Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.
SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
This paper reports on an Irish study examining first year students' recollections of their concerns, motivations, level of preparedness and perceived skills on entry to university. The study aims to investigate and understand the implications of the attitudes of first year students as they make the transition to university. It also explores students' behaviour during their initial weeks at university. It is important to understand the anxieties of new students, their views on their abilities and their confidence in managing their new role as these factors will have consequences for their experience as first year university students. These findings are explored with a view to enhancing the quality of support for students during this key transition.
Participatory media fora have been the subject of sustained sociological investigation in recent decades. These fora allow the audience a presence and so create at least an illusion of access to the mass media. Studies have looked at letters to the editor (Ericson et al.There has been a concern to analyse the meaning and significance of this audience participation in massmediated debate and discussion. This discussion looks at one such forum, talk radio, drawing on a qualitative case study of an Irish talk radio show, The Gerry Ryan Show. I draw on qualitative interviews with 42 callers to the show who got on-air during a two-week period in May 1996. I also draw on an analysis of the text of the show over the same time period, and a study of the production of the show.The approach taken focuses on callers' experiences of participating in the show. The discussion highlights the issue of the presentation of the self in relation to calling. This is an aspect of participation in talk radio shows that has been largely neglected by previous studies on callers to talk radio shows. Talk radio is often thought of in relation to its democratic functions; researchers have focused on the role talk radio plays in keeping listeners up to date with political issues, and how talk radio shows provide a forum where these issues can be discussed by ordinary citizens (see for example Crittenden 1971;Hofstetter et al., 1994). In a different approach Turow (1974) introduces the idea that talk radio can be analysed as a form of interpersonal communication. His hypothesis was that calling a talk radio
Increasing emphasis in recent years has been placed on how faculty, staff and students in higher education can be drawn into more collaborative learning relationships through partnership working. The significant challenges in terms of negotiating shifting roles and responsibilities have been well documented. Less attention has been paid to the affective challenges, and particularly the emotional labour involved. This paper focuses on the adoption of a partnership approach to first year peer mentoring and orientation in a large Social Science programme. Peer mentors played a critical role as designers of the programme, as partners delivering the programme, and as co-researchers, offering a unique understanding and insight into aspects of the peer mentor experience that often remain hidden. Our findings draw attention to the need to consider and manage more carefully the impact of students on each other in mentoring relationships but also suggest an opportunity to harness the mentoring experience to embed a partnership culture more fully.
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