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2. Joblessness and Lost Earnings after Acute Respiratory Distress Syndrome in a 1-Year National Multicenter Study

Author

Kamdar, Biren B, Huang, Minxuan, Dinglas, Victor D, Colantuoni, Elizabeth, von Wachter, Till M, Hopkins, Ramona O, Needham, Dale M, Hudson, L, Gundel, S, Hough, C, Neff, M, Sims, K, Ungar, A, Watkins, T, Steingrub, J, Tidswell, M, Braden, E, DeSouza, L, Kardos, C, Kozikowski, L, Ouellette, S, Guntupalli, K, Bandi, V, Pope, C, Ross, C, Brower, R, Fessler, H, Hager, D, Mendez-Tellez, P, Needham, D, Oakjones, K, Sevransky, J, Workneh, A, Shanholtz, C, Herr, D, Howes, H, Netzer, G, Rock, P, Sampaio, A, Titus, J, Sloane, P, Beck, T, Highfield, D, King, S, Lee, B, Bolouri, N, Wiedemann, HP, Ashton, RW, Culver, DA, Frederick, T, Guzman, JA, Komara, JJ, Reddy, AJ, Hejal, R, Andrews, M, Haney, D, Connors, AF, Lasalvia, S, Thornton, JD, Warren, EL, Moss, M, Burnham, EL, Gray, L, Maloney, J, Mealer, M, Douglas, I, Overdier, K, Thompson, K, Wolken, R, Frankel, S, McKeehan, J, Warner, ML, Bost, T, Higgins, C, Hodgin, K, MacIntyre, N, Brown, L, Cox, C, Gentile, M, Govert, J, Knudsen, N, Carson, S, Chang, L, Choudhury, S, Hall, W, Lanier, J, Wheeler, AP, Bernard, GR, Hays, M, Mogan, S, Rice, TW, Hite, RD, Harvey, A, Morris, PE, Ragusky, M, Wright, P, Groce, S, McLean, J, Overton, A, and Truwit, J

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Clinical Sciences, Lung, Rare Diseases, Acute Respiratory Distress Syndrome, Adult, Critical Illness, Employment, Female, Humans, Income, Longitudinal Studies, Male, Middle Aged, Respiratory Distress Syndrome, Survivors, Time Factors, Unemployment, United States, employment, intensive care unit, income, health insurance, National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome Network, Medical and Health Sciences, Respiratory System, Cardiovascular medicine and haematology, Clinical sciences
Abstract

RationaleFollowing acute respiratory distress syndrome (ARDS), joblessness is common but poorly understood.ObjectivesTo evaluate the timing of return to work after ARDS, and associated risk factors, lost earnings, and changes in healthcare coverage Methods: Over 12-month longitudinal follow-up, ARDS survivors from 43 U.S. ARDSNet hospitals provided employment and healthcare coverage data via structured telephone interviews. Factors associated with the timing of return to work were assessed using Fine and Gray regression analysis. Lost earnings were estimated using Bureau of Labor Statistics data.Measurements and main resultsOf 922 consenting survivors, 386 (42%) were employed before ARDS (56% male; mean ± SD age, 45 ± 13 yr), with seven dying by 12-month follow-up. Of 379 previously employed 12-month survivors, 166 (44%) were jobless at 12-month follow-up. Accounting for competing risks of death and retirement, half of enrolled and previously employed survivors returned to work by 13 weeks after hospital discharge, with 68% ever returning by 12 months. Delays in return to work were associated with longer hospitalization and older age among nonwhite survivors. Over 12-month follow-up, 274 (71%) survivors accrued lost earnings, averaging $26,949 ± $22,447 (60% of pre-ARDS annual earnings). Jobless survivors experienced a 14% (95% confidence interval, 5-22%; P = 0.002) absolute decrease in private health insurance (from 44% pre-ARDS) and a 16% (95% confidence interval, 7-24%; P

