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2.
Int J Environ Res Public Health ; 19(1)2021 12 24.
Article in English | MEDLINE | ID: covidwho-1580831

ABSTRACT

(1) Background: The COVID-19 pandemic forced healthcare workers to adapt to challenges in both patient care and self-protection. Dental practitioners were confronted with a potentially high possibility of infection transmission due to aerosol-generating procedures. This study aims to present data on healthcare worker (HCW) screening, infection status of HCWs, pre-interventional testing, the use of personal protective equipment (PPE) and the economic impact of the pandemic in dental facilities. (2) Methods: Dental facilities were surveyed nationwide using an online questionnaire. The acquisition of participants took place in cooperation with the German Society for Dentistry, Oral and Maxillofacial Medicine. (3) Results: A total of 1094 private practices participated. Of these, 39.1% treated fewer than 600 patients per quarter and 59.9% treated over 600 patients per quarter. Pre-interventional testing was rarely performed in either small (6.6%) or large practices (6.0%). Large practices had a significantly higher incidence of at least one SARS-CoV-2-positive HCW than small practices (26.2% vs.14.4%, p < 0.01). The main source of infection in small practices was the private environment, and this was even more significant in large practices (81.8% vs. 89.7%, p < 0.01). The procedure count either remained stable (34.0% of small practices vs. 46.2% of large practices) or decreased by up to 50% (52.6% of small practices vs. 44.4% of large practices). Revenue remained stable (24.8% of small practices vs. 34.2% of large practices) or decreased by up to 50% (64.5% of small practices vs. 55.3% of large practices, p = 0.03). Overall, employee numbers remained stable (75.5% of small practices vs. 76.8% of large practices). A vaccination readiness of 60-100% was shown in 60.5% (n = 405) of large practices and 59.9% (n = 251) of small practices. (4) Conclusion: Pre-interventional testing in dental practices should be increased further. Economic challenges affected small practices as well as large practices. Overall, a steady employee count could be maintained. Vaccination readiness is high in dental practices, although with some room for improvement.


Subject(s)
COVID-19 , Pandemics , Dentists , Germany/epidemiology , Health Personnel , Humans , Pandemics/prevention & control , Professional Role , SARS-CoV-2 , Surveys and Questionnaires
3.
Dig Dis ; 2021 Dec 10.
Article in English | MEDLINE | ID: covidwho-1574053

ABSTRACT

COVID-19 was first described in 2019, with significant impact on everyday life since then. In 2020, the first vaccine against COVID-19 was approved. Little is known about immune response to vaccination in patients with inflammatory bowel disease (IBD). Aim of our study was to investigate antibody response to SARS-CoV-2 vaccination in IBD patients receiving immunomodulators/biologics compared to healthy controls. This was a single-center retrospective study. 72 patients with IBD were included. Data from 72 healthy employees were used as control group matched by propensity score. Blood samples were analyzed for antibody response. 65 (90.3%) patients of the IBD group received immunomodulatory therapy. Mean antibody level for IBD patients was 1257.1 U/ml (SD 1109.626) in males and 1500.1 U/ml (SD 1142.760) in females (reduced antibody response IBD group 1383.76 U/ml SD 1125.617; control group 1885.65 U/ml SD 727.572, p < 0.05)). There was no vaccination failure in IBD group. After first vaccination, side effects were reported more often in IBD patients (total symptoms IBD group 58.3 %, control group 34.5 %, p < 0.007) with the opposite after the second vaccination (total symptoms IBD group 55.4 %, control group 76 %, p = 0.077)). There was a trend to reduced immune response in elderly. Disease duration and immunomodulatory therapy had no impact on immune response. Longer time to last medication given and time passed to vaccination in IBD group seem to have a positive impact on antibody levels. High antibody response to vaccination in all patients with IBD was seen. Vaccination was well tolerated. Concomitant immunomodulatory therapy had no impact on seroconversion. Antibody levels in the IBD group were lower compared to control group.

