Elective Medical Procedures Research Articles

The worldwide COVID-19 pandemic caused a decline in sonographic examinations - is this a continuing trend?

Due to the increasing number of COVID-19 infections since spring 2020 the patient care workflow underwent changes in Germany. To minimize face-to-face exposure and reduce infection risk, non-time-critical elective medical procedures were postponed. Since ultrasound examinations include non-time-critical elective examinations and often can be substituted by other imaging modalities not requiring direct patient contact, the number of examinations has declined significantly. The aim of this study is to quantify the baseline number of ultrasound examinations in the years before, during, and in the early post-pandemic period of the COVID-19 pandemic (since January 2015 to September 2023), and to measure the number of examinations at different German university hospitals. The number of examinations was assessed based on a web-based database at all participating clinics at the indicated time points. N = 288 562 sonographic examinations from four sites were included in the present investigation. From January 2020 to June 2020, a significantly lower number of examinations of n = 591.21 vs. 698.43 (p = 0.01) per month and included center was performed. Also, excluding the initial pandemic period until June 2020, significantly fewer ultrasound examinations were performed compared to pre-pandemic years 648.1 vs. 698.4 (p < 0.05), per month and included center, while here differences between the individual centers were observed. In the late phase of the pandemic (n = 681.96) and in the post-pandemic phase (as defined by the WHO criteria from May 2023; n = 739.95), the number of sonographic examinations returned to pre-pandemic levels. The decline in the number of sonographic examinations caused by the COVID-19 pandemic was initially largely intentional and can be illustrated quantitatively. After an initial abrupt decline in sonographic examinations, the pre-pandemic levels could not be reached for a long time, which could be due to restructuring of patient care and follow-up treatment. In the post-pandemic phase, the pre-pandemic level has been achieved again. The reasons for a prolonged reduction in ultrasound examinations are discussed in this article. · During the pandemic, significantly fewer ultrasound examinations were performed in the included centers.. · The number of examinations could not be reach the pre-pandemic level for a long time, which could be due to restructuring of patient care and follow-up treatment.. · Identifying causes for sonographic exam reduction is crucial in pandemic preparedness to uphold healthcare quality and continuity for all patients.. · The prolonged decline in sonographic examinations during the pandemic does not represent a lasting trend, as evidenced by the return to pre-pandemic levels..

Not Just Non-Consensual Pelvic Exams

Not Just Non-Consensual Pelvic Exams

The Myth Of Superfluous Pre-Operative NPO After Midnight.

Madam, Pre-operative nil per or nothing by mouth from midnight practice has been in work since 1960s.1 Its indiscriminate use is believed to prevent perioperative aspiration causing pneumonia 2, respiratory failure, morbidity and mortality. In almost every hospital in Pakistan and globally, the fasting orders from midnight are excessively used in case of morning elective surgical and medical procedures using general or regional anaesthesia.3 These not take into account the duration and type of surgery, type of sedation, choice of airway, risk stratification for increased chances of aspiration such as obesity, age, esophageal disorders. 4 However, the revolutionised current guidelines for pre-operative fasting by ASA 5-6 suggest the much shorter “2-4-6” hour rule, with NPO for two hours for clear liquids, four hours for breast milk and six hours for solids. Hence, the awareness about this myth needs to change in Pakistani healthcare centres. Recent studies have led to a more sophisticated understanding of gastric emptying and pH of gastric contents. For instance, a cochrane review showed no statistical difference in gastric volumes or stomach pH in patients on a prolonged standard fast vs shortened (&lt;180 minute) liquid fast.7 Furthermore, the 2-4-6 rule minimises the risk of dehydration, electrolyte imbalance, patient discomfort (thirst, hunger, nausea, vomiting, anxiety) 8, hypoglycemia, intraoperative haemodynamic instability, post- operative dehyhydration and extended hospital stay. In this way patient cooperation and satisfaction can be increased. Therefore, it is high time to change the highly controversial NPO policy to reach the international healthcare standard.

Effectiveness of virtual reality in managing pain and anxiety in adults during periprocedural period: a systematic review and meta-analysis.

