COVID-19 infections (CI) amongst patients.Results There was no delay in the simulation training. Wet lab training was delayed due to temporary center closure. The surgeon's learning curve was slower at the beginning of the program. This was attributed to the lower influx of patients as a result of prioritization, lesser operative sessions, and delays in the mandatory training completion. 41 RS procedures were done in the first 8 month following a COVID-19 free pathway and were operated in an elective surgery hub with no visitors allowed. There were no cancellations due to CI during this period. Following the return to NHS hospital, 102 patients underwent RS in the subsequent 8 months. Preoperative isolation was gradually reduced then cancelled. One patient had a CI and was rescheduled accordingly. Conclusion Covid pandemic has impacted the learning curve for RS with significant improvement noted after the gradual release of Covid related restrictions.
Acculturation and acculturative stress are potential risk factors for adverse perinatal outcomes. This study investigates whether and how acculturative stress affects preterm birth (PTB) in a sample of migrant women in Berlin. We interviewed 955 women who recently gave birth using standardized questionnaires (Frankfurt Acculturation Scale and Acculturative Stress Index). Multivariable logistic regression analyses assessed the effects of acculturation and acculturative stress on PTB. Women with migrant backgrounds did not have significantly higher PTB rates than German natives. First-generation migrants experienced higher acculturative stress levels than second-generation migrants, 38.8% vs. 13.2%. Acculturative stress could not be identified as a risk factor for PTB in our sample. These results need to be considered in the context of an international city and the wide use of antenatal care services in our population, which could be responsible for similarly good perinatal outcomes and highlights the potential of good access to perinatal care for vulnerable groups.
Background: Despite the key role of optimized fasting in modern perioperative patient management, little current data exist on perioperative fasting intervals in routine clinical practice. Methods: In this multicenter prospective study, the length of pre- and postoperative fasting intervals was assessed with the use of a specifically developed questionnaire. Between 15 January 2021 and 31 May 2022, 924 gynecology patients were included, from 13 German gynecology departments. Results: On average, patients remained fasting for about three times as long as recommended for solid foods (17:02 ± 06:54 h) and about five times as long as recommended for clear fluids (9:21 ± 5:48 h). The average perioperative fasting interval exceeded one day (28:23 ± 14:02 h). Longer fasting intervals were observed before and after oncological or extensive procedures, while shorter preoperative fasting intervals were reported in the participating university hospitals. Smoking, treatment in a non-university hospital, an increased Charlson Comorbidity Index and extensive surgery were significant predictors of longer preoperative fasting from solid foods. In general, prolonged preoperative fasting was tolerated well and quality of patient information was perceived as good. Conclusion: Perioperative fasting intervals were drastically prolonged in this cohort of 924 gynecology patients. Our data indicate the need for better patient education about perioperative fasting.
included 3973 patients (52 countries; 7 world regions; 27% from low-and-middle-income countries).Lower-than-reported rate (22/3778; 0.6%) of perioperative SARS-CoV-2 infections was observed. This group had higher morbidity (63.6% vs 19.1%; p<0.0001) and mortality (18.2% vs 0.7%; p<0.0001) rates, compared to the uninfected cohort.In 20.7% (823/3973), standard of care was adjusted. Significant delay (>8 weeks) was observed in 11.2% (424/3784), particularly in those with ovarian cancer (213/1355; 15.7%). This delay was associated with the use of neoadjuvant chemotherapy (p<0.0001), a composite of adverse outcomes including disease progression and death (95/424; 22.4% versus 601/ 3360; 17.9%, p=0.024), compared to those who had operations within 8 weeks of their MDT decisions.One in thirteen did not receive their planned operations (189/2430; 7.9%), in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of MDT decisions for surgery Conclusion One in five surgical patients with gynecological cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations. This global data on the magnitude of care changes and their consequences could be used to leverage resources for the ongoing mitigating strategies worldwide.
groups more predisposed to PTSD. Distress was highest in emergency admissions, reinforcing the need for earlier diagnosis through improved diagnostic pathways. Psychological support may improve patient experience, especially for younger, less educated unemployed women.
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