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INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.
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OBJECTIVES/GOALS: Evaluate the impact of COVID-19 on oral clefts services including surgical and dental treatments in Puerto Rico. METHODS/STUDY POPULATION: This Observational retrospective cohort study will consider patients 0-21 y/o with CL/P that visited the UPR school of Dental Medicine, Pediatric University Hospital Dr. Antonio Ortiz and ongoing case-control research project Face-Genes. Records to be used are classified as follow: Pandemic (March 15, 2020 to March 15 2022) Pre-pandemic (March 15, 2015 to March 15, 2017) Power analysis (power=0.80 alpha=0.05) will be calculated. Unavailable and incomplete medical records and those that did not attended study clinic during study period will be excluded. Data extraction instrument will be based on previous published study. Descriptive statistics, Chi-square, Odds Ratios at 95% confidence intervals and multiple logistic regression will be estimated. RESULTS/ANTICIPATED RESULTS: We hypothesize that surgical and dental services in Puerto Rico will be adversely impacted because of COVID-19 pandemic. DISCUSSION/SIGNIFICANCE: CL/P are common congenital diseases that require early interdisciplinary attention. Lack of timely care as well as surgery and treatment delays, could be associated with poorer prognosis, increased morbidity and mortality. If there is high risk of dh services during emergency situations, our findings will help to allocate the available resources
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OBJECTIVES: Professionals in the United Kingdom providing care to new families affected by cleft lip and/or palate (CL/P) had to adapt to ensure families' needs were met during a time of uncertainty due to Covid-19. The aims of this study were to explore the impacts of the pandemic on CL/P care provision for new families from the perspectives of professionals working in medical and community settings along with any personal impact on professionals and their reflections on the future of CL/P care. DESIGN: Semistructured interviews (n = 27) were completed about experiences from March 2020 to October 2020 with consultant cleft surgeons (n = 15), lead clinical nurse specialists (n = 8), and staff working at the Cleft Lip and Palate Association (n = 4). Transcripts were analyzed using inductive thematic analysis. RESULTS: Three themes were identified: (1) the impact of Covid-19 on the provision of cleft care in the United Kingdom, including working conditions, delays to treatment, and Covid-19 policies; (2) the impact of the pandemic on professionals' mental health, including personal distress and concerns about Covid-19 exposure; and (3) reflections on the future of CL/P care, whereby professionals expressed both hope and concern about the Covid-19 recovery effort. CONCLUSIONS: The ongoing Covid-19 pandemic has impacted CL/P service delivery for new families significantly, warranting recommendations for cohesive psychological support for families in addition to a safe and resourced recovery effort. Support for professionals is also suggested, following existing evidence-based models for providers' needs that address the difficulties of working throughout challenging times.
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Objective: The objective of this study was to determine factors that may affect anesthesia and surgical complications, difficult airway, and the need for intensive care unit (ICU) care in cleft lip and cleft palate (CLCP) surgeries. Materials and Methods: The study was a retrospective review of the records of 617 patients who underwent CLCP surgery between 2015–2019. Results: The number of anesthesia complications was higher in patients with difficult mask ventilation. Surgical complications were more common in patients >1 year of age. Isolated cleft palate (CP) surgery;presence of a concomitant disease, syndrome, or micrognathia;age >1 year;and the CP subtype were associated with a higher rate of difficult intubation. Isolated cleft palate, concomitant disease, syndrome, micrognathia, difficult intubation, difficult mask ventilation, and anesthesia complications were associated with ICU admission. Conclusion: The CP subtype was associated with a higher rate of difficult intubation and ICU hospitalization even in patients who were nonsyndromic and/or >1 year of age. Therefore, special attention should be paid to the anesthesia and surgical management of these patients.
