Change In Hospital Policy Research Articles

De-implementation of Routine Maternal Oxygen Supplementation for Intrauterine Fetal Resuscitation: A Retrospective Cohort Study.

Current practice guidelines for laboring patients with category II intrapartum tracings recommend maternal oxygen supplementation despite emerging randomized data challenging its benefit and utility. We aim to validate that de-implementing maternal oxygen supplementation for fetal resuscitation did not increase the risk of neonatal acidemia in a real-world setting. This is a retrospective observational study conducted at a single tertiary care center from January 2019 to June 2021. All laboring deliveries during the study period was reviewed and eligible participants included singleton or twin pregnancies between 23-42 weeks gestational age with persistent category II tracings. Known major fetal anomalies, contraindications to labor, and maternal indication for O2 supplementation, including active COVID-19, were excluded. Cohorts were allocated based on time of delivery. Those occurring prior to our hospital policy change identified as historical controls and deliveries after April 1, 2020, as the post-de-implementation cohort. Primary outcome was fetal acidemia, defined as umbilical cord pH < 7.2. Secondary outcomes included severe acidemia (pH < 7.0), 5-minute Apgar score < 4 and neonatal intensive care admission. Regression analyses controlling for known variables associated with neonatal acidemia generated adjusted odds ratios with 95% confidence intervals. Among 9088 deliveries during the study period, 1162 tracings were flagged as persistent category II, including 681 (59%) in the post-intervention group. The two cohorts had comparable baseline and obstetric characteristics. No difference in neonatal acidemia was observed between the post-de-implementation group and historical controls (13.8% vs 15.4%, aOR 0.87, 95% CI 0.62-1.22). Severe acidemia, 5-minute Apgar < 4 and neonatal intensive care admission were not increased in the post-de-implementation group. De-implementation of routine maternal oxygen supplementation for fetal resuscitation did not increase likelihood for neonatal acidemia in a real-world setting, validating guidelines recommending against the intervention.

Effects of first year COVID-19 pandemic on urology practice in three major Arab Countries: Sub-Analysis of a survey by Arab association of urology research group.

The World Health Organization (WHO) declared the coronavirus disease-19 (COVID-19) pandemic on March 11, 2020. The health care system faced tremendous challenges in providing ethical and high-quality care. The impact of COVID-19 on urological practices varied widely worldwide, including in Arab countries. This study aimed to compare the influence of the COVID-19 pandemic on urology practice in Egypt, the KSA, and the UAE during the first year of the pandemic. This sub-analysis assessed the demographics and COVID-19's effects on urological practice in terms of adjustments to hospital policy, including outpatient consultations, the management of elective and urgent surgical cases, and the continuation of education across the three countries. The availability of personal protective equipment (PPE) and urologists' emotional, physical, and verbal intimidation during COVID-19 were also compared. Regarding the impact on hospital policy, consultations replaced by telemedicine were significantly higher in the KSA (36.15%), followed by the UAE (33.3%), then Egypt (10.4%) (P = 0.008). Elective cases requiring ICU admission were 65.1% in Egypt, 45.2% in the KSA, and 58.2% in the UAE and were performed only in high-risk patients. PPE was freely available in 20.8% of the Egyptian hospitals compared to 83.3% in the KSA and 81.8% in the UAE. Online courses were significantly higher in Egypt (70.8%), followed by the UAE (53%) and the KSA (41.7%) (P = 0.02). Emotional intimidation was higher than verbal intimidation, representing 80%, 75.9%, and 76% in the UAE, KSA, and Egypt, respectively. This sub-analysis outlined significant hospital policy changes across the three Arab countries. Exposure to emotional, verbal, and physical intimidation was observed. The development of teleconsultations and online platforms for educational purposes was observed.

Optimizing Surgical Care Amidst COVID-19: A Scoping Review of Practices and Policies.

