CSF Rhinorrhea After Endonasal Intervention to the Skull Base (CRANIAL) — Part 2:Impact of COVID-19

Background During the pandemic, there has been a concern about the increased risk of perioperative mortality for patients with COVID-19, and the transmission risk to healthcare workers, particularly during endonasal neurosurgical operations. The Pituitary Society produced recommendations to guide management during this era. We sought to assess contemporary neurosurgical practice and the impact of COVID-19. Methods A multicentre, prospective, observational cohort study was conducted at twelve tertiary neurosurgical units (UK and Ireland). Data were collected from March 23rd-July 31st, 2020 inclusive. Data points collected were patient demographics, pre-operative COVID-19 testing, intra-operative operative modifications, and 30-day COVID infection rates. Results 124 patients were included. 116 patients (n=116/124, 94%) underwent COVID-19 testing pre-operatively (TSA: 97/105, 92%; EEA: 19/19, 100%). One patient (n=1/115, 1%) tested positively for COVID-19 pre-operatively, requiring a delay of operation until the infection was confirmed as resolved. Asides from transient diabetes insipidus; no other complications were reported for this case. All theatre staff wore at least level 2 PPE. Adaptations to surgical techniques included minimising drilling, draping modifications, and using nasal iodine wash. At 30 days postoperatively, there was no evidence of COVID infection (symptoms or on formal testing) in our cohort, and no mortality. Conclusions Preoperative screening protocols and operative modifications have facilitated endonasal neurosurgery during the COVID-19 pandemic, with Pituitary Society guidelines followed for the majority of these operations. There was no evidence of COVID infection in our cohort, and no mortality, supporting the use of risk mitigation strategies to continue endonasal neurosurgery in subsequent pandemic waves

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

Background: CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: (1) the scope of skull base repair methods used; and (2) corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours. We sought to pilot the project - assessing the feasibility and acceptability by gathering preliminary data. / Methods: A prospective, observational cohort pilot study was carried out at twelve tertiary UK neurosurgical units. Feedback regarding project positives and challenges were qualitatively analysed. / Results: 187 cases were included, 159 TSA (85%) and 28 EEA (15%). The most common pathologies included: pituitary adenomas (n=141/187), craniopharyngiomas (n=13/187) and skull-base meningiomas (n=4/187). The most common skull base repair techniques used were tissue glues (n=132/187, most commonly Tisseel®), grafts (n=94/187, most commonly fat autograft or Spongostan™) and vascularised flaps (n=51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n=125/187) and lumbar drains (n=22/187). Biochemically-confirmed CSF rhinorrhoea occurred in 6/159 (3.8%) TSA and 2/28 (7.1%) EEA. Four TSA (3%) and two EEA (7%) cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included: user-friendly and efficient data collection, strong support from senior team members) demonstrating acceptability. / Conclusions: Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice, particularly with respect to EEA cases

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1:Multicenter Pilot Study

Background CRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective, multicentre observational study seeking to determine: (1) the scope of skull base repair methods used; and (2) corresponding rates of postoperative CSF rhinorrhoea in endonasal transsphenoidal (TSA) expanded endonasal approaches (EEA) for skull base tumours. We sought to pilot the project - assessing the feasibility and acceptability by gathering preliminary data. Methods A prospective, observational cohort pilot study was carried out at twelve tertiary UK neurosurgical units. Feedback regarding project positives and challenges were qualitatively analysed. Results 187 cases were included, 159 TSA (85%) and 28 EEA (15%). The most common pathologies included: pituitary adenomas (n=141/187), craniopharyngiomas (n=13/187) and skull-base meningiomas (n=4/187). The most common skull base repair techniques used were tissue glues (n=132/187, most commonly Tisseel®), grafts (n=94/187, most commonly fat autograft or Spongostan™) and vascularised flaps (n=51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n=125/187) and lumbar drains (n=22/187). Biochemically-confirmed CSF rhinorrhoea occurred in 6/159 (3.8%) TSA and 2/28 (7.1%) EEA. Four TSA (3%) and two EEA (7%) cases required operative management for CSF rhinorrhoea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included: user-friendly and efficient data collection, strong support from senior team members) demonstrating acceptability. Conclusions Our pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicentre dissemination of this project, in order to establish a benchmark of contemporary skull base neurosurgery practice, particularly with respect to EEA cases. Keywords Cerebrospinal fluid rhinorrhoeaCSFCerebrospinal fluid leakskull base surgeryendoscopic endonasalEE

