Aerosol exposure during surgical tracheotomy with and without laminar air flow

Introduction In the context of the current SARS-CoV-2 pandemic, aerosol generating activities have moved into focus. In the field of ENT surgery, one such activity is tracheotomy. The aim of this study was to clarify the aerosol exposure during tracheotomy. Material and method To simulate the air flow during a tracheotomy an airway model filled with artificial fog was developed. With the help of a projector the dispersion of the fog was visualized and video documented for further evaluation. The evaluation was performed with and without a laminar airflow system. Results Without LAF the aerosol was only slowed down by gravity. Approximately 50% of the aerosol volume reached the face of the surgeon. With LAF the aerosol rose about 40 cm upwards for about 1.6 seconds. During this ascent was noticeably slowed down. Afterwards, the flow was reversed to a large extent and began sinking. Nevertheless, approx. 4.8 ± 3.4% of the aerosol volume reached the surgeon's face. Discussion Although the LAF systems mandatory in German operating theatres considerably reduce the amount of aerosol that reaches the surgeon's face, a relevant measurable proportion still was detected in front of the surgeon's face mask. Wherever possible the protective measures in the context of a surgical tracheotomy should include performing the tracheotomy under a laminar air flow.

Survey-based analysis of the treatment quality of head-and-neck tumor-patients using telephone consultation

Introduction At the time of the Covid19 pandemic and the associated reduction of outpatient contacts, further care of tumor patients must be ensured. For this purpose, a telephone consultation was established for the discussion of medical findings and for the planning of procedures as part of the aftercare. The aim of this study is to measure the quality of care in telephonic patient care. Method Following a medical teleconsultation, patients were given a standardised questionnaire (EvaSys) and the quality of the interviews was queried according to defined criteria (general, technical implementation/organisation, content, summary). Results In terms of technical implementation, the majority considered the quality of the connection, timeframes and punctual contact to be good. Findings and further proceedings were largely well understood in terms of content, own concerns could be expressed, there was room for questions and despite tumor disease and possible anatomical limitations, communication was sufficiently possible. The lack of travel and the lower waiting time were perceived positively, but the majority of patients lacked physical examination and the inclusion of relatives. Conclusion The establishment of a telephone consultation is not considered a substitute for personal appointments, but seems to be feasible for selected contacts. It means conserving resources, increasing safety for patients and medical staff, and increasing time efficiency. Despite the mentioned advantages in time, travel, etc., the lack of involving relatives and the lack of physical examination lead to the overwhelming desire for a personal presentation.

[Development of the publication activity at the German university hospitals for Otorhinolaryngology, Head and Neck Surgery during the SARS-CoV-2-pandemic in 2020]

INTRODUCTION: The SARS-CoV-2 pandemic has led to profound limitations in patient care and student teaching at the University Hospitals of Otorhinolaryngology (ORL). In contrast, the impact on research has been variable. To classify the pandemic-related effect on research, the development of the number of scientific publications of the German ORL university hospitals before and during the pandemic was analyzed. MATERIAL AND METHODS: The publication performance between 2015 and 2020 of the 39 current chairmen was surveyed using a literature search (Pubmed). All entries relating to the chairmen of the university hospital as first, last or co-author were included. The absolute and relative development of each author's publication performance was determined and evaluated using nonparametric statistical methods. RESULTS: A total of 2420 publications could be documented. From 2015 to 2019, an average of 368 publications were published per year. In 2020, this number increased by 57.9 % to 581 publications. While the number of monthly publications remained constant between 2015 and 2019, a significant increase was seen from May 2020 up to a maximum of 74 publications in September 2020. In 2020, 34 articles (5.9 %) had a thematic relation to the SARS-CoV-2 pandemic, with 7 of these papers (20.6 %) resulting from cross-site publications. CONCLUSION: In 2020, the number of scientific publications was raised to more than 1.5 times the usual annual publications. This increase was clearly related in time to the reduction of elective patient care during the SARS-CoV-2 pandemic starting in mid-March 2020. Probably, free time capacities enabled this increased publication output. Our results confirm the great scientific potential of the ORL university hospitals, which has been successfully implemented despite the pandemic.

