Background: This trial aims to investigate the effectiveness and cost implications of 'pharmaceutical care' provided by community pharmacists to elderly patients in the community. As the UK government has proposed that by 2004 pharmaceutical care services should extend nationwide, this provides an opportunity to evaluate the effect of pharmaceutical care for the elderly. Design: The trial design is a randomised multiple interrupted time series. We aim to recruit 700 patients from about 20 general practices, each associated with about three community pharmacies, from each of the five Primary Care Trusts in North and East Yorkshire. We shall randomise the five resulting groups of practices, pharmacies and patients to begin pharmaceutical care in five successive phases. All five will act as controls until they receive the intervention in a random sequence. Until they receive training community pharmacists will provide their usual dispensing services and so act as controls.The community pharmacists and general practitioners will receive training in pharmaceutical care for the elderly. Once trained, community pharmacists will meet recruited patients, either in their pharmacies (in a consultation room or dispensary to preserve confidentiality) or at home. They will identify drug-related issues/problems, and design a pharmaceutical care plan in conjunction with both the GP and the patient. They will implement, monitor, and update this plan monthly. The primary outcome measure is the 'Medication Appropriateness Index'. Secondary measures include adverse events, quality of life, and patient knowledge and compliance. We shall also investigate the cost of pharmaceutical care to the NHS, to patients and to society as a whole.
Frontmatter -- INTRODUCTION -- CONTENTS -- The Theory of Institutional Adjustment -- The Institutional Basis of a Progressive Approach to Economic Development -- Orthodox Economics and Institutionalized Behavior -- Adjustment of Economic Institutions in Contemporary: America The Trends of Changes Now Underway -- The Government and Institutional Adjustment: The American Experience -- Creative Legal Interpretation and the Process of Institutional Adjustment -- Implementing the Objective of Full Employment in Our Free Enterprise Economy -- Monetary Institutions to Serve the Modern Economy -- INDEX
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Intro -- Contents -- Preface / JoVonn G. Hill and John A. Barone -- 1. A Synopsis of Southeastern Blackland Prairies / S. Lee Echols and Wendy B. Zomlefer -- 2. Historical Distribution of Prairies in Arkansas / John A. Barone -- 3. The Use of General Land Office Survey Notes to Locate Prairie Patches in the Jackson Prairie Region / Toby Gray and Timothy J. Schauwecker -- 4. Eastern Texas Prairie Landscapes / Jason R. Singhurst and Matt White -- 5. Floristics of the Louisiana Cajun and Inland Prairies / Charles M. Allen -- 6. The Native Flora of Grasslands and Associated Woodlands in the Grand Prairie Ecoregion of Eastern Arkansas / C. Theo Witsell, Thomas L. Foti, and Brent T. Baker -- 7. Vegetation and Flora on Lowlands in the Central Black Belt of Mississippi-How Low Did the Original Prairie Go? / J. J. N. Campbell and W. R. Seymour Jr. -- 8. An Alternative Natural Distribution for Osage Orange, Maclura pomifera, Including the Prairies of the Southeast / Jennifer L. Seltzer -- 9. Prehistoric Molluscan Faunas of the Mississippi Black Prairie / Evan Peacock -- 10. The Grasshopper Fauna of Southeastern Grasslands: A Preliminary Investigation / JoVonn G. Hill -- 11. Encroachment and Persistence of Trees in Southeastern Grasslands / J. Morgan Varner -- 12. Experimental Removal of Eastern Redcedar to Restore Black Belt Prairie Remnants: Effects on Plant, Ant, and Grasshopper Communities / John A. Barone, JoVonn G. Hill, and Lisa McInnis -- 13. Conservation and Management of Subtropical Grasslands in South-Central Florida / Elizabeth H. Boughton, Patrick J. Bohlen, Steve L. Orzell, Edwin L. Bridges, and Reed F. Noss -- 14. Effects of Landscape History on Plant Communities in Semi-Natural Grassland Buffers / Jolie G. Dollar, Timothy J. Schauwecker, Samuel K. Riffell, and L. Wes Burger Jr
