Reducing last-minute cancellations of elective urological surgery-effectiveness of specialist nurse preoperative assessment.

Last-minute cancellations in urological surgery are a global issue, resulting in the wastage of resources and delays to patient care. In addition to non-cessation of anticoagulants and inadequately treated medical comorbidities, untreated urinary tract infections are a significant cause of last-minute cancellations. This study aimed to ascertain whether the introduction of a specialist nurse clinic resulted in a reduction of last-minute cancellations of elective urological surgery as part of our elective recovery plan following the Coronavirus disease 2019, the contagious disease caused by severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2 pandemic. A specialist urology nurse-led clinic was introduced to review urine culture results preoperatively. Specialist nurses contacted patients with positive urine cultures and their general practitioners by telephone and email to ensure a minimum of 2 days of 'lead-in' antibiotics were given prior to surgery. Patients unfit for surgery were postponed and optimized, and vacant slots were backfilled. A new guideline was created to improve the timing and structure of the generic preassessment. Between 1 January 2021 and 30 June 2021, a mean of 40 cases was booked each month, with average cancellations rates of 9.57/40 (23.92%). After implementing changes on 1 July 2021, cancellations fell to 4/124 (3%) for the month. On re-audit, there was a sustained and statistically significant reduction in cancellation rates: between 1 July 2021 and 31 December 2021 cancellations averaged 4.2/97.5 (4.3%, P < .001). Two to nine (2%-16%) patients were started on antibiotics each month, while another zero to two (0%-2%) were contacted for other reasons. The implementation of a specialist urology nurse-led preassessment clinic resulted in a sustained reduction in cancellations of last-minute elective urological procedures.

Adaptive Noise Cancellation Using a Fully Connected Network: A Lesson Learned

Ambient noise causes annoying difficulty for listeners, especially in online learning and work-from-home environments such as during the COVID-19 pandemic. The aim of this work was to employ the neural network to mitigate such ambient noise in the online environment. The software was designed, implemented, and tested on 4 types of noise. The algorithm used was a fully connected network. The results indicated that the standard fully connected network might not be an effective solution for a specific situation. Nonetheless, the processing time was very low, making it possible for real-time application on standalone devices. The implementation using leaky ReLu, creating leaky networks, offered slightly better results in English speeches, i.e. an average of 1.382 and 0.4389 in the PESQ and STOI, respectively. The Thai leaky networks, on another hand, exhibited an average of 3.111 and 0.7096 in PESQ and STOI, respectively. © 2022 IEEE.

AIR PASSENGER RIGHTS IN TIMES OF PANDEMIC BETWEEN EXTRAORDINARY CANCELLATIONS, DENIED REIMBURSEMENTS AND FORCED VOUCHERS

The Covid-19 pandemic has taken its toll on air transport, forcing many airlines to cancel flights as a result of the restrictive measures adopted by the authorities or due to other reasons related to the emergency. The remedies, stemming from EU law, of ticket refunds and compensation for damages may expose carriers to serious liquidity crises and bankruptcy. The aim of this article is to discuss the opportunity to provide for compulsory vouchers in lieu of immediate reimbursement, which passengers could not refuse on condition that they have a reasonable content, with a view to enhancing competition in the European air transport market. © 2022 Ibero-American Law Institute. All rights reserved.

Triple grief cycle of cancelled events: The emotional crisis aftermath

Purpose: The coronavirus (COVID-19) pandemic response is not only devastating nations and economies across the globe but it is also severely disrupting the event industry, with government and health authorities forcing many events to be postponed or cancelled. The purpose of this study is to investigate the prospective attendees' emotional responses to cancelled events. This study draws upon grief cycle theory to articulate different layers of the grief process in the event domain of inquiry. Design/methodology/approach: The National Collegiate Athletic Association basketball tournament was selected as the research context. Taking user-generated messages from Twitter, this study first performed content analysis to organize lexical patterns into categories and higher-order themes based on the grief cycle. It also performed social network analyses using UCINET to illustrate how different grief phases are inter-related. Findings: Results not only point to attendees' self-expression manifested through a continuum of denial, anger, bargaining and acceptance but they also reveal a three-layer hierarchy of grief, namely, event-related, socio-politics-related and crisis-related. The network analysis further illustrates how grief phases are tied into a complex network of grief messages. Originality/value: This study advances the event literature by improving knowledge about attendees' emotional responses to cancelled events. It increases our understanding of the grieving process in the aftermath of COVID-19. The proposed triple grief cycle helps advance the literature by showcasing how voices from prospective attendees represent three pillars of grief hierarchy. The findings also underscore the emotional crisis of the COVID-19 aftermath. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Incidence, etiology and time course of delays to adult spinal deformity surgery: a single-center experience.