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Background/Purpose: Nutritional education and lactation support are key strategies to maintain a healthy nutritional status for a patient with cleft lip and palate. For this reason, specialized health personnel should receive up-to-date training and have the necessary tools for timely diagnosis and nutritional treatment. Smile Train organized a virtual course that included 15 modules of innovations in nutrition for partner centers in the Mexico, Central America, and the Caribbean during the SARS-COV2 pandemic. Methods/Description: The course was conducted virtually by two nutrition experts and five international guests in weekly sessions from August to November 2020. The course covered concepts of nutrition care, clinical evaluation, dietetics, feeding stages and approaches to associated disorders, malnutrition, overweight and selective feeding. During the course, participants evaluated sociodemographic variables, effectiveness, satisfaction, the confidence of acquired knowledge and application of knowledge in the short and medium term through questionnaires, which were validated statistically. Descriptive statistics, the Kolmogorov-Smirnoff normality test, Student's test for the effectiveness variable, and Fisher's exact test for dichotomous variables were used. Results: Sixty-eight health professionals from 26 comprehensive cleft care centers in 7 countries participated in the course. 90.2% of participants identified as female and 9.8% identified as male, with an average age of 38.42, and an average of 10 years of experience with cleft lip and palate. The course was effective in 97% of participants, which is an increase in percentage when comparing before [x=63.67 (45 89)] and after the course [x= 84.60 (65-95)], (p<0.001). The overall satisfaction of users was very high (9.78/ 10.0), and can be broken down to these categories: 1. Content and materials (9.84/10) 2. Course design (9.75/10) 3. Instructors and professors (9.8/10) 4. Acquired knowledge (9.73/10) 5. Organization (sending materials, evaluations and (9.84/10) 6. Recommendation of the course to colleagues (9.92/10) 7. Clarity of information (9.55/ 10) The confidence in the acquired knowledge and its possible application in the short and medium term was greater than 96%, given that the course provided tools for clinical application. 98.4% of participants considered the course to be stimulating, 98.2% have a greater interest in the subject, 98% considered learning new content in this area, 99% considered the course to be effective and to increase competencies on nutritional diagnosis and treatment. 98% of the professionals thought the course improved their clinical performance and 90.2% believed they had sufficient tools to change their nutritional practice in the short and medium term. Conclusions: The educational intervention on nutrition for patients with cleft was effective and highly satisfactory, confirming that a virtual space offers the possibility of execution, accessibility, and adoption of knowledge.
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Background/Purpose: Cleft Surgery in our centre is delivered by a single specialist surgeon in a regional Burns and Plastic service. We see 35-45 cleft-affected births per annum and, prior to the COVID-19 pandemic, ran 6 theatre lists per month, conducting 170-180 cleft procedures annually. The pandemic severely hindered elective operating in even tertiary centres, due to the redeployment of theatre staff and resources to manage the emergency care load. Cleft surgery was suspended entirely during the first wave (March-June 2020), before efforts in collaboration with the RCPCH (UK) to conserve the cleft pathway restored it as a priority. Primary palatine reconstruction is recommended at 6-9 months of age to optimise velopharyngeal function and speech proficiency by 5 years (Slater et al 2019). Our service was restarted at 1-2 ad hoc lists a month, which was both insufficient to manage ongoing demands and deal with rising outstanding cases. We faced a major challenge in safely distributing scarce surgical time and capacity across the entire cleft surgical burden. Therefore, we aim to examine our response to these limitations in the face of rising cases and time pressures, illustrating our methods in prioritising cleft procedures. Methods/Description: We reviewed the current literature to determine which of the main cleft procedures were most time critical, and compiled a cleft priority document with a broad evidence basis. Babies with palate involvement were top priority, in light of the strong evidence advocating primary palate repair by 13 months of age (CRANE 2020), after which there is a risk of speech delay (Shaffer et al 2020). Primary lip +/- alveolar involvement were prioritised lower and performed later (∼1 year), as cosmesis during infancy was deemed less detrimental, although there remained the psychological impact on the parent (Grollemund et al 2020). Secondary speech surgery was next, the lack of which can inhibit education and require intensive speech therapy to support patients (Baillie and Sell 2020). This was followed by alveolar bone grafting, ideally performed prior to canine eruption at ∼8-9 years to limit further dental reconstructions (Vandersluis et al 2020). As per national consensus, all adult cleft surgery was suspended to accommodate higher priorities. Focusing on early palate repair helped restart the cleft pathway and prevent functional delay as well as further interventions and schoolage support. However, late lip repair saw a rise in complications - two cases of dehiscence were associated with self-inflicted toddler trauma. This is in addition to the psychosocial implications of cosmesis, including early maternal interactions (Montirosso et al 2011), stigmatisation by peers (Bous et al 2021), and parental anxiety (Bous et al 2020). We recommend isolated lip reconstructions are also undertaken within 9 months. Long-term physical and psychosocial impacts of delay in surgery should guide resource allocation in the event of future operating limitations.
