Avoidable Delays Research Articles

'ThinkCancer!': randomised feasibility trial of a novel practice-based early cancer diagnosis intervention.

UK cancer deaths remain high; primary care is key for earlier cancer diagnosis as half of avoidable delays occur here. Improvement is possible through lower referral thresholds, better guideline adherence, and better safety-netting systems. Few interventions target whole practice teams. We developed a novel whole-practice team intervention to address this. To test the feasibility and acceptability of a novel, complex behavioural intervention, 'ThinkCancer!', for assessment in a subsequent Phase III trial. Pragmatic, superiority pilot randomised controlled trial (RCT) with an embedded process evaluation and feasibility economic analysis in Welsh general practices. Clinical outcome data were collected from practices (the unit of randomisation). Practice characteristics and cancer safety-netting systems were assessed. Individual practice staff completed evaluation and feedback forms and qualitative interviews. The intervention was adapted and refined. Trial recruitment and workshop deliveries took place between March 2020 and May 2021. Trial progression criteria for recruitment, intervention fidelity, and routine data collection were met. Staff-level fidelity, retention, and individual level data collection processes were reviewed and amended. Interviews highlighted positive participant views on all aspects of the intervention. All practices set out to liberalise referral thresholds appropriately, implement guidelines, and address safety-netting plans in detail. 'ThinkCancer!' appears feasible and acceptable. The new iteration of the workshops was completed and the Phase III trial has been funded to assess the effectiveness and cost-effectiveness of this novel professional behaviour change intervention. Delivery at scale to multiple practices will likely improve fidelity and reach.

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi: a retrospective analysis of verbal autopsy data

ObjectivesTo use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care...

Provision of post construction support (PCS) services to state water authorities in Nigeria: constraints and the way forward

Abstract Post-construction Support (PCS) services refer to all forms of assistance/support given to water service providers (WSPs) to enable them to detect, correct and maintain water system infrastructure or prevent future system faults. PCS enhances the quality and sustainability of water supply services. This paper examines the provision of PCS to state water authorities in Nigeria. Specifically, we identified the sources of PCS and relevance of PCS; then we discussed the pattern of occurrence of system faults the bureaucracy associated with PCS provision across the sampled states. Finally, we examined the constraints to PCS provision and the options for overcoming the challenges. The study used empirical data derived from questionnaire surveys, through key informant interviews (KIIs) and from published literature. The data were analyzed using descriptive statistical tools. Results of the study revealed the current sources and patterns of PCS provision which vary widely across the sampled states. PCS is provided intermittently based on resource availability and on the willingness of the provider. The constraints and bureaucracies associated with PCS provision cause prolonged and avoidable delays and limit quality service delivery with often great consequences for the end users. WSPs lack legislative, and policy instruments to compel governments to act and ensure that PCS services are provided speedily and in a sustainable manner. The poor quality of service delivery in the area can be traced, in part, to a lack of needed PCS services. Consequently, the way forward for WSPs is to confront the dearth of PCS in the water supply sector frontally. Suggestions on how to surmount the dearth of PCS and improve the quality of service delivery in the area were advanced.

Potentially avoidable delays in diagnosis among patients with colorectal cancer: A population-based study.