Published
2017

5. Nursery Guide for Diseases Caused by Phytophthora ramorum on Ornamentals: Diagnosis and Management.

Author

Tjosvold, S A, Buermeyer, K R, Blomquist, C, and Frankel, S

Subjects
floriculture, plant diseases and disorders
Abstract

Phytophthora ramorum has caused widespread mortality in native oaks and tanoaks in coastal areas of central and northern California. On oaks, the disease is commonly called sudden oak death. Camellias, rhododendrons, and other popular ornamental plants are susceptible to infection, and the pathogen can be moved long distances through ship ments of infected nursery stock. Federal and state quarantines are in effect that require nursery inspections, and if the pathogen is found, affected nursery stock must be destroyed as a means of eradication.

Published
2005

6. Magnetic Monopole Decay and Its Consequences

Author

Frankel, S.

Subjects
Nuclear Theory, High Energy Physics - Theory
Abstract

We return to further examination of the need for the existence of magnetic monopoles based on the decades old derivation [Sherman Frankel, Amer. Jour. of Physics, 44, 7, 683-6 1976], of both the monopole-charge force, vec(F) = eg(vec(r) * vec(v)/c)/r^3, as well as the Dirac angular momentum, vec(l_f) = eg hat(r), from P and T conservation alone, without any recourse whatsoever to Maxwell's Equations. The eg product also appeared in the charge conserving equation, deg/dt = 0 = edg/dt + gde/dt, and this paper examines the second possible solution, dg/dt = - de/dt, namely monopole decay, accounting for the non-observance of stable monopoles. It treats astrophysics and neutrino physics consequences and suggestions for experimental searches., Comment: uuencoded files, 10 pages

Published
1999

7. J/Psi Suppression Revisited

Author

Frankel, S. and Frati, W.

Subjects
High Energy Physics - Phenomenology
Abstract

The production of J/Psi's in nuclei is re-examined and the critical role of Feynman x distributions in the study of photoproduction and hadronic production of both J/Psi's and Drell-Yan dimuons is expatiated. The need to consider both initial and final state interactions and the key effect of initial state interactions on the total J/Psi cross section are demonstrated. We use a Woods-Saxon Monte Carlo simulation to obtain distributions of the numbers of collisions prior and subsequent to the charmonium production. With those results we relate the mean number of nucleon-nucleon collisions, $$ to $A^{1/3} + B^{1/3}$, and give a new analytic functional form for the A dependence of the suppression. Finally we carry out a full Monte Carlo calculation of S, including an initial state prior energy loss in keeping with the measured Feynman x distributions in $\pi$-A and p-A interactions. We use an energy loss parameterization which is consistent with the energy loss from minimum bias data fitted in ISAJET. We also use an open charm absorption cross section, $\sigma_{oc}$, constrained from photoproduction of J/Psi's, to analyze the latest data on the J/Psi suppression. The role of color screening, the time evolution of off-shell charmonium to the on-shell J/Psi, and the energy dependence of the charmonium-nucleon inelastic and absorption cross sections are discussed. We find no anomalous suppression when comparing our results to published data., Comment: files of latex and postscript, including 1 table and 11 figures

Published
1997

8. j_psi Suppression and the Quark-Gluon Plasma

Author

Frankel, S. and Frati, W.

Subjects
Nuclear Theory
Abstract

All measured Feynman x_f distributions of the ratio, R, of j_psi production in nuclei relative to production on protons fall off with x_f. They show [2] that absorption of charmonium cannot be the only source of j_psi suppression and that energy loss of the constituents of the incident proton prior to the j_psi production, because of the exponential sqrt(s) dependence of the charmonium cross section, should not be neglected. Including the effects of initial state energy loss we find that the latest measured Pb-Pb j_psi cross sections do not provide any evidence for deconfinement., Comment: 9 pages, 2 figures, additional material, accepted by Physics Letters

Published
1997
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9. A Dependence of Hadron Production in Inelastic Muon Scattering and Dimuon Production by Protons

Author

Frankel, S. and Frati, W.