Patients undergoing medical procedures often experience pain and anxiety. These periprocedural outcomes can be overcome by providing a distraction using virtual reality (VR), decreasing their perception. VR has proved effective in reducing pediatric pain and anxiety; however, limited studies have confirmed its effectiveness in adults. We performed a systematic review and meta-analysis on the effectiveness of VR, as opposed to standard care, in reducing periprocedural pain and anxiety in adults. A systematic search of randomized controlled trials was conducted using the databases of MEDLINE, Cochrane CENTRAL, and Scopus. Trials involving patients (> 18years) undergoing elective medical procedures conducted with or without local anesthesia and participating in VR therapy were included. Primary outcomes were pre-procedural anxiety, post-procedural anxiety, and intra-procedural pain. Pre-procedural pain, post-procedural pain, and intra-procedural anxiety were secondary outcomes. Data from 10 studies shortlisted for inclusion revealed no significant association between the use of VR and lower pre-procedural anxiety compared to standard care (p > 0.05) (SMD = -0.02, 95% CI = -0.18 - 0.14, P = 0.81) but demonstrated that the use of VR was significantly associated with a reduction in post-procedural anxiety (SMD = -0.73, 95% CI = -1.08 - -0.39, P < 0.0001), intra-procedural pain (SMD = -0.61, 95% CI = -1.18 - -0.04, P = 0.04), and post-procedural pain (SMD = -0.25, 95% CI = -0.44 - -0.05, P = 0.01). The use of VR caused a significant reduction in post-procedural anxiety, intra-procedural pain, and post-procedural pain in adults undergoing medical procedures, although the findings were insignificant concerning pre-procedural anxiety.

Trajectories and Predictors of Raised State Anxiety Among Outpatients Who Have Undergone Medical Imaging Procedures

PurposeThe aim of this study was to examine the prevalence of raised state anxiety before and after medical imaging procedures, the prevalence of state anxiety trajectories, and factors associated with postprocedural raised state anxiety. MethodsA prospective survey was administered to outpatients undergoing elective medical imaging procedures (CT, radiography, MRI, ultrasound, angiography, or fluoroscopy) recruited from one center. Participants completed a self-report survey preprocedure (time 1) and postprocedure (time 2). State anxiety was measured using the six-item State-Trait Anxiety Inventory. The point prevalence of raised state anxiety (State-Trait Anxiety Inventory score ≥33.16) at time 1 and time 2 was calculated, as was the prevalence of four state anxiety trajectories over time: persistent low anxiety, decreasing anxiety, increasing anxiety, and persistent raised anxiety. Factors predictive of raised state anxiety at time 2 were examined using logistic regression analysis. ResultsThree hundred fifteen participants completed both surveys. The prevalence of raised state anxiety at time 1 (50%) and time 2 (51%) was similar. Most patients reported persistent raised anxiety (36%) and persistent low anxiety (34%) over time. Fewer patients reported increasing anxiety (15%) and decreasing anxiety (14%). Raised state anxiety (odds ratio, 4.84; 95% confidence interval, 2.48-9.48) and lower reported health status (odds ratio, 2.48; 95% confidence interval, 1.11-5.51) at time 1 were significantly associated with greater odds of raised anxiety at time 2. ConclusionsRaised state anxiety related to medical imaging procedures is common among outpatients. Half of patients either developed or continued to experience raised anxiety after their procedures. Outpatients may benefit from evidence-based methods of alleviating anxiety before their procedures.

Surgeon supply and healthcare quality: Are revision rates for hip and knee replacements lower in hospitals that employ more surgeons?

We study the link between department-wide surgeon supply and quality of care for two major elective medical procedures. Several countries have adopted policies to concentrate medical procedures in high-volume hospitals. While higher patient volumes might translate to higher quality, we provide evidence for a positive relationship between surgeon supply and hospital revision rates for hip and knee replacement surgery. Hence, hospital performance decreases with higher surgeon supply, and this finding holds conditional on patient volumes.

