Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

Introduction and Objectives: Urethral stricture is a reduction in the caliber of the urethral lumen impeding the outflow of urine. It predominantly affects males. The disease burden is severe in our milieu where access to specialized care is limited. Our goal was therefore to assess the management and outcome of male urethral stricture at two tertiary hospitals in Douala, Cameroon. Materials and Methods: This was a hospital-based retrospective study of patients managed for urethral stricture over 5 years (January 1st, 2017 to December 31st, 2021) at the Douala General and Laquintinie Hospitals. Data on sociodemographic, clinical, paraclinical, and treatment options were extracted using pre-structured forms. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 28. Statistical significance was set at p-value Results: We exploited 130 medical records. The mean age of patients was 46.5 years. Dysuria and weak urine stream were the major presenting complaints (63.8% and 23.8% respectively). The etiology of urethral stricture was iatrogenic in 42.3% of cases. The strictures were mostly single (89.8%), and the bulbar urethra was most affected (46.9%). 28 patients had urinary tract infections and the most frequently isolated germ was E. coli in 29.6%. Direct visual internal urethrotomy (DVIU) was performed in 42.3% of cases. Surgery, especially excision and primary anastomosis (EPA) was done in 28.5% of cases. Major complications were wound infection, acute kidney injury (AKI), and urethrocutaneous fistulae affecting 3.1, 2.3, and 1.5% of cases respectively. The recurrence rate was 17% with a mortality rate of 0.08%. Conclusion: Urethral stricture is common in our adult male population. The cause is mainly iatrogenic and the bulbar urethra is most affected. Minimally invasive and open reconstruction are frequently used treatment options with significant recurrence rates in the long term.

A Study on the Correlation of Body Mass Management During Pregnancy with Adverse Pregnancy Outcomes and Labor Progression

Objective:To investigate the effects of body mass management during pregnancy on adverse pregnancy outcomes,duration of labor,and neonatal birth weight.Methods:472 pregnant women who visited Beijing Anzhen Hospital from January to December 2023 were selected,and the pregnant women were divided into 236 each in the observation group and the control group.Body mass of pregnant women was measured and BMI was calculated in early and late pregnancy respectively,and the pregnant women in the control group were guided by routine management,while the observation group was guided by body mass management during pregnancy.The growth of maternal body mass,mode of delivery,postpartum hemorrhage,neonatal score,neonatal blood glucose at birth,and umbilical artery blood,as well as the comparison of the duration of labor,were observed.Results:The observation group was significantly better than the control group in terms of mode of delivery,postpartum hemorrhage,and body mass growth,with statistically significant differences(P<0.05),and there was no statistical significance in terms of neonatal scores,neonatal blood glucose at birth,and umbilical artery blood(P>0.05);the time of the first stage of labor and the time of the second stage of labor of the mothers in the observation group was significantly better than that of the control group,with statistical differences(P<0.05),and the time of the third stage of labor of the mothers in the observation group was statistically better than that of the control group.There was no statistically significant difference between the time of the third stage of labor in the observation group and the control group(P>0.05),and the time of the total stage of labor in the observation group was statistically better than that in the control group(P<0.05).Conclusion:Body mass management during pregnancy can effectively improve maternal control of weight gain,reduce labor time,and decrease the occurrence of adverse pregnancy outcomes.

Characteristics, Management, and Outcomes of Tetanus Cases in a Referral Center in Senegal, between 2010 and 2017

Tetanus is an infection caused by Clostridium tetani. The disease has been described from the earliest medical literature. Despite this old knowledge, the existence of a vaccine, and the progress made in pathophysiology and treatment, tetanus remains a real public health problem, particularly in developing countries. Tetanus in children and adults is still a frequent cause of hospitalization in the Infectious and Tropical Diseases Department (SMIT) of the Fann National University Hospital (CHNU). We conducted this study with the main objective of carrying out a situational analysis of tetanus at SMIT from 2010 to 2017. We recorded 706 cases of tetanus in a total of 8123 hospitalized patients. The median age of the patients was 23 years [1 - 90 years]. The sex ratio (M/F) was 4/1. More than half (58.78%) came from suburban areas. The population was most frequently made up of students (24%) or manual workers (22.1%). At least one comorbidity was present in 107 patients (15.15%). The absence of a vaccination record was found in 99.56%. The main portal of entry was integumentary (83.3%), post-circumcision (5.7%) and otogenous (4%). Tetanus was generalized in 93.9% of cases. The main signs of tetanus found were trismus and dysphagia. Patients were most frequently classified as stage II (78.7%). Antibiotic therapy was based on metronidazole (51.41%). Anti-tetanus serotherapy was carried out by sub-occipital administration in 97.6%. Tracheostomy was performed in 48 patients. Complications occurred in 226 patients (32.01%). The main complications were respiratory (53.98%), infectious (45.13%) and cardiovascular (41.59%). The average delay in hospitalization was 3.6 ± 3.4 days. The mean length of hospital stay was 11.9 ± 8.2 days. The hospital case-lethality rate was 18.98%. Despite the decline in cases over the years in our country, tetanus remains a public health problem because of its prevalence, severity, and lethality.

