacities to respond to the crisis during the surge period is assumed to be the main culprit.

Review of claustrophobia incidence in MRI: A service evaluation of current rates across a multi-centre service.

INTRODUCTION: Magnetic Resonance Imaging remains an anxious experience for many, often exhibiting as fear of enclosed spaces. A useful metric to assess its prevalence and impact in practice is premature termination due to claustrophobia. Incidence varies and depends on many factors such as the physical nature of the imaging equipment and examination being undertaken, as well as the patient themselves. METHODS: Scan appointment data from between April 2019-March 2021 was extracted and reviewed. Analysis included the type of scanner used, patient age, sex, examination area, funding source, attendance and completion status. Binomial logistic regression was performed to look for any relevant predictors of failure to scan due to claustrophobia. RESULTS: Overall incidence of incomplete examinations due to claustrophobia was 0.76%. Whilst the majority of scans were performed on conventional systems, those undergoing Open scans were over three times more likely to fail a scan due to claustrophobia, whilst those undergoing UpRight scanning were half as likely. Likelihood of claustrophobia increases with females, those between 45-64years of age, funded by the NHS and entering the scanner head first or having a head scan. CONCLUSION: Incidence of incomplete scanning is below 1% but with the potential for further reduction with implementation and use of improved scanner design and technology. Understanding the impact of other variables is also useful to raise awareness of those at greater risk of claustrophobia. However, there are wider influences beyond data alone to consider and account for. IMPLICATIONS FOR PRACTICE: Whilst occurrence of claustrophobia is low, there remains a cost impact, as well as an importance in understanding the patient experience. Drawing on operational data can help provide a limited, generalised view to support service improvement.

From "Cure" to "Care": The Role of the MultiDisciplinary Team on Colorectal Cancer Patients' Satisfaction and Oncological Outcomes.

Background: MultiDisciplinary Team (MDT) are held to undertake decisions regarding the whole aspect of oncological diseases. Over the years, they acquired a collaborative approach where clinical decisions are shared by all members. Different guidelines recommend the implementation of MDT, in order to improve the outcomes of these patients. Our aim is to evaluate how the implementation of MDT affects the patients' satisfaction and adherence to treatment. Methods: A survey was submitted to every patient affected by colorectal cancer treated by the MDT of Sant'Andrea Hospital (Rome, IT). The investigation period was January 2017-March 2020. Data from patients inside the MDT were compared with patients outside the MDT to evaluate a reduction in waiting times. Results: A total of 591 patients were collected. A total of 355 patients with colorectal neoplasia were included in our analysis. Cumulative overall survival was 79%. The average waiting time for computed tomography or colonoscopy was 14.9 days for patients in the MDT versus 24.5. A total of 201 patients were eligible for our satisfaction survey. An 89.5% of patients felt followed in their treatment. A 93.5% of patients expressed a high grade of satisfaction for the MDT design. Conclusion: Our study confirms the importance of a well-structured MDT. Dedicated slots shorten the waiting time, leading to better satisfaction and faster diagnosis. Patients' satisfaction should be considered as an index of good practice when it comes to oncological patients' treatment.