4.
Z Gastroenterol ; 59(12): 1278-1287, 2021 Dec.
Article in German | MEDLINE | ID: covidwho-1483192

ABSTRACT

BACKGROUND: Practices and hospitals are facing great challenges in coping with the COVID-19-pandemic. So far, data on the impact of the pandemic on gastroenterological facilities are lacking, especially on a temporal course. A database is lacking, especially for the outpatient care sector. University Hospital of Augsburg was commissioned to generate data on this as a part of the collaborative project B-FAST of the Network of University Medicine (NUM). METHODS: Gastroenterological institutions nationwide were surveyed by an online questionnaire. Recruitment was carried out via the German Society of Gastroenterology, Digestive and Metabolic Diseases (DGVS) and the Professional Association of Gastroenterologists in Private Practice (bng). This manuscript provides an overview of data on the use of protective equipment, pre-interventional testing of patients, staff screening and economic impact over the course of the pandemic. RESULTS: 429 facilities answered the questionnaire. Practices tested their patients pre-interventionally significantly less often than clinics (7.8% vs. 82.6%). In clinics, inpatients (93.1%) were tested significantly more often than outpatients (72.2%). The use of personal protective equipment (PPE) increased significantly during the pandemic. It was shown that over 70% of facilities screened their staff for SARS-CoV-2 without cause. Clinics cancelled elective procedures significantly more often than practices in quarter 4/2020. Procedures and turnover decreased in 2020 compared to the previous year. However, fewer facilities were affected by a loss of revenue than expected in previous studies. CONCLUSION: Our data demonstrate the variable implementation of pre-interventional SARS-CoV-2 testing in outpatient and inpatient care. The use of adequate PPE and staff screening increased during the pandemic.


Subject(s)
COVID-19 , COVID-19 Testing , Endoscopy, Gastrointestinal , Germany/epidemiology , Humans , SARS-CoV-2
5.
United European Gastroenterol J ; 9(9): 1081-1090, 2021 11.
Article in English | MEDLINE | ID: covidwho-1469560

ABSTRACT

BACKGROUND: Corona virus disease 2019 (COVID-19) patients are at increased risk for thromboembolic events. It is unclear whether the risk for gastrointestinal (GI) bleeding is also increased. METHODS: We considered 4128 COVID-19 patients enrolled in the Lean European Open Survey on SARS-CoV-2 (LEOSS) registry. The association between occurrence of GI bleeding and comorbidities as well as medication were examined. In addition, 1216 patients from COKA registry were analyzed focusing on endoscopy diagnostic findings. RESULTS: A cumulative number of 97 patients (1.8%) with GI bleeding were identified in the LEOSS registry and COKA registry. Of 4128 patients from the LEOSS registry, 66 patients (1.6%) had a GI bleeding. The rate of GI bleeding in patients with intensive care unit (ICU) admission was 4.5%. The use of therapeutic dose of anticoagulants showed a significant association with the increased incidence of bleeding in the critical phase of disease. The Charlson comorbidity index and the COVID-19 severity index were significantly higher in the group of patients with GI bleeding than in the group of patients without GI bleeding (5.83 (SD = 2.93) vs. 3.66 (SD = 3.06), p < 0.01 and 3.26 (SD = 1.69) vs. 2.33 (SD = 1.53), p < 0.01, respectively). In the COKA registry 31 patients (2.5%) developed a GI bleeding. Of these, the source of bleeding was identified in upper GI tract in 21 patients (67.7%) with ulcer as the most frequent bleeding source (25.8%, n = 8) followed by gastroesophageal reflux (16.1%, n = 5). In three patients (9.7%) GI bleeding source was located in lower GI tract caused mainly by diverticular bleeding (6.5%, n = 2). In seven patients (22.6%) the bleeding localization remained unknown. CONCLUSION: Consistent with previous research, comorbidities and disease severity correlate with the incidence of GI bleeding. Also, therapeutic anticoagulation seems to be associated with a higher risk of GI bleeding. Overall, the risk of GI bleeding seems not to be increased in COVID-19 patients.


Subject(s)
COVID-19/epidemiology , Endoscopy, Gastrointestinal , Gastrointestinal Hemorrhage/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anticoagulants/adverse effects , Child , Child, Preschool , Comorbidity , Critical Illness , Diverticular Diseases/diagnosis , Europe/epidemiology , Female , Gastroesophageal Reflux/complications , Gastrointestinal Hemorrhage/etiology , Hospitalization , Humans , Infant , Intensive Care Units , Male , Middle Aged , Peptic Ulcer/diagnosis , Registries , Severity of Illness Index , Young Adult
6.
Endosc Int Open ; 9(10): E1556-E1560, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1428940