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We are grateful to the animal house staff for their care of the animals. This work was supported in part by the US National Institute of Health grants R01AG043972 to J.R.S. and D.B.A. and P30AG050886 and P30DK056336 to D.B.A. The opinions expressed are those of the authors and do not necessarily represent those of the N.I.H. or any other organization. A.H.A.J. was supported by an Iraqi government student scholarship. ; Peer reviewed ; Publisher PDF
Book Reviews in This Article:F. M. L. Thompson. Chartered Surveyors: the Growth of a Profession.B. W. E. Alford and T. C. Barker. A History of the Carpenters Company.C. R. Elrington (Ed.). A History of the County of Gloucester. Vol. viii. Victoria History of the Counties of England.Kathleen Major (Ed.). The Registrum Antiquissimum of the Cathedral Church of Lincoln. Vol. ix.Robert W. Dunning (Ed.). The Hylle Cartulary. Somerset Record Society, vol. 68.Ida Darlington (Ed.). London Consistory Court Wills, 1492‐1547.Howell A. Lloyd. The Gentry of South‐West Wales, 1540‐1640.Theodore K. Rabb. Enterprise & Empire: Merchant and Gentry Investment in the Expansion of England, 1575‐1630.Don M. Wolfe (Ed.). Leveller Manifestoes of the Puritan Revolution. Foreword by Charles A. Beard.Ragnhild Hatton and J. S. Bromley (Eds.). William HI and Louis XIV. Essays 1680‐1J20 by and for Mark A. Thomson.G. A. Chinnery (Ed.). Records of the Borough of Leicester. Vol. vi. The Chamberlains'' Accounts 1688‐1835.I. K. Steele. Politics of Colonial Policy: The Board of Trade in Colonial Administration, i6g6‐ij20.James L. Clifford (Ed.). Man versus Society in Eighteenth‐Century Britain. Six Points of View.University of Birmingham Historical Journal. Vol. ix, no. i. The Lunar Society of Birmingham.Timothy L. S. Sprigge (Ed.). The Correspondence of Jeremy Bentham. Vol. 1: 1752‐76. Vol. 2: 1777‐80.A. G. Banks and R. B. Schofield. Brindley at Wet Earth Colliery: An Engineering Study.Robert Craig and Rupert Jarvis. Liverpool Registry of Merchant Skips. Chetham Society, 3rd series, vol. xv.Jean Lindsay. The Canals of Scotland.E.J. Hobsbawm. Industry and Empire: An Economic History of Britain since 1750.John Francis. A History of the English Railway.Henry Grote Lewin. The Railway Mania and its Aftermath, 184.5‐1852.D. C. M. Platt. Finance, Trade, and Politics in British Foreign Policy, 1815‐1914.Seymour Shapiro. Capital and the Cotton Industry in the Industrial Revolution.David Dougan. The History of North East Shipbuilding.Archibald Prentice. History of the Anti‐Corn‐Law League. With a new introduction by W. H. Ghaloner.F. F, Rosenblatt. The Chartist Movement in its Social and Economic Aspects.P. W. Slosson. The Decline of the Chartist Movement.Donald Read. Cobden and Bright: A Victorian Political Partnership.University of GlasgowPhilip Gaskell. Morvern Transformed: A Highland Parish in the Nineteenth Century.Roy A. Church. Economic and Social Change in a Midland Town: Victorian Nottingham, 1815‐igoo.Helen Merrell Lynd. England in the Eighteen‐Eighties. Toward a Social Basis for Freedom.Peter d'A. Jones. The Christian Socialist Revival, 1877‐1914. Religion, Class, and Social Conscience in Late‐Victorian