14 research outputs found

    Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

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    AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

    Cortometraje de ficción NEFELIBATA

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    Treball Final de Grau en Comunicació Audiovisual. Codi: CA0932. Curs acadèmic: 2017-2018Este trabajo de final de grado ha tenido como objetivo la realización de una pieza audiovisual, en este caso, un cortometraje titulado Nefelibata. Para ello se ha desarrollado el proyecto desde la concepción de la idea hasta su realización, siguiendo las fases habituales para la creación de un producto audiovisual: la pre-producción, la producción y la post-producción. En este trabajo se puede encontrar en primer lugar la justificación de la elección del tema y los objetivos que se pretenden alcanzar con el mismo, además de documentos que detallan el proyecto. En segundo lugar se profundizará en la trama argumental y la elaboración del cortometraje a través diferentes dossieres en los que se se encontrarán los documentos que se han requerido para la realización de la pieza audiovisual, tales como, guiones, desgloses, material ilustrado, entre otros. Seguidamente, encontraremos una memoria que relata todo el procedimiento que ha sido llevado a cabo por el equipo, además de las conclusiones y resultados obtenidos tras las finalización del proyecto. Finalmente en los anexos se ha incluido material adicional como: el making off, el vídeo de casting, la banda sonora, el script y la foto fija.This finaldegree project had an audio-visual piece as a target, in this case, a short film called Nefelibata. The work has been developed from the idea’s conception up to its accomplishment, by following the usual steps for the creation of an audio-visual product: the pre-production, the production and the post-production. In this work, in addition the documents that detail the project, you can find first of all the reason for the choice of this subject and what aimes are intended to be achieved with it. Secondly , we will go deep in the storyline and the elaboration of the short film through different dossiers, where some documents that have been required for the realization of the audiovisual piece, are found. Such as scripts, disaggregation, illustrated material, among others. Next, we will find a report that relates the entire procedure that has been carried out by the team, and also the conclusions and results obtained after the end of the project. Finally, additional material has been included in the annexes such as: the making off, the casting video, the soundtrack, the script and the still photo

    Development of a prediction model for postoperative pneumonia A multicentre prospective observational study

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    BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 degrees C; leucocyte count more than 12 000 mu l(-1). RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO(2) values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia

    SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

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    Background Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.The aim of this study was to inform vaccination prioritization by modelling the impact of vaccination on elective inpatient surgery. The study found that patients aged at least 70 years needing elective surgery should be prioritized alongside other high-risk groups during early vaccination programmes. Once vaccines are rolled out to younger populations, prioritizing surgical patients is advantageous

    UK Head and neck cancer surgical capacity during the second wave of the COVID—19 pandemic: Have we learned the lessons? COVIDSurg collaborative

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    Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

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