Laser hair reduction should be withheld according to coronavirus disease 2019 (COVID-19) guidelines. As a result of which, patients with hirsutism are suffering. However, in case of urgency, procedures can be done with appropriate precautions. According to Centers for Disease Control and Prevention guidelines, it is necessary to cover the patient's face with a protective mask. Because a traditional mask covers most of the face, it is not possible to perform a laser procedure when a patient's mask is being worn. The chances of infection are increased if the patient's mask is removed during the procedure.
BackgroundThe COVID-19 pandemic and subsequent lockdowns adversely affected global health care services to varying extent. Emergency Services were affected along-with elective surgeries, to accommodate the added burden of COVID19 affected patients. We aimed to reflect, quantify and analyse the trends of essential surgeries and bellwether procedures during the waxing and waning of the pandemic, across various hospitals in India.MethodologyA research consortium led by WHO Collaboration Centre (WHOCC) for Research in Surgical Care Delivery in Low-and Middle-Income countries, India, conducted this study with 5 centres. All surgeries performed during the months of April 2020 (wave 1), November 2020 (recovery 1) and April 2021 (wave 2) were compared with those performed in April 2019 (pre-pandemic period). ResultsThe total number of surgeries reduced by 77% during wave 1, which improved to 52% reduction in recovery 1, as compared to pre-pandemic period. However, surgeries reduced again during wave 2 to 68%, but reduction was less as compared to wave 1. Emergency and essential surgeries were affected along-with the elective ones, but to a lesser extent.ConclusionOur study quantified the effects of the pandemic on surgical-care delivery across a timeline and documented reduction in overall surgical volumes during the peaks of the pandemic (wave 1 and 2) with minimal improvement as the surge of COVID19 cases declined (recovery 1). The second wave showed improved surgical volumes as compared to the first one which may be attributable to improved preparedness. Caesarean sections were affected the least.
Academic global surgery is a rapidly growing field that aims to improve access to safe surgical care worldwide. However, no universally accepted competencies exist to inform this developing field. A consensus-based approach, with input from a diverse group of experts, is needed to identify essential competencies that will lead to standardization in this field. A task force was set up using snowball sampling to recruit a broad group of content and context experts in global surgical and perioperative care. A draft set of competencies was revised through the modified Delphi process with two rounds of anonymous input. A threshold of 80% consensus was used to determine whether a competency or sub-competency learning objective was relevant to the skillset needed within academic global surgery and perioperative care. A diverse task force recruited experts from 22 countries to participate in both rounds of the Delphi process. Of the n = 59 respondents completing both rounds of iterative polling, 63% were from low- or middle-income countries. After two rounds of anonymous feedback, participants reached consensus on nine core competencies and 31 sub-competency objectives. The greatest consensus pertained to competency in ethics and professionalism in global surgery (100%) with emphasis on justice, equity, and decolonization across multiple competencies. This Delphi process, with input from experts worldwide, identified nine competencies which can be used to develop standardized academic global surgery and perioperative care curricula worldwide. Further work needs to be done to validate these competencies and establish assessments to ensure that they are taught effectively.
Background
It is well established that disease-free survival and overall survival after breast conservation surgery (BCS) followed by radiotherapy are equivalent to that after mastectomy. However, in Asian countries, the rate of BCS continues to remain low. The cause may be multifactorial including the patient’s choice, availability and accessibility of infrastructure, and surgeon’s choice. We aimed to elucidate the Indian surgeons’ perspective while choosing between BCS and mastectomy, in women oncologically eligible for BCS.
Methods
We conducted a survey-based cross-sectional study in January–February 2021. Indian surgeons with general surgical or specialised oncosurgical training, who consented to participate were included in the study. Multinomial logistic regression was performed to assess the effect of study variables on offering mastectomy or BCS.
Results
A total of 347 responses were included. The mean age of the participants was 43 ± 11 years. Sixty-three of the surgeons were in the 25–44 years age group with the majority (80%) being males. 66.4% of surgeons ‘almost always’ offered BCS to oncologically eligible patients. Surgeons who had undergone specialised training in oncosurgery or breast conservation surgery were 35 times more likely to offer BCS (p < 0.01). Surgeons working in hospitals with in-house radiation oncology facilities were 9 times more likely to offer BCS (p < 0.05). Surgeons’ years of practice, age, sex and hospital setting did not influence the surgery offered.
Conclusion
Two-thirds of Indian surgeons preferred BCS over mastectomy. Lack of radiotherapy facilities and specialised surgical training were deterrents to offering BCS to eligible women.
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