England.Basil Greenhill. The Merchant Schooners.Harry W. Richardson and Derek H. Aldcroft. Building in the British Economy between the Wars.R. W. Southern (Ed.). Essays in Medieval History selected from the Transactions of the Royal Historical Society on the Occasion of its Centenary.Sidney J. Madge. The Domesday of Crown Lands.Frances Gardiner Davenport. The Economic Development of a Norfolk Manor, 1086‐1565.R. A. Buchanan. Technology mid Social Progress.Alice Clark. The Working Life of Women in the Seventeenth Century.Bernard Jennings (Ed.). A History of Nidderdak written by the Pateley Bridge Local History Tutorial Class.W. R. Bisschop. The Rise of the London Money Market, 1640‐1826. With a Preface by H. S. Foxwell.William A. Shaw (Ed.). Select Tracts and Documents Illustrative of English Monetary History, 1626‐1730.Eric Roll. An Early Experiment in Industrial Organization: Being a History of the Firm of Boulton and Watt, 1775‐1805.H. W. Dickinson. James Watt, Craftsman and Engineer.Alexander J. Warden. The Linen Trade, Ancient and Modern.Stanley D. Chapman (Ed.). Felkin's History of the Machine‐Wrought Hosiery and Lace Manufactures.G. I. H. Lloyd. The Cutlery Trades: An Historical Study in the Economics of Small‐Scale Production.Harry Scrivenor. History of the Iron Trade.W. K. V. Gale (Ed.). Griffiths' Guide to the Iron Trade of Great Britain.Samuel Timmins (Ed.). Birmingham and the Midland Hardware District, 1866.C. A. W. Ward. A Bibliography of the History of Industry in the West Riding of Yorkshire, 175°∼1914‐ Proceedings of the Leeds Philosophical and Literary Society, Literary and Historical Section, vol. xIII, pt I.Robert Owen. The Life of Robert Owen Written by Himself with Selections from his Writings and Correspondence.Ronald Miller and David Sawers. The Technical Development of Modern Aviation.Samuel Mencher. Poor Law to Poverty Program, Economic Security Policy in Britain and the UnitedStates.David T. Gilchrist (Ed.). The Growth of the Seaport Cities, 1790‐1825.Alan R. Pred. The Spatial Dynamics of U.S. Urban‐Industrial Growth.Marvin Fisher. Workshops in the Wilderness. The European Response to American Industrialization, 1830‐1860.Jean Alexander Wilburn. Biddle's Bank: The Crucial Years.Stephen Salsbury. The State, the Investor, and the Railroad: The Boston & Albany, 1825‐i86y.Alice E. Smith. Millstone and Saw: The Origins of Neenah‐Menasha.John G. Clark. The Grain Trade in the Old Northwest.John A. Hawgood. The American West.Charles B. Dew. Ironmakers to the Confederacy: Joseph R. Anderson and the Tredegar Iron Works.Gene M. Gressley. Bankers and Cattlemen.Gerd Korman. Industrialization, Immigrants and Americanizers: The View from Milwaukee, i866‐ig2i.Gerald G. Eggert. Railroad Labor Disputes: The Beginnings of Federal Strike Policy.Thomas G. Manning. Government in Science. The United States Geological Survey, i86j‐i8q4.W. Turrentine Jackson. The Enterprising Scot. Investors in the American West after 1873.Henry F. Bedford. Socialism and the Workers in Massachusetts, 1886‐1912.Glenn Weaver. The Hartford Steam Boiler Inspection and Insurance Company, 1866‐1966.Earl W. Hayter. The Troubled Farmer, 1850‐1goo: Rural Adjustment to Industrialism.Thomas D. Clark and Albert D. Kirwan. The South since Appomattox: A Century of Regional Change.Paul W. MacAvoy. The Economic Effect of Regulation.Ralph M. Hower. History of Macy's of New York, 1858‐1919.Allen F. Davis. Spearheads for Reform: The Social Settlements and the Progressive Movement, 1890‐1914.Benjamin G. Rader. The Academic Mind and Reform: The Influence of Richard T. Ely in American Life.Louis Galambos. Competition and Cooperation: the Emergence of a National Trade Association.