Impact of the COVID pandemic on major abdominal cancer resections in Germany: a retrospective population-based cohort study.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is estimated to have claimed more than 6 million lives globally since it started in 2019. Germany was exposed to two waves of coronavirus disease 2019 in 2020, one starting in April and the other in October. To ensure sufficient capacity for coronavirus disease 2019 patients in intensive care units, elective medical procedures were postponed. The fraction of major abdominal cancer resections affected by these measures remains unknown, and the most affected patient cohort has yet to be identified. This is a register-based, retrospective, nationwide cohort study of anonymized 'diagnosis-related group' billing data provided by the Federal Statistical Office in Germany. Cases were identified using diagnostic and procedural codes for major cancer resections. Population-adjusted cancer resection rates as the primary endpoint were compared at baseline (2012-2019) to those in 2020. A change in resection rates for all analyzed entities (esophageal, gastric, liver, pancreatic, colon, rectum, and lung cancer) was observed from baseline to 2020. Total monthly oncological resections dropped by 7.4% (8.7% normalized to the annual German population, P =0.011). Changes ranged from +3.7% for pancreatic resections ( P =0.277) to -19.4% for rectal resections ( P <0.001). Reductions were higher during lockdown periods. During the first lockdown period (April-June), the overall drop was 14.3% (8.58 per 100 000 vs. 7.35 per 100 000, P <0.001). There was no catch-up effect during the summer months except for pancreatic cancer resections. In the second lockdown period, there was an overall drop of 17.3%. In subgroup analyses, the elderly were most affected by the reduction in resection rates. There was a significant negative correlation between regional SARS-CoV-2 incidences and resections rates. This correlation was strongest for rectal cancer resections (Spearman's r : -0.425, P <0.001). The pandemic lockdowns had a major impact on the oncological surgical caseload in Germany in 2020. The elderly were most affected by the reduction. There was a clear correlation between SARS-CoV-2 incidences regionally and the reduction of surgical resection rates. In future pandemic circumstances, oncological surgery has to be prioritized with an extra focus on the most vulnerable patients.

Abstract No. 289 Modern Search Analytics: What Are Patients Asking ecan Uterine Artery Embolization?

Patients considering elective medical procedures such as uterine artery embolization (UAE) often turn to search engines. For each search term, Google distills frequently asked questions and links users to websites with answers. The purpose of this study is to characterize this data for UAE, a condition with a relatively younger (and perhaps more technologically literate) patient population, which may improve patient counseling and awareness. SearchResponse.io is a commercially available marketing database that has scraped the “People Also Ask” section of Google for questions, links, and popularity. For UAE, the database was queried for “UFE,” “uterine artery embolization,” and “uterine fibroid embolization.” Using established methods in the literature, questions were categorized using Rothwell’s classification (Fact, Policy, Value), and further divided into subcategories (Fact: Specific Activities & Restrictions, Recovery, Technical Details, Cost, Condition Details; Policy: Indications, Management of Risks & Complications; Value: Pain, Evaluation of Symptoms, Evaluation of Intervention). Websites were classified into five categories (Commercial, Academic, Medical Practice, Government, and Social Media). JAMA Benchmark scores were determined for all websites linked to assess credibility. Two reviewers performed the classification; a third reviewer resolved discrepancies. 170 questions were extracted from 87 unique links at 54 unique domains. The most popular subcategories were recovery (45, 26.4%), evaluation of intervention (34, 20%), technical details (34, 20%), cost (19, 11.1%), specific activities and restrictions (15, 8.8%), pain (12, 7.1%), indications (6, 3.5%), condition details (4, 2.4%), evaluation of symptoms (1, 0.6%). The most common website types were academic (72, 42.4%), medical practice (45, 26.5%), government (33, 19.4%), commercial (15, 8.8%), social media (5, 2.9%). JAMA scores (0-4) were highest for government websites (mean score = 3.64), followed by commercial (2.33), academic (2.31), social media (2.0), and medical practice (1.89). Patients searching for UAE online were most interested in UAE recovery, value of UAE, and technical details. This may reflect the major appeal of UAE’s minimally invasive nature. While > 68% of websites linked to academic centers and medical practices, their associated JAMA benchmark scores were among the lowest. Accurate patient-facing information of UAE resources must be developed to empower patients to choose their optimal medical treatment.

Impact of COVID-19 pandemic healthcare restrictions on utilisation and diagnostic yield of outpatient transthoracic echocardiograms.