The coronavirus disease (COVID-19) pandemic significantly disrupted surgical care worldwide, affecting different specialties in various ways. Lockdowns, surges in COVID-19 cases, and changes in hospital policies notably impacted patient attendance, management practices, and access to surgical services. This scoping review examines the adverse impacts of the COVID-19 pandemic on surgical services and the policies adopted to address these care barriers. We conducted a comprehensive literature review using the preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews (PRISMA-ScR) guidelines. Our search, spanning 31 December 2019, to 29 January 2023, focused on understanding the multifaceted impacts of COVID-19 on surgical services, particularly across different specialties. An analysis of 75 articles indicated that the pandemic challenged surgeons worldwide to maintain a balance between delivering emergency and elective surgical care, and implementing safety measures against viral transmission. There was a marked decline in the surgical volume, leading to extended waitlists and decreased operating theater usage. Strategies such as prioritizing medically necessary and time-sensitive surgeries and integrating telemedicine have emerged as pivotal for ensuring the continuity of urgent care. Despite the reduced rates, essential surgeries such as appendectomies and cancer-related operations continued, yet faced hurdles, including reduced staffing, limited operating theater capacity, and complications in patient transfers. This review emphasizes the steep reduction in surgical service utilization at the beginning of the pandemic and emergence of new compounded barriers. Policies that designated surgeries as essential, and focused on equitable and timely access, were effective. Incorporating these findings into post-pandemic assessments and future planning is crucial to sustain adequate surgical care during similar health emergencies.

Radiotherapy service amidst COVID-19: Experience from Tertiary Referral Hospital in Semarang, Indonesia.

Several changes in hospital policies took place to mitigate the spread of Coronavirus disease 2019 (COVID-19). However, the patient's perception to these abrupt changes in medical services is not known. This study analyzed the quality of radiotherapy service during the COVID-19 pandemic and the patient's perception of them. This descriptive study will qualitatively assess cancer patient perception of the quality of radiotherapy service during COVID-19 pandemic. Willing participants were given a questionnaire that explore two major aspects: the patient's general knowledge of COVID-19 and their perception of radiotherapy service during the pandemic. The 145 participants of this study were generally well-informed about the significance of COVID-19 pandemic. Most respondents claimed to adequately practice preventive measures and put high regards in personal protective equipment (PPE) worn by them and healthcare workers for their safety. Their level of trust to all healthcare workers remained high and identified hospital announcements (television, brochures) educated them the most in regards to the relationship of COVID-19 and cancer. The changes in hospital policies and radiation oncology service in our institution were well-received by the study population. Despite the majority of respondents were afraid and anxious of being infected of COVID-19 while undergoing treatment, only a minority of them contemplated to delay or completely stop going for treatment. By adhering to major guidelines and adjustments of local resources, the delivery of radiotherapy service can remain consistent during the pandemic.

Healthcare adjustments and concerns: a qualitative study exploring the perspectives of healthcare providers and administrative staff during the COVID-19 pandemic in Saudi Arabia.

Healthcare systems have modified their strategies to manage their staff, supplies, and space to deal systematically with the COVID-19 pandemic. This research aimed to explore the nature of hospital adjustments and the concerns of healthcare providers and administrative staff working in Governmental and private hospitals throughout the Qassim Region of the Kingdom of Saudi Arabia (KSA) during the pandemic. A qualitative phenomenological study using semi-structured in-depth interviews were conducted with 75 purposively selected healthcare providers and administrative staff working at three main hospitals in the Qassim Region, KSA. The maximum variation sampling technique was utilized. Recruitment of participants was continued until data saturation was reached. All interviews were audiotaped, transcribed verbatim, and analyzed thematically. Four core themes were identified in this paper: (1) changes in hospital policy and procedures, (2) workforce management, (3) the well-being of the workforce, and (4) apprehensions and expectations of the workforce. The participants showed satisfaction with timely administrative decisions and new policies during the COVID-19 pandemic. Furthermore, the psychological health of healthcare professionals was affected more than their physical state. Finally, the providers perceived the emergence of multiple concerns in the coming months. Although healthcare providers were initially overwhelmed, they gradually accepted new administrative policies. Numerous innovative interventions effectively reduced their physical workload and increased their productivity, but they remained significantly affected by a wide range of psychological disorders, with a high prevalence of obsessive-compulsive disorder. There were some concerns about the new SARS-CoV-2 variant, but the majority were optimistic.

