St Clara Hospital

Healthcare across Europe was affected by COVID-19 pandemic lockdowns. How different national healthcare systems coped with this impact remains unclear. Healthcare in Switzerland differs significantly from that in Scotland, for example, in terms of centralization. The aim of this study was to assess the impact of the COVID-19 pandemic on the diagnosis and surgical treatment of colorectal cancer (CRC) in contrasting healthcare systems. This retrospective cohort study was conducted in south-east Scotland and in the extended north-west of Switzerland from January 1st, 2019 to February 28th, 2023. All patients diagnosed with CRC were included. The primary outcomes were the time from CRC diagnosis to treatment and the UICC stage at diagnosis, assessed prior to, during, and following the period of lockdown. The lockdown in Scotland lasted from March 2020 to October 2020 and in Switzerland from March 2020 to April 2020. A total of 6745 patients were included (4127 from Scotland and 2618 from Switzerland). Median time from diagnosis to treatment remained unaltered during the lockdown period in both countries. However, after the lockdown, the median time from diagnosis to treatment increased from 59 to 76days in Scotland. The median number of patients who were diagnosed per annual quarter declined from 177 (IQR: 171-190) to 152 (IQR: 150-154), and the median number of who received treatment from declined from 256 (IQR: 253-259) to 203 (IQR: 186-218) during lockdown in Scotland. In multivariable logistic regression, the odds of being diagnosed with UICC stage IV increased by 42% for patients diagnosed during lockdown (95%-CI: 12%-81%). In Switzerland, the time from diagnosis to treatment increased slightly after the pandemic. However, the other effects described above were not observed in Switzerland. This descriptive study demonstrated that the impact of the pandemic on colorectal cancer care was less pronounced in Switzerland, but considerable in Scotland. Because separate subgroup analyses were conducted, direct comparisons cannot be made between Scotland and Switzerland. This trial is registered on clinicaltrials.gov as part of the EvaCol study (NCT04550156).

A 33-year-old multiparous woman with no relevant medical history, at 33 weeks of gestation, presented to the emergency department of a tertiary care hospital with a five-day history of fatigue, arthralgia, chills, and abdominal pain. The patient rapidly developed respiratory failure and was intubated and placed on mechanical ventilation. Continuous fetal monitoring, including Doppler velocimetry, was performed to assess fetal well-being during maternal respiratory support. Fetal Doppler evaluations demonstrated reassuring parameters during mechanical ventilation, with normal umbilical artery and middle cerebral artery flow patterns. No signs of fetal hypoxia or centralization were observed. A review of the literature identified fewer than a dozen case reports or series involving mechanical ventilation in pregnant patients, most commonly associated with severe pneumonia, acute respiratory distress syndrome, or trauma. Few studies addressed fetal monitoring strategies or outcomes related to Doppler indices during maternal ventilation. This case highlights the feasibility and importance of fetal Doppler surveillance in pregnant patients undergoing invasive mechanical ventilation. Despite limited data, current evidence suggests that individualized maternal ventilatory management, coupled with serial fetal assessment, can support favorable perinatal outcomes. Further studies are needed to define optimal respiratory parameters and standardized fetal monitoring protocols in this unique clinical scenario.