PURPOSE: We sought to determine the incidence, origin, and timeframe of delays to adult spinal deformity surgery so that institutions using preoperative multidisciplinary patient assessment teams might better anticipate and address these potential delays. METHODS: Complex spine procedures for treatment of adult spinal deformity from 1/1/18 to 8/31/21 were identified. Procedures for infection, tumor, and urgent/emergent cases were excluded. Operations delayed due to COVID or those that were performed outside of our established perioperative care pathway were also excluded. The electronic health record was used to identify the etiology and timeline of all pre- and peri-operative delays. RESULTS: Of 235 patients scheduled for complex spine surgery, 193 met criteria for inclusion. Of these patients, 35 patients experienced a surgical delay (18.1%) with a total of 41 delays recorded. Reasons for delay include medically unoptimized (25.6%), intraoperative complication (17.9%), patient directed delay (17.9%), patient illness/injury (15.4%), scheduling complication (10.3%), insurance delay/denial (5.1%), and unknown (2.6%). Twenty-four delays experienced by 22 individuals occurred within 7 days of their scheduled surgery date. CONCLUSION: At a single multidisciplinary center, most delays to adult spinal deformity surgery occur before a patient is admitted to the hospital, and for recommendations of additional medical workup/clearance. We suspect that the preoperative protocol might increase pre-admission delays for unoptimized patients, as the protocol is intended to ensure patients receive surgery only when they are medically ready. Further research is needed to determine the economic and system impact of delays related to a preoperative optimization protocol weighed against the reduction in adverse events these protocols can provide.

School Snow Days, Absenteeism, and Student Achievement: A Comparative Study of Nova Scotia and Massachusetts

Recent research on the effects of school cancellations because of snow or storms confirms what school authorities in Canada and the United States have understood for some time: missed school days have a detrimental effect upon student learning. Disrupted instructional time and student learning have been analyzed in Massachusetts and in policy studies conducted in the Canadian province of Nova Scotia. One 2012 study in Massachusetts showed a strong relationship between student absences and achievement, but little or no impact attributable to inclement-weather school closures. Yet on balance, most research studies link school-day cancellations with declining student test scores. This research note assesses the impact of storm closings in Nova Scotia between the school years 2008-2009 and 2017-2018. There, the number of snow days is normally double that of Massachusetts and reported rates of student absenteeism are higher. This study assesses the ‘accumulative effect’ of missing whole school days, planned and unplanned, on student mathematics scores and high-school completion, and it proposes a some policy responses. Some consideration is given also to the profound impact of COVID-19 school disruptions and remote learning experiments on the changing policy landscapes in both Nova Scotia and Massachusetts.

On Women's Times in a Pandemic

Time plays in different ways in relation to pandemics. Our question stems from a feminist perspective - one that is interested in lives that the sense of haste generated by the pandemic response does not protect and those whose time and fate are reconfigured in the health crisis. The country has been the global epicenter of maternal deaths due to COVID-19, yet despite scientific evidence, Brazil has raised a number of barriers against the vaccination of pregnant women ([10]). [Extracted from the article] Copyright of International Journal of Feminist Approaches to Bioethics is the property of University of Toronto Press 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 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 . (Copyright applies to all s.)

Associations of telemedicine vs. in-person ambulatory visits and cancellation rates and 30-day follow-up hospitalizations and emergency department visits.

Little is known about cancellation frequencies in telemedicine vs. in-person appointments and its impact on clinical outcomes. Our objective was to examine differences between in-person and video telemedicine appointments in terms of cancellation rates by age, race, ethnicity, gender, and insurance, and compare 30-day inpatient hospitalizations rates and 30-day emergency department visit rates between the two visit types. Demographic characteristics and comorbidities for adults scheduled for an Emory Healthcare ambulatory clinic appointment from June 2020 to December 2020 were extracted from the electronic medical record. Each appointment was identified as either a video telemedicine or in-person clinic appointment. The outcomes were ambulatory clinic cancellation rates, 30-day hospitalization rates, and 30-day emergency department visit rates. Multivariable logistic regression was used to assess differences between appointment types. A total of 1,652,623 ambulatory clinic appointments were scheduled. Ambulatory appointment cancellations rates were significantly lower among telemedicine compared to in-person appointments overall (20.4% vs. 31.0%, p < .001) and regardless of gender, age, race, ethnicity, insurance, or specialty (p < .05 for all sub-groups). Telemedicine appointments were associated with lower 30-day hospitalization rates compared to in-person appointments (AOR: 0.72, 95% CI: 0.71-0.74). There was no difference in 30-day emergency department visit rates between telemedicine and in-person appointment patients (AOR: 1.00, 95% CI: 0.98-1.02). Our findings suggest that there are fewer barriers to attending an ambulatory care visit via telemedicine relative to in-person. Using video telemedicine was not associated with more frequent adverse clinical events compared with in-person visits.