Book Reviews in This Article:C. D. Ross (Ed.). The Cartulary of Cirencester Abbey, Gloucestershire.Joyce Godber (Ed.). The Cartulary of Newnham Priory.Alice Beardwood. The Trial of Walter Langton, Bishop of Lichfield, 1307‐1312.Peter Heath. Medieval Clerical Accounts. Calendar of the Patent Rolls. Preserved in the Public Record Office. Elizabeth I, vol. IV, 1566–69.E. Ashworth Underwood (Ed.). A History of the Worshipful Society of Apothecaries of London.Julia de L. Mann (Ed.). Documents Illustrating the Wiltshire Textile Trades in the Eighteenth Century.R. H. Campbell (Ed.). States of the Annual Progress of the Linen Manufacture, 1727–1754, From the Records of the Board of Trustees for Manufactures, etc., in Scotland preserved in the Scottish Record Office.Denis Gray. Spencer Perceval. The Evangelical Prime Minister, 1762‐1812.J. Oxley Parker. The Oxley Parker Papers. From the Letters and Diaries of an Essex Family of Land Agents in the Nineteenth Century.J. A. and Olive Banks. Feminism and Family Planning in Victorian England.J. W. Birch. The Isle of Man. A Study in Economic Geography.I. Gray and E. Ralph (Eds.). Guide to the Parish Records of the City of Bristol and the County of Gloucester.GENERALK. G. Davies (Ed.). Peter Skene Ogden's Snake Country Journal, 1826–27.F. H. Hinsley (Ed.). The New Cambridge Modern History.T. H. Von Laue. Sergei Witte and the Industrialization of Russia.Alec Nove. Was Stalin Really Necessary? Some Problems of Soviet Political Economy.UNITED STATESPeter J. Coleman. The Transformation of Rhode Island, 1790‐1860.Donald F. Swanson. The Origins of Hamilton's Fiscal Policies.Adna Ferrini Weber. The Growth of Cities in the Nineteenth Century.Philip Taft. Organized Labor in American History.Ralph W. Hidy, Frank Ernest Hill, and Allan Nevins. Timber and Men: The Weyerhaeuser Story.Harold F. Williamson and Arnold R. Daum. The American Petroleum Industry.Harold F. Williamson, Ralph L. Andreano, Arnold R. Daum, Gilbert C. Klose. The American Petroleum Industry.Ping Chiu. Chinese Labor in California, 1850‐1880: An Economic Study.Neal Potter and Francis T. Christy, Jr. Trends in Natural Resource Commodities: Statistics of Prices, Output, Consumption, Foreign Trade, and Employment in the United States. 1870–1957.Stanley Lebergott. Manpower in Economic Growth: The United States Record since 1800.Morton Keller. The Life Insurance Enterprise, 1885‐1910. A Study in the Limits of Corporate Power.Walter Baron von Richthofen. Cattle‐Raising on the Plains of North America.Lester Fields Sheffy. The Francklyn Land and Cattle Company: A Panhandle Enterprise, 1882‐1957.W. M. Pearce. The Matador Land and Cattle Company.William H. Harvey. Coin's Financial School.John W. Allen. Legends and Lore of Southern Illinois.David Brody. The Butcher Workman: A study of unionization.H. G. Lewis. Unionism and Relative Wages in the United States.Murray N. Rothbard. America's Great Depression.Sidney Fine. The Automobile Under the Blue Eagle.Melvin L. Greenhut and W. Whitman, (Eds.) Essays in Southern Economic Development.Victor Fuchs. Productivity Trends in the Goods and Service Sectors, 1929‐1961. A Preliminary Survey.George H. Borts and Jerome L. Stein. Economic Growth in a Free Market.Seymour E. Harris. Economics of the Kennedy Tears and a Look Ahead.Douglas Alan Fisher. The Epic of Steel.PERIODICAL LITERATUREEUROPE AND OTHER Libro (Il) Vermiglio di Corte di Roma e di Avignone del Segnale del C, della Compagnia fiorentina di Iacopo Girolami, Filippo Corbizzi e Tommaso Corbizzi, 1332‐1337.A. Sisto, Banchieri feudatari subalpini nei secoli XII‐XIV.L. Bulferetti, Agricoltura, industria e commercio in Piemonte nel secolo XVIII.G. Muttini Conti, La popolazione del Piemonte nel secolo XIX.M. Pagella, L'evoluzione economica delle colline dell' astigiano.A. Della Rovere, La crisi monetaria siciliana, 1531‐1802.A. Nobile Ventura, Le dottrine economiche nel periodo Umanistico Rinascimentale e nel Seicento.P. Rossi, I filosofi e le macchine, 1400‐1700.Dante Zanetti, Problemi alimentari di una economia preindustriale – cereali a Pavia dal 1398 al 1700.Gabriele Lombardini, Pane e denaro a Bassano tra il 1501 e il 1799.G. Capodaglio, Fondazione e rendimento della Società Italiana per le Strade Ferrate Meridionali.PERIODICAL LITERATURE, 1963.
Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.
Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.