BackgroundThe aim of this study was to investigate the associations between individual surgeon’s intraoperative nerve monitoring (IONM) practice and factors associated with vocal cord (VC) dysfunction in patients with thyroid cancer undergoing thyroidectomy.MethodsUsing Collaborative Endocrine Surgery Quality Improvement Program (CESQIP) 2014-21 data, multivariable logistic regression analyses investigated variables associated with short- and long-term VC-dysfunction, associations of routine use of IONM with postoperative outcomes, and patient characteristics associated with IONM use.ResultsAmong 5,446 patients (76.7% female, mean age 49 years), 68.5% had surgery by surgeons using IONM in ≥ 90% of cases (63% of surgeons, n = 73). Post-operative VC-dysfunction was diagnosed by laryngoscopy in 3.0% of patients in the short-term and 2.7% in the long-term. When surgeons routinely used IONM, the incidence of VC-dysfunction was 2.4% in the short-term and 2.2% in the long-term, compared to 4.4% and 3.7%, respectively, when surgeons did not routinely use IONM (p < 0.01). After adjustment, routine use of IONM was independently associated with reduced risk of short- (OR 0.48, p < 0.01) and long-term (OR 0.52, p < 0.01) VC-dysfunction, a lower risk of postoperative hypoparathyroidism in the short- (OR 0.67, p < 0.01) and long-term (OR 0.54, p < 0.01), and higher likelihood of same-day discharge (OR 2.03, p < 0.01). Extrathyroidal tumor extension and N1-stage were factors associated with postoperative VC-dysfunction in the short- (OR 3.12, p < 0.01; OR 1.92, p = 0.01, respectively) and long-term (OR 3.11, p < 0.01; OR 2.32, p < 0.01, respectively).ConclusionRoutine use of IONM was independently associated with a lower risk of endocrine surgery-specific complications and greater likelihood of same-day discharge.

Associated midgut malrotation and colon cancer in adult patients is extremely rare and associated with delayed diagnosis and increased morbidity. We present the case of a patient with a three-week history of weakness, diarrhea, and abdominal pain with invagination of the distal ileum. Exploratory laparotomy with ileocecal resection revealed invagination, malrotation, and cecal adenocarcinoma.

Introducción: la baja adherencia en el tratamiento antirretroviral de alta efectividad TARGA se&#x0D; asocia a peores desenlaces en salud; además de las comorbilidades infecciosas, muchos pacientes con&#x0D; VIH/SIDA presentan asociado psicopatología, farmacodependencia y problemas socioeconómicos.&#x0D; Existe alta frecuencia de abandono a la terapia en nuestro medio.&#x0D; &#x0D; Objetivo: identificar las variables asociadas al abandono de terapia TARGA en pacientes con&#x0D; VIH de un hospital de tercer nivel en Colombia.&#x0D; &#x0D; Métodos y resultados estudio descriptivo corte transversal: se incluyeron 51 pacientes pertenecientes&#x0D; al programa durante un año; 12 pacientes (23%) tuvieron adherencia al tratamiento, 32&#x0D; (62%) tenían antecedente de consumo de sustancias psicoactivas y 33 (64%) tenían asociada alguna&#x0D; patología psiquiátrica. Los factores que se asociaron a la no adherencia fueron la psicopatología y&#x0D; la pobre red de apoyo.&#x0D; &#x0D; Conclusión: En la población a estudio se documenta alta tasa de abandono a la terapia TARGA,&#x0D; probablemente asociado a enfermedad mental y pobre red social.

RESUMEN Antecedentes La necesidad de mantener la cavidad abdominal abierta ha sido reconocida y empleada desde hace 35 años. El desarrollo del sistema de vacío continuo, ha constituido una nueva manera de abordar este problema quirúrgico. Los sistemas comerciales son costosos, lo que limita su utilización. Varios grupos han reportado sistemas de fabricación local, con resultados satisfactorios. Aquí mostramos nuestra experiencia al respecto y los detalles técnicos del sistema que usamos. Materiales y métodos Se describen los aspectos técnicos del sistema de vacío artesanal y un estudio observacional descriptivo retrospectivo, con los pacientes en que se aplicó succión continua abdominal entre enero de 2007 y marzo de 2013. Resultados Describimos 77 casos. Los tres primeros diagnósticos de ingreso fueron trauma penetrante abdominal (25 casos); obstrucción intestinal (7 casos) y pancreatitis aguda (6 casos). Hubo 42 casos con fistula enterostomal; 41 con fístula antes del inicio de la terapia. En 12 casos (28,6%) se cerró la fístula con manejo médico y en 14 (33,3%) con cirugía. El porcentaje de cierre de la cavidad abdominal es de 31%. Conclusión La complejidad de los pacientes con abdomen abierto y fístulas enterostomales, condiciona una morbimortalidad importante. Consideramos que el principio general de manejo con el sistema de vacío continuo en la cavidad abdominal y particularmente con nuestro sistema es una herramienta valiosa que posibilita la protección de la piel, el drenaje permanente de la cavidad y la cuantificación de drenajes; disminuye el tiempo para lograr el cierre abdominal y el número de intervenciones quirúrgicas. How to cite this article Facundo H, Troncoso JM. Abdomen Abierto y Presión Subatmosférica: Experiencia con un Sistema Artesanal. Panam J Trauma Crit Care Emerg Surg 2016;5(1): 11-17.