Prevalence, Management and Outcomes of Enterocutaneous Fistulas in Buea Regional Hospital and Laquintinie Hospital of Douala. A Five Years Retrospective Study

Background: An Enterocutaneous fistula (ECF) is an abnormal connection between the intestinal tracts or stomach and the skin. They are a major catastrophe to the patient and surgeons and still have a high incidence of morbidity and mortality which varies between 6% - 33%;their management remains a big challenge. These patients frequently face complications, and a well-organized multidisciplinary approach must be implemented in their management to improve outcomes. Objectives: Our study aims to assess the prevalence, management and outcomes of enterocutaneous fistulas in Buea regional hospital and Laquintinie hospital of Douala over the past 5 years. Methods: This was a hospital-based retrospective study in Buea regional hospital and Laquintinie hospital of Douala. Records of patients who had enterocutaneous fistulas within the period of 1st January 2017 to 31st December 2020 in the surgical departments. Data included demographics, pre-operative diagnosis, comorbidities, type of fistula, management modality and means, the indication of operative treatment, length of stay in the hospital and outcomes. Data was analysed using SPSSv26. Results: The study constituted 1343 medical records of which 83 medical records of patients with enterocutaneous fistulas, giving a prevalence of 6.2%, female predominance at 59% (n = 49), 42.2% (n = 35) were referred cases from the periphery for better management. A vast majority (96.4%) occurred as post-operative complications with appendectomy the most common indication (18.8%). High output fistulas were predominant (43.4%). 59% (n = 47) were managed medically, 6% (n = 5) received both conservative and surgical modalities while 35% (n = 5) were managed surgically. 64.1% (n = 50) were placed on enteral nutrition while 35.9% (n = 28) were placed on parenteral nutrition. Peritonitis/infection 50% (n = 18) was the commonest indication of surgical treatment, followed by failure of medical treatment 25% (n = 9) then high output fistulas 16.7% (n = 6). Resection with end-to-end anastomosis was the preferred repaired work at 61% (n = 22). The mortality rate was 38.5% (n = 32), 29% (n = 24) healed after conservative treatment, 21.7% (n = 18) healed after surgery, 7.2% (n = 6) persisted after surgery while 3.6% (n = 3) persisted after conservative treatment. Anaemia, sepsis, electrolyte imbalance, dehydration and malnutrition were the commonest complications. Conclusion: The prevalence of enterocutaneous fistulas was high, with a female predominance and a mean age of 38 years. Most cases were seen as a referral from the periphery for better management. The greatest majority of fistulas occurred as a postoperative complications. Conservative management with enteral feedings was preferred, they had better outcomes and gave more chances of healing. The commonest indication of surgical treatment was an infection. Resection with end-to-end anastomosis was the preferred repaired work. The mortality rate was high, and anaemia, sepsis and electrolyte imbalance were the commonest complications.

Clinical Presentation, Management and Materno-Fetal Outcome of Patients with HELLP Syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital

