Global International Society of University Colon and Rectal Surgeons in collaboration with European Society of Coloproctology audit on office-based and surgical treatment of haemorrhoidal disease: Study protocol.

AIM: Haemorrhoidal disease (HD) is one of the most common anal disorders in the adult population. Despite that, treatment options differ among different countries and specialists, even for the same grade of HD. The aim of this study is to evaluate the differences in patient demographics, surgeon preference for the treatment option, outcomes as well as patient satisfaction rate for the procedure using an office-based or surgical approach for the treatment of HD among International Society of University Colon and Rectal Surgeons (ISUCRS) and European Society of Coloproctology (ECSP) fellows. METHOD: A panel of the ISUCRS and ECSP members will answer questions that are included in a questionnaire about the treatment of HD. The questionnaire will be distributed electronically to ISUCRS and ECSP fellows included in our database and will remain open from 1 April 2024 to 31 May 2024. CONCLUSION: This multicentre, global prospective audit will be delivered by consultant colorectal and general surgeons as well as trainees. The data obtained will lead to a better understanding of the incidence of HD, treatment and diagnostic possibilities. This snapshot audit will be hypothesis generating and inform areas the need future prospective study.

On the search for efficient face recognition algorithm subject to multiple environmental constraints.

From literature, majority of face recognition modules suffer performance challenges when presented with test images acquired under multiple constrained environments (occlusion and varying expressions). The performance of these models further deteriorates as the degree of degradation of the test images increases (relatively higher occlusion level). Deep learning-based face recognition models have attracted much attention in the research community as they are purported to outperform the classical PCA-based methods. Unfortunately their application to real-life problems is limited because of their intensive computational complexity and relatively longer run-times. This study proposes an enhancement of some PCA-based methods (with relatively lower computational complexity and run-time) to overcome the challenges posed to the recognition module in the presence of multiple constraints. The study compared the performance of enhanced classical PCA-based method (HE-GC-DWT-PCA/SVD) to FaceNet algorithm (deep learning method) using expression variant face images artificially occluded at 30% and 40%. The study leveraged on two statistical imputation methods of MissForest and Multiple Imputation by Chained Equations (MICE) for occlusion recovery. From the numerical evaluation results, although the two models achieved the same recognition rate (85.19%) at 30% level of occlusion, the enhanced PCA-based algorithm (HE-GC-DWT-PCA/SVD) outperformed the FaceNet model at 40% occlusion rate, with a recognition rate of 83.33%. Although both Missforest and MICE performed creditably well as de-occlusion mechanisms at higher levels of occlusion, MissForest outperforms the MICE imputation mechanism. MissForest imputation mechanism and the proposed HE-GC-DWT-PCA/SVD algorithm are recommended for occlusion recovery and recognition of multiple constrained test images respectively.

Time series based road traffic accidents forecasting via SARIMA and Facebook Prophet model with potential changepoints.

Road traffic accident (RTA) is a critical global public health concern, particularly in developing countries. Analyzing past fatalities and predicting future trends is vital for the development of road safety policies and regulations. The main objective of this study is to assess the effectiveness of univariate Seasonal Autoregressive Integrated Moving Average (SARIMA) and Facebook (FB) Prophet models, with potential change points, in handling time-series road accident data involving seasonal patterns in contrast to other statistical methods employed by key governmental agencies such as Ghana's Motor Transport and Traffic Unit (MTTU). The aforementioned models underwent training with monthly RTA data spanning from 2013 to 2018. Their predictive accuracies were then evaluated using the test set, comprising monthly RTA data from 2019. The study employed the Box-Jenkins method on the training set, yielding the development of various tentative time series models to effectively capture the patterns in the monthly RTA data. SARIMA(0,1,1)×(1,0,0)12 was found to be the suitable model for forecasting RTAs with a log-likelihood value of -266.28, AIC value of 538.56, AICc value of 538.92, BIC value of 545.35. The findings disclosed that the SARIMA(0,1,1)×(1,0,0)12 model developed outperforms FB-Prophet with a forecast accuracy of 93.1025% as clearly depicted by the model's MAPE of 6.8975% and a Theil U1 statistic of 0.0376 compared to the FB-Prophet model's respective forecasted accuracy and Theil U1 statistic of 84.3569% and 0.1071. A Ljung-Box test on the residuals of the estimated SARIMA(0,1,1)×(1,0,0)12 model revealed that they are independent and free from auto/serial correlation. A Box-Pierce test for larger lags also revealed that the proposed model is adequate for forecasting. Due to the high forecast accuracy of the proposed SARIMA model, the study recommends the use of the proposed SARIMA model in the analysis of road traffic accidents in Ghana.

Factors affecting access to dialysis for patients with end-stage kidney disease in Sub-Saharan Africa: A scoping review.