During the COVID-19 pandemic, Kentucky prohibited elective medical procedures from 3/18/2020-4/27/2020. We sought to determine if cessation of elective procedures in Kentucky during the COVID-19 pandemic resulted in a decrease in the proportion of rarely appropriate outpatient transthoracic echocardiograms interpreted at the open echocardiography lab at Norton Children's Hospital. A retrospective chart review was conducted comparing proportions of rarely appropriate outpatient paediatric transthoracic echocardiograms performed pre-COVID (3/21/2019-4/28/2019) and during COVID (3/19/2020-4/27/2020). Transthoracic echocardiogram indication was determined by chart review and echocardiogram reports. Indication appropriateness was evaluated using paediatric appropriate use criteria for initial outpatient transthoracic echocardiogram or CHD follow-up as applicable. Of transthoracic echocardiograms pre-COVID, 100 (37.7%) were rarely appropriate versus 18 (20.2%) during COVID. Pre-COVID, paediatric cardiologists tended to order fewer rarely appropriate transthoracic echocardiograms than paediatricians (35.9% versus 46.4%), although this difference was not statistically significant. Cardiologists ordered the majority of outpatient transthoracic echocardiograms during COVID (77/89, 86.5%), limiting the ability to compare transthoracic echocardiogram indications by provider type. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms with (13.0%) abnormal studies pre-COVID versus 7 (15.5%) during COVID. While elective procedures were prohibited in Kentucky during the COVID-19 pandemic, a decrease in the proportion of rarely appropriate outpatient paediatric transthoracic echocardiograms was observed. There was no significant difference in diagnostic yield of initial outpatient transthoracic echocardiograms between time periods, suggesting that clinically significant echocardiogram findings were still detected despite more prudent utilisation of echocardiography during this time.

Advanced Medical Procedures Following College Football Upper Extremity Surface Trauma On Artificial Turf And Grass

With the perception of a higher incidence of injuries on artificial turf, and the potential for long term sequelae of sport injuries leading to increased medical costs as well, no long term studies have compared elective imaging and medical procedures following upper extremity (UE) trauma on artificial turf (AT) with natural grass (NG). PURPOSE: To quantify elective imaging and surgery following UE surface-related college football game trauma on AT and NG fields. METHODS: 39 universities were evaluated over 15 seasons (2006-2020) across all Football Bowl Subdivision (FBS) conferences. Playing surfaces were divided into two groups: a heavyweight AT infill system (≥9.0 lbs infill/ft2) and NG. Outcomes of interest included elective procedures across injury severity, primary type of injury, anatomical location, and extremity disorder. Data were subject to MANOVA and Wilks’ λ criteria, and expressed as incidence rates (lR) per 10 games. RESULTS: Of the 2,215 games documented, 1,097 games (49.5%) were played on the heavyweight AT and 1,118 games (50.5%) played on NG. In sum, of the 9,137 total injuries reported, 650 were UE surface-related cases, with 244 injuries reported on AT and 406 on NG. UE surface-related trauma on AT resulted in 123 elective imaging and 35 surgical procedures, with 172 imaging and 46 surgeries ordered following injuries on NG. MANOVA indicated significant main effects by advanced medical procedures (F3,291 = 4.436; P = .004) between surfaces. Post hoc analyses indicated significantly lower (P < .05) incidence of total UE surface-related trauma [2.2, (95% CI, 2.0-2.5) vs 3.6 (3.4-3.9)], substantial UE trauma requiring elective imaging [0.2, (95% CI, 0.1-0.3) vs 0.5 (0.4-0.6)], number of radiographs ordered [0.8, (95% CI, 0.7-1.0) vs 1.1 (1.0-1.3)], and elective imaging procedures combined [1.1, (95% CI, 0.9-1.3) vs 1.5 (1.3-1.8)] on heavyweight AT when compared to NG fields, respectively. CONCLUSION: The significantly lower incidence of injury and subsequent elective imaging following UE surface-related trauma during competitive play on heavyweight AT translates to lower health care costs than observed on NG surfaces. This is the first longitudinal study that directly compares and addresses elective medical procedures as they relate specifically to UE surface-related football injury.

Carriers of COL3A1 pathogenic variants in Denmark: Interfamilial variability in severity and outcome of elective surgical procedures.

The study describes all patients in Denmark with vascular Ehlers–Danlos syndrome (vEDS). Carriers of pathogenic or likely pathogenic COL3A1 variants were retrospectively identified through registries and specialized clinics. Medical records were reviewed for vascular‐ or organ ruptures and invasive procedures performed. Identified families were divided by variant type (null, splice, and missense) and familial phenotypes (severe or attenuated). Families in which at least one carrier has suffered a major event before the age of 30 were classified as severe, whereas families in which at least three carriers had reached the age of 40 without a major event were classified as attenuated. Eighty‐seven persons (59 still alive) from 25 families were included with a mean observation time of 44 years. Sixty‐seven percent of patients could be subclassified in a familial phenotype. Thirty‐one major events were observed. Eleven complications in 172 invasive procedures were recorded. No fatal complications to elective surgery were observed. The type of COL3A1 variant did not reliably predict phenotype, but a pattern of intrafamilial consistency emerged with some families showing an attenuated form of vEDS. Elective medical procedures appear to be safer than previously thought, although data only allow for conclusions regarding individuals from families with the attenuated form of vEDS.