Understanding buyer stringent environmental requirements in the context of sustainable supply chain

Aim/Purpose Due to uncertain changes in buyer environmental requirements, it is necessary to investigate how and to what extent supplier firms adopt these environmental requirements. This research aims to conceptualise 'stringent buyer environmental requirements' and investigating its impact on organization's environmental performance. Design/methodology/approach: Transaction cost economics theory is employed to explore and understand the concept of stringent buyer environmental requirements and dynamic capability framework is used to explain the role of capability. Although the quantitative survey is the prominent method used in this study, a qualitative pre-test has also been conducted to discuss and confirm the items or dimensions of the constructs. Using data from Bangladesh Ready-made garment (RMG) industry and employing structural equation modelling (SEM) technique this study investigates how the stringent environmental requirements from customers around the world impact the environmental performance of suppliers. Findings: Results demonstrate that stringent customer environmental requirements positively influence suppliers to develop their capability while that capability facilitates the translation of stringent customer environmental requirements into desired environmental performance. Furthermore, buyer-supplier relationship quality positively impacts supplier's environmental capability development while it also influences the strength of the relationship between stringent buyer environmental requirements and capability development. Originality/ Value: This research establishes the evidence for relatively new concept of stringent customer environmental requirements and develops a unique theoretical framework which demonstrates the relationships among the critical determinants around it. Results could be of interest to the future researchers in sustainable supply chains and managers to understand the dynamics of environmental requirements and gain vital ins

Relationship between stringent customer environmental requirements and environmental performance in sustainable supply chain

The recent move towards environmental sustainability around the world forced firms to adopt environmentally sustainable practice in their operations along the supply chain. The objective of this research is to critically comprehend and establish the concept of `stringent customer environmental requirements' and to explore its impact on the supplier's capability and environmental performance in sustainable supply chain context. Using data from Bangladesh Ready-made garment (RMG) industry, this research investigates how the stringent environmental requirements from customers around the world impact the environmental performance of suppliers in garment supply chain. Result shows that the stringent customer environmental requirements, supplier's capability and environmental performance are highly correlated. It might help to understand the dynamics of environmental requirements from customers and may provide important insight to the managers of supplier organizations about how to handle unpredictable changes in environmental demands from their customers

How do suppliers address stringent environmental requirements from buyers? An exploratory study in the Bangladesh ready-made garment industry

Purpose: Stakeholders such as customers, governments and environmental organisations are more concerned than ever about the impact of supply chain practices on the environment, leading firms to introduce environmental requirements into their supply contracts. While the extant literature on supply chains acknowledges this trend, it fails to inform comprehensively on the concept of stringent environmental requirement and its consequences. The purpose of this paper is to investigate this concept and explore how such requirements may translate into supplier environmental performance. Design/methodology/approach: Qualitative methodology was adopted by the study and data were collected through conducting eight case studies in the Bangladesh ready-made garment (RMG) industry. Findings: A number of factors were found to be influencing suppliers perception of stringency, such as uncertainty relating to the newness and deadline of buyers environmental requirements, the complexity of implementing the requirements, and the use of buyer-specific frameworks. The research also shows that suppliers efforts in building environmental capability play a vital role in dealing with stringent environmental requirements. Research limitations/implications: The case studies are limited to the Bangladesh RMG industry. Given that environmental regulations vary across different countries and industries, the data may not reflect all the possible variations in stringent environmental requirements. Practical implications: The new insight proposed by this research can guide firms to further understand how supplier environmental performance and the sustainability of their supply chain can be achieved. The research provides broad insight into how suppliers can address stringent environmental requirements and improve their environmental performance. Originality/value: This research establishes evidence for the relatively new phenomenon of stringent environmental requirements, and develops a th