ABSTRACT

Background and study aims The European Society of Gastrointestinal Endoscopy (ESGE) has defined COVID-19 infection prevention and control strategies within the endoscopy unit. These include pre-endoscopic questionnaire-based risk-stratification as well as pre-procedure viral testing. Real-life data on the effectiveness of these measures are presented here. Patients and methods Data from the outpatient endoscopic unit of the University Hospital Augsburg between July 1, 2020 and December 31, 2020 including the second pandemic wave were reviewed retrospectively. All patients were assessed with a pre-endoscopic risk-stratification questionnaire as well as viral testing using an antigen point-of-care test (Ag-POCT) in conjunction with a standard polymerase chain reaction (PCR) test. Highly elective procedures were postponed. The theoretically expected number of SARS-CoV-2-positive patients was simulated and compared with the actual number. In addition, endoscopy staff was evaluated with a rapid antibody test to determine the number of infections among the personnel. Results In total, 1029 procedures, 591 questionnaires, 591 Ag-POCTs, and 529 standard PCR tests were performed in 591 patients. 247 procedures in 142 patients were postponed. One Ag-POCT was positive but with a negative PCR test, while one PCR test was positive but with a negative Ag-POCT. This was lower than the theoretically expected number of COVID-19-positive patients (n = 15). One of 43 employees (2.3 %) in the outpatient endoscopy unit was seropositive. Conclusions Pre-endoscopic risk management including questionnaire-based risk stratification and viral testing seems to be an effective tool in combination with personal protective equipment for SARS-CoV-2 infection prevention and control within the endoscopy unit even in a high-prevalence setting.

7.
BMC Infect Dis ; 21(1): 798, 2021 Aug 10.
Article in English | MEDLINE | ID: covidwho-1352650

ABSTRACT

OBJECTIVES: The gold standard for diagnosing an infection with SARS-CoV-2 is detection of viral RNA by nucleic acid amplification techniques. Test capacities, however, are limited. Therefore, numerous easy-to-use rapid antigen tests based on lateral flow technology have been developed. Manufacturer-reported performance data seem convincing, but real-world data are missing. METHODS: We retrospectively analysed all prospectively collected antigen tests results performed between 23.06.2020 and 26.11.2020, generated by non-laboratory personnel at the point-of-care from oro- or nasopharyngeal swab samples at the University Hospital Augsburg and compared them to concomitantly (within 24 h.) generated results from molecular tests. RESULTS: For a total of 3630 antigen tests, 3110 NAAT results were available. Overall, sensitivity, specificity, NPV and PPV of antigen testing were 59.4%, 99.0%, 98.7% and 64.8%, respectively. Sensitivity and PPV were lower in asymptomatic patients (47.6% and 44.4%, respectively) and only slightly higher in patients with clinical symptoms (66.7% and 85.0%, respectively). Some samples with very low Ct-values (minimum Ct 13) were not detected by antigen testing. 31 false positive results occurred. ROC curve analysis showed that reducing the COI cut-off from 1, as suggested by the manufacturer, to 0.9 is optimal, albeit with an AUC of only 0.66. CONCLUSION: In real life, performance of lateral-flow-based antigen tests are well below the manufacturer's specifications, irrespective of patient's symptoms. Their use for detection of individual patients infected with SARS-CoV2 should be discouraged. This does not preclude their usefulness in large-scale screening programs to reduce transmission events on a population-wide scale.


Subject(s)
COVID-19 , Humans , Nucleic Acid Amplification Techniques , RNA, Viral , Retrospective Studies , SARS-CoV-2 , Sensitivity and Specificity
8.
Rofo ; 193(10): 1189-1196, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1127196

ABSTRACT

PURPOSE: To evaluate imaging patterns of a COVID-19 infection of the lungs on chest radiographs and their value in discriminating this infection from other viral pneumonias. MATERIALS AND METHODS: All 321 patients who presented with respiratory impairment suspicious for COVID-19 infection between February 3 and May 8, 2020 and who received a chest radiograph were included in this analysis. Imaging findings were classified as typical for COVID-19 (bilateral, peripheral opacifications/consolidations), non-typical (findings consistent with lobar pneumonia), indeterminate (all other distribution patterns of opacifications/consolidations), or none (no opacifications/consolidations). The sensitivity, specificity, as well as positive and negative predictive value for the diagnostic value of the category "typical" were determined. Chi² test was used to compare the pattern distribution between the different types of pneumonia. RESULTS: Imaging patterns defined as typical for COVID-19 infections were documented in 35/111 (31.5 %) patients with confirmed COVID-19 infection but only in 4/210 (2 %) patients with any other kind of pneumonia, resulting in a sensitivity of 31.5 %, a specificity of 98.1 %, and a positive and negative predictive value of 89.7 % or 73 %, respectively. The sensitivity could be increased to 45.9 % when defining also unilateral, peripheral opacifications/consolidations with no relevant pathology contralaterally as consistent with a COVID-19 infection, while the specificity decreases slightly to 93.3 %. The pattern distribution between COVID-19 patients and those with other types of pneumonia differed significantly (p < 0.0001). CONCLUSION: Although the moderate sensitivity does not allow the meaningful use of chest radiographs as part of primary screening, the specific pattern of findings in a relevant proportion of those affected should be communicated quickly as additional information and trigger appropriate protective measures. KEY POINTS: · COVID-19 infections show specific X-ray image patterns in 1/3 of patients.. · Bilateral, peripheral opacities and/or consolidations are typical imaging patterns.. · Unilateral, peripheral opacities and/or consolidations should also raise suspicion of COVID-19 infection.. CITATION FORMAT: · Kasper J, Decker J, Wiesenreiter K et al. Typical Imaging Patterns in COVID-19 Infections of the Lung on Plain Chest Radiographs to Aid Early Triage. Fortschr Röntgenstr 2021; 193: 1189 - 1196.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Humans , SARS-CoV-2 , Triage
9.
Endoscopy ; 53(2): 156-161, 2021 02.
Article in English | MEDLINE | ID: covidwho-882960