Delirium, polypharmacy and adverse outcomes: findings from a hospital in Kerala, India

Introduction Delirium is an acute disorder of attention and awareness, a medical emergency associated with increased morbidity and mortality. Delirium remains under-recognised, and few studies are from India. Methods This study aimed to estimate the prevalence of delirium and its risk factors among hospitalised older patients admitted to medical and surgical wards in a teaching hospital in Central South India. We performed a retrospective cross-sectional study on 100 older patients admitted to medical and surgical wards in April-October, 2020. Patient data were obtained from a record review, extracting information on comorbidities, medications, and terms indicating delirium. Results Delirium was present in 39% of the study population and was significantly associated with older age (88%), abnormal electrolytes (59%), and polypharmacy (87%). Delirium was also significantly associated with mortality (28%) and prolonged hospital stay. (36%) Discussion The prevalence of delirium is high among older hospitalised patients and is significantly related to adverse hospital outcomes. The findings of this study could trigger changes in hospital policies in screening for delirium in older persons for its prompt recognition and prevention of adverse health outcomes.

Privacy-Preserving Fast Three-Factor Authentication and Key Agreement for IoT-Based E-Health Systems

Electronic healthcare (e-health) systems have received renewed interest, particularly in the current COVID-19 pandemic (e.g., lockdowns and changes in hospital policies due to the pandemic). However, ensuring security of both data-at-rest and data-in-transit remains challenging to achieve, particularly since data is collected and sent from less insecure devices (e.g., patients’ wearable or home devices). While there have been a number of authentication schemes, such as those based on three-factor authentication, to provide authentication and privacy protection, a number of limitations associated with these schemes remain (e.g., (in)security or computationally expensive). In this study, we present a privacy-preserving three-factor authenticated key agreement scheme that is sufficiently lightweight for resource-constrained e-health systems. The proposed scheme enables both mutual authentication and session key negotiation in addition to privacy protection, with minimal computational cost. The security of the proposed scheme is demonstrated in the Real-or-Random model. Experiments using Raspberry Pi show that the proposed scheme achieves reduced computational cost (of up to 89.9% in comparison to three other related schemes).

Risk Factor Analysis of Hospital Readmissions at St. Petersburg General Hospital.

Decreased readmission rates are largely seen as an indicator of effective care and improved resource management. The case management team at St. Petersburg General Hospital in St. Petersburg, Florida identified chronic obstructive pulmonary disease (COPD) exacerbation, pneumonia, and sepsis as 3 of the leading diagnoses on index admission that later led to 30-day readmissions. By examining patients with these 3 diagnoses on index admission, we decided to investigate potential readmission risk factors including patient age, sex, race, body mass index (BMI), length of stay during the index admission, insurance type during index admission, discharge placement after index admission, coronary artery disease, heart failure, and type 2 diabetes. We conducted a retrospective study with data from 4180 patients at St. Petersburg General Hospital from 2016 through 2019 with index admission diagnoses of COPD exacerbation, pneumonia, and sepsis. A univariate analysis was conducted on patient sex, race, BMI, length of stay during the index admission, health insurance type during the index admission, discharge placement after the index admission, presence of coronary artery disease, presence of heart failure, and presence of type 2 diabetes. Subsequently, a bivariate analysis was run on these variables in relation to 30-day readmissions. Then a multivariable analysis was completed using binary logistic regression and pairwise analysis to determine the significance between variables within the categories of discharge disposition and insurance type. Of the 4180 patients included in this study, 926 (22.2%) were readmitted within 30 days of discharge. In the bivariate analysis race, BMI, mean length of stay during the index admission, coronary artery disease, heart failure, and type 2 diabetes were not significantly associated with readmission. The bivariate analysis revealed that patients discharged to skilled nursing facilities had the highest readmission rates (28%), followed by home care (26%) (P = .001). Medicaid patients (24%) and Medicare patients (23%) demonstrated higher read-mission rates than those with private insurance (17%) (P = .001). Readmitted patients were slightly younger (62.14 vs. 63.69 years; P = .02) in the bivariate analysis. However, in the multi-variable analysis, only patients with type 2 diabetes and patients with non-private insurance were associated with increased readmission rates. Pairwise analysis of the variables within insurance and discharge disposition categories demonstrates decreased readmission for individuals with Private/Other when compared to other insurance subtypes and decreased readmission for Other when compared to discharge disposition subtypes. Our data demonstrate that hospital readmissions are associated with a diagnosis of type 2 diabetes and having a non-private insurance status. Our findings lead us to suggest further investigation into changes in hospital policies and procedures for these groups that will aim to decrease readmission rates in the future.