Poster 115: Elective Imaging and Surgical Procedures Following Surface-Related College Football Game Trauma on Artificial Turf and Natural Grass. A 15-Season Prospective Study

Objectives:With increasing concerns of rising medical costs, the potential for long-term articular changes, and the perceived higher incidence of injury while playing on artificial turf, no long term studies have specifically compared elective medical procedures following injury from competitive play on artificial and natural grass surfaces. Therefore, this study quantified elective imaging and surgery following surface-related college football game trauma on artificial and natural grass fields.Methods:39 universities were evaluated over 15 competitive seasons (2006-2020) across all Football Bowl Subdivision (FBS) conferences. Playing surfaces were divided into two groups based on a heavyweight, artificial turf infill system (≥9.0 lbs infill/ft2) and natural grass. Outcomes of interest included elective imaging and surgery across injury category, primary type of injury, anatomical location, and specific procedures. Data were subject to multivariate analyses of variance (MANOVA) and Wilks’ λ criteria using GLM procedures, and expressed as elective imaging and surgical incidence rates (lR) per 10 game season.Results:Of the 2,215 games documented, 1,097 games (49.5%) were played on a 3-layer artificial turf (≥9.0 lbs/ft2) infill system versus 1,118 games (50.5%) played on natural grass. In sum, of the 9,137 total injuries reported, 4,010 were surface-related cases, with 1,757 injuries reported on artificial turf and 2,253 on natural grass, totaling 1,081 player-to-surface impacts, 2,429 shoe:surface injuries during physical contact, and 500 shoe:surface during noncontact cases. Surface-related trauma on artificial turf resulted in 773 elective imaging and 231 surgical procedures, with 965 imaging and 308 surgeries ordered following injuries on natural grass. MANOVA indicated significant main effects by elective imaging (F2,1738 = 4.718; P = .009) and surgical procedure (F1,539 = 5.974; P = .003) between surfaces. Post hoc analyses indicated a significantly lower (P < .05) incidence of radiographs [4.1, (95% CI, 3.8-4.4) vs 4.7 (4.4-5.0)], MRIs [2.8, (95% CI, 2.6-3.1) vs 3.6 (3.4-3.9)] and elective imaging procedures combined [7.1, (95% CI, 6.8-7.3) vs 8.6 (8.4-8.8)] following trauma on heavyweight artificial turf fields versus natural grass, respectively. A significantly lower (P < .05) incidence of imaging procedures were ordered on player-to-surface impact trauma [1.5, (95% CI, 1.3-1.8) vs 2.1 (1.9-2.4)], shoe:surface trauma during physical contact [4.4, (95% CI, 4.1-4.7) vs 5.2 (4.9-5.5)], foot injuries [0.6, (95% CI, 0.5-0.7) vs 1.1 (0.9-1.2)], contusions [0.4, (95% CI, 0.3-0.6) vs 0.9 (0.7-1.1)], ligament sprains/tears [4.6, (95% CI, 4.3-4.9) vs 5.3 (5.0-5.6)], and muscle strains/tears [0.2, (95% CI, 0.2-0.3) vs 0.7 (0.6-0.9)] following injury on heavyweight artificial turf when compared to natural grass fields, respectively. Post hoc analyses indicated a significantly lower (P < .05) incidence of total surgeries [2.1, (95% CI, 1.9-2.4) vs 2.8 (2.5-3.0)], surgeries following shoe:surface trauma during physical contact [1.1, (95% CI, 0.9-1.3) vs 1.6 (1.4-1.8)], and surgeries as a result of ligament tears [1.0, (95% CI, 0.9-1.2) vs 1.5 (1.3-1.7)] following competitive play on heavyweight artificial turf when compared to natural grass fields, respectively. Surgical procedures involving artificial turf injuries required single tissue arthroscopic repair (n=92; 40%), multiple tissue reconstructive repair (n=90; 39%), and ORIF (n=49; 21%), whereas (n=152, 49%) of natural grass trauma involved single tissue arthroscopic repair, followed by multiple tissue reconstructive repair (n=94; 31%) and ORIF (n=62; 20%).Conclusions:The significantly lower incidence of elective imaging and surgical procedures following competitive play on heavyweight artificial turf surfaces translates to lower health care costs from less severe trauma than observed on natural grass surfaces. This is the first longitudinal study that directly compares and addresses elective medical procedures as they relate specifically to football injury. The findings of this study, however, may be generalizable only to this level of football competition.