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Background/Purpose: During the COVID 19 pandemic in Brazil, for a period of six months to a year and by determination of the National Supplementary Health Agency (ANS), elective health procedures were suspended in public and private hospitals, including cleft lip and palate treatment. The measure took into account the high occupancy rates of Intensive Care Unit (ICU) beds in the country and the prevention of contamination. For a condition such as cleft lip and palate, can be harmful to the patient. To report the impacts on cleft lip and palate treatment during the COVID 19 pandemic in Brazil. Methods/Description: Exploratory and descriptive research with 55 accredited cleft lip and palate treatment centers and partners of an international philanthropic institution. Results: Among the of 55 partners centers (100%), 11% provided essentially multidisciplinary outpatient care and 89% provided surgical procedures besides the outpatient care. In the latter, 100% of the surgeries were postponed but, with the support of the International Philanthropic Institution, the 55 centers continued to provide integral care, including nutrition, speech therapy, social service, dentistry and psychological support to the patients through telemedicine. This online working method has saved lives, such as breastfeeding and proper nutritional counseling for mothers of babies born with the malformation. Doctors from these partner centers have treated thousands of patients remotely, providing vital guidance to families, following up with new patients who were waiting for their surgeries. They also received personal protective equipment (PPE) and essential equipment, such as pulse oximeters and non-contact infrared thermometers, so they could continue to care for patients with clefts, protecting against COVID-19. As government restrictions begin to ease around the world, there is a cautious resumption of free cleft lip and palate surgeries and life-saving outpatient follow-ups. Partner centers are developing safe surgery guidelines in accordance with regulations and recommendations from local and global Medical Advisory Boards allowing for continuity of care and a full and productive life for patients. Conclusions: The COVID-19 pandemic postponed the treatment of many children with cleft lip and palate in Brazil, but gave the partner centers the possibility to study in depth the problems relevant to clinical practice. It was in this context that the International Philanthropic Institution promoted online training with the teams, covering the integral care of the cleft patient, from the first consultation to the surgical treatment and multidisciplinary continuity.
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Background/Purpose: COVID-19 fundamentally changed cleft teams' ability to care for their patients. This study aims to study;1) the effect of COVID-19 on elective surgery timings and outcomes;2) preoperative screening and isolation protocols;3) the impact of operating with personal protective equipment (PPE). Methods/Description: Between the start of the first UK lockdown in March 2020 and April 2021 operative details from 651 cleft procedures performed in eight UK centres were entered into a secure REDCap database. Results: 651 records were entered (59% male, 41% female). 9% patients had a known syndrome. Operations were as follows: cleft palate repair (40%), unilateral cleft lip repair +/- vomer flap (23%), alveolar bone grafting (16%), secondary speech surgery (10%), fistula repair (3.7%), lip revision (1%) and rhinoplasty (1%). 39% of surgical cases were deemed delayed compared to normal protocol timings, with 80% of the delays attributable to COVID. Mean age at initial cleft lip repair was 230 days exceeding a previous representative mean of 137 days as well as breaching the UK national standards for upper age limit of 183 days. Mean age at cleft palate repair was 387 days compared to the UK national standard for upper age limit of 396 days, and previous representative mean of 320 days. 81% of patients undertook some form of pre-operative isolation;47% isolated for two weeks. COVID screening was performed in the 72 hrs prior to surgery in 89% of patients and 13% of parents/carers. Only one patient had a positive test. 69% surgeons wore an FFP3 (N99) mask to operate, and 64% of cases involved difficulty during the operation as a result of the PPE;most commonly communication difficulties (45%). No patients developed COVID in the early post-operative period. Conclusions: This data demonstrates that initial cleft lip and palate repair in the UK has been delayed as a direct result of the COVID-19 pandemic. Secondary surgery has been significantly affected and efforts will need to be made at national level to provide capacity to catch up. Isolation and testing protocols for COVID-19 vary from unit to unit, but appear safe. Routine cleft surgery can safely continuing through the pandemic, as long as appropriate infection control measures are followed and resources allow.