AIMS: This scoping review examined the factors affecting access to dialysis for patients with end-stage kidney disease in Sub-Saharan Africa. DESIGN: Scoping review. METHODS: The scoping review is conducted following the Joanna Briggs Institute methodology for scoping reviews and modelled by Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review. RESULTS: A descriptive content analysis of 30 included articles revealed three main findings affecting access and use of dialysis: Health system-related factors, health provider-related factors and patient factors. PATIENT OR PUBLIC CONTRIBUTION: Equity in renal replacement therapy access and use will require concerted advocacy for good public policy, healthcare delivery, workforce capacity and education.

International Society of University Colon and Rectal Surgeons survey of surgeons' preference on rectal cancer treatment.

PURPOSE: Rectal cancer treatment has a wide range of possible approaches from radical extirpative surgery to nonoperative watchful waiting following chemoradiotherapy, with or without, additional chemotherapy. Our goal was to assess the personal opinion of active practicing surgeons on rectal cancer treatment if he/she was the patient. METHODS: A panel of the International Society of University Colon and Rectal Surgeons (ISUCRS) selected 10 questions that were included in a questionnaire that included other items including demographics. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in our database and remained open from April 16 to 28, 2020. RESULTS: One hundred sixty-three specialists completed the survey. The majority of surgeons (n=65, 39.9%) chose the minimally invasive (laparoscopic) surgery for their personal treatment of rectal cancer. For low-lying rectal cancer T1 and T2, the treatment choice was standard chemoradiation+local excision (n=60, 36.8%) followed by local excision±chemoradiotherapy if needed (n=55, 33.7%). In regards to locally advanced low rectal cancer T3 or greater, the preference of the responders was for laparoscopic surgery (n=65, 39.9%). We found a statistically significant relationship between surgeons' age and their preference for minimally invasive techniques demonstrating an age-based bias on senior surgeons' inclination toward open approach. CONCLUSION: Our survey reveals an age-based preference by surgeons for minimally invasive surgical techniques as well as organ-preserving techniques for personal treatment of treating rectal cancer. Only 1/4 of specialists do adhere to the international guidelines for treating early rectal cancer.

Low Anterior Resection Syndrome: What Have We Learned Assessing a Large Population?

Our goal was to assess the rate of symptoms commonly included in LARS score in a large general population. The study was based on a population-based design. We disseminated LARS scores through community online platforms and general practitioners throughout Lithuania. We received 8183 responses to the questionnaire. There were 142 (1.74%) participants who were excluded for lack of information. There were 6100 (75.9%) females and 1941 (24.1%) males. After adjusting for sex and age, male participants had a significant average score of 18.4 (SD ± 10.35) and female 20.3 (SD ± 9.74) p < 0.001. There were 36.4% of participants who had minor LARS symptoms, and 14.2% who had major LARS symptoms. Overall, major LARS-related symptoms were significantly related to previous operations: 863 participants in the operated group (71.7%), and 340 in the non-operated group (28.3%; p0.001). In 51−75-year-old patients, major LARS was significantly more prevalent with 22.7% (p < 0.001) and increasing with age, with a higher incidence of females after the age of 75. After excluding colorectal and perineal procedures, the results of multivariate logistic regression analysis indicated the use of neurological drugs and gynaecological operations were independent risk factors for major LARS−odd ratio of 1.6 (p = 0.018, SI 1.2−2.1) and 1.28 (p = 0.018, SI 1.07−1.53), respectively. The symptoms included in the LARS score are common in the general population, and there is a variety of factors that influence this, including previous surgeries, age, sex, comorbidities, and medication. These factors should be considered when interpreting the LARS score following low anterior resection and when considering treatment options preoperatively.

DElayed COloRectal cancer care during COVID-19 Pandemic (DECOR-19): Global perspective from an international survey.