122 Background: Colorectal cancers (CRCs) have the second highest cancer mortality for both sexes combined because approximately 60% of incident cases are not diagnosed until progression to later stages. Many patients with CRC experience cancer-related signs and symptoms up to a year prior to diagnosis, but they are often non-specific in nature, leading to diagnostic difficulty and delays in care. Few studies have assessed the timeliness of CRC diagnosis using Medicare claims data. This study examines pre-diagnosis healthcare utilization of patients with CRC to understand potentially avoidable delays in diagnosis and estimates the association between delay and short-term mortality. Methods: We used SEER-Medicare data from 2008-2017 to identify Medicare beneficiaries aged 66+ at the time of invasive CRC diagnosis. ICD-9 and ICD-10 codes on claims were used to identify alarm or “red flag” signs/symptoms (e.g., rectal bleeding) and general signs/symptoms (e.g., fatigue) based on a literature review. The diagnostic interval (DI) was defined as the count of days from the first claim for a sign/symptom of CRC in the one-year pre-diagnosis period until the diagnosis date. Avoidable diagnostic delay was defined as having a DI longer than the 80th percentile (320 days) or 3+ visits for the same sign/symptom at least 14 days apart in the year prior to the diagnosis. Logistic regression was used to estimate 1-year mortality odds ratios among symptomatic patients who survived at least one month as a function of the avoidable delay adjusted for age, sex, year of diagnosis, comorbidity score, cancer stage at diagnosis, and tumor site. Results: Among111,283 Medicare beneficiaries diagnosed with invasive CRC, 92,450 (83%) patients experienced at least one sign/symptom in the year prior to diagnosis. The most common sign/symptom experienced was anemia (42%), followed by abdominal pain (37%) while blood in stool was observed in 20% of patients. The median DI was 176 days (IQR: 41-302) and those with only alarm symptoms recorded had substantially shorter DI compared to those who experienced general symptoms (median 29 vs 207 days). 29% of patients were classified as having a potentially avoidable diagnostic delay: 12% had 3+ visits for the same sign/symptom, 6.5% had a DI >80th percentile, and 9.9% had both. The adjusted odds of 1–year mortality was 14% higher among those with potentially avoidable diagnostic delay compared to those that did not experience diagnostic delay (AOR: 1.14, 95%CI: 1.09-1.21). Conclusions: Many patients with CRC experience CRC related signs/symptoms up to one year prior to their diagnosis. Despite screening availability and use, a substantial number of patients with CRC have a diagnostic delay, and diagnostic delays negatively impact mortality. Therefore, efforts to identify patients early, before progression to later stages, and decreasing diagnostic delays is vital to improve CRC outcomes.

Exploring why European primary care physicians sometimes do not think of, or act on, a possible cancer diagnosis. A qualitative study.

While primary care physicians (PCPs) play a key role in cancer detection, they can find cancer diagnosis challenging, and some patients have considerable delays between presentation and onward referral. To explore European PCPs' experiences and views on cases where they considered that they had been slow to think of, or act on, a possible cancer diagnosis. A multicentre European qualitative study, based on an online survey with open-ended questions, asking PCPs for their narratives about cases when they had missed a diagnosis of cancer. Using maximum variation sampling, PCPs in 23 European countries were asked to describe what happened in a case where they were slow to think of a cancer diagnosis, and for their views on why it happened. Thematic analysis was used to analyse the data. A total of 158 PCPs completed the questionnaire. The main themes were as follows: patients' descriptions did not suggest cancer; distracting factors reduced PCPs' cancer suspicions; patients' hesitancy delayed the diagnosis; system factors not facilitating timely diagnosis; PCPs felt that they had acted wrongly; and problems with communicating adequately. The study identified six overarching themes that need to be addressed. Doing so should reduce morbidity and mortality in the small proportion of patients who have a significant, avoidable delay in their cancer diagnosis. The 'Swiss cheese' model of accident causation showed how the themes related to each other.

780 Injury to Intervention: Is There Another Opportunity to Improve Burn Care?

Abstract Introduction The treatment of burn-injured patients requires early intervention to prevent adverse events such as local or systemic infection, increased mortality, or exacerbation of other homeostatic processes. Early intervention also reduces delays in treatment, return to work, and the related costs of hospitalization, wound care, and pain control. The purpose of this study was to evaluate potential delays in treatment and the associated costs compared to those seen with more accurate diagnosis and treatment on admission. Methods A prospective, IRB-approved study was undertaken with nine burn centers in nine states and three ABA burn regions. Data points included times of injury, admission, and surgery. Inclusion criteria included: life expectancy > 6 months, thermal burn mechanism (flame, scald, or contact), and minimum burn wound size for adult or pediatric patients of 0.5% TBSA. Data was collected by onsite research staff and confirmed during periodic monitoring visits. Avoidable inpatient days (AID) was defined as the time of admission to the time of surgery, and avoidable treatment delays (ATD) as the time of injury to the time of surgery. The average daily bed costs were defined as $7,554 from recent real-world published data. Results One hundred thirty-eight (138) patients in this study were admitted and treated with surgical intervention for full thickness burn injuries from 2017 to 2022. The total AID was 506 (median 3 days, range 0-9, mean 4, 25%tile 3, 75% 4). The total ATD was 733 days for 138 patients (median 5 days, range 0-9, mean 5, 25%tile 4, 75%tile 6). The median AID cost savings were calculated at $22,662 per patient had surgery been indicated and performed within 24 hours of admission. The median ATD cost savings were $30,216 per patient had surgery been indicated and conducted within 24 hours of injury or evaluation at an emergency room or burn center. The total savings for 138 patients whose surgery had been determined necessary and performed within 24 hours of the burn would have been $4,169,808 as opposed to having surgery indicated and completed within 24 hours of admission, $2,084,904. Conclusions If early diagnosis of burn injuries requiring surgery could be obtained within 24 hours of injury or admission, facilities and patients would benefit from reduced treatment delays and inpatient care costs. Our study was limited to patients undergoing surgery and those with non-healing wounds. An additional benefit could also be found in patients with healing wounds; if a confident diagnosis could be made earlier, such patients could be discharged rather than spending excess time as inpatients. Further studies are in progress with larger populations and more burn centers to better determine benefits for these patients. Applicability of Research to Practice We must understand the economic impact of our clinical decisions to pursue research initiatives that are clinically significant to our patients and financially viable to the institutions that support burn care.

