Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov , NCT04384926 . Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include...

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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

AbstractIntroduction. Methodological Instructions for Procedures of Healthcare Institution Reports on the Indicators of the Quality of Healthcare from 2007 also involve reaction times (RTs) I, II, I+II, III and IV, as the obligatory indicator of the quality of expert work of Emergency Medical Services (EMS). Objective. Evaluation of the quality of expert work of Belgrade EMS based on RTs. Methods. A retrospective analysis of priority 1 emergency calls in September 2009 vs September 2010, and RTs from I to IV as the recommended indicators of the quality of expert work of Belgrade EMS. Results. As detected, in 2010 there has been decrease in the total number of calls for physicians, and the total number of priority 1 emergency calls. By comparing RTs, the obtained data showed that in 2010 the time elapsed from when a priority 1 call was received until it was handed to the EMS team for implementation (RT I) was on average faster by 0.1 min (p<0.01), that the time elapsed from the dispatcher’s receipt of the call until the EMS team arrived to the patient (RT II) was faster on average by 0.42 min (p<0.05), and that the time for the team to reach the patient after the received call through the call centre (RT I+II) was faster by 0.15 min. Also, in 2010, RT III was shortened by 1.27 min and RT IV by 1.00 min. By summing RTs I, II and III, independently resolved level I emergency calls at the scene are obtained. In 2009, this time interval was, on average 38.02 min, and in 2010 it was an average of 36.23 min. By summing RTs I, II and IV, the time elapsed from the call received through the call centre until the patient’s hospital admission is obtained. In 2009 this time was average 31.08 min, and in 2010 it was average 29.16 min. Conclusion. One of the major advances in emergency medicine is providing assistance to a request for emergency medical care where this is produced. Therefore, the indicator of RTs may measure the quality of care provided by pre-hospital services.

Question of missed injuries is more often a question of human errors: task execution errors, procedural errors, communication errors, decision errors and noncompliance. Missed injuries are those which are not idetified in the first three days of hospitalisaation. This theme is not popular among physicians. Literature data mention percent from 3-29% missed injuries overall. The underlying causes errors are: false attributin, false negative prediction and false lebeling. False attribution involves a tendency to incorrectly link a clinical observation with an arroneous cause. This tendency also ignores one of the fundamental principles of the management of traumatic injury: that the index of suspicion should proceed on the basis of assumed wors resonable case scenario. Weaknesses of trauma systems: high patients volume, high-risk patients, long hours, changing set of resources, and problems sush bad admission planing, defficite anamnesis, defficite diagnostic procedures, bad communication, improvisation etc.