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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Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.

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Background: Since the onset of the COVID-19 pandemic, efforts have been aimed at promoting preventive measures towards curtailing the spread of the SARS-CoV-2 virus. The effectiveness of measures put in place by the government are mostly determined by the Knowledge, Attitude, and Practices (KAP) of the citizenry. We sought to determine the KAP of young Nigerian adults towards preventive strategies against COVID-19. Methods: An online survey was prepared using an 18-question questionnaire to assess the KAP of each participant that satisfied predefined criteria. Data obtained were screened for error and analyzed with SPSS version 23. The level of significance was set at p<0.05. Results: A total of 925 valid responses were received with a 96.25% response rate. Females made up 52.4% of the respondents, 62.4% were aged between 21-24, and 88.4% were from South-western Nigeria. The mean knowledge score was 9.02 (SD 1.18) with a maximum possible knowledge score of 13. Most of the participants (91.7%) agreed that COVID-19 will eventually be successfully controlled. Only 31.1% however had been wearing masks when leaving home. The confidence of winning the battle against COVID-19 differed significantly across the ethnic groups (p<0.01). Ages between 15 and 24 were more likely to visit crowded places (p<0.01). Conclusion: This study revealed a good knowledge level and an optimistic attitude towards the control of the COVID-19 pandemic. However, much more work is needed by government and health officials to translate these to better practices towards prevention and control as the fight against the COVID-19 pandemic continues.

Traumatic Brain Injuries (TBI) or head injuries are injuries or trauma to the scalp and or brain caused by an outside force, usually a violent blow or collision to the head by accident or deliberate attack. It can also be called be craniocerebral trauma. TBI are examples of acquired, non-degenerative assault to the brain from an external mechanical force, causing impairment of brain functions, with or without alteration to the mental state or consciousness of the victim. This paper provides a synopsis of the epidemiology and patterns of associated injuries in mild and moderate head injuries in literature. Mild and moderate head injuries were selected because they are by far commoner than severe head injuries and the outcomes are widely varied than severe head injuries. Traumatic brain injury is a global and public health problem, which in the coming years, might be the leading cause of death in Africa. High incidence is found among the adolescent and the adult age group and gender-wise, it is common among the males of the same age group. Likewise, the provision of an ambulance system and standard healthcare facilities to manage 18 patients with a traumatic brain injury can not be overemphasized.