BACKGROUND: The widespread nature of coronavirus disease 2019 (COVID-19) has been unprecedented. We sought to analyze its global impact with a survey on colorectal cancer care during the pandemic. METHODS: The impact of coronavirus disease 2019 on preoperative assessment, elective surgery, and postoperative management of colorectal cancer patients was explored by a 35-item survey, which was distributed worldwide to members of surgical societies with an interest in colorectal cancer care. Respondents were divided into 2 comparator groups: (1) "delay" group: colorectal cancer care affected by the pandemic and (2) "no delay" group: unaltered colorectal cancer practice. RESULTS: A total of 1,051 respondents from 84 countries completed the survey. No substantial differences in demographics were found between the delay (745, 70.9%) and no delay (306, 29.1%) groups. Suspension of multidisciplinary team meetings, staff members quarantined or relocated to coronavirus disease 2019 units, units fully dedicated to coronavirus disease 2019 care, and personal protective equipment not readily available were factors significantly associated to delays in endoscopy, radiology, surgery, histopathology, and prolonged chemoradiation therapy-to-surgery intervals. In the delay group, 48.9% of respondents reported a change in the initial surgical plan, and 26.3% reported a shift from elective to urgent operations. Recovery of colorectal cancer care was associated with the status of the outbreak. Practicing in coronavirus disease-free units, no change in operative slots and staff members not relocated to coronavirus disease 2019 units were statistically associated with unaltered colorectal cancer care in the no delay group, while the geographic distribution was not. CONCLUSION: Global changes in diagnostic and therapeutic colorectal cancer practices were evident. Changes were associated with differences in health care delivery systems, hospital's preparedness, resource availability, and local coronavirus disease 2019 prevalence rather than geographic factors. Strategic planning is required to optimize colorectal cancer care.

COVID-19 and the Global Impact on Colorectal Practice and Surgery.

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. MATERIALS AND METHODS: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. RESULTS: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. CONCLUSION: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period.

International consensus on natural orifice specimen extraction surgery (NOSES) for gastric cancer (2019).

At present, natural orifice specimen extraction surgery (NOSES) has attracted more and more attention worldwide, because of its great advantages including minimal cutaneous trauma and post-operative pain, fast post-operative recovery, short hospital stay, and positive psychological impact. However, NOSES for the treatment of gastric cancer (GC) is still in its infancy, and there is great potential to improve its theoretical system and clinical practice. Especially, several key points including oncological outcomes, bacteriological concerns, indication selection, and standardized surgical procedures are raised with this innovative technique. Therefore, it is necessary to achieve an international consensus to regulate the implementation of GC-NOSES, which is of great significance for healthy and orderly development of NOSES worldwide.

Waiting Time following Neoadjuvant Chemoradiotherapy for Rectal Cancer: Does It Really Matter.

BACKGROUND: Neoadjuvant chemoradiotherapy (CRT) is considered the standard approach before any surgical intervention for locally advanced rectal tumors and has been proven to significantly improve the local recurrence rates of rectal cancer. However, the optimal timing of surgical resection after neoadjuvant CRT remains debatable. OBJECTIVE AND METHODS: We conducted a retrospective review of 65 consecutive patients with locally advanced rectal cancer who underwent preoperative CRT followed by surgical resection in order to evaluate the optimal time for surgical treatment. We used two alternative groups for analysis: patients who underwent surgery up to 6 weeks after CRT (n = 28) and those who underwent surgery 6 weeks or more after CRT (n = 27). Also, we compared patients who were operated on within 3 months (n = 39) with those who underwent surgical resection after more than 3 months (n = 16). Nonresponders to CRT were excluded from the analysis. RESULTS: There was no statistically significant association between waiting period post CRT and radiological downstaging for any group (p > 0.05 for any association). Also, there was no association between recurrence of disease, cancer-related deaths, perineural invasion, or positive lymph node ratio and any waiting period up to 3 months (p > 0.05 for all associations). CONCLUSION: In this small exploratory study there was no evident difference in outcome according to timing of surgery, which suggests that further research in larger cohorts is warranted.

Ghana's National Health Insurance Scheme: insights from members, administrators and health care providers.

The Ghana National Health Insurance Scheme (NHIS) was established as part of a poverty reduction strategy to make health care more affordable to Ghanaians. It is envisaged that it will eventually replace the existing cash-and-carry system. This paper examines the views of NHIS administrators, members/enrollees, and health care providers on how the Scheme operates in practice. It is part of a larger evaluation project on Ghana's NHIS, sponsored by the Bill and Melinda Gates Foundation and the Global Development Network as part of a two-year global research. We rely primarily on qualitative data from focus group discussion in the Brong Ahafo and the Upper East regions respectively. Our findings suggest that the NHIS has improved access to affordable health care services and prescription drugs to many people in Ghana. However, there are concerns about fraud and corruption that must be addressed if the Scheme is to be financially viable.

The "diamond port configuration": a standardised laparoscopic technique for adolescent intestinal resection and anastomosis.