Radiological Follow-Up of Adults Hospitalised With Pneumonia and SARS-Cov-2 Infection, In Bristol UK, During The CO

Introduction: Radiological change which may be attributed to infection can also be attributable to lung cancer. Patients with SARS-CoV-2 infection can develop groundglass lung opacification which may result in chronic lung changes. Current British Thoracic Society (BTS) guidelines recommend patients with pneumonia and COVID19 undergo repeat chest radiography. Methods: A single-centre audit of patients hospitalised with communityacquired pneumonia or COVID19 over three time periods during the COVID19 pandemic (Aug-Dec 2020, Jun-Aug 2021, Dec-Jan 2022). We assessed whether patients were eligible for radiological follow-up and if repeat radiological investigation occurred. Results: 1040 adults were hospitalised with infective radiological change (pneumonia=596, COVID19=444). 831/1040 patients (80%) required radiological follow-up under BTS guideline criteria: there was minimal difference between the first two time periods studied. Patients hospitalised with CAP were less likely to have radiological follow-up planned than those admitted with COVID19 disease (49% versus 59% respectively). Following a change in hospital policy, follow-up rates increased to 69% and 71% for pneumonia and COVID19. Overall, only 47% eligible patients received follow-up in line with current guidelines. Conclusion: BTS guideline adherence is important to avoid delay in diagnosing underlying malignancy or chronic lung disease. Radiological follow-up following CAP and COVID19 may be suboptimal, with a paucity of data. Follow-up arranged under the hospital team was more likely to occur than when the GP was responsible for instigating repeat radiological imaging. Further investigation into rates of radiological follow-up should be undertaken, including reasons for non-adherence, to ensure patients receive appropriate treatment following respiratory infection

The association of social, economic, and health-related variables with suicidal and/or self-harm thoughts in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic: An exploratory study

Individuals with pre-existing psychiatric diagnoses appear to be vulnerable to worsening mental health symptoms during the coronavirus disease 2019 (COVID-19) pandemic. Furthermore, psychiatric hospitalizations during the pandemic may be complicated by increased risk of SARS-Cov-2 infection and limited social engagement due to changes in hospital policies. The objective of our exploratory study was to determine whether social, economic, and health-related variables were associated with thoughts of suicide and/or self-harm since March 2020 in individuals admitted to a psychiatric inpatient unit during the COVID-19 pandemic. Chi-square tests revealed four variables were significantly associated with thoughts of suicide and/or self-harm: 1) difficulty with cancellation of important events, 2) some form of loneliness, 3) decreased time spent in green spaces, and 4) increased time spent using devices with screens. The logistic regression model showed a significant association between suicidal and/or self-harm thoughts and cancellation of important events. Further investigation of the loneliness variable components revealed a significant association between suicidal and/or self-harm thoughts and feeling a lack of companionship, feeling isolated, and feeling alone. These results suggest that social challenges experienced during the pandemic were associated with negative mental health symptoms of individuals admitted to a psychiatric inpatient unit.

The Operating Room Black Box: Understanding Adherence to Surgical Checklists.

We report for the first time the use of the Operating Room Black Box (ORBB) to track checklist compliance, engagement, and quality. Implementation of operative checklists is associated with improved outcomes. Compliance is difficult to monitor. Most studies report either no assessment of checklist compliance or deployed in-person short-term assessment. The ORBB a novel artificially intelligence-driven data analytic platform affords the opportunity to assess checklist compliance without disrupting surgical workflow. This was a retrospective review of prospectively collected ORBB data. Operative cases included elective surgery at a quaternary referral center. Cases were analyzed as prepolicy change (first 9 months) or as a postpolicy change (last 9 months). Measures of checklist compliance, engagement, and quality were assessed. There were 3879 cases that were performed and monitored for checklist compliance between August 15, 2020, and February 20, 2022. The overall scores for compliance, engagement, and quality were 81%, 84%, and 67% respectively. When broken down by phase, the scores for time-out were compliance 100%, engagement 98%, and quality 61%. Scores for the debrief phase were 81% for compliance, 98% for engagement, and 66% for quality. After a hospital policy change, the debrief scores improved significantly (85%; P <0.001 for compliance, 88%; P <0.001 for engagement and 71%; P <0.001 for quality). ORBB provides the unprecedented ability to assess not only compliance with surgical safety checklists but also engagement and quality. Utilization of this technology allows the assessment of compliance in near real time and to accurately address safety threats that may arise from noncompliance.