[Effects of the SARS-CoV­2 pandemic on the otolaryngology university hospitals in the field of research, student teaching and specialist training]. / Auswirkungen der SARS-CoV­2-Pandemie auf die universitäre Hals-Nasen-Ohren-Heilkunde im Bereich der Forschung, Lehre und Weiterbildung.

BACKGROUND: From spring 2020, SARS-CoV­2 began to spread worldwide, with what is now known as the first wave of the pandemic, starting in March 2020. This resulted in restructuring and shift of resources at many hospitals. The aim of our work was to detect the effects of the pandemic on the german Oto-Rhino-Laryngology (ORL) university hospitals in terms of research, student teaching and further specialist training. MATERIAL AND METHODS: The chairmen of the 39 ORL university hospitals in Germany were asked about the effects of the pandemic on research, student teaching and ORL specialist training (residency) in the period from March to April 2020 using a structured online survey. RESULTS: All 39 chairmen took part in the survey. Of these, 74.4% (29/39) stated that their research activities had deteriorated as a result of the pandemic. In 61.5% (24/39) pandemic-related research issues were addressed. All hospitals reported a restriction for in-house teaching and 97.5% (38/39) introduced new digital teaching methods. During the observation period, 74.4% of the chairmen did not see ORL specialist training (residency)at risk. CONCLUSION: Our results provide an insight into the heterogeneous effects of the pandemic. The fast processing of pandemic-related research topics and the introduction of innovative digital concepts for student teaching impressively demonstrates the great innovative potential and the ability of the ORL university hospitals to react quickly in order to maintain their tasks in research, student teaching and ORL specialist training in the best possible way even during the pandemic.

[Effects of the SARS-CoV-2 pandemic on the otorhinolaryngology university hospitals in the field of medical care]. / Auswirkungen der SARS-CoV-2-Pandemie auf die universitäre Hals-Nasen-Ohrenheilkunde im Bereich der Krankenversorgung.

INTRODUCTION: Since December 2019, the SARS-CoV-2 virus has been rapidly spreading worldwide. In Germany, an exponential increase in the number of infections was registered at the beginning of March 2020 and led to a call of the Ministry of Health to create more capacity for intensive medical treatment in hospitals. The aim of the present study was to determine the effects of the SARS-CoV-2 pandemic on Oto-Rhino-Laryngology (ORL) university hospitals regarding patient care. MATERIALS AND METHODS: An online survey was sent out to all chairmen of the 39 ORL university hospitals in Germany. The answers to the questions referred to the defined period from March 15th to April 15th 2020 and were carried out using the online survey tool "SurveyMonkey". 87 questions focused on general information, health care, and structural effects in the respective institution. RESULTS: All chairmen of the 39 university hospitals in Germany participated in the survey. The collected data prove the considerable impact on organizational, structural and medical aspects of patient care. For example, the surveyed clinics reported a decrease in outpatient cases by 73.8 % to 26.2 ±â€Š14.2 % and in surgical treatments by 65.9 % to 34.1 ±â€Š13.9 %. In contrast, emergency treatment remained unchanged or even increased in 80 % of the facilities and surgical treatment of emergency patients remained unchanged or even increased in more than 90 %. Emergency outpatient and surgical treatment of patients was provided throughout the pandemic in all facilities. In total, about 35 000 outpatients and about 12 000 surgical cases were postponed. As a result of the acute structural changes, the potential danger of falling below current treatment standards was seen in individual areas of patient care. DISCUSSION: The assessment of the impact of the SARS-CoV-2 pandemic is heterogeneous. The majority of the chairmen are critically aware of the risk of falling below current medical treatment standards or guidelines. In the phase of an exponential increase in the number of infections, significant changes in treatment processes had to be accepted for understandable reasons. However, with the currently significantly reduced number of infections, falling below treatment standards and guidelines should not be allowed to remain constant and tolerated. SUMMARY: This study shows a differentiated picture with regard to the effects of the SARS-CoV-2 pandemic on outpatient, inpatient and operative patient care at the ORL university hospitals in Germany and illustrates the importance of these institutions for ensuring patient care during this critical phase.