ABSTRACT
The COVID-19 pandemic is having a significant impact on the provision of non-COVID-19 related clinical services. Early recommendations for head and neck reconstructive surgery were based on guidance from expert groups, advocating de-intensification of surgery. Since then, patient outcomes derived data has suggested that the continued practice of head and neck reconstructive surgery based upon pre-pandemic standard of care is safe if appropriate measures are in place for appropriate screening and segregation of care pathways for patients. In addition, adequate levels of personal protective equipment (PPE) are vital for both patients and the healthcare team. We present the current practice guidance within the UK National Health Service (NHS) for head and neck reconstructive surgery in the COVID-19 pandemic era in the following areas: COVID-19 testing/screening, care pathways for patients, the potential future role of immunisation against SARS-CoV-2, airway management, selection of the type of reconstruction, postoperative care and rehabilitation. The guidance produced reflect the evolving nature of the response of NHS to the COVID-19 pandemic, some of the suggested practice protocols could differ from local policies in various parts of the world however the principles which underlie these standards are the results of regular review of the needs of the patients and health service, balanced against the background of the ebb and flow of the prevalence of COVID-19 infection within the community and healthcare settings. © Frontiers of Oral and Maxillofacial Medicine. All rights reserved.
ABSTRACT
Background: One in five women will experience a maternal mental health condition or substance use disorder during pregnancy or the first year following pregnancy (Gavin, 2005, Fawcett, 2019). There are many barriers that women face when seeking perinatal mental health care including time, financial constraints, transportation, childcare concerns, and stigma (Goodman, 2009). The option of telehealth visits may help to alleviate some of these barriers. At Boston Medical Center, the largest safety net hospital in New England, the obstetrics-psychiatry clinic transitioned to telehealth during the COVID-19 pandemic. We performed qualitative interviews and collected demographic information to identify patients' experiences with telehealth vs. in person visits with those seen in the obstetrics-psychiatry clinic. Method(s): Women, from a generated list (n=90) of those who met inclusion criteria and were seen by an obstetrics-psychiatry clinic provider between 10/1/2019 and 1/20/2021, were called and asked to participate in a semi-structured, qualitative interview regarding their experience. These dates included women who experienced both in person and telehealth visits as well as only telehealth visits. Interviews were recorded and rapid analysis was performed by each individual interviewer (Palinkas, 2019). This study was determined to be exempt by the Boston University Medical Campus IRB. Result(s): Participants (n=12) had a mean age of 34.58 (SD 5.82), with 58.3% born in the US, 50% employed, 58.3% married, and 50% completed a bachelor's degree. Visits were primarily (58%) post-partum. Preliminary themes included a patient preference for telehealth visits due to the convenience, the efficiency, and the comfort of being home. However, there were notable difficulties with telehealth visits due to lack of privacy at home and issues with phone or video connection. Opinions were mixed regarding continuing telehealth in the future, with many participants advocating for the option of both telehealth and in-person appointments. Conclusion(s): Our findings suggest that patients seen in the obstetrics-psychiatry clinic appreciated many aspects of telehealth appointments, although some preferred to have the choice of in-person appointments in certain situations. More research is needed to minimize barriers to care and determine the optimal approach to provide psychiatric care for perinatal patients. References: Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T: Perinatal depression: a systematic review of prevalence and incidence. Obstet Gynecol 2005;106(5 Pt 1):1071-1083. Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM: The Prevalence of Anxiety Disorders During Pregnancy and the Postpartum Period: A Multivariate Bayesian Meta-Analysis. J Clin Psychiatry 2019;80(4):18r12527. Goodman JH: Women's attitudes, preferences, and perceived barriers to treatment for perinatal depression. Birth 2009;36(1):60-69. Palinkas LA, Zatzick D: Rapid Assessment Procedure Informed Clinical Ethnography (RAPICE) in Pragmatic Clinical Trials of Mental Health Services Implementation: Methods and Applied Case Study. Adm Policy Ment Health 2019;46(2):255-270. Copyright © 2022
ABSTRACT