Improved Rates of Same-day Discharge in Patients Undergoing Surgery for Endometrial Cancer Following the COVID-19 Pandemic

Study ObjectiveTo determine the effect of the coronavirus disease 2019 (COVID-19) pandemic on the rate of same-day discharge (SDD) after minimally invasive surgery for endometrial cancer.DesignRetrospective cohort.SettingTeaching hospital.PatientsA total of 166 patients underwent a minimally invasive surgery procedure for the indication of endometrial cancer at a large academic institution from September 1, 2019, to October 1, 2020—80 patients before the implementation of the COVID-19 restrictions and 86 patients after.InterventionsCOVID-19 pandemic with visitor restrictions and hospital policy changes placed on March 17, 2020.Measurements and Main ResultsSDD rate was increased by 18% after the start of the COVID-19 pandemic (40% vs 58%, p = .02). There were no differences between the 2 groups with regard to operative time (p = .07), estimated blood loss (p = .21), uterine weight (p = .12), age (p = .06), body mass index (p = .42), or surgery start time (p = .15). In a multivariable logistic regression model, subjects in the COVID-19 group had 3.08 times (95% confidence interval, 1.40–6.74; p = .01) higher odds of SDD than those in the pre-COVID-19 group. There was no difference in 30-day readmission rates (7.5% vs 5.8%, p = .66).ConclusionThere was a significant increase in the SDD of patients with endometrial cancer since the start of the COVID-19 pandemic. The pandemic has strained hospital resources and motivated patients and physicians to avoid hospitalization. This shows that with proper motivation, an increase in SDD rates is possible without an increase in complications or rehospitalization.

PD30-09 IMPACT AND IMPLICATIONS OF THE COVID-19 PANDEMIC ON UROLOGIC TRAINING

You have accessJournal of UrologyCME1 May 2022PD30-09 IMPACT AND IMPLICATIONS OF THE COVID-19 PANDEMIC ON UROLOGIC TRAINING Brandon Piyevsky, John Maclean, Anqing Li, Stephen Rhodes, Megan Prunty, Erin Jesse, Anood Alfahmy, Ramy Abou-Ghayda, Michael Zell, and Michael Callegari Brandon PiyevskyBrandon Piyevsky More articles by this author , John MacleanJohn Maclean More articles by this author , Anqing LiAnqing Li More articles by this author , Stephen RhodesStephen Rhodes More articles by this author , Megan PruntyMegan Prunty More articles by this author , Erin JesseErin Jesse More articles by this author , Anood AlfahmyAnood Alfahmy More articles by this author , Ramy Abou-GhaydaRamy Abou-Ghayda More articles by this author , Michael ZellMichael Zell More articles by this author , and Michael CallegariMichael Callegari More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002578.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The COVID-19 pandemic has impacted many facets of healthcare in the United States. Changes in public health and hospital policies led to changes in the surgical care of patients and caused disruptions in medical training. Currently, there is limited understanding of how significantly the pandemic impacted urology resident education across the U.S.. The aim of this project is to examine the trends in urologic procedures, as captured by the Accreditation Council for Graduate Medical Education (ACGME) performed by residents before, during and after the peak of the COVID-19 pandemic. METHODS: A retrospective review was performed of publicly available urology resident case logs between July 1 2016 and June 30 2021. Cases were divided into subcategories defined by ACGME and analyzed with linear regression models using year and category as predictors. Statistical calculations were conducted using R (version 4.0.2). RESULTS: Statistical analysis of the national average number of procedures performed by urology residents indicate an upward trend of urology cases. Starting in 2016, the national average of general urology procedures performed by residents has increased by 4-5 each year except for 2020, which saw a drop in case volume. However, in 2021 the case volume dramatically increased to the same rate as projected had there not been a disruption in 2020. The same analysis applied to other categories of urology procedures resulted in the same findings of a decrease in 2020 followed by a quick rebound in 2021. CONCLUSIONS: Trends in ACGME urologic resident case logs suggest that despite widespread pandemic-related disruptions in surgical case volume, there has been minimal detriment to urologic resident training over time. Urologic care is essential and in high demand as evidenced by the uptick in volume across training programs within the U.S. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e513 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Brandon Piyevsky More articles by this author John Maclean More articles by this author Anqing Li More articles by this author Stephen Rhodes More articles by this author Megan Prunty More articles by this author Erin Jesse More articles by this author Anood Alfahmy More articles by this author Ramy Abou-Ghayda More articles by this author Michael Zell More articles by this author Michael Callegari More articles by this author Expand All Advertisement PDF DownloadLoading ...