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Background/Purpose: Since the outbreak of COVID-19 was declared a pandemic, there has been concern regarding the social isolation born from safety mandates. Literature suggests that social distancing guidelines provoke anxiety and uncertainty among children and adolescents. This study aims to evaluate the effects of pandemic guidelines on pediatric patients with craniofacial conditions (CFCs), by studying the Health-Related Quality of Life (HRQoL) in a matched sample of pediatric patients with CFCs prior to and during the COVID-19 pandemic. Methods/Description: This matched cohort study (N=88) utilized the Craniofacial Quality of Life Scale (CFC-QoL), a bilingual patient- and parent-reported outcome measure, to assess social and psychological HRQoL domains. CFC-QoL surveys were collected from CFC patients and parents prior to March 11, 2020 (pre-pandemic) and compared to a separate cohort that completed the survey after July 1, 2020, during the pandemic. The patients in each sample (n = 44) were matched by diagnosis (bilateral or unilateral cleft lip and palate, craniosynostosis, microtia or dermatologic condition), age range (7-12, 13-17, 18+) and gender. Mean scores for both patient and parent responses to each survey item within the social and psychological impact subscales were computed and compared between the matched cohorts. Results: Comparison of mean responses found significant differences between the pre-pandemic and pandemic cohorts. On the social impact subscale, patients in the pandemic sample reported that 'People tease me', 'People ask me what is wrong with my face', and 'People notice that my face is different' less often than those in the pre-pandemic sample (p = .021;p = .041;p = .038). Parents in the pandemic sample reported 'People ask my child what is wrong with their face' and 'People notice my child's face is different' less often compared to the pre-pandemic sample (p = .040;p = .020). Within the psychological subscale, patients in the pandemic sample reported feeling less worried about their future (p = .030), less anxious or scared (p = .024), and more likely to try new things (p = .039) compared to those who answered the survey pre-pandemic. The parents in the pandemic sample reported 'My child feels bad about himself/herself' less often compared to parents in the prepandemic sample (p = .038). Conclusions: This study found that a sample of patients with CFCs and their parents reported better indications of social and psychological HRQoL during the COVID-19 pandemic compared to a matched pre-pandemic cohort. Factors that might influence these findings include decreased negative social impact due to containment measures such as school closures. Additionally, enforced mask wearing in social settings may serve as a protective barrier to decrease negative attention drawn toward a child's facial differences.
