Timeshare Owners’ Perceptions of and Preferred Ways of Participating in Tourism Planning

Purpose To explore the impact of prostate cancer treatment on: (a) the experience of symptoms (i.e. sexual, urinary, and bowel), and (b) perceived health state of men with prostate cancer one month following their radiation treatment. Methods A prospective pre-test–post-test descriptive survey was conducted on a convenience sample of 73 men with prostate cancer who were recruited from a Regional Cancer Centre in Southwestern Ontario, Canada. Participants receiving radiation treatment (brachy therapy, high dose radiation [HDR] and external beam radiation [EBR], or EBR alone) completed a questionnaire that elicited information pertaining to quality of life (QOL), symptom experiences, and perceived health state prior to, and one month after completion of their radiation treatment. Results Post-treatment scores showed increased problems with urinary bother (ppp=0.002) and function (p=0.001), and sexual function (p Discussion Our findings suggest that prostate cancer treatment presents a challenge with regard to symptom experiences and perceived health state in men with prostate cancer. Therefore, strategies for patient education to assist men to cope with their symptoms and to provide them with support in the initial weeks following treatment are discussed

L’impact d’un campus clinique régional en milieu urbain : les perceptions des parties prenantes de la collectivité

Background: Regional medical campuses (RMC) have shown promise in addressing physician shortages. RMCs have been positively evaluated in rural/remote communities, however, it is unclear whether this model will be as beneficial in underserved urban areas. This study evaluated the impact of a RMC on a midsized urban city (Windsor, Ontario). We compare our results with a similar study conducted in a remote community in British Columbia (BC). Methods: A broad array of community stakeholders representing different sectors were consulted using a semi-structured interview format replicated from the BC Northern Medical Program (NMP) study. Thematic analysis based on the resulting rich data was conducted within a grounded theory context. Results: Twenty-three participants (52% male) representing healthcare, education, business, community and government/politico sectors were consulted. Their views regarding the Windsor Regional Medical Campus (WRMC) aligned around several themes: improved healthcare, enhanced community reputation, stimulated economic/community development, expanded training opportunities and an engaged community regarding the WRMC. These results were compared to the main findings of the NMP study with both similarities (e.g. increased community pride) and differences (e.g. resource concerns) discussed. Conclusion: Community stakeholders provided strong support for the WRMC through their perceptions of its positive impact on this urban region. These findings are consistent with similar RMC studies in rural/remote areas. Those interested in developing a RMC might benefit from considering these findings.Contexte : Les campus cliniques régionaux (CCR) se sont révélés prometteurs pour remédier à la pénurie de médecins. Les CCR ont été évalués positivement dans les collectivités rurales/éloignées, mais il n’est pas certain que ce modèle soit aussi bénéfique dans les zones urbaines mal desservies. La présente étude évalue l’impact d’un CCR dans une ville de taille moyenne (Windsor, Ontario). Nous comparons nos résultats avec ceux d’une étude similaire menée dans une collectivité éloignée en Colombie-Britannique (BC). Méthode : Un large éventail de parties prenantes de la collectivité représentant différents secteurs a été consulté par le biais d’entrevues semi-structurées calquées sur celles de l’étude du BC Northern Medical Program (NMP). L’analyse thématique des riches données obtenues a été faite selon l’approche de la Grounded Theory (théorie ancrée). Résultats : Vingt-trois participants (52 % d’hommes) des secteurs de la santé, de l’éducation, des affaires, de la vie communautaire, du gouvernement ou encore du monde politique ont été consultés. Leurs opinions concernant le campus clinique régional de Windsor (WRMC) s’articulaient autour de plusieurs thèmes : l’amélioration des soins de santé, le renforcement de la réputation de la collectivité, la stimulation du développement économique et communautaire, l’élargissement des possibilités de formation et l’engagement de la communauté envers le WRMC. Les résultats ont été comparés aux principales conclusions de l’étude du NMP, en analysant aussi bien les similitudes (par exemple, fierté accrue de la collectivité) que les différences (par exemple, les préoccupations en matière de ressources). Conclusion : Percevant l’impact positif qu’a eu le WRMC dans la région urbaine, les acteurs de la collectivité témoignent d’un ferme appui à son égard. Ces résultats sont conformes aux études similaires portant sur des CCR dans les zones rurales/éloignées. Les résultats de l’étude seraient utiles à tous ceux qui souhaitant mettre sur pied un CCR

A Quality Assurance Evaluation of Hydromorphone Adverse Events Post-Implementation of a Safety Initiative