Understanding the Barriers Towards Delivery of Patient Education and Perceptions on Health Education Delivery During Covid Pandemic among the Nurses in One of the Hospitals in Bhutan

Background: Patient education is a dynamic process, including formal and informal interactive activities, which influences patients’ behavior and produces changes in knowledge, attitudes and skills for better health care outcomes. Educating patient and their relatives are a source of satisfaction for the nurses; however, they felt powerless to deliver patient education consistently due to some obstacles. Purpose: This qualitative study aims to explore barriers towards patient education among nurses and also to understand the perceptions of nurses towards patient education delivery during Covid pandemic. Methods: The study design is qualitative and the study was conducted using semi-structured interview. Recruitment of participants for the interview was based on purposive sampling techniques in order to gain broad range of perspective. Interviews were conducted with a maximum of 12 participants or until the point of saturation was achieved. Thematic analysis technique was used in order to analyze the data. Results: The findings of the study revealed that nurse related factors, patient related factors and inadequate infrastructure hindered the delivery of patient education. Only health education which required patients’ co-operation for undergoing procedure was delivered and the health education on disease condition was usually not imparted. It was also found out that the change in hospital policy during Covid pandemic has an impact on patient education delivery and that during the pandemic, Covid related education was strengthened. Conclusion: Understanding nurses’ perceptions and factors influencing the delivery of patient education may lead to information to develop strategies to promote nursing engagement in patient educational activities.

Intermittent Versus Continuous Infusion Dosing of Intravenous Proton Pump Inhibitors for Upper Gastrointestinal Bleeding.

Proton pump inhibitor (PPI) continuous infusions or intermittent boluses are used for the treatment of upper gastrointestinal bleeding (UGIB). Intermittent boluses are easier to give and are of lower cost without affecting clinical outcomes. To compare the rate of rebleeding between intermittent bolus and continuous infusion PPI therapy. We performed a retrospective, multicenter review of patients with UGIB receiving either continuous or intermittent PPI therapy. During the study period, due to drug and supply shortages, each institution implemented policies preferring intermittent PPI bolus therapy. We performed bivariate and multivariable comparisons of the 2 treatment strategies, with the primary outcome of interest being incidence of rebleeding. Additional variables of interest included intensive care unit (ICU) and hospital lengths of stay, discharge disposition, and in-hospital mortality. Compared with intermittent bolus dosing (n = 209), patients receiving continuous infusion PPI (n = 237) were associated with a higher rate of rebleeding (33.8% vs 23.0%; P = 0.012); however, no difference was detected in multivariable analysis: adjusted odds ratio, 1.50 (95% confidence interval, 0.91-2.50). There was no difference in median hospital or ICU length of stay, discharge disposition, or in-hospital mortality. Correlatively, patients receiving continuous infusion therapy were more likely to have liver disease (29.1% vs 20.1%; P = 0.028), alcohol use disorder (28.3% vs 16.3.%; P = 0.003), history of lower gastrointestinal bleeding (6.4% vs 1.9%; P = 0.021), variceal bleeding (6.3 vs 2.4%, P = 0.045), and be admitted to the ICU (65.0% vs 32.5%, P = 0.00). Introduction of intermittent PPI bolus UGIB treatment via change in hospital policy was not associated with higher rates of rebleeding. However, continuous PPI therapy may have been perceived as more effective as it was used more commonly in high-risk patients.

How did the first year of the COVID-19 pandemic affect urology practice in Arab countries? A cross-sectional study by the Arab Association of Urology research group.