BACKGROUND Hypercoagulability with thrombosis and associated inflammation has been well-documented in COVID-19, and catastrophic cerebral venous sinus thromboses (CVSTs) have been described. Another COVID-19–related complication is bacterial superinfection, including sinusitis. Here, the authors reported three cases of COVID-19–associated sinusitis, meningitis, and CVST and summarized the literature about septic intracranial thrombotic events as a cause of headache and fever in COVID-19. OBSERVATIONS The authors described three adolescent patients with no pertinent past medical history and no prior COVID-19 vaccinations who presented with subacute headaches, photosensitivity, nausea, and vomiting after testing positive for COVID-19. Imaging showed subdural collections, CVST, cerebral edema, and severe sinus disease. Two patients had decline in mental status and progression of neurological symptoms. In all three, emergency cranial and sinonasal washouts uncovered pus that grew polymicrobial cultures. After receiving broad-spectrum antimicrobials and various additional treatments, including two of three patients receiving anticoagulation, all patients eventually became neurologically intact with varying ongoing sequelae. LESSONS These cases demonstrated similar original presentations among previously healthy adolescents with COVID-19 infections, concurrent sinusitis precipitating CVST, and subdural empyemas. Better recognition and understanding of the multisystem results of severe acute respiratory syndrome coronavirus 2 and the complicated sequelae allows for proper treatment.
ABSTRACT
As the COVID-19 pandemic continues to spread around the world, unprecedented disruption to the global economy and international trade have prompted widespread fears especially when it comes to the scramble for personal protective equipment (hereinafter "PPE"), as a result of critical shortages. Government officials around the world have raised concerns about how to ensure that their countries have adequate access to PPE. Many governments have introduced trade-related measures, such as restricting exports of critical PPE and medical supplies. Governments are also mounting special efforts including temporarily revising import procedures and easing technical barriers to ensure the supply of PPE in response to a crisis-within-a-crisis. Such trade-related measures on both export restrictions and import facilitation in response to COVID-19 have brought considerable attention to the role of the multilateral trading system in promoting stability and predictability of international trade flows in a time of global crisis and have also exposed the existing limits of international trade law. This article presents an overview of both the European Union's export restrictions and import facilitation measures on PPE, as an example, and provides analyses of issues associated measures in the international trade law regime.
ABSTRACT
Late in 2020, two genetically-distinct clusters of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with mutations of biological concern were reported, one in the United Kingdom and one in South Africa. Using a combination of data from routine surveillance, genomic sequencing and international travel we track the international dispersal of lineages B.1.1.7 and B.1.351 (variant 501Y-V2). We account for potential biases in genomic surveillance efforts by including passenger volumes from location of where the lineage was first reported, London and South Africa respectively. Using the software tool grinch (global report investigating novel coronavirus haplotypes), we track the international spread of lineages of concern with automated daily reports, Further, we have built a custom tracking website (cov-lineages.org/global_report.html) which hosts this daily report and will continue to include novel SARS-CoV-2 lineages of concern as they are detected.
ABSTRACT
As the coronavirus disease (COVID-19) continues to spread around the world, international trade has prompted widespread fears especially when it comes to the scramble of essential goods. Technical barriers to trade (TBT) are necessary to ensure the quality of exports, and for the protection of human, animal, and plant life or health. TBT varies from country to country and this issue is more pronounced when it comes to personal protective equipment (PPE) amid COVID-19. Mutual recognition plays an important role in facilitating the trade of essential goods, in particular during a pandemic. However, the number of existing mutual recognition agreements (MRAs) on essential goods for a pandemic is limited. It is envisaged that in the post-pandemic future, more countries will endeavour to negotiate MRAs on essential goods. However, issues such as origin-based bias under MRAs remain arguably unclear. This article seeks to analyse the role mutual recognition plays when it comes to trade in PPE in time of global pandemic, identify the issues with existing MRAs on PPE and suggest a model provision for the future MRA negotiations. © 2021 Kluwer Law International BV, The Netherlands