Transitions in care are a top priority for the US health care system as well as a core component of the CSC standards. Nurses are key in facilitating care from admission to discharge ensuring successful transitions through a stroke health challenge. Impetus to examine hospital readmission rates has been heightened by public reporting and potential CMS financial penalities. The purpose of this presentation is to describe an interdisciplinary approach in planning care transitions supporting discharge. Our experience as a recently certified CSC identified opportunities for improvement in stroke care transitions. A Stroke Continum Subgroup was formed including key stakeholders in partnering rehab facilities, inpatient rehab, home care, and stroke inpatient units to examine care transitions. Focused efforts evaluated discharge resources emphasizing patient and caregiver assessment, caregiver preparedness, and educational materials. Areas developed to support transitions included: standard caregiver resources including respite needs, daily discharge huddle identifying home needs and 7-day phone follow-up process. Metrics tracked included length of stay, discharge disposition, number of patients surveyed, number of caregivers provided educational materials and readmissions. Developing interdisciplinary relationships promoted improvements in communication that lead to improved patient transitions related to follow up care, medication reconciliation and sharing of clinical information to promote continuity of care. At one year, 75% of patients received a structured post-discharge phone call which continues to identify opportunities to assist with scheduling follow up care, support early recognition of post stroke depression and ensure caregivers utilize respite resources. Our 30 day readmission rates in our ischemic stroke patients decreased to 7%, an overall 5% reduction from previous year. Assessment of patient and caregiver needs after discharge can be difficult and requires a coordinated multidisciplinary effort with multi-prong interventions. Development of a Stroke Care Continum team allowed the CNS and Stroke Director to work with both inpatient and outpatient stakeholders.

Patients presenting with an acute obstructing carcinoma of the left bowel are a surgical challenge. Under more difficult circumstances with gross distension of the proximal colon many surgeons will decide to defer anastomosis. Hartmann's procedure still represents a valid treatment option. We describe our experience with primary resection and side-to-end anastomosis next to an end-colostomy in the management of acute malignant obstruction of the left bowel. The surgical procedure involves resection of the tumour and primary stapled side-to-end anastomosis next to a protecting end-colostomy. This type of enterostomy was first described by Santulli and Blanc in 1961. Colostomy closure is possible via a local procedure avoiding relaparotomy. Ten patients (five women) underwent surgery using this technique. Their mean age was 71 years (range 54-88 years). All patients had a massively distended colon. All obstructing lesions were biopsy-proven adenocarcinomas. There was no postoperative mortality and no anastomotic leakage. The colostomy could be closed without a laparotomy in all patients. The only two complications were one superficial necrosis of the stoma and one wound infection after colostomy closure. In all other patients the postoperative course was uneventful. Wound infection after colostomy closure was seen in the very first patient in whom the wound was closed primarily. In subsequent patients the skin was left open. The concept of an end-colostomy next to the anastomosis is an alternative approach combining the safety of proximal decompression and the advantages of primary anastomosis. This technique may be considered in patients presenting with a massively distended and faeces-loaded colon caused by an obstructing tumour in the descending or sigmoid colon, when the surgeon would otherwise elect to defer anastomosis.