How to prevent uncontrolled abdominal desufflation during laparoscopy in times of the coronavirus pandemic.
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ABSTRACT:
SUBMITTER: Bharathy KGS
PROVIDER: S-EPMC7460989 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:IntroductionThe advent of the COVID-19 pandemic led to recommendations aimed at minimizing the risk of gas leaks at laparoscopy. As this has continuing relevance including regarding operating room pollution, we empirically quantified carbon dioxide (CO2) leak jet velocity (important for particle propulsion) occurring with different instruments inserted into differing trocars repeated across a range of intra-abdominal pressures (IAPs) and modern insufflators in an experimental model.MethodLaparoscopic gas plume leak velocity (metres/second) was computationally enumerated from schlieren optical flow videography on a porcine cadaveric laparoscopic model with IAPs of 4-5, 7-8, 12-15 and 24-25 mmHg (repeated with 5 different insufflators) during simulated operative use of laparoscopic clip appliers, scissors, energy device, camera and staplers as well as Veres needle (positive control) and trocar obturator (negative control) in fresh 5 mm and 12 mm ports.ResultsClose-fitting solid instruments (i.e. cameras and obturators) demonstrated slower gas leak velocities in both the 5 mm and 12 mm ports (p = 0.02 and less than 0.001) when compared to slimmer instruments, however, hollow instrument designs were seen to defy this pattern with the endoscopic linear stapler visibly inducing multiple rapid jests even when compared to similarly sized clip appliers (p = 0.03). However, on a per device basis the operating instrumentation displayed plume speeds which did not vary significantly when challenged with varying post size, IAP and a range of insufflators.ConclusionIn general, surgeon's selection of instrument, port or pressure does not usefully mitigate trocar CO2 leak velocity. Instead better trocar design is needed, helped by a fuller understanding of trocar valve mechanics via computational fluid dynamics informed by relevant surgical modelling.
| S-EPMC9063625 | biostudies-literature
Project description:To understand and analyse the global impact of COVID-19 on outpatient services, inpatient care, elective surgery, and perioperative colorectal cancer care, a DElayed COloRectal cancer surgery (DECOR-19) survey was conducted in collaboration with numerous international colorectal societies with the objective of obtaining several learning points from the impact of the COVID-19 outbreak on our colorectal cancer patients which will assist us in the ongoing management of our colorectal cancer patients and to provide us safe oncological pathways for future outbreaks.
| 2346925 | ecrin-mdr-crc
Project description:Behavioural scientists have been studying public perceptions to understand how and why people behave the way they do towards climate change. In recent times, enormous changes to behaviour and people's interactions have been brought about by the worldwide coronavirus disease 2019 (COVID-19) pandemic, unexpectedly and indefinitely; some of which have environmental implications (e.g., travelling less). An innovative way to analyse public perceptions and behaviour is with the use of social media to understand the discourse around climate change. This paper focuses on assessing changes in social media discourse around actions for climate change mitigation over time during the global pandemic. Twitter data were collected at three different points during the pandemic: February (time 1), June (time 2), and October 2020 (time 3). By using machine learning techniques, including recurrent neural networks (RNN) and unsupervised learning Latent Dirichlet Allocation (LDA) topic modelling, we identified tweets mentioning actions to mitigate climate change. The findings identified topics related to "government actions," "environmental behaviours," "sustainable production," and "awareness," among others. We found an increase in tweets identified as "action tweets" relating to climate change for time 2 and time 3 compared with time 1. In addition, we found that the topic of energy seemed to be of relevance within the public's perceptions of actions for climate change mitigation; this did not seem to change over time. We found that the topic of "government actions" was present across all time points and may have been influenced by political events at time 1, and by COVID-19 discourse at times 2 and 3. Moreover, topic changes over time within Twitter indicated a pattern that may have reflected restrictions on mobility as these tended to focus on individual and private sphere behaviours rather than group and public sphere behaviours. Changes in topic patterns may also reflect an increase in salience of certain behaviours (e.g., shopping), which may have received increased attention due to lockdown restrictions. Considering restrictions and adaptability challenges people face in times of a global pandemic may help to identify how to support sustainable behaviour change and the likely persistence of these changes.
| S-EPMC8239357 | biostudies-literature
Project description:The management of blunt abdominal trauma has evolved over time. While laparotomy is the standard of care in hemodynamically unstable patients, stable patients are usually treated by non-operative management (NOM), incorporating adjuncts such as interventional radiology. However, although NOM has shown good results in solid organ injuries, other lesions, namely those involving the hollow viscus, diaphragm, and mesentery, do not qualify for this approach and need surgical exploration. Laparoscopy can substantially reduce additional surgical aggression. It has both diagnostic and therapeutic potential and, when negative, may reduce the number of unnecessary laparotomies. Although some studies have shown promising results on the use of laparoscopy in blunt abdominal trauma, randomized controlled studies are lacking. Laparoscopy requires adequate training and experience as well as sufficient staffing and equipment.
| S-EPMC5477632 | biostudies-other
Project description:Abstract This paper focuses on the accuracy of COVID-19-related knowledge during the 2020 pandemic. We look at the effects of traditional vs. digital news use and distinguish between positive (number of recoveries) and negative (number of casualties) knowledge. Importantly, the moderating role of crisis context is examined when tracing media effects on knowledge. Relying on a four-wave panel survey fielded in the Netherlands, we find that people’s knowledge became more accurate over the course of the crisis. News exposure did not lead to more accuracy, in fact, a negative relation was found. The impact of digital news use weakened as the crisis continued.
