This study aimed to identify whether changes to service made during the COVID-19 pandemic have had an impact on postoperative tumour histopathological grading and, therefore, prognosis. There was a significant increase in time between initial referral and surgery during the first and second waves compared with before the pandemic. However, despite the delay from initial referral to surgery, histology of the surgical specimens showed no significant difference between any of the three groups.
The impact of the COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Surveillance for cancer was paused and, because of the unprecedented demand on services, referral pathways slowed and waiting times for cancer operations were prolonged [1][2][3][4] . Any delay in cancer surgery is likely to cause understandable distress to patients and potential unease for clinicians. This study aimed to identify whether the changes to service made during the pandemic have had an impact on postoperative tumour histopathological grading and, therefore, prognosis.All patients diagnosed with colorectal cancer and entered in the authors' tertiary surgical unit local cancer database in three 4-month intervals were included. These corresponded to before the pandemic (March-June 2019), during the UK's first wave of COVID-19 (March-June 2020), and during the second wave (December 2020-March 2021). The total number of patients diagnosed with colorectal cancer and, for those undergoing elective primary surgical resection, the interval from referral to surgery and the postoperative histology, was compared between groups. Only patients with confirmed
At the APPEA 2017 Conference in Perth, Bernadette Cullinane and Susan Gourvenec drew our attention to the looming challenge for Australia’s oil and gas industry in decommissioning its aging assets (Cullinane and Gourvenec 2017). While Cullinane and Gourvenec’s paper focussed on the experience challenge for the Australian industry, this paper will drill down to explore the funding and financial challenges and opportunities for decommissioning in the decades ahead. In approaching the decommissioning of their assets, oil and gas companies must consider a broad range of stakeholders, beyond their immediate shareholders and board members. As we have seen in the development of new projects, Australian Government, environmental organisations and community groups, all have increasingly significant impact. These stakeholders have been considered and managed with (at best) varying degrees of effectiveness in the recent past. This impact will continue to grow for decommissioning of existing assets. However, right now, with few decommissioning projects in play, the industry has a limited window of opportunity to set the agenda for how, when and under what kind of funding arrangements and financial structures decommissioning can take place. By getting ahead of the game and establishing best practices from the outset, the industry can demonstrate to Australian Government, environmental organisations and community groups a level of commitment and accountability that will allow us to move ahead on decommissioning, with reduced outside interference. The window of opportunity is closing. The time to act is now.
Aims The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact. Methods All patients diagnosed with colorectal cancer in the authors’ tertiary surgical unit in three 4-month intervals were included. These corresponded to before the pandemic (March–June 2019), during the UK's first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The incidence of stomas was compared between groups. Results In patients undergoing elective surgery the incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during the first wave and increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves. Conclusion A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
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