Background: HELLP (Hemolysis, Elevated Liver enzymes and Low Platelets) syndrome is a common complication of severe preeclampsia, with a high maternal and perinatal mortality rate. Data on HELLP syndrome is scanty in our setting. We sought to study the clinical presentation, management, and materno-fetal outcome of patients with HELLP syndrome at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital (YGOPH). Methods: This was a cross-sectional, analytical study with a retrospective data collection of patients, diagnosed with HELLP syndrome at the YGOPH between 1st January 2020 and 31st July 2021. Data were analyzed using the software R version 4.0.2. Results are presented as mean ± standard deviation, frequencies and percentages. P values < 0.05 were considered statistically significant. Results: Of 254 cases of severe preeclampsia, 17 developed HELLP syndrome, giving us a frequency of 6.7%. One patient who presented with hepatitis B was excluded. The mean age was 27.19 ± 6.44 years. Most patients (56.3%) had poor follow up during antenatal contacts. The most common symptom was headache (93.8%). Most cases (56.3%) were diagnosed during post-partum, prepartum (25.0%), and per partum (18.8%). Obstetrical management was done by cesarean section (62.5%) and vaginal delivery (37.5%). Post-partum management of HELLP syndrome consisted of antihypertensive medication, anticonvulsants, sedatives, transfusion of blood and blood products, and fluid resuscitation. Of the 50% of patients who presented with acute kidney injury, only 12.5% (1) were referred for dialysis. Over 50% of our study participants presented severe complications after delivery, but 43.8% recovered, while 56.2% finally died. The fetal outcome was: still birth (31.2%), intra-uterine growth restriction/low birth weight (12.5%), term delivery (≥37 weeks) (31.3%), and preterm deliveries (<37 weeks) (68.7%). Three (18.8%) of the neonates delivered alive presented with a poor Apgar score at the 5th minute. Conclusion: Although rare, HELLP syndrome exists in our setting. Proper management in appropriate centers is key to improving maternal and fetal outcomes.

Balancing Dermatological and Gynecological Considerations: Evaluating the Necessity of Pelvic Exams in OCP Prescriptions for Acne Management

Routine pelvic examinations in women prescribed oral contraceptive pills (OCPs) for acne management are scrutinized to assess their impact on dermatological outcomes versus gynecological health. A synthesis of clinical trials, patient surveys, and medical guidelines reveals that these routine exams do not significantly enhance the effectiveness of acne treatment with OCPs but are linked to increased patient discomfort and false-positive results. Evidence suggests that routine pelvic examinations do not significantly impact the effectiveness of acne management with OCPs but are associated with increased patient discomfort and higher rates of false-positive results. The analysis indicates that a more personalized approach, focusing on selective pelvic examinations based on individual risk factors and clinical symptoms, may offer a more practical and patient-centered alternative. The review advocates for a reexamination of existing guidelines to better align with a model of individualized care, emphasizing the need for further research to optimize best practices at the intersection of dermatological and gynecological care. Adopting a personalized approach to pelvic examinations could substantially improve patient care by minimizing unnecessary interventions and discomfort while maintaining the efficacy of acne treatment with oral contraceptive pills.

Utilization Management:Walking the Line Between Patient Needs and Healthcare Economics-Short Communication

Utilization management plays a crucial role in healthcare by optimizing resource allocation,improving patient outcomes,and effectively controlling costs.By balancing patient needs with economic considerations,healthcare institutions can ensure efficient and sustainable service delivery.Utilization management encompasses various strategies,including prior authorization,concurrent review,and clinical pathways,to enhance care quality,manage expenses,and streamline resource use.The benefits of utilization management include cost containment,improved care standards,and the implementation of consistent treatment guidelines,thereby increasing the overall efficiency and effectiveness of healthcare delivery.

Colonoscopic perforation:Incidence,risk factors,management and outcome

This review discusses the incidence,risk factors,management and outcome of colonoscopic perforation(CP).The incidence of CP ranges from 0.016% to 0.2% following diagnostic colonoscopies and could be up to 5% following some colonoscopic interventions.The perforations are frequently related to therapeutic colonoscopies and are associated with patients of advanced age or with multiple comorbidities.Management of CP is mainly based on patients' clinical grounds and their underlying colorectal diseases.Current therapeutic approaches include conservative management(bowel rest plus the administration of broadspectrum antibiotics),endoscopic management,and operative management(open or laparoscopic approach).The applications of each treatment are discussed.Overall outcomes of patients with CP are also addressed.