Objective:The aim of this study was to assess of the effect of coronavirus disease 2019 (COVID-19) pandemic on urology practice in the Arab world during the first year of the crisis.Methods:An Internet-based questionnaire was created and sent out via email to members of the Arab Association of Urology (AAU) using ‘Google Forms’. The survey assessed participants’ demographics in terms of age, gender, country of origin, type of practice and position. Impacts of COVID-19 on urological practice were assessed in terms of the changes in hospital policies regarding consultations, and elective and emergency surgical cases. Moreover, impacts of COVID-19 on urologists were assessed.Results:A total of 255 AAU members across 14 Arab countries (Emirates, Egypt, Saudi Arabia, Iraq, Jordan, Algeria, Kuwait, Yemen, Qatar, Lebanon, Libya, Oman, Sudan and Syria) completed the survey; 4% were female urologists. Consultations at outpatient clinics were closed or restricted to emergency cases or replaced by telemedicine in almost 15%, 40% and 25% of hospitals, respectively. Elective surgeries were stopped or reduced to under 25% of surgical capacity in >10% and about 25% of hospitals, respectively. Almost 90% (228) reported changes in the policy for emergency theatres. Nearly 65% of hospitals offered preoperative COVID-19 testing to patients and 50% of hospitals provided personal protective equipment (PPE) to their urologists. Of 99% (253) who reported a change in urological education, 95% relied on online webinars. About 56% of respondents had their own private practice, of whom 91% continued private practice during the crisis. About 38% of participants reported exposure to intimidation (75% emotional, 20% verbal and 5% physical).Conclusion:The COVID-19 pandemic resulted in major changes in hospitals’ policies regarding outpatient consultations, elective and emergency operative cases, and the shift to telemedicine. Arab urologists have been facing major challenges either in both the governmental or the private sectors, and some of them were exposed to emotional, verbal and even physical intimidation.

"Mourning the Experience of What Should Have Been": Experiences of Peripartum Women During the COVID-19 Pandemic.

ObjectivesThe ongoing COVID-19 pandemic may significantly affect the peripartum experience; however, little is known about the perceptions of women who gave birth during the COVID-19 pandemic. Thus, the purpose of our study was to describe the peripartum experiences of women who gave birth during the COVID-19 pandemic in the United States.MethodsUsing a cross-sectional design, we collected survey data from a convenience sample of postpartum women recruited through social media. Participants were 18 years of age or older, lived in the United States, gave birth after February 1, 2020, and could read English. This study was part of the COVID-19 Maternal Attachment, Mood, Ability, and Support study, which was a larger study that collected survey data describing maternal mental health and breastfeeding during the COVID-19 pandemic. This paper presents findings from the two free-text items describing peripartum experiences. Using the constant comparative method, responses were thematically analyzed to identify and collate major and minor themes.Results371 participants responded to at least one free-text item. Five major themes emerged: (1) Heightened emotional distress; (2) Adverse breastfeeding experiences; (3) Unanticipated hospital policy changes shifted birthing plans; (4) Expectation vs. reality: “mourning what the experience should have been;” and (5) Surprising benefits of the COVID-19 pandemic to the delivery and postpartum experience.Conclusions for PracticePeripartum women are vulnerable to heightened stress induced by COVID-19 pandemic sequalae. During public health crises, peripartum women may need additional resources and support to improve their mental health, wellbeing, and breastfeeding experiences.

Impact of the COVID-19 pandemic on perinatal care and outcomes in the United States: An interrupted time series analysis.

