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1.
International Journal of Stroke ; 17(2 Supplement):8-9, 2022.
Article in English | EMBASE | ID: covidwho-2079342

ABSTRACT

Background: The COVID-19 pandemic has disrupted modern healthcare and delayed time to acute stroke treatment at some centres internationally. The effect of the pandemic on time metrics in patients with a large vessel occlusion (LVO) at Australian stroke centres is unknown. Aim(s): To evaluate time metrics for patients with an LVO transferred from a primary stroke centre (PSC) to a comprehensive stroke centre (CSC), during and before the coronavirus pandemic. Method(s): Retrospective analysis of consecutive patients with an LVO who were transferred from a single PSC to any of three CSCs were enrolled. The pandemic period was defined as the 24 months following the March 2020 state of emergency declaration in Melbourne, and prepandemic period the preceding 24 months. "Door-in" was the time triaged as a stroke, and "Door-out" was the time ambulance staff departed. Result(s): 159 patients were included, 82 in the pandemic group and 77 in the pre-pandemic group. There were no significant differences between groups in patient age, sex, modified Rankin scale score, or National Institute of Health Stroke Scale score. Door-in to Door-out (DIDO) times were reduced during the pandemic (median 52 vs 66 minutes, IQR 41-66 vs 52-95 minutes, p<0.001). There was no change in time from PSC Door-in to the first CSC DSA images (median 125 vs 125 minutes, p=0.79). Within the DIDO workflow, the only significantly different metric was time from CSC advising of patient acceptance to PSC door-out, which improved (median 8 vs 14 minutes, p=0.016). DIDO times out of hours when the stroke registrar was called in also improved (median 51 vs 87 minutes, p=0.003). Conclusion(s): The median DIDO times at our PSC improved during the pandemic. Further studies are required to determine if this is due to a continued quality improvement program at our centre, or due to other factors.

3.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:7, 2021.
Article in English | EMBASE | ID: covidwho-1817128

ABSTRACT

Introduction: Preoperative carbohydrate loading in Enhanced Recovery After Surgery (ERAS) is an independent predictor of postoperative outcomes. By reducing the impact of surgical stress response, fasting-induced insulin resistance is modulated. As a clear fluid, consuming whey protein-infused carbohydrate is safe up to 2 hours preoperatively. Widely practiced in abdominal surgeries, its implementation in hip fracture surgeries is yet to be recognized. Methods: We aim to identify the feasibility of preoperative carbohydrate loading in hip fracture surgery and assess its clinical effects. A randomized controlled, open labelled trial in patients ≥ 65 years old without diabetes mellitus, has hip fracture was conducted in University Malaya Medical Centre between November 2020 and May 2021. Intervention: Carbohydrate loading (Resource-Nestle®) with 100g on the day before surgery and 50g up to 2 hours preoperatively versus standard preoperative fasting. Results: Thirty ASA 1-3 patients (carbohydrate loading and control, n = 15 each), mean age 79 years (SD±8.5), mean body mass index 23.8 (SD±3.5kg/m2) were recruited. Analysis for feasibility of carbohydrate loading (n = 15) demonstrated attrition rate of 20%, n = 3 (one participant completed the drinks but operation was postponed and two patients were not served the third drink by ward staff). Otherwise, patients were 100% compliant with no adverse events reported. 26 randomized participants were analyzed for secondary outcomes (intervention n = 12, control n = 14). There was no significant difference among groups in the postoperative nausea and vomiting, pain score, fatigue level and muscle strength assessed at 24-48 hours postoperatively. Conclusion: COVID-19 pandemic had interrupted recruitment resulting in a small number of participants. Nevertheless, this study demonstrated that implementation of preoperative carbohydrate loading is feasible for hip fracture surgeries without complications but requires careful coordination among surgical, anaesthetic and nursing teams. An adequately powered randomized controlled study is needed to examine the full benefits of preoperative carbohydrate loading in this group of patients.

