Dysphagia incidence in intensive care unit patients with coronavirus disease 2019: retrospective analysis following systematic dysphagia screening.

OBJECTIVE: Post-extubation dysphagia in critically ill patients is known to affect about 18 per cent of mixed medical-surgical intensive care unit patients. This study investigated the incidence of post-extubation dysphagia in adult intensive care unit patients with coronavirus disease 2019. METHOD: This study was a retrospective analysis of consecutive intensive care unit patients prospectively screened for dysphagia. Systematic screening of all extubated intensive care unit patients at our tertiary centre was performed using the Bernese intensive care unit dysphagia algorithm. The primary outcome measure was the incidence of post-extubation dysphagia. RESULTS: A total of 231 critically ill adult coronavirus disease 2019 positive patients were included, and 81 patients remained in the final analysis after exclusion criteria were applied (e.g. patients transferred). Dysphagia screening positivity was 25 of 81 (30.9 per cent), with 28.2 per cent (22 of 78) having confirmed dysphagia by specialist examination within 24 hours (n = 3 lost to follow up). CONCLUSION: In this observational study, it was observed that the incidence of dysphagia in adult critically ill coronavirus disease 2019 patients was about 31 per cent (i.e. increased when compared with a historical pre-pandemic non-coronavirus disease 2019 intensive care unit cohort).

Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic.

INTRODUCTION: Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative "cocooning" or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. MATERIALS AND METHODS: Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. RESULTS: 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. CONCLUSION: The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.

Coronavirus disease 2019 and sudden sensorineural hearing loss.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 emerged in December 2019 in Wuhan, China, and was declared a global health emergency of international concern by the World Health Organization on 30th January 2020. It has resulted in almost 600 000 deaths to date worldwide. Sudden sensorineural hearing loss is a known complication of a number of viral infections, but there is little in the literature to date on its association with coronavirus disease 2019. CASE REPORT: This paper presents the case of a 30-year-old female staff nurse who contracted coronavirus disease 2019 and presented to our department with a significant unilateral sensorineural hearing loss confirmed on audiogram. She was treated with a course of oral steroids, but unfortunately there was no improvement in her hearing. CONCLUSION: This case report is important as it highlights the importance of having a low index of suspicion when patients present with a variety of symptoms not previously associated with coronavirus disease 2019. The paper also discusses the controversy surrounding the use of steroids in the management of this disease.

Tracheostomy stomal seeding following oral cavity resection.

BACKGROUND: Tracheal stoma recurrence following oral cavity surgery is exceedingly rare. Although several different mechanisms for this have been described, the pathogenesis still remains uncertain. METHODS: We present the case of a gentleman who presented 6-months following oral cavity SCC resection with a large fungating mass at his previous tracheostomy site, and also review the reported literature on this rare phenomenon. RESULTS: Four weeks after diagnosis of his recurrence he underwent a total laryngectomy, wide-local skin excision and reconstruction with a pectoralis major pedicled flap. He recovered well initially following his operation, however unfortunately contracted nosocomial SARS-Cov2 and succumbed from respiratory complications during his post-operative recovery. CONCLUSION: Stomal recurrence after temporary tracheostomy for oral cavity malignancies are very rare. Previously reported management of these can vary from surgical to palliative treatment. Methods to prevent these include delaying tracheostomy until after surgical resection, packing the pharynx during resection and adjuvant radiotherapy.

Prosumers in times of crisis: definition, archetypes and implications

Purpose: This paper defines prosumers in light of the COVID-19 crisis and other contexts. It addresses how prosumers helped overcome challenges caused by COVID-19 and is the first paper to develop a taxonomy of prosumers, their differentiating characteristics and the degree to which they are useful in overcoming the challenges of COVID-19. Design/methodology/approach: We conducted a literature search of the prosumer literature using the Web of Science and Scopus databases. Findings: This study solves a definitional dilemma of prosumers and develops six prosumer archetypes displaying the nuances of prosumers. The study shows that the six prosumer archetypes vary in their usefulness in addressing challenges caused by COVID-19. The findings demonstrate the micro (individual), meso (organizational) and macro (societal) benefits offered by prosumers in times of crises. Research limitations/implications: This study has some clear implications for the prosumer literature, the services literature and the crisis literature by clarifying the role of prosumers in times of crisis. Practical implications: This paper offers several implications at the micro (individual), meso (organizational), and macro (societal) levels that are offered by prosumers in times of crises. The benefits of prosumers afford individuals, service practitioners and other organizations ways to remain resilient and strong in the face of significant crises such as COVID-19. Originality/value: This paper makes three specific contributions. First, it contributes to the service literature by highlighting the role and value of prosumers in crises, an area currently under-researched. Secondly, it developed six prosumer archetypes displaying the nuances of prosumers, contributing to the prosumer literature by sharpening the focus of this versatile phenomenon and demonstrating the differential value of each type of prosumer in times of crises. Lastly, the study advances the prosumer literature by resolving the definitional dilemma of prosumers and by providing a broad, yet specific definition of prosumers that captures the different perspectives evident in the prosumer literature. © 2020, Emerald Publishing Limited.