Are orthopaedic providers willing to work overtime to address COVID-19-related patient backlogs and financial deficits?

AIMS: COVID-19-related patient care delays have resulted in an unprecedented patient care backlog in the field of orthopaedics. The objective of this study is to examine orthopaedic provider preferences regarding the patient care backlog and financial recovery initiatives in response to the COVID-19 pandemic. METHODS: An orthopaedic research consortium at a multi-hospital tertiary care academic medical system developed a three-part survey examining provider perspectives on strategies to expand orthopaedic patient care and financial recovery. Section 1 asked for preferences regarding extending clinic hours, section 2 assessed surgeon opinions on expanding surgical opportunities, and section 3 questioned preferred strategies for departmental financial recovery. The survey was sent to the institution's surgical and nonoperative orthopaedic providers. RESULTS: In all, 73 of 75 operative (n = 55) and nonoperative (n = 18) providers responded to the survey. A total of 92% of orthopaedic providers (n = 67) were willing to extend clinic hours. Most providers preferred extending clinic schedule until 6pm on weekdays. When asked about extending surgical block hours, 96% of the surgeons (n = 53) were willing to extend operating room (OR) block times. Most surgeons preferred block times to be extended until 7pm (63.6%, n = 35). A majority of surgeons (53%, n = 29) believe that over 50% of their surgical cases could be performed at an ambulatory surgery centre (ASC). Of the strategies to address departmental financial deficits, 85% of providers (n = 72) were willing to work extra hours without a pay cut. CONCLUSION: Most orthopaedic providers are willing to help with patient care backlogs and revenue recovery by working extended hours instead of having their pay reduced. These findings provide insights that can be incorporated into COVID-19 recovery strategies. Level of Evidence: III Cite this article: Bone Jt Open 2021;2(7):562-568.

Cancelled routine vaccination appointments due to COVID-19 pandemic in Germany.

Pandemic measures to mitigate the outbreak of SARS-CoV-2 in Germany led to cancellations of routine vaccination appointments for both adults and children. Survey data indicate that, with easing pandemic restrictions, many cancelled appointments were rescheduled or caught up. Nevertheless, 40% of cancelled appointments were still not rescheduled and were primarily cancelled by patients. Therefore, doctors should regularly remind patients of vaccinations and use every visit to improve their vaccination statuses.

On the degree of synchronization between air transport connectivity and COVID-19 cases at worldwide level.

COVID-19 is one of the most impactful pandemics in recent history, not only in terms of direct casualties but also regarding socio-economic impact. The goal of our study is to investigate the degree of synchronization between the number of confirmed cases in specific countries, on one hand, and how/at which stage these countries adapted their air transportation operations, on the other hand. We investigate the global air transportation system as a network of countries whose edges represent the existence of direct flights. Aggregated analysis of this country network and its evolving dynamics leads to novel insights regarding the synchronization with the number of confirmed cases; finding that most country borders were likely closed too late. We believe and hope that our analysis leads to a more efficient/effective prevention and control of future epidemics.

Coronavirus disease 2019 pandemic: staged management of surgical services for gynecology and obstetrics.

The coronavirus disease 2019 pandemic warrants an unprecedented global healthcare response requiring maintenance of existing hospital-based services while simultaneously preparing for high-acuity care for infected and sick individuals. Hospitals must protect patients and the diverse healthcare workforce by conserving personal protective equipment and redeployment of facility resources. While each hospital or health system must evaluate their own capabilities and surge capacity, we present principles of management of surgical services during a health emergency and provide specific guidance to help with decision making. We review the limited evidence from past hospital and community responses to various health emergencies and focus on systematic methods for adjusting surgical services to create capacity, addressing the specific risks of coronavirus disease 2019. Successful strategies for tiered reduction of surgical cases involve multidisciplinary engagement of the entire healthcare system and use of a structured risk-assessment categorization scheme that can be applied across the institution. Our institution developed and operationalized this approach over 3 working days, indicating that immediate implementation is feasible in response to an unforeseen healthcare emergency.