| S-EPMC8499763 | biostudies-literature
Project description:AimsTo investigate control measures for COVID-19 pandemic in GIE centers in China.MethodsThis is a retrospective multi-center research, including seven centers. Data collection was from 1 February to 31 March 2020 and the same period in 2019.ResultsThere were a total of 28 COVID-19 definite cases in these hospitals. Six out of seven GIE centers were arranged to shut down on 1 February, with a mean number of shutdown days of 23.6 ± 5.3. The actual workloads were only 10.3%-62.9% compared to those last year. All centers had a preoperative COVID-19 screening process. Epidemiological questionnaire, temperature taking and QR-code of journey were conducted. Chest CT scan was conducted during the shutdown period and continued in five centers after return to work. Antibody and nucleic acid test were applied in one to three centers. All endoscopists had advanced PPE. Five centers used surgical mask and the rest used N95 mask. Six centers used goggles or face shield. Five centers selected isolation gowns and the rest selected protective suits. The change frequency of these PPE was 4 h. Sterilizing measures were improved in six centers. Five centers utilized ultraviolet and six centers strengthened natural ventilation. Four and six centers used peracetic acid during the period of shutdown and return to work, alone or matched with OPA or acidified water.ConclusionsMany effective control measures were conducted in GIE centers during the outbreak, including patients' volume limitation, preoperative COVID-19 screening, advanced PPE and disinfection methods.
| S-EPMC7300959 | biostudies-literature
Project description:BACKGROUND:There is minimal evidence evaluating the risks and benefits of laparoscopy use in hemodynamically stable children with suspected abdominal injuries. The objective of this study was to evaluate postoperative outcomes in a large cohort of hemodynamically stable pediatric patients with blunt abdominal injury. METHODS:Using the 2015-2016 National Trauma Data Bank, all patients aged <18 y with injury severity score (ISS) ≤25, Glasgow coma scale ≥13, and normal blood pressure who underwent an abdominal operation for blunt abdominal trauma were included. Patients were grouped into three treatment groups: laparotomy, laparoscopy, and laparoscopy converted to laparotomy. Treatment effect estimation with inverse probability weighting was used to determine the association between treatment group and outcomes of interest. RESULTS:Of 720 patients, 504 underwent laparotomy, 132 underwent laparoscopy, and 84 underwent laparoscopy converted to laparotomy. The median age was 10 (IQR: 7-15) y, and the median ISS was 9 (IQR: 5-14). Mean hospital length of stay was 2.1 d shorter (95% confidence interval [CI]: 0.9-3.2 d) and mean intensive care unit length of stay was 1.1 d shorter (95% CI: 0.6-1.5 d) for the laparoscopy group compared with the laparotomy group. The laparoscopy group had a 2.0% lower mean probability of surgical site infection than the laparotomy group (95% CI: 1.0%-3.0%). CONCLUSIONS:In this cohort of hemodynamically stable pediatric patients with blunt abdominal injury, laparoscopy may have improved outcomes over laparotomy.
| S-EPMC7247932 | biostudies-literature
Project description:Surgery in a frozen abdomen can be difficult and dangerous with a significant risk of visceral injuries. We report a case of a 26-year-old lady with chronic pelvic pain diagnosed to have large bilateral adnexal cysts on magnetic resonance imaging with normal tumor markers. She had previous two laparotomies for benign conditions. Laparoscopy was planned, but pneumoperitoneum could not be created due to dense intraperitoneal adhesions. Direct entry was done into the preperitoneal space followed by insufflation of gas in this space. Blunt and sharp dissection of this space was done without breaching the peritoneum to reach the adnexa. The adnexal cyst was found to be encysted collection due to adhesions from previous surgeries. Deroofing was done followed by the visualization of pelvic structures intraperitoneally. Extraperitoneal laparoscopy may be used as a safe alternative to laparotomy in patients with dense intra-abdominal adhesions with the advantage of faster postoperative recovery.
| S-EPMC8384020 | biostudies-literature
Project description: Not available
| S-EPMC7486046 | biostudies-literature
Project description:Using data from the first wave of the SHARE COVID-19 Survey and additional information collected from the previous waves of SHARE (Survey of Health Ageing and Retirement in Europe), we explore the effects of job characteristics on two outcomes: (i) the probability of work interruptions and (ii) the length of such interruptions during the first phase of the Coronavirus Pandemic. In order to assess the relationship between job features and labour market outcomes, we define two indexes proxying the pre-COVID-19 technical remote work feasibility as well as the level of social interaction with other people while working. Moreover, we use an indicator that classifies ISCO-08 3-digit job titles based on the essential nature of the good or service provided. We find that job characteristics have been major determinants of the probability of undergoing work interruptions and their duration. In addition, we show that women have been negatively affected by the Pandemic to a much larger extent than men, suggesting the relevance of the intrinsic characteristics of jobs they are mainly involved in, and the role of gender selection into specific activities. Not only females were more likely to have undergone work interruptions but they also exhibited larger probabilities of longer work breaks. A similar impact is seen for self-employed and less-educated workers.Supplementary informationThe online version contains supplementary material available at 10.1007/s10433-021-00651-5.
| S-EPMC8500256 | biostudies-literature