The impact of the COVID-19 associated shutdown on orthopedic patient care.

BackgroundDue to the surge of COVID-19 cases in the US in early March 2020, health care facilities temporarily suspended elective and non-urgent medical procedures such as joint replacement surgeries. The aim of this study was to analyze the impact of the COVID-19 associated shutdown on orthopedic patient care at a specialized orthopedic hospital located at the epicenter of the COVID-19 pandemic.MethodsPatient volume of outpatient visits and joint replacement surgeries were analyzed and compared for 2019 and 2020. The volumes were further aligned with the timeline of governmental and institutional COVID-19 associated restrictions.ResultsThe annual surgery volume was reduced by 20.2% in 2020 and did not make up for the reduction experienced during the shutdown. The total number of patient visits decreased by 25.5% and new patient visits remained 25% lower at the end of 2020. Patient care and surgery volume recovered with declining SARS-CoV-2-cases but did not return to levels prior to the shutdown. During the second quarter of 2020, 28.5% of all patient visits were telehealth appointments. By the end of the year it dropped to 7.6%. There was a shift towards patient appointments at outpatient satellite offices.ConclusionOrthopedic providers faced a substantial disruption in outpatient and surgical volume. Telemedicine appointments were crucial for maintaining follow-up patient care and will be an important sector in future patient care. There has been a major push to utilize satellite offices outside the city center.

Impact of COVID-19 on Surgical Interventions and Medical Practices in Pediatric Otolaryngology: A Narrative Review.

The novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge. All types of elective and semi-urgent medical care and procedures have been discontinued during the pandemic to maintain the capacity to care for patients with this disease. The pandemic has had a significant impact on almost every medical field, including pediatric otolaryngology. This review highlights the impact of COVID-19 on surgical interventions and medical practices in pediatric otolaryngology owing to its direct association with ear, nose, and throat disorders, with an emphasis on immediate and potential long-term transformations in clinical practice. We reviewed several articles and scientific websites and summarized the currently available evidence and best practices for safety in the field of otolaryngology during the COVID-19 pandemic. Extensively discussed issues in pediatric otolaryngology include surgical interventions, medical practices, modes of transmission of COVID-19, personal protective equipment, and duration of exposure. Otolaryngologists should preserve their integrative medical approaches and subspecialty expertise during the COVID-19 pandemic. There has been a marked change in the approach to managing pediatric ear, nose, and throat conditions, both in the outpatient department and operating room, during the COVID-19 pandemic. The pandemic requires a great deal of flexibility and necessitates exploring new opportunities to create a safe and patient-friendly environment for children with otolaryngology problems. Many of the precautions implemented will remain necessary until a robust evidence shows the pandemic has come to an end.