Subjects
High Energy Physics - Phenomenology
Abstract

The A dependence of the production of hadrons in inelastic muon scattering and of the production of dimuons in high $Q^2$ proton interactions are simply related. Feynman x distributions and z scaling distributions in nuclei are compared with energy loss models. Suggestions for new data analyses are presented., Comment: 14pp +13 figures, UPR report 607T (available from ftp://dept.physics.upenn.edu/muhad )

Published
1994
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12. Remuneration rights and national treatment

Author

Hugenholtz, P.B., Frankel, S., Chon, M., Dinwoodie, G.B., Lauriat, B., Schovsbo, J., FdR overig onderzoek, and IViR (FdR)

Abstract

National treatment applies to all copyright rights, unless such treatment is excluded under the Berne Convention or the TRIPS Agreement. Renumeration rights are not specific in these agreements, but flow from the rights of authors and owners. Therefore, questions arise about when national treatment applies and when it does not. This chapter analyses the types of remuneration rights in four broad categories: exceptions, rights per se, exploitation contracts and residual rights. The chapter shows the extent of national treatment obligations to these categories of rights of remuneration found in national copyright law.

Published
2023

13. Expressive genericity revisited: What EU policymakers can learn from Rochelle Dreyfuss

Author

Senftleben, M., Frankel, S., Chon, M., Dinwoodie, G.B., Schovsbo, J., Lauriat, B., and IViR (FdR)

Abstract

Martin Senftleben explores possibilities for weaving a general bias in favour of artistic expression into the fabric of the EU system of trademark limitations and, in particular, the test of compliance with honest practices in industrial and commercial matters. Following Dreyfuss’ recommendation to develop specific rules when expressive use is at issue, the analysis leads to the insight that use of trademarks should be deemed fair in artistic contexts unless the trademark proprietor manages to overcome the legal presumption of fairness by presenting individualized facts that provide proof of unusually grave trademark harm. More specifically, the trademark owner should demonstrate that, despite the artistic setting, the use explicitly misleads consumers as to the commercial origin of the artwork. In dilution cases, the trademark owner should show that the use deliberately blurs, tarnishes or exploits in an unfair manner the distinctiveness or repute of the trademark.

Published
2023

14. FAIR, FRAND and open - The institutionalization of research data sharing under the EU data strategy

Author

van Eechoud, M., Frankel, S., Chon, M., Dinwoodie, G.B., Schovsbo, J., Lauriat, B., and IViR (FdR)

Abstract

As part of its Open Science agenda, the EU is mainstreaming open access to research data through a mix of instruments. The reforms are an attempt to institutionalise calls from several sectors and organisations for publicly funded research to be generally accessible without restraint on the basis that science should never be locked behind paywalls. The Open Data Directive in particular is intended to foster unhindered and non-discriminatory access to data derived from publicly funded research for both commercial and non-commercial uses. Open content licensing plays a key role. The recent Data Governance Act and the proposed Data Act further institutionalise research data governance. This chapter examines the significance of these developments for academic research, particularly from the perspective of academic freedom which is a core element of scholarship.

Published
2023

16. Research of cognitive disorders in patients with COVID-19 using neuropsychological tests = Дослідження когнітивних розладів у пацієнтів з COVID-19 з використанням нейропсихологічних тестів

Author

Frankel, S.