Avoidable Discharge Delays: Children Waiting in Hospitals Deserve More Attention.

Avoidable Discharge Delays: Children Waiting in Hospitals Deserve More Attention.

The KidScope Study: An Analysis of a Community Paediatric Clinic Set in a Disadvantaged Area of Ireland

The most critical period of human development is from conception to age six years when important brain structures develop. These structures influence child development, well-being, learning, and behaviours that follow. Research shows children from economically disadvantaged areas have poorer developmental, health, and lifelong outcomes. A considerable proportion of developmental delay is avoidable and early detection and intervention can improve child, family, and community outcomes. Ireland’s disjointed early intervention system sees children from more affluent communities access services faster through paid private assessment and intervention. KidScope is the only community paediatric clinic in Ireland to offer assessment and onward referral from birth to six years within a disadvantaged area. The clinic intercepts the gap within the early intervention system and breaks the cycle of intergenerational poverty by disrupting the impact exclusion to healthcare has on vulnerable children and families. We aim to evaluate KidScope in order to contribute to the evidence on addressing avoidable developmental delay in disadvantaged areas through early detection and timely referral to services. Findings to date highlight the challenges vulnerable families face when accessing paediatric healthcare, the healthcare needs of children experiencing adversity, and how community paediatric clinics identify and support developmental delay.

Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India.

There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.

Lane clearance approach for emergency vehicles in highways network.

The steady rise in the number of vehicles in modern urban areas and poor conformance to traffic laws (or rules) lead to avoidable commute delays and traffic jams. Also, there is an increased likelihood of road accidents requiring immediate medical attention. Emergency vehicle (EV) service is adversely affected due to the unavailability of the clear lane that supports EVs to get to their endpoint without being delayed along the national highways. Moreover, the EV's sirens have a limited range, which may fail to reach and notify other vehicular traffic about its mobility promptly. In addition to this range constraint, EVs in motion often lose their communication links while moving from network to network. This paper delineates an approach using the next generation mobile internet protocol, for automated pathway clearance, for EVs. The prototype model of the proposed approach was experimentally designed and implemented. The proposed design concept is validated by performance characterization via numerical analysis.

964 Cheques and Balances: A Five-Year Review of Surgical Settlements

Abstract Aim The litigious burden in the NHS has been increasing yearly, costing an estimated £2.5 billion per year in financial settlements. We investigated the causes of general surgical settlements and attributed costs at a district general hospital over a five-year period. Method A retrospective analysis of all general surgical claims between 2016–2021 using the NHS Resolutions Case Management System. Selected cases were those which resulted in out of court financial settlements; whilst these claims have been settled, the trust admitted no negligence in each case. Results A total of 12 settlements were made with a total cost of £249,918 (£8000-£60,000, mean £20,827). Eight of the claims (67%) related to elective cases with four (33%) emergency cases. Of the total cases, 41% and 33% related to management of gallstones and appendicitis respectively. The majority of claims (58%) related to delays in treatment with a total cost of £103,500 (£8000-£35,000), accounting for 41% of total settlement costs. Five cases (42%) were due to harm with a combined total of £146,418 (£9000-£60,000), 59% of the total settlement. Of the claims due to harm, 80% suffered recognised complications of the procedure. Conclusions Increasing litigation in the NHS over the last decade now accounts for 2% of the total NHS budget. The majority of settlements reviewed here were for avoidable delays in elective treatment, with higher financial settlements for well documented surgical complications related to the consent process. Better access to investigations, earlier clinical review, and reductions in delays to elective surgeries may reduce the financial burden of litigation.