Purpose: Hydromorphone is a potent opioid that may lead to respiratory and central nervous system depression prompting naloxone use. The primary objective of this study was to evaluate whether a safety initiative implemented at Windsor Regional Hospital involving interchanging hydromorphone intravenous or subcutaneous doses of 1 mg or greater to low dose (0.5 mg) in opioid naïve, medical and surgical patients was associated with naloxone events. The secondary objective was to assess whether there was a compromise in patient pain control with the low dose. Methods: We conducted a retrospective, multicenter, observational study of medical and surgical opioid-naïve patients admitted to Windsor Regional Hospital who received intravenous or subcutaneous hydromorphone within an eighteen-month timeframe. To determine if there is an association between naloxone events and implementation of the safety initiative, we compared patients who experienced a naloxone event (cases) with patients who did not experience a naloxone event (controls) in approximately 1:4 ratio. Efficacy outcomes assessed changes in patient pain control before and after interchange policy implementation (i.e. need for increase in dose, frequency or additional analgesics). Results: Of the 4343 patients who received hydromorphone, 143 opioid naïve patients were included in the final analysis. Of the 27 patients who experienced a naloxone event, 0% of patients were interchanged. In contrast, of the 116 patients who did not experience a naloxone event, 52% were interchanged (OR = 0, 95% 0 to 0.13, p<0.01). There were no significant differences in terms of patient pain control before and after interchange policy implementation. Conclusions: The pharmacist-led safety initiative of interchanging all opioid naïve patients to low dose hydromorphone was not associated with naloxone events and did not compromise patient pain control

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

Background 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&lt;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&lt;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

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract 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

Fluid mechanics and heat transfer in the blade channels of a water-cooled gas turbine.

Thesis (Ph.D.)--Massachusetts Institute of Technology, Dept. of Aeronautics and Astronautics, 1979.MICROFICHE COPY AVAILABLE IN ARCHIVES AND AERONAUTICS.Vita.Includes bibliographical references.Ph.D

Exploring the influence of enforcing infection control directives on the risk of developing healthcare associated infections in the intensive care unit: A retrospective study.

Background Although strict adherence to infection control strategies is recognised as the simplest and most cost effective method to prevent the spread of healthcare associated infections (HAIs), measurement of the direct impact that such adherence may have on the risk of developing such infections has always been a challenge. Purpose The purpose of this study was to compare the risk of HAIs before and during the SARS outbreak. Such comparison is intended to provide a surrogate measure of the influence that strict enforcement of infection control strategies during the SARS outbreak may have had on the risk of HAIs. Methods A retrospective chart review was conducted on the medical records of 400 intensive care patients who were admitted to the ICU three months before and during the 2003 SARS outbreak. Results The rate of HAIs was higher in the pre-SARS period than the SARS period. Specifically, 61.7% of all reported infections were diagnosed in the pre-SARS period. The rate of HAIs in the pre-SARS period was 14.5% as opposed to 9% during the SARS period. Adjusted logistic regression analysis suggested that the odds of HAIs were 2.2 times higher in the pre-SARS period as compared to the SARS period (OR=2.2; 95%CI=1.08–4.49). Conclusion Our findings suggest that strict enforcement of infection control strategies may have a positive impact on the efforts to minimise the risk of HAIs. These findings carry a clinical significance that shall not be ignored with regard to our overall efforts to minimise the risk of developing HAIs in the ICU

Predicting Seasonal Influenza Vaccination Among Hospital-Based Nurses

A descriptive cross-sectional online survey of a convenience sample of 202 hospital-based nurses was conducted to explore the factors associated with influenza vaccination. The findings suggest that the independent predictors of influenza vaccination were perception of job as a risk increasing factor (OR = 12.14; 95% CI [1.89, 78.08]), workplace vaccination clinics and campaigns (OR = 2.88; 95% CI [1.12, 7.38]), vaccination in the previous season (OR = 34.80; 95% CI [12.99, 93.28]), viewing vaccination as an inconvenience (OR = 0.22; 95% CI [0.07, 0.67]), and one\u27s belief that the immune system provides better protection than the vaccine (OR = 0.29; 95% CI [0.11, 0.77]). In conclusion, the findings support the existing literature with regards to low vaccination rates among health care providers. Furthermore, the identification of the predictors of influenza vaccination among nurses may assist administrators and policy makers with the implementation of evidence-based vaccination strategies. © The Author(s) 2011