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Background/Purpose: The Covid-19 pandemic has restricted in person care at our cleft treatment center, delayed patient turnout, and led to financial losses and an increased number of missed scheduled appointments. Thus, we have sought new ways to monitor the nutritional status of infant patients with clefts, by using the WhatsApp® application, so as to conduct timely nutritional interventions and to prevent malnutrition and anemia. The purpose was to monitor the nutritional status of newborn babies with cleft, using the WhatsApp® application, and to validate its use. Methods/Description: 71% of internet users in Brazil use WhatsApp® to send and receive messages. This application is easy to use, with privacy ensured by cryptography. This research project was approved by the Institutional Review Board. The protocol established: 1) new cases of infants up to 30 days old, with cleft lip and/or cleft palate;2) consent form signed by parent or guardian;3) the first appointment was in person;with mothers receiving training and guidance to send information about their children's height and weight every month;4) data comparisons were conducted against WHO benchmarks (WAZ score between 0 and - 1 = healthy weight;between - 1 and - 2 = nutritional risk;< - 2 = underweight);6) nutritional interventions considering RDI's. Results: 18 patients were followed up by regular data submission through the WhatsApp® application;8 had cleft lips, 3 cleft palates, and 7 cleft lip and palates. Among these patients, 1 had a gastrostomy tube, 2 had cow milk protein allergy, and 1 had cardiac disease. Thus far, 8 have already been submitted to lip surgery, and 10 are waiting to reach the appropriate age for surgery. Twelve were classified as coming from low-income families, and 6 from medium income families. Most of them (no. = 17) travelled between 100-500 km to receive care, and 1 more than 100 km. Eight received transportation and food subsidized by public funds, and 10 used their own funds. Thirteen children were fed breast milk for 120 days, 8 were breast fed directly and 5 were fed pumped breast milk;5 were fed formula. Nine began eating additional foods at 6 months, the remaining patients were not old enough for that yet. Eleven children had normal weight (eutrophic) since the onset, 3 were malnourished when the study began and recovered after about 54 days, 4 were at risk when the study began and recovered after about 26.5 days. No patient had to delay surgery because of anemia (mean Hb = 11.45g/ dL). Nutritional interventions included encouraging breast feeding and different breastfeeding positions, guidance regarding the appropriate concentration of infant formula and how /when to introduce of additional foods. Milk formula, bottles, scales, and measuring tapes were donated. Conclusions: The use of the WhatsApp® application for nutritional follow up proved to be a valid and effective way tomonitor the patients' growth and development, yielding efficient nutritional recovery.
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Background/Purpose: Since COVID-19 was declared a worldwide pandemic by the World Health Organization (WHO) in March of 2020, foundation-based cleft outreach programs to Low- and Middle-Income Countries (LMICs) were halted considering global public health challenges, scarcity of capacity and resources, and travel restrictions. This led to an increase in the backlog of untreated patients with cleft lip and/or palate, with new challenges to providing comprehensive care in those regions. Resumption of international outreach programs requires an updated course of action to incorporate necessary safety measures in the face of the ongoing pandemic. In this manuscript, we outline safety protocols, guidelines, and recommendations implemented in Global Smile Foundation's (GSF) most recent outreach trip to Beirut, Lebanon. Methods/Description: COVID-19 safety protocols for outreach cleft care and an Action Response Plan were developed by the GSF team based on the published literature and recommendations from leading international organizations. Results: GSF conducted a 1-week surgical outreach program in Beirut, Lebanon, performing 13 primary cleft lip repairs, 7 cleft palate repairs, and 1 alveolar bone grafting procedure. Safety protocols were implemented at all stages of the outreach program, including patient pre-selection and education, hospital admission and screening, intraoperative care, and post-operative monitoring and follow-up. Conclusions: Organizing outreach programs in the setting of infectious diseases outbreaks should prioritize the safety and welfare of patients and team members within the program's local community. The COVID-19 protocols and guidelines described may represent a reproducible framework for planning future similar outreach initiatives in high risk conditions.