TU7.7 Cheques and Balances: A Five Year Review of Surgical Settlements

Abstract Aim The litigious burden in the NHS has been increasing yearly, costing an estimated £2.5 billion per year in financial settlements. We investigated the causes of general surgical settlements and attributed costs at a district general hospital over a five-year period. Method A retrospective analysis of all general surgical claims between 2016–2021 using the NHS Resolutions Case Management System. Selected cases were those which resulted in out of court financial settlements; whilst these claims have been settled, the trust admitted no negligence in each case. Results A total of 12 settlements were made with a total cost of £249,918 (£8000-£60,000, mean £20,827). Eight of the claims (67%) related to elective cases with four (33%) emergency cases. Of the total cases, 41% and 33% related to management of gallstones and appendicitis respectively. The majority of claims (58%) related to delays in treatment with a total cost of £103,500 (£8000-£35,000), accounting for 41% of total settlement costs. Five cases (42%) were due to harm with a combined total of £146,418 (£9000-£60,000), 59% of the total settlement. Of the claims due to harm, 80% suffered recognised complications of the procedure. Conclusions Increasing litigation in the NHS over the last decade now accounts for 2% of the total NHS budget. The majority of settlements reviewed here were for avoidable delays in elective treatment, with higher financial settlements for well documented surgical complications related to the consent process. Better access to investigations, earlier clinical review, and reductions in delays to elective surgeries may reduce the financial burden of litigation.

EP-488 Pre-operative electronic checklists as a systematic method to improve patient care

AimsThe COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over the telephone, and pre-operative tests carried out a few days before surgery to coincide with the COVID testing visit. This increased the chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays.MethodsAn audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on the theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and the team, including doctors and nurses, were educated on its value in improving patient care.ResultsThe implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided; however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained.ConclusionCOVID-19 has reduced the time for hospital visit and face to face interactions, but this created the opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.

The avoidable delay in weight loss surgery for those with BMI over 50.

Many insurance companies mandate medically supervised weight loss programs (MSWLPs) prior to bariatric surgery. This retrospective study aims to elucidate whether the average 6-month preoperative medical-management period decreases preoperative BMI for those with BMI ≥ 50. All adult patients with bariatric consultation at any time at the New York University Langone Health campuses during the period 2015 to 2021 were evaluated via electronic medical records. Only patients with ≥ BMI 50, without previous bariatric surgeries, and those with 6-month insurance-mandated medical visits were included. A paired t-test was performed on the difference in BMI and percent-weight loss among the subjects at least 6months before surgery and on the day of surgery. Of the 130 patients with BMI ≥ 50, undergoing preoperative 6-month office weigh-ins, the mean difference in BMI was -1.51 (P < 0.01). The mean total body weight loss was 4.8% (P < 0.01). There were no intraoperative complications nor 30-day complications or mortality in the group. We found that there was weight loss during the 6-month insurance-mandated medical management prior to surgery, but the amount (4.8%) did not reach the goal target of 10% of body weight. We found that there were no complications and question the need for prolonged delay to surgery.