Hospitals quickly adapted perinatal care to mitigate SARS-CoV-2 transmission at the onset of the COVID-19 pandemic. The objective of this study was to estimate the impact of pandemic-related hospital policy changes on perinatal care and outcomes in one region of the United States. This interrupted time series analysis used retrospective data from consecutive singleton births at 15 hospitals in the Pacific Northwest from 2017 to 2020. The primary outcomes were those hypothesized to be affected by pandemic-related hospital policies and included labor induction, epidural use, oxytocin augmentation, mode of delivery, and early discharge (<48hours after cesarean and <24hours after vaginal births). Secondary outcomes included preterm birth, severe maternal morbidity, low 5-minute Apgar score, neonatal intensive care unit (NICU) admission, and 30-day readmission. Segmented Poisson regression models estimated the outcome level shift changes after the pandemic onset, controlling for underlying trends, seasonality, and stratifying by parity. No statistically significant changes were detected in intrapartum interventions or mode of delivery after onset of the pandemic. Early discharge increased for all births following cesarean and vaginal birth. Newborn readmission rates increased but only among nulliparas (aRR: 1.49, 95%CI: 1.17, 1.91). Among multiparas, decreases were observed in preterm birth (aRR: 0.90, 95%CI: 0.84, 0.96), low 5-minute Apgar score (aRR: 0.75, 95%CI: 0.68, 0.81), and term NICU admission rates (aRR: 0.85, 95%CI: 0.80, 0.91). Increases in early discharge and newborn readmission rates among nulliparas suggest a need for more postpartum support during the pandemic. Decreases in preterm birth and term NICU admission among multiparas may have implications beyond the pandemic and deserve further study.

Higher versus Lower Oxygen Concentration during Respiratory Support in the Delivery Room in Extremely Preterm Infants: A Pilot Feasibility Study.

Background: Optimal starting oxygen concentration for delivery room resuscitation of extremely preterm infants (<29 weeks) remains unknown, with recommendations of 21–30% based on uncertain evidence. Individual patient randomized trials designed to answer this question have been hampered by poor enrolment. Hypothesis: It is feasible to compare 30% vs. 60% starting oxygen for delivery room resuscitation of extremely preterm infants using a change in local hospital policy and deferred consent approach. Study design: Prospective, single-center, feasibility study, with each starting oxygen concentration used for two months for all eligible infants. Population: Infants born at 23 + 0–28 + 6 weeks’ gestation who received delivery room resuscitation. Study interventions: Initial oxygen at 30% or 60%, increasing by 10–20% every minute for heart rate < 100 bpm, or increase to 100% for chest compressions. Primary outcome: Feasibility, defined by (i) achieving difference in cumulative supplied oxygen concentration between groups, and (ii) post-intervention rate consent >50%. Results: Thirty-four infants were born during a 4-month period; consent was obtained in 63%. Thirty (n = 12, 30% group; n = 18, 60% group) were analyzed, including limited data from eight who died or were transferred before parents could be approached. Median cumulative oxygen concentrations were significantly different between the two groups in the first 5 min. Conclusion: Randomized control trial of 30% or 60% oxygen at the initiation of resuscitation of extremely preterm neonates with deferred consent is feasible. Trial registration: Clinicaltrials.gov NCT03706586

COVID19 Pandemic Impact on Same-Day Discharge Rates after Minimally Invasive Surgery for Endometrial Cancer

Study ObjectiveTo determine if the COVID19 pandemic increased the rate of same-day discharge (SDD) after minimally invasive surgery (MIS) for endometrial cancer.DesignRetrospective cohort study of patients undergoing MIS hysterectomy for endometrial cancer for the six months before and after the COVID19 restrictions went into place on March 17, 2020.SettingRobotic or laparoscopic procedure in the low dorsal lithotomy position. Arms were tucked and padded at their sides.Patients or Participants166 patients underwent a MIS procedure for the indication of endometrial cancer at a large, academic institution from September 1, 2019, through October 1, 2020. 80 patients prior to the implementation of the COVID19 restrictions and 86 patients after.InterventionsCOVID19 pandemic with visitor restrictions and hospital policy changes placed on March 17, 2020.Measurements and Main ResultsSDD rate was increased following the start of the COVID19 pandemic (40% vs 58%, p= 0.02). There were no differences between the two groups in regard to operative time (p= 0.07), estimated blood loss (EBL) (p= 0.21), uterine weight (p= 0.12), age (p= 0.06), BMI (p=0.42), or surgery start time (p= 0.15). In a multivariable logistic regression model, subjects in the post COVID19 group had a 3.08 (95% CI: 1.40, 6.74, p= 0.01) higher odds of SDD than those in the pre COVID19 group. There was no difference in 30-day readmission rates (7.5% vs 5.8%, p=0.66).ConclusionWith no additional interventions from a surgical standpoint, the start of the COVID19 pandemic improved SDD rates. The reason for this is speculative but may be related to patient and physician desire to keep patients out of the hospital and may provide further evidence that subjective reasons lead to an increase in hospital length of stay.