Abstract

Frankel S. Research of cognitive disorders in patients with COVID-19 using neuropsychological tests = Дослідження когнітивних розладів у пацієнтів з COVID-19 з використанням нейропсихологічних тестів \\ Актуальні проблеми транспортної медицини / Actual problems of transport medicine / 2022;3(69):72-77. ISSN 1818-9385 DOI http://dx.doi.org/10.5281/zenodo.7188233 http://aptm.org.ua УДК 616.89 DOI: http://dx.doi.org/10.5281/zenodo.7188233 RESEARCH OF COGNITIVE DISORDERS IN PATIENTS WITH COVID-19 USING NEUROPSYCHOLOGICAL TESTS Frankel S. International Academy of Ecology and Medicine, Kyiv, Ukraine The article presents the results of a study of cognitive disorders against the background of COVID-19 with the use of neuropsychological tests (MMSE mental status assessment scales, time drawing test, and ten word memory). When examining the level of cerebral insufficiency in patients of working age with COVID-19, it was established that on the eighth day of hospital stay, cognitive disorders were observed in 100% of patients and were manifested both by objective disorders and mild and moderate dementia. It has been proven that the cognitive dysfunction of COVID-19 does not have a direct dependence on age, since objective disorders and dementia of a mild degree were noted not only in patients 51-60 years old, but also in the age group 40-50 years old. Keywords: cognitive disorders, COVID-19, neuropsychological tests ДОСЛІДЖЕННЯ КОГНІТИВНИХ РОЗЛАДІВ У ПАЦІЄНТІВ З COVID-19 З ВИКОРИСТАННЯМ НЕЙРОПСИХОЛОГІЧНИХ ТЕСТІВ Френкель С. Міжнародна академія екології та медицини, м. Київ, Україна В статті представлені результати дослідження когнітивних розладів на тлі COVID-19 з використання нейропсихологічних тестів (шкали оцінки психічного статусу MMSE, тесту малювання годинника та запам’ятовування десяти слів). При дослідженні рівня церебральної недостатності у пацієнтів працездатного віку з COVID19 встановлено, що на восьму добу перебування у стаціонарі когнітивні розлади спостерігалися у 100 % пацієнтів та проявлялися як предметними порушеннями, так і деменцією легкого та помірного ступеня вираженості. Доведено, що когнітивна дисфункція при COVID-19 не має прямої залежності від віку, оскільки предметні порушення та деменції легкого ступеня відмічалися не лише у пацієнтів 51-60 років, але й у віковій групі 40-50 років. Ключові слова: когнітивні розлади, COVID-19, нейропсихологічні тести ИССЛЕДОВАНИЕ КОГНИТИВНЫХ НАРУШЕНИЙ У ПАЦИЕНТОВ С COVID-19 С ИСПОЛЬЗОВАНИЕМ НЕЙРОПСИХОЛОГИЧЕСКИХ ТЕСТОВ Френкель С. Международная академия экологии и медицины, г. Киев, Украина В статье представлены результаты исследования когнитивных расстройств на фоне COVID-19 с использованием нейропсихологических тестов (шкалы оценки психического статуса MMSE, теста рисования часов и запоминание десяти слов). При исследовании уровня церебральной недостаточности у пациентов трудоспособного возраста с COVID-19 установлено, что на восьмые сутки пребывания в стационаре когнитивные расстройства наблюдались у 100% пациентов и проявлялись как предметными нарушениями, так и деменцией легкой и умеренной степени выраженности. Доказано, что когнитивная дисфункция COVID-19 не имеет прямой зависимости от возраста, поскольку предметные нарушения и деменция легкой степени отмечались не только у пациентов 51-60 лет, но и в возрастной группе 40-50 лет. Ключевые слова: когнитивные расстройства, COVID-19, нейропсихологические тесты &nbsp

Published
2022
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17. Correlation between cognitive disorders and some biochemical indicators in patients with COVID-19 = Кореляційний взаємозв'язок між когнітивними розладами та деякими біохімічними показниками у пацієнтів з COVID-19

Author

Frankel, S.