Importance of Analyzing Intervals to Emergency Medical Service Treatments

Background Although most US emergency medical services (EMS) systems collect time-to-treatment data in their electronic prehospital patient care reports (PCRs), analysis of these data seldom appears in publications. We believe EMS agencies should routinely analyze the initial time-to-treatment data for various potentially life-threatening conditions. This not only assures that protocol-required treatments have been provided but can discover avoidable delays and drive protocol/treatment priority change. Our study purpose was to analyze the interval from 9-1-1 call receipt until the first administration of naloxone to adult opioid overdose victims to demonstrate the quality assurance importance of analyzing time-to-treatment data. Methods Retrospective analysis of intervals from 9-1-1 call receipt to initial naloxone treatment in adult opioid overdose victims. We excluded victims <18 years of age and cases where a bystander, police, or a health care worker gave naloxone before EMS arrival. We compared data collected before and during the COVID-19 pandemic to determine its effect on the analysis. Results The mean patient age of 582 opioid overdose victims was 40.7 years [95% CI 39.6, 41.8] with 405 males (69.6%). EMS units’ scene arrival was 6.7 minutes from the 9-1-1 call receipt. It took 1.8 minutes to reach the victim, and 8.6 additional minutes to administer the first naloxone regardless of administration route (70.4% intravenous, 26.1% intranasal, 2.7% intraosseous, 0.7% intramuscular). EMS personnel administered the first naloxone 17.1 minutes after the 9-1-1 call receipt, with 50.3% of the delay occurring after patient contact. There was no statistically significant difference in the times-to-treatment before vs. during the pandemic. Conclusion The prepandemic interval from 9-1-1 call receipt until initial EMS administration of naloxone was substantial and did not change significantly during COVID-19. Our findings exemplify why EMS agencies should analyze initial time-to-treatment data, especially for life-threatening conditions, beyond assuring that protocol-required treatments have been provided. Based on our analysis, fire department crews now carry intranasal naloxone, and intranasal naloxone is given to “impaired" opioid overdose victims the first-arriving fire department or EMS personnel. We continue to collect data on intervals-to-treatment prospectively and monitor our critical process/treatment intervals using the plan-do-study-act model to improve our process/carry out change, and publish our results in a future publication.

Delays in Diagnosis, Treatment, and Surgery: Root Causes, Actions Taken, and Recommendations for Healthcare Improvement.

Although patient safety continues to be a priority in the U.S. healthcare system, delays in diagnosis, treatment, or surgery still led to adverse events for patients. The purpose of this study was to review root cause analysis (RCA) reports in the Veterans Health Administration to identify the root causes and contributing factors of delays in diagnosis, treatment, or surgery in an effort to prevent avoidable delays in future care. The RCA reports from Veterans Health Administration hospitals from October 2016 through September 2019 were reviewed and the root causes and contributory factors were identified. These elements were coded by consensus and analyzed using descriptive statistics. During the 3-year study period, 206 RCAs were identified and 163 were analyzed that were specific to delays in diagnosis, treatment, and surgery. The reports identified 24 delays in diagnosis, 117 delays in treatment, and 22 delays in surgery. Delays occurred most often in outpatient settings. Results supported the need for standardization of care processes and procedures, improved communication between and within department personnel, and improved policies and procedures that will be followed as intended. By reviewing adverse events, root causes, and contributing factors identified by local RCA teams, strategies can be developed to reduce delays in diagnosis and treatment of patients and lead to safer care.

Frequency of Adverse Perinatal Outcome in Women Undergoing Emergency Lower Segment Cesarean Section at Term Due To Non–Reassuring CTG at Tertiary Care Hospital

Objective: To determine the frequency of adverse perinatal outcome in women undergoing emergency lower segment cesarean section at term due to non–reassuring CTG at Tertiary Care Hospital. Study Design: Descriptive case series-longitudinal. Study Setting: Study was conducted at Department of Gynaecology and Obstetrics, Aga Khan University Hospital. Duration of Study: Six months from 1st July, 2018 till 31st December 2018. Subjects and Methods: Data was prospectively collected from patients after taking a consent. A total of 211 patients were included. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Post stratification chi square test was applied taking p-value of ≤ 0.05 as significant. Results: Mean age in group A and B was 33.56±3.91 and 34.71±4.01 years respectively. Adverse fetal outcome showed that birth weight &lt; 2500 gm (20.4% vs 12.3%), APGAR score &lt; 7 (16.6% vs 12.3%), Umblical cord ph &lt; 7.1 (14.2% vs 9%), NICU admission (11.8% vs 8.5%) and still birth patients (4.3% vs 1.9%) who were in decision to delivery group of &lt; 30 minutes and &gt; 30 minutes respectively. Conclusion: This study showed that there are still avoidable delays in emergency caesarean section. Improving health care delivery so as to eliminate the identified causes would go a long way in reducing these delays. But given the results of this study, adverse fetal outcomes appears to be less in DDI &gt; 30 minutes group when compared with DDI &lt; 30 minutes group. Keywords: Elective lower segment cesarean section, decision to delivery time, birth weight, APGAR score, NICU admission, umbilical ph and still birth.