Editors' Selections from Relevant Scientific Publications

Transient bacterial infection leads to colon tumorigenesis (art work from Cancer Discovery)New research links the enteropathogenic and enterohemorrhagic strains of Escherichia coli bacteria responsible for hundreds of millions of cases of diarrheal disease annually to heightened cancer risk. Liu et al. have identified a genotoxin produced by the murine counterpart of these pathogens, Citrobacter rodentium, that can fuel onset of colon cancer. This protein, UshA, inflicted considerable genomic damage on murine colon epithelial cells even after transient exposure, and C. rodentium infection led to accelerated tumorigenesis in a cancer-prone mouse model. UshA is also produced by human-infecting E. coli, and this mechanism could pose a critical link between high prevalence of diarrheal disease and climbing colon cancer rates in sub-Saharan Africa.Liu Y, … Wan F. Cancer Discov. 2022 Jan;12(1):236-249.Illustration of breast tumor and tumor microenvironment (adapted from an image by Adrián Blanco-Gómez for Cancer Research)This HTAN Breast PreCancer Atlas study of ductal carcinoma in situ (DCIS) used a multiplex ion beam imaging by time of flight and a 37-plex antibody staining panel to analyze tumor microenvironment (TME) in 79 patient-matched surgical samples. Risom et al. found four TME states that were defined based on the location and function of myoepithelium, fibroblasts, and immune cells. Critically, disruption of the myoepithelial was more advanced in DCIS patients that did not develop invasive breast cancer, suggesting this process could be protective against disease recurrence. This study improves understanding of the drivers of breast cancer relapse and emphasizes the crucial role of TME in disease progression.Risom T, … Angelo M. Cell. 2022 Jan 20;185(2):299-310.e18.Ductal carcinoma in situ (by Kauczuk via Wikimedia Commons)This histological, molecular, and immunological profiling study explored the diverse, interconnected immune landscapes in 39 premalignant lesions from patients with ductal carcinoma in situ. Nachmanson et al. used multiple microdissected regions to analyze phenotype and subtype heterogeneity, B- and T-lymphocyte spatial analysis, mutational profiling, driver mutations, and immunological status. The authors successfully isolated regions within the same sample to characterize different histological features and infer phylogenetic relationships. This study provided richness to the breast pre-cancer atlas and contributed to better models for outcomes and progress risk.Nachmanson D, …Harismendy O. NPJ Breast Cancer. 2022 Jan 13;8(1):6.Illustration of gene variants and cancer cumulative risk (adapted from figures by Michael J. Hall for Cancer Prevention Research)A pair of recent clinical studies identified nine genes that, when disrupted by truncating or missense mutations, can meaningfully increase breast cancer risk. The researchers of the Breast Cancer Association Consortium have now conducted a follow-up investigation of nearly 90,000 participants from one of these trials, BRIDGES, to determine which tumor types are associated with these mutations. This analysis revealed distinctive patterns in terms of age of onset and histological type—for example, triple-negative tumors were notably overrepresented in women with BRCA1 or BARD1 mutations. These results could thus enable more accurate risk prediction based on genetic test results and inform the development of improved screening guidelines.Breast Cancer Association Consortium, … Easton DF. JAMA Oncol. 2022 Jan 27:e216744.44.Colorectal cancer (by Dcoetzee via Wikimedia Commons)People who were obese in early adulthood have an increased risk of early-onset colorectal cancer later in life. Obesity has long been known as a risk factor for many cancers, but weight loss prior to diagnosis can confound the association. Li et al. analyzed the medical records of 6602 colorectal cancer patients enrolled in a German screening study and compared them to 7950 matched controls. They found that people who had been obese at age 20 or 30 were 2.6 times and 2 times, respectively, more likely to develop colorectal cancer before age 55 as those of normal weight at those ages. The authors say that body mass history, not just current weight, should be considered when assessing a person's risk of colorectal cancer.Li H, … Brenner H. Gastroenterology. 2021 Dec 13:S0016-5085(21)04074-9.Illustration of declines in cancer screening and diagnosis due to the Covid-19 pandemic (SARS-Cov-2 image is by Iketsi via Wikimedia Commons)Cancer screenings and diagnosis procedures – and the number of new cancers diagnosed – declined significantly due to the Covid-19 pandemic. Restrictions on elective medical procedures resulted in the widespread cancellation of appointments and decreased many people's access to care. Englum et al. reviewed the medical records of more than 9 million veterans who visited 1244 Veterans’ Affairs facilities across the United States between 2016 and 2020. They found that these facilities performed 45% fewer colonoscopies in 2020 than the average from previous years, as well as fewer CT scans, biopsies, and cystoscopies. The number of new cancer diagnoses dropped by 13% to 23%, which the authors say necessitates a recovery plan to ensure that health centers can catch up with the backlog and meet the needs of patients whose healthcare access was disrupted.Englum BR… Lal BK. Cancer. 2022 Mar 1;128(5):1048-1056.

Equitable COVID-19 Vaccination for Hispanics in the United States: A Success Story from California Border Communities.