Post-pancreaticoduodenectomy hemorrhage:risk factors, managements and outcomes

BACKGROUND： Post-pancreaticoduodenectomy（PD） hemorrhage（PPH） is an uncommon but serious complication. This retrospective study analyzed the risk factors, managements and outcomes of the patients with PPH.METHODS： A total of 840 patients with PD between 2000 and2010 were retrospectively analyzed. Among them, 73 patients had PPH： 19 patients had early PPH and 54 had late PPH.The assessment included the preoperative history of disease,pancreatic status and surgical techniques. Other postoperative complications were also evaluated.RESULTS： The incidence of PPH was 8.7%（73/840）. There were no independent risk factors for early PPH. Male gender（OR=4.40, P0.02）, diameter of pancreatic duct（OR=0.64,P0.01）, end-to-side invagination pancreaticojejunostomy（OR=5.65, P0.01）, pancreatic fistula（OR=2.33, P0.04）and intra-abdominal abscess（OR=12.19, P0.01） were the independent risk factors for late PPH. Four patients with early PPH received conservative treatment and 12 were treated surgically. As for patients with late PPH, the success rate of medical therapy was 27.8%（15/54）. Initial endoscopy was operated in 12 patients（22.2%）, initial angiography in 19（35.2%）,and relaparotomy in 15（27.8%）. Eventually, PPH resulted in 19 deaths. The main causes of death were multiple organ failure,hemorrhagic shock, sepsis and uncontrolled rebleeding.CONCLUSIONS： Careful and ongoing observation of hemorrhagic signs, especially within the first 24 hours after PD or within the course of pancreatic fistula or intra-abdominal abscess, is recommended for patients with PD and a prompt management is necessary. Although endoscopy and angiography are the standard procedures for the management of PPH,surgical approach is still irreplaceable. Aggressive prevention of hemorrhagic shock and re-hemorrhage is the key to treat PPH.

Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome

AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation. METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002. RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes. CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most commoncauses of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.

Management and outcome of hepatocellular adenoma with massive bleeding at presentation

To evaluate outcome of acute management and risk of rebleeding in patients with massive hemorrhage due to hepatocellular adenoma (HCA). METHODSThis retrospective cohort study included all consecutive patients who presented to our hospital with massive hemorrhage (grade II or III) due to ruptured HCA and were admitted for observation and/or intervention between 1999-2016. The diagnosis of HCA was based on radiological findings from contrast-enhanced magnetic resonance imaging (MRI) or pathological findings from biopsy or resection of the HCA. Hemorrhage was diagnosed based on findings from computed tomography or MRI. Medical records were reviewed for demographic features, clinical presentation, tumor features, initial and subsequent management, short- and long-term complications and patient and lesion follow-up. RESULTSAll patients were female (n = 23). Treatment in the acute phase consisted of embolization (n = 9, 39.1%), conservative therapy (n = 13, 56.5%), and other intervention (n = 1, 4.3%). Median hemoglobin level decreased significantly more on days 0-3 in the intervention group than in the patients initially treated conservatively (0.9 mmol/L vs 2.4 mmol/L respectively, P = 0.006). In total, 4 patients suffered severe short-term complications, which included hypovolemic shock, acute liver failure and abscess formation. After a median follow-up of 36 mo, tumor regression in non-surgically treated patients occurred with a median reduction of 76 mm down to 25 mm. Four patients underwent secondary (elective) treatment (i.e., tumor resection) to address HCA size of > 5 cm and/or desire for future pregnancy. One case of rebleeding was documented (4.3%). None of the patients experienced long-term complication (mean follow-up time: 36 mo). CONCLUSIONWith a 4.3% risk of rebleeding, secondary (elective) treatment of HCA after massive hemorrhage may only be considered in patients with persistent HCA > 5 cm.

Short- and long-term outcomes associated with enhanced recovery after surgery protocol vs conventional management in patients undergoing laparoscopic gastrectomy