BACKGROUND: Familiarity with technique and repetition enhance efficiency during laparoscopic surgery. This is particularly important when undertaking complex bowel resections. We report a standardised protocol that includes theatre layout, patient position and port insertion, which we believe facilitates excellent abdominal access and ergonomics and has the potential to shorten the duration of the team-learning curve. MATERIALS AND METHODS: A strategic unit development plan led to the commencement of a laparoscopic service for adolescents with bowel disorders. A standardised protocol for intestinal resections was agreed upon at a monthly Paediatric Minimal Access Group meeting. This covered patient position, port insertion, technical aspects of intestinal resection and perioperative management. In particular, a diamond configuration for ports was agreed upon. Data were prospectively collected, and included patient demographics, operative times, conversion rates and postoperative outcomes. Unless otherwise indicated, data are presented as medians with ranges. RESULTS: Seven procedures were carried out in six patients (three female) aged 14 (11-14) years. Access to the entire abdominal cavity, vision and ergonomics were excellent in all. There were no conversions to open surgery. In all procedures, the technique was considered safe and effective. The length of hospital stay was 6.5 (5.8-14) days. CONCLUSION: A standardised protocol including the use of the diamond port configuration has several putative advantages for laparoscopic bowel resections and anastomoses. These include efficiency, reproducibility, predictability, good visibility and excellent ergonomics. We recommend this approach as a means to shorten the procedure-specific learning curve of the laparoscopic team.

Ghana's National Health Insurance Scheme in the context of the health MDGs: an empirical evaluation using propensity score matching.

In 2003 the Government of Ghana established a National Health Insurance Scheme (NHIS) to improve health-care access for Ghanaians and eventually replace the cash-and-carry system. This study evaluates an important aspect of its promise in the context of the Millennium Development Goals #4 and #5 which deal with the health of women and children. We use Propensity Score Matching techniques to balance the relevant background characteristics in our survey data and compare health indicators of recent mothers who are enrolled in the NHIS with those who are not. Our findings suggest that NHIS women are more likely to receive prenatal care, deliver at a hospital, have their deliveries attended by trained health professionals, and experience less birth complications. We conclude that NHIS is an effective tool for improving health outcomes among those who are covered, which should encourage the Ghanaian government to promote further enrollment, in particular among the poor.

Adenocarcinoma arising in the middle of ileoanal pouches: report of five cases.

Restorative proctocolectomy with ileal pouch-anal anastomosis with or without mucosectomy has become the procedure of choice in patients with long-standing ulcerative colitis complicated by malignancy or medically refractory disease and for familial polyposis syndrome. Some reports have demonstrated the development of malignancy at the ileoanal anastomosis. We present a recent series of five patients who developed adenocarcinoma in the middle of their ileal pouch including the first case of pouch carcinoma in a patient who underwent pouch formation for ulcerative colitis. We discuss their presentation and management. Development of ileal pouch cancers, while rare, has been seen with increasing frequency in our practice. Patients with long-standing ileal pouches may benefit from routine surveillance of the pouch as often as every six months, which can be performed quickly and easily in the office using flexible endoscopy.

Prevalence of intra-abdominal surgery: what is an individual's lifetime risk?

BACKGROUND: The lifetime risk of intra-abdominal surgery is unknown. The objectives of this study were to derive this information from our local population, and to consider the role of incidental surgery. METHODS: Over an 8-year period, 2648 autopsy and clinical records from a public and private hospital were reviewed for evidence of intra-abdominal surgery. RESULTS: 2262 (85%) cases were from the public hospital and 386 (15%) from the private hospital. The adjusted intra-abdominal surgical rate was 43.8% in those over the age of 60. With the exception of the age group 21-40, there were no statistical significant differences in operative rates between hospitals. The intra-abdominal surgical rate over the age of 60 was used as an estimate of the lifetime risk of intra-abdominal surgery. CONCLUSIONS: The lifetime risk of intra-abdominal surgery can be used to assess the utilization of healthcare among ethnic groups and in considering the role of incidental surgery.

Management of acquired rectourinary fistulas: how often and when is permanent fecal or urinary diversion necessary?

PURPOSE: The objective of this study was to evaluate our experience in the management of acquired rectourinary fistulas at our tertiary center. METHODS: Eighteen patients with fistulas treated from 1999 to 2004 were retrospectively reviewed for demographics, etiology of the fistulas, treatment, and outcome. RESULTS: The median age of the group was 69 years. Sixteen patients had fistulas that were malignant-associated. One patient died from tumor progression before any surgical therapy. The remaining 17 patients underwent surgical treatment of the fistula with a median of one procedure per patient. Eight patients had excision with permanent diversion, two had excision with repair/reconstructive procedures, and seven had repair surgical procedures. Initial surgical management was successful for 13 (76 percent) patients. Reoperation resulted in a final success rate of 100 percent. The rates of permanent fecal, urinary, and fecal plus urinary diversion in the malignant associated fistula group were 5.8, 47, and 5.8 percent, respectively. The median follow-up for all patients was 9.5 months. There were no procedure-related mortalities and five (29 percent) patients had significant surgical-related morbidity. CONCLUSIONS: Our data suggest that surgical treatment for acquired rectourinary fistulas can successfully avoid permanent fecal and/or urinary diversion in a large number of patients if locally curative cancer treatment can be achieved.