Abstract

Frankel S. Correlation between cognitive disorders and some biochemical indicators in patients with COVID-19 = Кореляційний взаємозв’язок між когнітивними розладами та деякими біохімічними показниками у пацієнтів з COVID-19. Вісник морської медицини / 2022;3(96):24-29. ISSN 2707-1324 DOI http://dx.doi.org/10.5281/zenodo.7317898 УДК 616.127-005.8-036.11-06:616.89-008.46/47-039.74-053.85 DOI http://dx.doi.org/10.5281/zenodo.7317898 C. Френкель КОРЕЛЯЦІЙНИЙ ВЗАЄМОЗВ’ЯЗОК МІЖ КОГНІТИВНИМИ РОЗЛАДАМИ ТА ДЕЯКИМИ БІОХІМІЧНИМИ ПОКАЗНИКАМИ У ПАЦІЄНТІВ З COVID-19 ПЗВО «Міжнародна академія екології та медицини», м. Київ ORCID 0000-0002-8536-6735 Summary. Frankel S. CORRELATION BETWEEN COGNITIVE DISORDERS AND SOME BIOCHEMICAL INDICATORS IN PATIENTS WITH COVID-19. - International Academy of Ecology and Medicine, Kyiv; e-mail: prof_s.i.v@ukr.net. To date, a sufficiently large number of scientific publications have been accumulated on the epidemiology, diagnostics, clinical manifestations, therapy and prevention of COVID-19, however, the theoretical and practical aspects of complications that arise against the background of COVID-19 remain insufficiently studied and ambiguous. The goal is to study the correlation between test scores characterizing cognitive dysfunction and biochemical markers - cortisol and CRP. Research materials and methods. The study was conducted on the basis of the Odesa Regional Clinical Hospital. 120 patients aged 40 to 60 with COVID-19 were examined. Cognitive disorders in working-age patients with COVID-19 were detected using neuropsychological tests: the MMSE mental status assessment scale, the clock drawing test, and the Luria test. The cortisol level was determined by the ST AIA-PACK CORT method, the CRP concentration was studied using the unified ring precipitation method. Evaluation of relationships was carried out on the 8th and 20th day of the study. Research results. According to the MMSE scale, reliable medium-strength inverse correlations between the index of cognitive dysfunction and the age of the patients were determined. A direct average correlation was established between the indicators of cognitive dysfunction according to the Luria test on the 8th and 20th days of hospitalization; a reliable weak direct correlation was determined between the cortisol level on the 8th day of hospitalization and the indicator according to the Luria test on the 20th a day According to the clock drawing test, a reliable inverse correlation of low and medium strength was determined between the age of the patients and, respectively, the test results on the 8th and 20th day of hospital stay. Conclusions. A reliable regression of cognitive disorders was established, using neuropsychological testing, in patients with COVID-19 on the 20th day of treatment. Key words: cognitive disorders, C-reactive protein, cortisol, correlational analysis. Реферат. Френкель C. КОРЕЛЯЦІЙНИЙ ВЗАЄМОЗВ’ЯЗОК МІЖ КОГНІТИВНИМИ РОЗЛАДАМИ ТА ДЕЯКИМИ БІОХІМІЧНИМИ ПОКАЗНИКАМИ У ПАЦІЄНТІВ З COVID-19. На сьогодні накопичено достатньо велику кількість наукових публікацій щодо епідеміології, діагностики, клінічних проявів, терапії та профілактики COVID-19 однак недостатньо вивченими та неоднозначними залишаються теоретичні та практичні аспекти ускладнень, які виникають на тлі COVID-19. Метa - вивчити кореляційній зв’язок між показниками тестів, що характеризували когнітивну дисфункцію та біохімічними маркерами – кортизолом та СРБ. Матеріали та методи дослідження. Дослідження проведено на базі Одеської обласної клінічної, де обстежено 120 хворих віком від 40 до 60 років з COVID-19. Когнітивні розлади у пацієнтів працездатного віку на COVID-19виявляли за допомогою нейропсихологічних тестів: шкали оцінки психічного статусу MMSE, тесту малювання годинника та тесту Лурія. Рівень кортизолу визначали за методом ST AIA-PACK CORT, концентрацію СРБ досліджували за допомогою уніфікованого методу кільцепреципітації. Оцінку взаємозв’язків було проведено на 8-у та 20-у добу дослідження. Результати дослідження. За шкалою MMSE визначались достовірні середньої сили зворотні кореляційні зв’язки між показником когнітивної дисфункції та віком пацієнтів. Встановлено пряму середню кореляцію між показниками когнітивної дисфункції за тестом Лурія на 8-у та 20-у добу перебування в стаціонарі; достовірна слабка пряма кореляція була визначена між рівнем кортизолу на 8-у добу перебування в стаціонарі та показником за тестом Лурія на 20-у добу. За тестом малювання годинника достовірна зворотна низької та середньої сили кореляція визначалася між віком пацієнтів та відповідно результатами тесту на 8-у та 20-у добу перебування в стаціонарі. Висновки. Встановлено достовірний регрес когнітивних розладів, за допомогою нейропсихологічного тестування, у пацієнтів з COVID-19 на 20-у добу лікування. Ключові слова: когнітивні розлади, С-реактивний білок, кортизол, кореляційний аналіз. &nbsp