BACKGROUND At present,the enhanced recovery after surgery(ERAS)protocol is widely implemented in the field of gastric surgery.However,the effect of the ERAS protocol on the long-term prognosis of gastric cancer has not been reported.AIM To compare the effects of ERAS and conventional protocols on short-term outcomes and long-term prognosis after laparoscopic gastrectomy.METHODS We retrospectively analyzed the data of 1026 consecutive patients who underwent laparoscopic gastrectomy between 2012 and 2015.The patients were divided into either an ERAS group or a conventional group.The groups were matched in a 1:1 ratio using propensity scores based on covariates that affect cancer survival.The primary outcomes were the 5-year overall and cancer-specific survival rates.The secondary outcomes were the postoperative short-term outcomes and inflammatory indexes.RESULTS The patient demographics and baseline characteristics were similar between the two groups after matching.Compared to the conventional group,the ERAS group had a significantly shorter postoperative hospital day(7.09 d vs 8.67 d,P<0.001),shorter time to first flatus,liquid intake,and ambulation(2.50 d vs 3.40 d,P<0.001;1.02 d vs 3.64 d,P<0.001;1.47 d vs 2.99 d,P<0.001,respectively),and lower medical costs($7621.75 vs$7814.16,P=0.009).There was a significantly higher rate of postoperative complications among patients in the conventional group than among those in the ERAS group(18.1 vs 12.3,P=0.030).Regarding inflammatory indexes,the C-reactive protein and procalcitonin levels on postoperative day 3/4 were significantly different between the two groups(P<0.001 and P=0.025,respectively).The ERAS protocol was associated with significantly improved 5-year overall survival and cancer-specific survival rates compared with conventional protocol(P=0.013 and 0.032,respectively).When stratified by tumour stage,only the survival of patients with stage III disease was significantly different between the two groups(P=0.044).CONCLUSION Adherence to the ERAS protocol improves both the short-term outcomes and the 5-year overall survival and cancer-specific survival of patients after laparoscopic gastrectomy.

Gastric cancer in Africa:Current management and outcomes

Gastric cancer is the fourth most common cancer and second most common cause of cancer death worldwide. Globally, gastric cancer poses a significant public health burden - both economically and socially. In 2008, the economic burden from premature cancer deaths and disability was $895 billion and gastric cancer was the second highest cancer responsible for healthy life lost. With the expected increase in cancer deaths and non-communicable diseases, these costs are expected to rise and impact patient care. World Health Organization, estimates a 15% increase in non-communicable disease worldwide, with more than 20% increase occurring in Africa between 2010 and 2020. Mali, West Africa, is ranked 15th highest incidence of gastric cancer worldwide at a rate of 20.3/100000, yet very scarce published data evaluating etiology, prevention or management exist. It is understood that risk factors of gastric cancer are multifactorial and include infectious agents (Helicobacter pylori, Epstein-Barr virus), genetic, dietary, and environmental factors (alcohol, smoking). Interestingly, African patients with gastric cancer are younger, in their 3rd-4th decade, and present at a late stage of the disease. There is sparse data regarding gastric cancer in Africa due to lack of data collection and under-reporting, which impacts incidence and mortality rates. Currently, GLOBOCAN, an International Agency for Research on Cancer resource, is the most comprehensive available resource allowing comparison between nations. In resource limited settings, with already restricted healthcare funding, data is needed to establish programs in Africa that increase gastric cancer awareness, curtail the economic burden, and improve patient management and survival outcomes.

Nonalcoholic fatty liver disease in lean subjects:Prognosis,outcomes and management

Nonalcoholic fatty liver disease(NAFLD)accounts for most cases of chronic liver disease worldwide,with an estimated global prevalence of approximately 25%and ranges from simple steatosis to nonalcoholic steatohepatitis and cirrhosis.NAFLD is strongly connected to metabolic syndrome,and for many years,fatty liver was considered to be an exclusive feature of obese patients.However,recent studies have highlighted the presence of NAFLD in non-obese subjects,with or without increased visceral fat or even in lean subjects without increased waist circumference.“Lean NAFLD”is a relatively new concept and there is significant scientific interest in understanding the differences in pathophysiology,prognosis and management compared with NAFLD in overweight/obese patients.In the present editorial,we discuss the clinical and metabolic profiles and outcomes of lean NAFLD compared with both obese NAFLD and lean healthy individuals from Asian and Western countries.Moreover,we shed light to the challenging topic of management of NAFLD in lean subjects since there are no specific guidelines for this population.Finally,we discuss open questions and issues to be addressed in the future in order to categorize NAFLD patients into lean and nonlean cohorts.