ABSTRACT

BACKGROUND: Infection prevention strategies to protect healthcare workers in endoscopy units during the post-peak phase of the COVID-19 pandemic are currently under intense discussion. In this paper, the cost-effectiveness of routine pre-endoscopy testing and high risk personal protective equipment (PPE) is addressed. METHOD: A model based on theoretical assumptions of 10 000 asymptomatic patients presenting to a high volume center was created. Incremental cost-effectiveness ratios (ICERs) and absolute costs per endoscopy were calculated using a Monte Carlo simulation. RESULTS: ICER values for universal testing decreased with increasing prevalence rates. For higher prevalence rates (≥ 1 %), ICER values were lowest for routine pre-endoscopy testing coupled with use of high risk PPE, while cost per endoscopy was lowest for routine use of high risk PPE without universal testing. CONCLUSION: In general, routine pre-endoscopy testing combined with high risk PPE becomes more cost-effective with rising prevalence rates of COVID-19.


Subject(s)
COVID-19/prevention & control , Cost-Benefit Analysis , Endoscopy/economics , Occupational Exposure/prevention & control , Personal Protective Equipment , COVID-19/diagnosis , Humans , Infection Control/economics , Occupational Exposure/economics , Pandemics
12.
Frontline Gastroenterol ; 11(6): 454-457, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-620662

ABSTRACT

OBJECTIVE: The COVID-19 crisis has impacted on all aspects of health care including medical education and training. We describe the disruption of endoscopy training in a tertiary care center in Germany. DESIGN/METHOD: The reorganization of a high-volume endoscopy unit during the German COVID-19 outbreak is described with special focus on endoscopy trainees. Changes in case volume of gastroenterology fellows were evaluated and compared to a year prior to the outbreak. RESULTS: Reallocation of resources led to the transfer of gastroenterology fellows to intensive care and infectious disease units. Case volume of fellows declined between January and April 2020 by up to 63%. When compared with data from the year prior to the outbreak, endoscopy performed by fellows reduced by up to 56%. Educational meetings and skill evaluation were cancelled indefinitely. CONCLUSION: The COVID-19 outbreak has had a negative impact on endoscopy training of gastroenterology fellows in a high-volume center in Germany. This must be taken into consideration when planning "return-strategies" after the pandemic.

13.
Endoscopy ; 52(6): 483-490, 2020 06.
Article in English | MEDLINE | ID: covidwho-72296

ABSTRACT

We are currently living in the throes of the COVID-19 pandemic that imposes a significant stress on health care providers and facilities. Europe is severely affected with an exponential increase in incident infections and deaths. The clinical manifestations of COVID-19 can be subtle, encompassing a broad spectrum from asymptomatic mild disease to severe respiratory illness. Health care professionals in endoscopy units are at increased risk of infection from COVID-19. Infection prevention and control has been shown to be dramatically effective in assuring the safety of both health care professionals and patients. The European Society of Gastrointestinal Endoscopy (www.esge.com) and the European Society of Gastroenterology and Endoscopy Nurses and Associates (www.esgena.org) are joining forces to provide guidance during this pandemic to help assure the highest level of endoscopy care and protection against COVID-19 for both patients and endoscopy unit personnel. This guidance is based upon the best available evidence regarding assessment of risk during the current status of the pandemic and a consensus on which procedures to perform and the priorities on resumption. We appreciate the gaps in knowledge and evidence, especially on the proper strategy(ies) for the resumption of normal endoscopy practice during the upcoming phases and end of the pandemic and therefore a list of potential research questions is presented. New evidence may result in an updated statement.


Subject(s)
Coronavirus Infections/transmission , Endoscopy, Gastrointestinal/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Pneumonia, Viral/transmission , Risk Management/standards , COVID-19 , Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Risk Management/methods
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