The ongoing 2019 novel coronavirus disease (COVID-19) pandemic continues to impact the health of individuals worldwide, including causing pauses in lifesaving cancer screening and prevention measures. From time to time, elective medical procedures, such as those used for cancer screening and early detection, were deferred due to concerns regarding the spread of the infection. The short- and long-term consequences of these temporary measures are concerning, particularly for medically underserved populations, who already experience inequities and disparities related to timely cancer care. Clearly, the way out of this pandemic is by increasing COVID-19 vaccination rates and doing so in an equitable manner so that communities most affected receive preferential access and administration. In this article, we provide a perspective on vaccine equity by featuring the experience of the California Hispanic community, who has been disproportionately impacted by the pandemic. We first compared vaccination rates in two United States–Mexico border counties in California (San Diego County and Imperial County) to counties elsewhere in California with a similar Hispanic population size. We show that the border counties have substantially lower unvaccinated proportions of Hispanics compared to other counties. We next looked at county vaccination rates according to the California Healthy Places Index, a health equity metric and found that San Diego and Imperial counties achieved more equitable access and distribution than the rest of the state. Finally, we detail strategies implemented to achieve high and equitable vaccination in this border region, including Imperial County, an agricultural region that was California’s epicenter of the COVID-19 crisis at the height of the pandemic. These United States–Mexico border county data show that equitable vaccine access and delivery is possible. Multiple strategies can be used to guide the delivery and access to other public health and cancer preventive services.

Elective Surgery Shutdown Due to CoVID-19 Did Not Decrease Vascular Integrated Resident Nor Vascular Fellow Operative Experience

In March of 2020, to preserve hospital beds and personal protective equipment due to the COVID-19 pandemic, the Centers for Medicare and Medicaid Services announced the delay of all elective and nonessential medical, surgical, and dental procedures. Multiple hospital-based and regional publications reported dramatic decreases in numbers of operative cases during that time. The purpose of this study was to examine the graduation case logs of vascular trainees to determine what effect this shutdown had on vascular trainee operative experience on a national level.

Procedural anesthesia and sedation for children undergoing diagnostic and medical procedures - A review of postprocedural pain, nausea, and vomiting by questionnaire-based survey.

Sedation and anesthesia are widely used to relieve pain and ensure cooperation during elective diagnostic and medical procedures in the pediatric population. However, there is currently limited evidence about the recovery trajectory following deep sedation or general anesthesia for such procedures in children. The primary aim was to describe the severity and duration of pain, nausea, and vomiting after common diagnostic and medical procedures. Secondary outcomes include return to baseline functioning and incidence of medical re-presentation. Recruitment was achieved postprocedurally by telephone interview with parents or legal guardians of patients who underwent botox injection, bronchoscopy, either or both a colonoscopy or upper gastrointestinal endoscopy, or MRI scan. Daily pain scores, nausea and vomiting, administration of at-home analgesia, and any adverse events requiring medical attention were obtained. Children were followed until pain completely resolved and baseline activity resumed. A total of 307 patients were included (50 botox injection, bronchoscopy and MRI; 48 colonoscopy, 58 upper gastrointestinal endoscopy, 51 colonoscopy plus upper gastrointestinal endoscopy). Parental-rated pain scores peaked on day of procedure across all groups and decreased over time, with most children resuming normal activity within 1day postprocedure. Pain was mostly mild and resolved quickly in botox injection (10% moderate to severe and 22% mild), bronchoscopy (8% and 10%, respectively), and MRI (2% mild) patients. Combined upper gastrointestinal endoscopy and colonoscopy was associated with greatest pain severity (29% moderate to severe and 20% mild). Highest rates of nausea and/or vomiting were observed in colonoscopy (23%), upper gastrointestinal endoscopy (28%), and combined procedure groups (20%). At-home simple analgesia was administered in 21% of patients. Unplanned medical re-presentations were infrequent across all groups. This study demonstrates that the recovery trajectory following procedural sedation and anesthesia is short, with minimal requirement for additional medical attention. These findings will aid in alleviating parental anxiety and encourage utilization of regular simple analgesia.

Impact of Coronavirus Disease 2019 on the Diagnosis and Therapy for Barrett’s Esophagus and Esophageal Cancer in the United States

Impact of Coronavirus Disease 2019 on the Diagnosis and Therapy for Barrett’s Esophagus and Esophageal Cancer in the United States

Managing an Unhappy Patient.

A clinical study has noted that one out of six patients is perceived as “difficult” by clinicians. Not surprisingly, patient dissatisfaction has to do with multiple factors, both within and outside the control of the surgeon. In the present times of electronic information and ratings, managing difficult patients is a critical skill—a patient's dissatisfactory review could adversely affect a practitioner's reputation built over years of meticulous practice. Patient expectations are often more pronounced in case of elective medical procedures such as hair transplants. The subject of managing an unhappy patient in the context of hair transplantation is, therefore, one that requires due enquiry and is the subject that this article seeks to explore.