Fractures in sport: Optimising their management and outcome

Fractures in sport are a specialised cohort of fracture injuries, occurring in a high functioning population, in which the goals are rapid restoration of function and return to play with the minimal symptom profile possible. While the general principles of fracture management, namely accurate fracture reduction, appropriate immobilisation and timely rehabilitation, guide the treatment of these injuries, management of fractures in athletic populations can differ significantly from those in the general population, due to the need to facilitate a rapid return to high demand activities. However, despite fractures comprising up to 10% of all of sporting injuries, dedicated research into the management and outcome of sport-related fractures is limited. In order to assess the optimal methods of treating such injuries, and so allow optimisation of their outcome, the evidence for the management of each specific sport-related fracture type requires assessment and analysis. We present and review the current evidence directing management of fractures in athletes with an aim to promote valid innovative methods and optimise the outcome of such injuries. From this, key recommendations are provided for the management of the common fracture types seen in the athlete. Six case reports are also presented to illustrate the management planning and application of sport-focussed fracture management in the clinical setting.

The impact of emergency department length of stay on the outcomes of trauma patients requiring hospitalization: a retrospective observational study

BACKGROUND: We aimed to explore the impact of the emergency department length of stay(EDLOS) on the outcome of trauma patients.METHODS: A retrospective study was conducted on all trauma patients requiring hospitalization between 2015 and 2019. Patients were categorized into 4 groups based on the EDLOS(<4 h, 4–12 h,12–24 h, and >24 h). Data were analyzed using Chi-square test(categorical variables), Student’s t-test(continuous variables), correlation coefficient, analysis of variance and multivariate logistic regression analysis for identifying predictors of short EDLOS and hospital mortality.RESULTS: The study involved 7,026 patients with a mean age of 32.1±15.6 years. Onefifth of patients had a short EDLOS(<4 h) and had higher level trauma team T1 activation(TTA-1), higher Injury Severity Score(ISS), higher shock index(SI), and more head injuries than the other groups(P=0.001). Patients with an EDLOS >24 h were older(P=0.001) and had more comorbidities(P=0.001) and fewer deaths(P=0.001). Multivariate regression analysis showed that the predictors of short EDLOS were female gender, GCS, SI, hemoglobin level, ISS, and blood transfusion. The predictors of mortality were TTA-1(odds ratio [OR]=4.081, 95%CI: 2.364–7.045), head injury(OR=3.920, 95%CI: 2.413–6.368), blood transfusion(OR=2.773, 95%CI: 1.668–4.609), SI(OR=2.132, 95%CI: 1.364–3.332), ISS(OR=1.077, 95%CI: 1.057–1.096), and age(OR=1.040, 95%CI: 1.026–1.054). CONCLUSIONS: Patients with shorter EDLOS had different baseline characteristics and hospital outcomes compared with patients with longer EDLOS. Patients with prolonged EDLOS had better outcomes;however, the burden of prolonged boarding in the ED needs further elaboration.

Effect of Intention on Outcome Bias in Decision Making—Implications for Safety Management

The evidence of outcome bias was explored in a two-player (Player 1: allocator and Player 2: evaluator) economic game experiment where the reward allocation was made between two players. The experimental factors were the intention of an allocator (Player 1), the type of chosen dice (selfish, fair, and generous), and the outcome (selfish, fair, and generous). The outcome bias occurred when the type of dice chosen by the allocator (Player 1) was not only a selfish one but also a generous one. The comparison between the two conditions (intentional and no-intentional conditions) definitely showed that Player 2 punished Player 1 to a larger extent when the outcome was disadvantageous for Player 2 (selfish outcome) and Player 2 rewarded Player 1 when the outcome was advantageous (generous outcome) irrespective of whether the die was chosen out of the three types intentionally or not. Moreover, the outcome bias was not observed when the outcome was fair. Thus, we could verify the hypothesis that we are readily got trapped in the outcome bias. Some implications were given for safety management that put more emphasis on the process than on the outcome.

Anesthesia Management at Fuwai Hospital:Practice,Evidence and Outcomes

Fuwai Hospital was established in 1956 and the Anesthesia Department of Fuwai Hospital was one of the earliest anesthesia departments then in China.Under the leadership of several department directors and with the concerted efforts of all generations of colleagues,the Anesthesia Department of Fuwai Hospital has dramatically transformed,upgraded and modernized.For more than six decades,the Anesthesia Department has been providing high-quality peri-operative anesthesia care for cardiovascular surgeries,conducting innovative experimental and clinical researches,and offering comprehensive training on cardiovascular anesthesiology for professionals across China.Currently,Fuwai Hospital is the National Center for Cardiovascular Diseases of China and one of the largest cardiovascular centers in the world.The present review introduces the Anesthesia Department of Fuwai Hospital,summarizes its current practice of anesthesia management,the outcomes of cardiovascular surgeries at Fuwai Hospital,accumulates relevant evidence,and provides prospects for future development of cardiovascular anesthesiology.

