Infants who underwent resection of the primary tumor at diagnosis had no better outcome than those in whom the decision was made not to operate.
We describe the London community testing programme developed for COVID-19, audit its effectiveness and report patient acceptability and patient adherence to isolation guidance, based upon a survey conducted with participants. Any patients meeting the Public Health England (PHE) case definition for COVID-19 who did not require hospital admission were eligible for community testing. 2,053 patients with suspected COVID-19 were tested in the community between January and March 2020. Of those tested, 75 (3.6%) were positive. 88% of patients that completed a patient survey felt safe and 82% agreed that community testing was preferable to hospital admission. 97% were able to remain within their own home during the isolation period but just 41% were able to reliably isolate from other members of their household. The London community testing programme allowed widespread testing for COVID-19 while minimising patient transport, hospital admissions and staff exposures. Community testing was acceptable to patients and preferable to admission to hospital. Patients were able to reliably isolate in their home but not from household contacts. The authors believe in the importance, feasibility and acceptability of community testing for COVID-19 as a part of a package of interventions to mitigate a second wave of infection.
Background NHS waiting lists for elective surgeries including non-urgent laparoscopic cholecystectomies (LC) have severely escalated during the Covid-19 pandemic, with some patients waiting over 2 years for their operations. LCs are highly variable in terms of operative time, difficulty, and risk making theatre utilisation a challenge to effectively clear waiting lists. Nassar et al.[1] developed and validated a pre-operative risk prediction score for predicting the difficult LC using an objective operative difficulty grading system. We aimed to assess if application of CholeS could be used to predict which LC may have longer operative times, and so aid theatre utilisation planning. Methods Consecutive elective LCs performed between May and October 2021 at our institution's day surgery unit were included and analysed. Each patient was scored retrospectively using the CholeS pre-operative risk score from electronic patient records. Operative time was obtained from theatre electronic record systems. Data was collected on conversion to open surgery, post-operative day of discharge, and intra or post-operative complications. Outliers with operating time recorded as <20 minutes were considered data entry errors and excluded from analysis. A ROC analysis was used, which determined a threshold value of 3. This value was used to divide patients into a low-risk (≤3 points) and high-risk (four and above) group. Two-sample independent t-test was used to compare mean operative time between the high-risk and low-risk CholeS score groups. Levene's test was used to determine if variance was equal between groups. SPSS version 27[2] was used for data analysis and statistical tests and p<0.05 was deemed significant. Results 81 LC were included for analysis. 53 patients were low-risk and 26 patients were high-risk. There was a significantly lower operative time in the low-risk group: low-risk = 57.6 minutes (95% CI 52.4–63.0) vs high-risk = 75.8 minutes (95% CI 58.7–92.9), p=0.046. Nine patients had surgeries lasting >90 minutes; 66% of these were in the high-risk LC group. 95% of patients were discharged on day 0, two patients on day 1, and two on day 2 or later. Three patients had conversion to open cholecystectomy and five patients had post-operative complications. Two out of three patients who required conversion to open cholecystectomies were in high-risk patients with high CholeS scores (7 and 10). In one patient, a cholecystoduodenal fistula was found. Cystic duct avulsion occurred in the other. Three out of five patients with post-operative complications were in the high-risk group, with corresponding higher Clavien-Dindo scores (3b, 2 and 2) when compared to the low-risk group (1 for both patients). Conclusions The CholeS pre-operative scoring system could be used to optimise LC theatre allocation. A score of ≤3 has a shorter operative time than a patient with a score of four or more (mean difference = 18.1 mins, 95% CI 4.4–31.9). Prediction of which LCs will be shorter operations could improve theatre utilisation and allow extra cases booking on the operating list. This, in turn, could help reduce the number of patients on the waiting list. Additionally, CholeS could be used to predict patients with more challenging and prolonged operations as well as those at higher risk of open conversion and complications. This could allow such patients to be managed by allocation to inpatient specialist upper GI specialist lists. [1] Nassar, A.H.M., Hodson, J., Ng, H.J. et al. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system. Surg Endosc 34, 4549–4561 (2020). [2] IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.
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