COVID-19 and the Global Impact on Colorectal Practice and Surgery

Background: The novel severe acute respiratory syndrome coronavirus 2 virus that emerged in December 2019 causing coronavirus disease 2019 (COVID-19) has led to the sudden national reorganization of health care systems and changes in the delivery of health care globally. The purpose of our study was to use a survey to assess the global effects of COVID-19 on colorectal practice and surgery. Materials and Methods: A panel of International Society of University Colon and Rectal Surgeons (ISUCRS) selected 22 questions, which were included in the questionnaire. The questionnaire was distributed electronically to ISUCRS fellows and other surgeons included in the ISUCRS database and was advertised on social media sites. The questionnaire remained open from April 16 to 28, 2020. Results: A total of 287 surgeons completed the survey. Of the 287 respondents, 90% were colorectal specialists or general surgeons with an interest in colorectal disease. COVID-19 had affected the practice of 96% of the surgeons, and 52% were now using telemedicine. Also, 66% reported that elective colorectal cancer surgery could proceed but with perioperative precautions. Of the 287 respondents, 19.5% reported that the use of personal protective equipment was the most important perioperative precaution. However, personal protective equipment was only provided by 9.1% of hospitals. In addition, 64% of surgeons were offering minimally invasive surgery. However, 44% reported that enough information was not available regarding the safety of the loss of intra-abdominal carbon dioxide gas during the COVID-19 pandemic. Finally, 61% of the surgeons were prepared to defer elective colorectal cancer surgery, with 29% willing to defer for ≤ 8 weeks. Conclusion: The results from our survey have demonstrated that, globally, COVID-19 has affected the ability of colorectal surgeons to offer care to their patients. We have also discussed suggestions for various practical adaptation strategies for use during the recovery period. We have presented the results of a survey used to assess the global impact of coronavirus disease 2019 (COVID-19) on the delivery of colorectal surgery. Despite accessible guidance information, our results have demonstrated that COVID-19 has significantly affected the ability of colorectal surgeons to offer care to patients. We have also discussed practical adaptation strategies for use during the recovery phase

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<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

'By-catch'- A problem of the industrial shrimp fishery in Ghana

Ghana has an important Industrial Shrimp Fishery which is based at the Tema fishing port. In March, 1996, I joined two of the shrimp trawlers (MV Benhill 10 and MV Benhill 3) to sea on a normal commercial fishing trip. Data was collected from three fishing grounds, off the Ghanaian coast, on the catch, by-catch and discards in addition to observations of fishing practices and behaviour. Except for times of mechanical failure or the need for repairs, trawling tended to be for long periods and were continuous throughout day and night. The trawlers fished in shallow waters (depths of between 18 and 37 m) and close to shore (between 2.8 and 4.0 nautical miles). The fish and invertebrate catches were diverse both at night and during the day. Catches also included substantial quantities of litter and occasional catches of sea snakes, sharks and a sea turtle. There was an enormous but variable amount (both in weight and numbers) of by-catch in hauls. A large portion of the by-catch was discarded with most of them already dead. The discards consisted mostly of small individuals which were either juveniles of commercial species or species which were of no commercial value. The practice of catching and discarding portions of the catch back into the sea, with little chance of survival, is viewed as posing a great ecological problem for the marine environment off the Ghanaian coast. JOURNAL OF THE GHANA SCIENCE ASSOCIATION Volume 1 Number 1, July (1998) pp. 17-2

Analysis of gender representation in basic level English textbooks in Ghana

Textbooks are known to influence the behaviours and worldview of children. Apart from imparting critical knowledge to pupils, textbooks also encourage pupils to form certain perceptions and stereotypes, including the ‘appropriate’ gender-specific roles in society. This paper examined gender stereotypes in the content and design of the Pupil’s English textbook at the Basic Level in Ghana using content analysis. The study revealed that, as teaching materials, the English Pupil’s Books 1, 2 and 3 displayed gross gender bias that reinforces the stereotypical roles of males and females in Ghanaian society. This does not reflect the development of society towards equality between men and women since there was no equality in how both genders are represented in the textbooks.Keywords: Gender; stereotype; gender stereotype; textbooks