4.
Med J Malaysia ; 76(1): 98-100, 2021 01.
Article in English | MEDLINE | ID: covidwho-1052661

ABSTRACT

Around June 2020, many institutions restarted full operating schedules to clear the backlog of postponed surgeries because of the first wave in the COVID-19 pandemic. In an online survey distributed among anaesthestists in Asian countries at that time, most of them described their safety concerns and recommendations related to the supply of personal protective equipment and its usage. The second concern was related to pre-operative screening for all elective surgical cases and its related issues. The new norm in practice was found to be non-standardized and involved untested devices or workflow that have since been phased out with growing evidence. Subsequent months after reinstating full elective surgeries tested the ability of many hospitals in handling the workload of non-COVID surgical cases together with rising COVID-19 positive cases in the second and third waves when stay-at-home orders eased.


Subject(s)
Anesthetists , COVID-19/diagnosis , COVID-19/prevention & control , Occupational Exposure/prevention & control , Occupational Health , Personal Protective Equipment/supply & distribution , Elective Surgical Procedures , Humans , Preoperative Period , SARS-CoV-2 , Surveys and Questionnaires , Workflow
5.
Anesth Analg ; 132(1): 15-24, 2021 01.
Article in English | MEDLINE | ID: covidwho-977697

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected and overwhelmed many health care systems around the world at an unprecedented speed and magnitude with devastating effects. In developing nations, smaller hospitals were unprepared to face this outbreak nor had strategies in place to do so at the beginning. Here, we describe the preparation in an anesthetic department using simulation-based training over 2 weeks, as the number of cases rose rapidly. METHODS: Three areas of priority were identified as follows: staff safety, patient movement, and possible clinical scenarios based on simulation principles in health care education. Staff was rostered and rotated through stations for rapid-cycle deliberate practice to learn donning and doffing of personal protective equipment (PPE) and powered air-purifying respirator (PAPR). For difficult airway management, Peyton's 4 steps for skills training and Harden's Three Circle model formed the structure in teaching the core skills. Several clinical scenarios used system probing to elicit inadequacies followed by formal debriefing to facilitate reflection. Finally, evaluation was both immediate and delayed with an online survey after 1 month to examine 4 levels of reaction, learning, behavior, and impact based on the Kirkpatrick Model. Frequency and thematic analysis were then conducted on the quantitative and qualitative data, respectively. RESULTS: A total of 15 of 16 (93%) consultants, 16 (100%) specialists, and 81 (100%) medical officers in the department completed training within 2 consecutive weeks. Reaction and part of the learning were relayed immediately to trainers during training. In total, 42 (39%) trained staff responded to the survey. All were satisfied and agreed on the relevance of training. A total of 41 respondents (98%; 95% confidence interval [CI], 87-99) answered 16 of 20 questions correctly on identifying aerosol-generating procedures (AGP), indications for PPE, planning and preparation for airway management to achieve adequate learning. About 43% (95% CI, 27-59) and 52% (95% CI, 36-68) recalled donning and doffing steps correctly. A total of 92 responses from 33 respondents were analyzed in the thematic analysis. All respondents reported at least 1 behavioral change in intended outcomes for hand hygiene practice (20%), appropriate use of PPE (27%), and airway management (10%). The emerging outcomes were vigilance, physical distancing, planning, and team communication. Finally, the impact of training led to the establishment of institutional guidelines followed by all personnel. CONCLUSIONS: Simulation-based training was a useful preparation tool for small institutions with limited time, resources, and manpower in developing nations. These recommendations represent the training experience to address issues of "when" and "how" to initiate urgent "medical education" during an outbreak.


Subject(s)
Anesthesia Department, Hospital , COVID-19/therapy , Delivery of Health Care , Developing Countries , Health Services Needs and Demand , Infection Control , Inservice Training , Simulation Training , Clinical Competence , Humans , Malaysia , Needs Assessment , Workflow
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