A Descriptive Longitudinal Study of Chronic Pain Outcomes and Gender Differences in a Multidisciplinary Pain Management Centre

Background: The long-term outcomes of patients with chronic pain treated in a multidisciplinary pain management center remain variable. Objective: This study aims to evaluate the changes in outcomes of patient’s self-reported pain, psychosocial status, health related quality of life and gender differences following treatment in amultidisciplinary pain management centre. Design: A prospective longitudinal cross-sectional study uses questionnaires. Treatment Setting: A pragmatic and individualized patient centered approach in a tertiary level multidisciplinary pain management center. Subjects: Patients with chronic pain referred to the centre from 2004-2010. Outcome Measures: Pain Numerical Rating Scale (NRS), Pain Temporal Description (1 - 6), Pain Self- Efficacy Questionnaire (PSEQ), Depression Anxiety Stress Scales (DASS-21) and Short Form-36 (SF- 36). Follow-up questionnaires were sent at 6 and 12 months after initial assessment. Results: Mean duration of baseline chronic pain was 8.1 years and 61% of chronic pains were involving the musculoskeletal system. At 6 and 12 month follow-ups, 273 and 180 participants had been surveyed respectively. At 6-month follow-up, there were significant improvements on pain intensity (Cohen’s d = 0.8), pain self-efficacy (Cohen’s d = 0.47), depression and stress scores (Cohen’s d = 0.16) and six out of eight domains of SF-36 (Cohen’s d = 0.2 - 0.4). At 12-month follow-up, improvements were maintained on pain intensity, self-efficacy and three out of eight domains of SF-36. There were distinctive pre- and post-treatment gender differences in these outcomes and overall females showed better short- and long-term outcomes than males. Conclusion: Multidisciplinary pain management using an individualized patient centered approach remains an effective treatment for chronic pain in both the short- (6 month) and long-term (12 month). The distinctive pre- and post-treatment gender differences particularly in the psychological outcomes, suggest that it may be beneficial to further delineate and better manage vulnerable patient subgroups.

COVID-19 pandemic changed the management and outcomes of acute appendicitis in northern Beijing:A single-center study

BACKGROUND Since the outbreak of the coronavirus disease 2019(COVID-19)pandemic,outcomes and management of many diseases have been affected.Acute appendicitis is a common acute abdomen.The incidence rate is 0.05%-0.5%.Studies reported that the number of patients with appendicitis admitted to emergency department significantly decreased since the pandemic.People avoided going to the hospital for fear of being infected.Different countries have different epidemic prevention measures that result in different treatment outcomes.The Chinese government also published some temporary measures in order to prevent the outbreak.AIM To explore the changes in management and outcomes of acute appendicitis during the COVID-19 pandemic in the North of Beijing.METHODS Patients with acute appendicitis admitted to Beijing Tsinghua Changgung Hospital between February and June 2019 and February and June 2020 were retrospectively reviewed.Cases were grouped according to admission year.The demographic characteristics,present illnesses,medical history,symptoms and signs,comorbidities,blood test results,imaging data,appendix pathology,and treatment details were compared.RESULTS Overall,74 patients received nonsurgical treatment and 113 patients underwent surgical treatment in group 2019,whereas 159 patients received nonsurgical treatment and 26 patients received surgical treatment in group 2020.Fever,thick appendix,nonsurgical management,and uncomplicated appendicitis(simple or supportive appendicitis)were more common in group 2020(P<0.05).Among the nonsurgical management cases,the neutrophil percentage,neutrophil-tolymphocyte ratio,and recurrence rate were higher in group 2020(P<0.05).Among surgically managed cases,there were more cases with gastrointestinal symptoms,peritonitis,ascites in the image,and intraoperative adhesion or ascites in group 2020(P<0.05).The white blood cell count,time from diagnosis to surgery,surgical time,and intraoperative blood loss were higher in group 2020(P<0.05).CONCLUSION During the COVID-19 pandemic,patients suffering from acute appendicitis in Beijing tended to present with severe symptoms and opt for nonsurgical treatment.For patients who underwent surgical management,the operation was delayed and more difficult during the pandemic.Nevertheless,the hospital stay and the incidence of postsurgical complications did not change.