ABSTRACT
‘Biological hazard' is regarded as a major human security threat to people's well-being and development. In the era of globalisation and rapid technological development, COVID-19 pandemic once again revealed how an emerging communicable disease might impact not only health but also the socioeconomic ecology of people globally, while the related health risk can be mitigated by the employment of appropriate technology. The chapter examines how the latest World Health Organization Health-EDRM framework (2019) may inform the conceptualisation and assessment of health risks and proposes a Health-EDRM assessments framework for biological hazard. A case study of how health risks and vulnerability associated with home care may be reduced by employing technology in non-standard living context during pandemic and a case study of community resilience and community engagement are also included. The discussion also puts Health-EDRM framework into a human security perspective. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer 2022.
ABSTRACT
Background: Optimizing management of gastroesophageal reflux disease (GERD) is important to preserve graft function after lung transplantation as patients with GERD are at higher risk of rejection. Patients with COVID-19 associated respiratory failure undergoing lung transplantation is an emerging subset of patients in which GERD pre- or post-transplant is not well characterized. Aim: To evaluate the prevalence and adverse effects of GERD both pre- and post-transplant in patients undergoing lung transplantation for severe COVID-19 infection. Methods: A retrospective review was conducted at a single academic medical center with a large multi-organ transplant program. All patients undergoing lung transplant due to COVID-19 from 2020-2021 were included in the study, with attention to pre- and post-operative physiological testing for GERD. Results: Seventeen patients were identified who had undergone lung transplant for COVID-19. All patients were male;52.9% (9/17) were Hispanic, 35.3% (6/17) Caucasian and 11.8% (2/17) Black. Median age was 50 (24- 70 years) with median time to transplant from documented infection of 131 days. A prehospitalization GERD diagnosis was found in 29.4% (5/17) patients, and two patients (11.8%) were taking prescribed proton-pump inhibitor (PPI) prior to their COVID-19 associated hospitalization. No patient underwent pre-transplant GERD testing, although three patients did undergo upper endoscopy for GI bleeding prior to transplant. Post-transplant, all patients were immediately treated with PPI per institutional protocol. 70.5% (12/17) patients reported post-transplant foregut symptoms including heartburn, regurgitation, dysphagia, early satiety, abdominal bloating/cramping, nausea and vomiting. All 17 patients had at least one symptomdriven foregut study such as a gastric emptying study, barium esophagram, upper endoscopy, esophageal manometry or pH testing. Three patients were referred for anti-reflux surgery (ARS) based on results of testing, including delayed gastric emptying, abnormal pH testing and bronchoscopy findings concerning for aspiration pneumonia. All three underwent Toupet fundoplication with or without hiatal hernia repair;one was performed early (< 3 mo) posttransplant, two occurred late (> 6 mo), and none had complications or symptom-based recurrence of reflux. Discussion: In this large single-center series of COVID-19 associated respiratory failure and lung transplant, pre-operative reflux testing could not be performed;however, post-transplant GERD symptoms were still routinely assessed and evaluated, prompting management with ARS in a small subset of patients, both early and late posttransplant, with resolution of GERD symptoms. Long-term outcomes of this unique group and comparison with others requiring transplant will necessitate further investigation to assess impact of GERD on allograft dysfunction.
ABSTRACT
Introduction: The COVID-19 pandemic has forced surgical educators to adopt new platforms for teaching. Evolving technologies in thoracic surgery require continuing education to the highest level of care. Our aim was to assess the safety, feasibility, and effectiveness of live-streaming surgery in teaching novel technology to practicing surgeons. Methods: Practicing physicians (n=32) participated in a virtual course on electromagnetic localization for lung nodules. Each group of three learners participated in preoperative discussion, an interactive HIPAA-compliant live-streamed operation, and postoperative debrief. Learners completed a 20-question survey. Results: All participants were satisfied to very satisfied with the virtual experience and 97% (n=31) agreed the video platform was easy to use. Most (94%) experienced good communication between the participants, but only 12.5% of learners often to always participated. On a 1-5 Likert scale with 5 being completely satisfied, learners rated the audio quality as 4.5 and the video as 4.3. Nineteen percent of the learners experienced audio interruptions and 28% experienced video interruption during the virtual course. No respondents felt that the live-stream created a distraction during the procedure and no participants felt that the technology posed a safety risk (0%). Conclusion: Live-streaming intraoperative teaching is a safe, feasible and effective means to teach novel technologies to practicing surgeons. Improvements can be made in audio and video connectivity as well as developing tools to engage more of the learners in discussion. Future directions will focus on surgeons’ adoption of technology in their own practice and their comfort with the new technology.
ABSTRACT
The COVID-19 pandemic has engendered rapid and significant changes in patient care. Within the realm of surgical training, the resultant reduction in clinical exposure and case volume jeopardizes the quality of surgical training. Thus, our general surgery residency program proceeded to develop a tailored approach to training that mitigates impact on resident surgical education and optimizes clinical exposure without compromising safety. Residents were engaged directly in planning efforts to craft a response to the pandemic. Following the elimination of elective cases, the in-house resident complement was effectively decreased to reduce unnecessary exposure, with a back-up pool to address unanticipated absences and needs. Personal protective equipment availability and supply, the greatest concern to residents, has remained adequate, while being utilized according to current guidelines. Interested residents were given the opportunity to work in designated COVID ICUs on a volunteer basis. With the decrease in operative volume and clinical duties, we shifted our educational focus to an intensive didactic schedule using a teleconferencing platform and targeted areas of weakness on prior in-service exams. We also highlighted critical COVID-19 literature in a weekly journal club to better understand this novel disease and its effect on surgical practice. The long-term impact of the COVID-19 pandemic on resident education remains to be seen. Success may be achieved with commitment to constant needs assessment in the changing landscape of healthcare with the goal of producing a skilled surgical workforce for public service.