Published
2022
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18. 756P Glypican-3 (GPC3) and NKp46 directed FLEX-NK engager antibody (CYT-303) recruits natural killer (NK) cells to tumors in a preclinical hepatocellular carcinoma (HCC) mouse model

Author

Arulanandam, A., primary, Potu, H., additional, Khairnar, V., additional, Zou, D., additional, Triggiano, M., additional, Dilmac, N., additional, Lin, L., additional, Chang, H-M., additional, Welch, A., additional, Mandelboim, O., additional, Ilan, Y., additional, Teper, D., additional, Frankel, S., additional, Kadouche, J., additional, and Li, W., additional

Published
2022
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36. Obituary

Author

Frankel, S. Herbert

Published
1928

44. Elective cancer surgery in COVID-19–Free surgical pathways during the SARS-cov-2 pandemic: An international, multicenter, comparative cohort study

Author

James C Glasbey, Dmitri Nepogodiev, Joana Ff Simoes, Omar Omar, Elizabeth Li, Mary L Venn, Mohammad Abou Chaar, Vita Capizzi, Daoud Chaudhry, Anant Desai, Jonathan G Edwards, Jonathan P Evans, Marco Fiore, Jose Flavio Videria, Samuel J Ford, Ian Ganyli, Ewen A Griffiths, Rohan R Gujjuri, Angelos G Kolias, Haytham Ma Kaafarani, Ana Minaya-Bravo, Siobhan C McKay, Helen M Mohan, Keith Roberts, Carlos San Miguel-Méndez, Peter Pockney, Richard Shaw, Neil J Smart, Grant D Stewart, Sudha Sundar, Raghavan Vidya, Aneel A Bhangu, James C Glasbey, Omar Omar, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C McKay, Emily C Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana Ff Simoes, Isobel M Trout, Mary L Venn, Richard Jw Wilkin, Aneel A Bhangu, James C Glasbey, Neil J Smart, Ana Minaya-Bravo, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran, Ewen A Griffiths, Sivesh K Kamarajah, Richard Pt Evans, Philip Townend, Keith Roberts, Siobhan McKay, John Isaac, Sohei Satoi, John Edwards, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli, Samuel Ford, Anant Desai, Alessandro Gronchi, Marco Fiore, Max Almond, Fabio Tirotta, Sinziana Dumitra, Angelos Kolias, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri, Richard Shaw, Andrew G Schache, Stuart C Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly, Raghavan Vidya, Alex Wilkins, Jagdeep K Singh, Dinesh Thekinkattil, Sudha Sundar, Christina Fotopoulou, Elaine Leung, Tabassum Khan, Luis Chiva, Jalid Sehouli, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, T S Shylasree, R Kottayasamy Seenivasagam, Joe Ng, Keiiji Fujiwara, Grant D Stewart, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan, Tobias Klatte, Joana Ff Simoes, Tom Ef Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth A Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, 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Subjects
Aged, 80 and over, Male, Critical Care, SARS-CoV-2, International Cooperation, COVID-19, Middle Aged, Cohort Studies, Logistic Models, Postoperative Complications, Elective Surgical Procedures, Neoplasms, Outcome Assessment, Health Care, Humans, Female, Epidemics, Aged
Abstract

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

Published
2021

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