Reducing Avoidable Transfer Delays in the Pediatric Intensive Care Unit for Status Asthmaticus Patients.

Introduction:Status asthmaticus (acute severe asthma) is one of the most common reasons for Pediatric Intensive Care Unit (PICU) admission. Accordingly, ensuring optimal throughput for patients admitted with status asthmaticus is essential for optimizing PICU capacity. Few studies specifically address effective methods to reduce delays related to PICU discharge. This project aimed to identify and reduce avoidable delays in PICU discharge for status asthmaticus patients.Methods:This quality improvement project focused on reducing transfer delays for status asthmaticus patients admitted to the PICU at a freestanding academic children’s hospital. We standardized the transfer criteria, identified barriers to an efficient transfer, and implemented multidisciplinary interventions. The primary aim was to decrease the average duration from fulfilling the transfer criteria to PICU discharge by 15% from the baseline within 8 months of implementation. The balancing measure was readmissions to the PICU for asthma exacerbations within 24 hours from PICU discharge.Results:The analysis included 623 patients. Following interventions, the time from fulfilling transfer criteria to PICU discharge decreased from 9.8 hours to 6.8 hours, a 30.6% reduction from baseline. Improvements were sustained for 6 months. In the preintervention group, three patients were readmitted to the PICU within 24 hours of transferring out of the PICU, but no patient was readmitted during the postintervention period.Conclusions:Standardizing transfer criteria and implementing multidisciplinary strategies can reduce avoidable PICU discharge delays for patients with status asthmaticus. The application of a similar approach could potentially reduce avoidable delays for other conditions in the PICU.

COVID-19 and Acute Coronary Syndrome: Lessons for Everyone

The Coronavirus Disease 2019 (COVID-19) pandemic has brought unprecedented changes to our world and healthcare system. In addition to millions of infected patients, non-COVID-19 care is also severely undermined due to change in human behaviour and resource availability. Treatment of medically emergent conditions like acute coronary syndrome (ACS) are particularly vulnerable and worldwide there were reports of reduction in ACS admissions with worsened in-hospital outcome.1-3 In fact, healthcare avoidance and treatment delay were apparent2,3 and may further translate into poorer medium or long term cardiovascular outcome such as higher incidence of heart failure (HF).

Knowledge about Complication of Congenital Hypothyroidism among Parents in Aseer Region, Saudi Arabia

Background: A lack of thyroid hormone present at birth is described as Congenital Hypothyroidism (CH). A difficulty with thyroid development or thyroid hormone production (dysgenesis) is most frequent in thyroid birth hormone insufficiency. It is one of the main causes of avoidable mental delay in infants This study aims to assess knowledge and awareness of Saudi parents towards complication of congenital hypothyroidism in Aseer region, KSA.&#x0D; Methods: A cross sectional study was conducted of general population of Aseer region. Data was collected by means of online questionnaire distributed online to be self-filled by parents. The study included 1086 participants. The collected data was entered and analyzed using the Statistical Package for the Social Science (SPSS Inc. Chicago, IL, USA) version 23. Descriptive statistics was performed.&#x0D; Results: All participants were from Aseer region, 39.5% of participants reported consanguinity between parents, 34.5% of all participants had heard of CH. 18.2% identified iodine deficiency during pregnancy as risk factor for CH. 22.6% identified excessive sleeping, 15.2% jaundice and 16% facial swelling. 60.2% did not know CH complications while 22.1% reported poor growth, resulting in short stature as a complication, followed by 14.4% Goiter, 14.1% delayed puberty, 13.5% mental retardation, 12.9% osteoporosis, 9.9% heart defects, and 4.6% bone fractures. 11.9% of all participants identified optimal time to start treatment to prevent complications as the first two weeks of the baby's life&#x0D; Conclusion: Parental knowledge of congenital hypothyroidism in Aseer is relatively unsatisfactory. Health campaigns and conferences to raise awareness is necessary looking to catastrophic complications caused by delayed diagnosis and management of the disease.