IMPACT OF COVID-19 ON ECT PRACTICE IN QATAR

There is paucity of Electroconvulsive therapy (ECT) utilization surveys from the Arabian Gulf region and none available from Qatar. There is no literature available on impact of Coronavirus Disease 2019 (COVID-19) pandemic on ECT provision. ECT is a lifesaving treatment in psychiatric practice requiring anesthetic support and there were concerns that redeployment of anesthetists due to COVID-19 pandemic might have comparatively bigger impact on the provision of ECT. These concerns stem from the fact that psychiatric patients often get discriminated against in health care systems; largely due to stigma and the belief among healthcare providers that psychiatric illness is somehow not as serious as other types of medical or surgical illness. In this brief report we present pre-COVID ECT utilization from Qatar. We also report findings on ECT utilization during COVID-19 and compare changes with other elective and non-elective surgeries. ECT provision was down by 40% during March to August 2020 in our setting. The decline in ECT provision was comparable to other elective and non-elective surgeries

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Psychiatric inpatients' views of their mental health, and their experience of social change, during the pandemic: A report from Qatar

What is known on the subject?: There is only limited information on how the COVID-19 pandemic has affected people diagnosed with mental health disorders, especially people admitted to psychiatric wards. We surveyed the views of inpatients at Qatar's only psychiatric hospital regarding how the pandemic had affected their mental health and social changes they had experienced during the pandemic. What the paper adds to existing knowledge?: Nearly half (43%) of those who completed the survey reported that the pandemic had led to a deterioration in their mental health. Those who reported deterioration in their mental health during the pandemic were significantly more likely to have experienced negative social changes during the pandemic. Examples included increased stress from the home and reduced ability to discuss emotions/feelings with family members. What are the implications for practice?: Mental health services need to ensure ongoing support for patients during and after the pandemic. Mental health nurses have a pivotal role including identifying early warning signs of relapse of mental disorders, delivering talking treatments and providing practical advice and COVID-19-related education. Further work is needed to assess the views of people diagnosed with mental health problems in different countries and at a different time point during the pandemic. Abstract: Introduction The impact of the COVID-19 pandemic on people under the care of mental health services has received relatively little attention in the scientific literature. Aim To assess psychiatric inpatients' views regarding their mental health and experience of social change during the pandemic. Method Cross-sectional survey of consecutive patients admitted to Qatar's only psychiatric hospital between mid-June and mid-October 2020. Results Data were analysed for 114/284 (40%) patients admitted during the study period. 8 (7%) reported a history of COVID-19. 43% reported that the pandemic had led to deterioration in their mental health, 11% to an improvement and 39% that there had been no attributable change. Those reporting worsened mental health, attributable to the pandemic, were significantly more likely to report having experienced four negative social changes during the pandemic, namely reduced ability to discuss emotions/feelings with family members, decreased time spent exercising, decreased time spent relaxing and increased stress from the home. Demographic factors did not distinguish those reporting worsened mental health from those whose mental health was improved or unchanged. Discussion A large proportion of psychiatric inpatients reported negative social and mental health changes during the pandemic. However, the study cannot determine causality. Implications for practice Mental health services should consider the psychological and social aspects of people's lives, including their interactions with family, friends and the community. This is especially relevant during the COVID-19 pandemic due to its wide impact on society. Interventions for people diagnosed with mental health disorders should address their psychological and social needs.This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors We wish to thank the patients who took part. We also thank Dr Rajvir Singh for statistical advice and reviewing the analysis.Scopu

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p<0·0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63·0% vs 82·7%; OR 0·35 [0·23–0·53]; p<0·0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer. Interpretation: Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised. Funding: National Institute for Health and Care Research

Search for third-generation scalar leptoquarks in the tτ channel in proton-proton collisions at √s =8 TeV

A search for pair production of third-generation scalar leptoquarks decaying to top quark and τ lepton pairs is presented using proton-proton collision data at a center-of-mass energy of $\sqrt{s}=8$ TeV collected with the CMS detector at the LHC and corresponding to an integrated luminosity of 19.7 fb$^{−1}$. The search is performed using events that contain an electron or a muon, a hadronically decaying τ lepton, and two or more jets. The observations are found to be consistent with the standard model predictions. Assuming that all leptoquarks decay to a top quark and a τ lepton, the existence of pair produced, charge −1/3, third-generation leptoquarks up to a mass of 685 GeV is excluded at 95% confidence level. This result constitutes the first direct limit for leptoquarks decaying into a top quark and a τ lepton, and may also be applied directly to the pair production of bottom squarks decaying predominantly via the R-parity violating coupling λ$_{333}^{′}$

Evidence for Transverse Momentum and Pseudorapidity Dependent Event Plane Fluctuations in PbPb and pPb Collisions

A systematic study of the factorization of long-range azimuthal two-particle correlations into a product of single-particle anisotropies is presented as a function of $p_\mathrm{T}$ and $\eta$ of both particles, and as a function of the particle multiplicity in PbPb and pPb collisions. The data were taken with the CMS detector for PbPb collisions at $\sqrt{s_{\mathrm{NN}}}$ = 2.76 TeV and pPb collisions at $\sqrt{s_{\mathrm{NN}}}$ = 5.02 TeV, covering a very wide range of multiplicity. Factorization is observed to be broken as a function of both particle $p_\mathrm{T}$ and $\eta$. When measured with particles of different $p_\mathrm{T}$, the magnitude of the factorization breakdown for the second Fourier harmonic reaches 20% for very central PbPb collisions but decreases rapidly as the multiplicity decreases. The data are consistent with viscous hydrodynamic predictions, which suggest that the effect of factorization breaking is mainly sensitive to the initial-state conditions rather than to the transport properties (e.g., shear viscosity) of the medium. The factorization breakdown is also computed with particles of different $\eta$. The effect is found to be weakest for mid-central PbPb events but becomes larger for more central or peripheral PbPb collisions, and also for very high-multiplicity pPb collisions. The $\eta$-dependent factorization data provide new insights to the longitudinal evolution of the medium formed in heavy ion collisions

Addressing Liability of Automated Systems in Air Traffic Management

In the current operational scenario of Air Traffic Management (ATM), liability is mainly allocated to the operators who are responsible for air traffic control and air navigation. However, this scenario will rapidly change: the adoption of new technologies with high automation levels is likely to raise new legal issues related to liability. The paper presents an outline of the issues of liability in relation to automation, focusing on the concept of autonomy and on the delegation of tasks to automatic systems or to hybrid human-machine systems. Finally a proposal to handle such issues is presented, based on a model of ATM as a socio-technical system, where the allocation of liabilities may be seen as a governance mechanism enabling the enhancement of the functioning of ATM