When to operate after SARS-CoV-2 infection? A review on the recent consensus recommendation of the DGC/BDC and the DGAI/BDA.

Since the eruption of the worldwide SARS-CoV-2 pandemic in late 2019/early 2020, multiple elective surgical interventions were postponed. Through pandemic measures, elective operation capacities were reduced in favour of intensive care treatment for critically ill SARS-CoV-2 patients. Although intermittent low-incidence infection rates allowed an increase in elective surgery, surgeons have to include long-term pulmonary and extrapulmonary complications of SARS-CoV-2 infections (especially "Long Covid") in their perioperative management considerations and risk assessment procedures. This review summarizes recent consensus statements and recommendations regarding the timepoint for surgical intervention after SARS-CoV-2 infection released by respective German societies and professional representatives including DGC/BDC (Germany Society of Surgery/Professional Association of German Surgeons e.V.) and DGAI/BDA (Germany Society of Anesthesiology and Intensive Care Medicine/Professional Association of German Anesthesiologists e.V.) within the scope of the recent literature. The current literature reveals that patients with pre- and perioperative SARS-CoV-2 infection have a dramatically deteriorated postoperative outcome. Thereby, perioperative mortality is mainly caused by pulmonary and thromboembolic complications. Notably, perioperative mortality decreases to normal values over time depending on the duration of SARS-CoV-2 infection.

Pre-endoscopy SARS-CoV-2 testing strategy during COVID-19 pandemic: the care must go on.

BACKGROUND: In response to the COVID-19 pandemic, endoscopic societies initially recommended reduction of endoscopic procedures. In particular non-urgent endoscopies should be postponed. However, this might lead to unnecessary delay in diagnosing gastrointestinal conditions. METHODS: Retrospectively we analysed the gastrointestinal endoscopies performed at the Central Endoscopy Unit of Saarland University Medical Center during seven weeks from 23 March to 10 May 2020 and present our real-world single-centre experience with an individualized rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy. We also present our experience with this strategy in 2021. RESULTS: Altogether 359 gastrointestinal endoscopies were performed in the initial period. The testing strategy enabled us to conservatively handle endoscopy programme reduction (44% reduction as compared 2019) during the first wave of the COVID-19 pandemic. The results of COVID-19 rtPCR from nasopharyngeal swabs were available in 89% of patients prior to endoscopies. Apart from six patients with known COVID-19, all other tested patients were negative. The frequencies of endoscopic therapies and clinically significant findings did not differ between patients with or without SARS-CoV-2 tests. In 2021 we were able to unrestrictedly perform all requested endoscopic procedures (> 5000 procedures) by applying the rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy, regardless of next waves of COVID-19. Only two out-patients (1893 out-patient procedures) were tested positive in the year 2021. CONCLUSION: A structured pre-endoscopy SARS-CoV-2 testing strategy is feasible in the clinical routine of an endoscopy unit. rtPCR-based pre-endoscopy SARS-CoV-2 testing safely allowed unrestricted continuation of endoscopic procedures even in the presence of high incidence rates of COVID-19. Given the low frequency of positive tests, the absolute effect of pre-endoscopy testing on viral transmission may be low when FFP-2 masks are regularly used.

Perspective on mHealth concepts to ensure users’ empowerment – From adverse event tracking for COVID-19 vaccinations to oncological treatment

Mobile applications have increasingly entered the healthcare sector. Besides being daily companions, so-called mHealth applications have the potential to enable individuals to collect data, document issues, and share them with healthcare professionals to better adjust medical treatment, side effects, or quality of life. While patient empowerment should be a paramount goal, the setup of these applications in a reliable and communication-effective way is under discussion. In particular, including mHealth applications in the clinical practice routine is crucial to boost their development. Security concerns are of utmost importance as such applications deal with personal data. Considering the sensitive nature of many of the involved data, a trustworthy transfer protocol to the respective health care providers is essential to convince potential users. On the same grounds, healthcare providers, which represent another major stakeholder, might be sceptical of utilizing mHealth applications. This issue is often not prioritized by app developers, and there is a multitude of apps lacking clear and transparent data transfer concepts with a focus on both security and usability. In the following, we present and discuss two different approaches for managing and reporting sensitive clinical information and their secure inter-sectoral transfer. Both use cases are currently implemented into clinical practice, and their applicability is under constant evaluation. Besides, to empower inter-sectoral communication, both approaches have been developed in close collaboration with healthcare providers to maximize both communication and effectiveness of the mHealth applications. Based on our work, we conclude that while mHealth applications can be important in many aspects of improving health care, there are often significant limitations of mHealth-based communication, which can hamper its integration in clinical settings. To overcome these limitations, we show how to apply and re-elaborate on existing security and communication strategies. Finally, we highlight how these approaches can strengthen both patient and healthcare professionals’empowerment. CCBY