ABSTRACT
Background: The coronavirus disease 2019 (COVID-19) pandemic has transformed health care delivery in the world, forcing clinicians to make challenging triage decisions. COVID-19 represents a significant harm for cancer patients, who are at high risk of infections due to their immunosuppressed status and serious COVID-19-related events. Portuguese oncologists joined forces to ensure safety of clinical practice without compromising cancer patients care, as the benefit of ensuring an anti-cancer treatment outweighs the risks of COVID-19. Methods: Description and outcomes analysis of structural organization measures adopted by a Portuguese Medical Oncology Department during the COVID-19 pandemic. Results: A proactive approach to the actual emergency panorama was promptly implemented: use of individual protection equipment, triage of patients accessing the hospital, use of telemedicine in selected patients with no need for on-site assessment, customising treatment delivery, regularly test patients under immunosuppressive treatments, test all patients prior to admission in oncology wards, limited access for visitors and caregivers, health professionals worked in “mirror teams” and most multidisciplinary boards have been converted in telematic meetings. Despite all the constraints in the activity, the number of consultations (including tele-consultations) increased compared to the same period of the previous year (3245 consultations from 1/03 to 15/05/2020 versus 3305 in the same period of 2019), the number of first consultations remained similar comparatively (15%) and were carried out in a timely manner, indicative that the cancer patient circuit was not compromised. 368 fewer treatments were performed in the same period, compared to 2019. Until May 15th, 288 tests have been carried out. Four patients were positive for COVID-19 without severity criteria, two of them with a diagnosis of cure, currently being under antineoplastic treatment without related complications. Conclusions: Practice recommendations from European and national oncology societies were applied, which translated into a safe continuum of cancer care delivery. In the middle-term, will be a priority to assess the real impact on cancer mortality. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
ABSTRACT
Objective: To analyze the epidemiological transition of fractures in patients who were treated in a tertiary hospital which is reference in traumatology during the COVID-19 pandemic to assess the changes in trauma service. Methods: This is a retrospective and descriptive analysis of data on orthopedics lesions treated at Instituto Doutor Jose Frota between December 16, 2019 and June 16, 2020 (three months before and after the first case of COVID-19 in Ceará). Results: In total, we evaluated 913 patients, 28.5% of which were women and 71.5%, men. We found a significative reduction (p < 0.05) in the proportion of female patients operated in the analyzed time. We also observed an increase in patients’ mean age, 35.4 years before the pandemic, and 38.48 (p = 0.04) during the consecutive period. Trauma mechanisms significantly changed (p < 0.05), with a proportional increase of high-energy traumas and reduction of instances of falling. We found a 11.9% reduction in orthopedic surgeries, from 655 to 577 at the time after the first case of COVID-19 (p = 0.071). Mean hospitalization length (p < 0.001) and time until surgeries decreased (p < 0.001). Conclusion: We observed the impact of lockdown in this hospital of trauma especially via the decreased number of operated cases and the change in patients’ profile and trauma mechanism. Level of Evidence III, Retrospective Comparative Study. © 2022, Acta Ortopedica Brasileira. All Rights Reserved.