Impact of the COVID-19 pandemic on surgical care in the Netherlands

BACKGROUND

The COVID-19 pandemic caused disruption of regular healthcare leading to reduced hospital attendances, repurposing of surgical facilities, and cancellation of cancer screening programmes. This study aimed to determine the impact of COVID-19 on surgical care in the Netherlands.

METHODS

A nationwide study was conducted in collaboration with the Dutch Institute for Clinical Auditing. Eight surgical audits were expanded with items regarding alterations in scheduling and treatment plans. Data on procedures performed in 2020 were compared with those from a historical cohort (2018-2019). Endpoints included total numbers of procedures performed and altered treatment plans. Secondary endpoints included complication, readmission, and mortality rates.

RESULTS

Some 12 154 procedures were performed in participating hospitals in 2020, representing a decrease of 13.6 per cent compared with 2018-2019. The largest reduction (29.2 per cent) was for non-cancer procedures during the first COVID-19 wave. Surgical treatment was postponed for 9.6 per cent of patients. Alterations in surgical treatment plans were observed in 1.7 per cent. Time from diagnosis to surgery decreased (to 28 days in 2020, from 34 days in 2019 and 36 days in 2018; P < 0.001). For cancer-related procedures, duration of hospital stay decreased (5 versus 6 days; P < 0.001). Audit-specific complications, readmission, and mortality rates were unchanged, but ICU admissions decreased (16.5 versus 16.8 per cent; P < 0.001).

CONCLUSION

The reduction in the number of surgical operations was greatest for those without cancer. Where surgery was undertaken, it appeared to be delivered safely, with similar complication and mortality rates, fewer admissions to ICU, and a shorter hospital stay.

The Effects of Biofeedback on Performance and Technique of the Boxing Jab

A growing body of research has addressed the application of movement-based biofeedback techniques for improving sports performers’ gross motor skills. Unlike in previous research, we aimed in this study to quantify the effects of this “external” biofeedback on selected performance and technique variables for the boxing jab among both novices and experts. The technical setup included two inertial measurement units linked wirelessly to a video game system with audio output. The units were configured to provide auditory external biofeedback, based on the peak acceleration of the bag (i.e., biofeedback with an external attentional focus). Sixteen participants (8 novices and 8 experts) performed boxing jabs against the bag in blocked phases of biofeedback. When compared to baseline, the acute effects of externally focused biofeedback on peak bag acceleration were possibly positive in both retention phases for novices (d = 0.29; d = 0.41) and likely positive for experts (d = 0.41; d = 0.30), respectively. The experts’ performance improvements were accompanied by substantive increases in trunk rotation, though this was not true for the novices. Thus, technique improvements can be promoted indirectly via externally focused biofeedback, but only when these actions are within the performers’ motor repertoire. Overall, biofeedback via inertial sensors appears to be a potent technique for modifying human movement patterns in both experts and novices. This low-cost technology could be used to support training across sports, rehabilitation and human-computer interactions.

The utility of a multimedia education program for prostate cancer patients: a formative evaluation

A multimedia program (MMP) was developed to educate patients with prostate cancer about their disease. A within-subjects design was used to investigate the changes in levels of cancer-related knowledge, psychosocial functioning, treatment decision-making role and information needs immediately after browsing the MMP. The participants were 67 men recently diagnosed with prostate cancer. Psychosocial functioning was assessed with 20 items describing common emotional states and coping strategies employed by cancer patients. Treatment decision-making role was assessed with the Control Preference Scale. A principle component analysis of the 20 psychosocial items yielded three components: distress, positive approach and nonacceptance. After browsing the MMP significant increases in knowledge and reductions in distress were reported. Marital status was significantly associated with knowledge gain. Married men and those attending the study session with their spouse displayed a significant shift towards a more active role in treatment decisions. The majority of information needs were fulfilled by the MMP; however, information related to the likelihood of a cure, treatment side effects, coping strategies and aetiology were not completely satisfied by the MMP. Implications of the findings and suggestions for future work on the design and evaluation of the MMP are discussed.

Evaluating a spoken dialogue system for recording clinical observations during an endoscopic examination

Paper, keyboard or mouse-driven systems may not be suitable for data capture because of the hands-busy constraint imposed by an endoscopic examination. A Spoken Dialogue System (SDS) has a number of advantages when compared to keyboard and mouse-driven input modalities, particularly with respect to hands free and eyes-free control of a system. However, any emerging technology will never deliver improved organizational effectiveness if it is not accepted and used. The Technology Acceptance Model (TAM) provides a framework that helps explain the determinants of computer acceptance. This study, through the application of TAM, demonstrates a high level of user acceptance with clinicians wanting to use spoken dialogue technology for recording clinical observations during an endoscopic examination. Clinicians would also prefer to use a SDS for recording endoscopy rather than use a paper-based or keyboard and mouse-driven system. Using a clinical narrative during an endoscopic examination was also perceived to be a natural way to record findings. Relationships between basic TAM variables were confirmed and relationships between quality of dialogue measures and TAM variables were established.

[Schizophrenia and the 22q11 deletion syndrome]

In 10-30% of the patients with the 22q11 deletion syndrome (22q11DS), a psychosis develops in adulthood, often schizophrenia. 22q11DS is a common genetic syndrome which is associated with an interstitial deletion at chromosome 22q11. The syndrome is characterised by a variable phenotype which includes cognitive and behavioural problems, in addition to congenital heart and facial anomalies. The presence of 22q11DS represents one of the highest risk factors for the development of schizophrenia. The study of 22q11DS offers a unique opportunity to increase the understanding of the pathogenesis of schizophrenia.

Effect of an educational multimedia prostate program on the International Prostate Symptom Score

OBJECTIVE

To determine the effect of an interactive multimedia prostate education program (MMP) on self assessment of symptom scores due to benign prostatic hyperplasia (BPH).

METHODS

The interactive MMP was developed including a computer-administered version of the International Prostate Symptom Score (IPSS) questionnaire. Eighty-eight men referred to the Urology Out-patients with prostatic symptoms entered the study. They first completed the IPSS on paper and secondly used the MMP before completing the computer-administered IPSS. A final feedback questionnaire enquiring into their experience including previous exposure to computers, ease of use, and value of the program content was completed.

RESULTS

The use of the MMP resulted in a significant decrease in mean IPSS score from 16.6 to 13.9 (t = 7.456, d.f. = 87, p < 0.01), but no change in quality of life. Patients felt that their knowledge had increased (chi2(1) = 21.253, p < 0.01) and that they had completed the IPSS more accurately (chi2(1) = 10.227, p < 0.01) with the MMP IPSS module compared to the IPSS on paper. Previous use of patient education, patient characteristics and MMP use beyond the information required for the IPSS did not affect IPSS difference (IPSS before versus after MMP use).

CONCLUSION

The use of the MMP enhanced patients' knowledge of their condition and reduced patients' IPSS score. The results were independent of previous exposure to information, previous IPSS completion, computer use and age.