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Introduction: Pregnant women have long been recognized as a vulnerable population during infectious disease pandemics due to physiological changes in the immune, pulmonary, cardiac and coagulation systems. It is essential to acquire knowledge of pregnancy outcomes, potential complications and neonatal health conditions born to an infected mother with COVID-19. Material and methods: This cross-sectional observational study was conducted in Combined Military Hospital (CMH), Jashore from June 2020 to July 2021 among 100 hospitalized laboratory-confirmed COVID-19 positive pregnant women, patients who had clinical symptoms of COVID but RT PCR negative were excluded. The aim of the study was to evaluate the clinical profile and maternal and fetal outcome of pregnancy. Relevant data were recorded in a preformed data collection sheet and analyzed by SPSS version 20. Results: Among 100 COVID-19 positive hospitalized pregnant women, the mean age of participants was 27years (range 19-40 years), Maximum infection rate observed during 12 to 28 weeks of gestation among the participants, 21% got infected at 37 to 40 weeks of gestation and 20% got infected at 32 to 36 weeks. Seventy-four percent patients underwent delivery during the study & 23% of them continued with ongoing pregnancy;67 of the participants underwent LUCS and 7 vaginal deliveries were done, 3% had abortion and IUFD 1%,61% were multipara and 39% were Primipara, associated co-morbidities were subclinical hypothyroidism(15%), pregnancy induced HTN(12%) and GDM(8%);36% participants were asymptomatic and 44% had mild symptoms, rate of LUCS was higher than (90.64%) vaginal delivery. Among the 73 live births, 80.82% were term and 10.18% were preterm of neonates, small for gestational was seen in the case of 20.55% neonates. Testing for SARS-CoV-2 was performed in all neonatal throat swabs and found positive in one case only. Eighty-six percent neonates were well-baby and 9.58% neonates required NICU admission. There were 2 neonatal deaths due to severe prematurity and 2 babies were found to have congenital cardiac anomaly and cleft lip, cleft palate. Though 36% of patients were asymptomatic but 10% were severe and in the critical stage. HDU support needed for 8% of patients and ICU support for 6%. Conclusion: This cross-sectional study supports that pregnant women with COVID-19 infection are at increased risk of adverse pregnancy and birth outcomes and a low risk of congenital transmission. Availability of ICU in critical conditions is needed for better pregnancy outcomes. [ FROM AUTHOR] Copyright of Journal of Bangladesh College of Physicians & Surgeons is the property of Bangladesh College of Physicians & Surgeons and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
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OBJECTIVES: Previous literature finds that having a child with a cleft lip and/or palate (CL/P) may pose social and emotional challenges for parents. For parents of children born during the Covid-19 pandemic, such challenges may be heightened. Further, novel demands brought about by the pandemic could have caused additional hardships. The aim of this study was to describe the impact of the pandemic on new parents through qualitative exploration of their experiences. DESIGN: Semi-structured interviews were conducted with 14 parents of children born in the United Kingdom with CL/P between January and June 2020, around the start of the pandemic. Data were analysed using inductive thematic analysis. RESULTS: Three themes, with sub-themes, were identified. The first theme, "Changes to Healthcare: The Impact of Restrictions and Reduced Contact", discussed the impact of the pandemic on perinatal care, the care received from the specialist CL/P teams, and parents' experiences of virtual consultations. The second theme, "Family Functioning During the Pandemic", covered parental anxiety, fathers' experiences, and social support. The third theme, "Surgical Prioritisation: Delays and Uncertainty", addressed changes to surgical protocols, coping with uncertainty, complications associated with delayed surgery, and how parents created positive meaning from this period. CONCLUSIONS: A range of increased and additional psychosocial impacts for parents were identified, along with several coping strategies, utilization of social support, and the positive aspects of their experiences. As the pandemic continues, close monitoring of families affected by CL/P remains imperative, particularly for those at risk of emotional distress.
Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Health Services Accessibility , Child , Humans , Cleft Lip/surgery , Cleft Palate/surgery , Pandemics , Time-to-Treatment , Physical Distancing , Uncertainty , Delivery of Health Care , Psychological DistressABSTRACT
INTRODUCTION: Cleft lip and/or palate is the most common craniofacial anomaly and occurs in 1 in 650 to 700 live births in the United Kingdom (UK). The majority of cleft surgery is elective, and as a result, almost all cleft surgery was suspended across the UK in March 2020 during the first national lockdown. The UK has centralised regional Cleft Services which all use the same agreed target-age standards for primary surgery including lip and palate repairs. The coronavirus disease-2019 (COVID-19) response has caused a delay in carrying out procedures. The severity of this delay depends on the impact of COVID-19 on local trusts and R-value within that region. As the country goes through the second and third wave, the impact could be long lasting, and we aimed to quantify it so that the data could be used to guide service prioritisation in the NHS and help future workforce planning. METHODS: An online survey was designed based on the cleft quality dashboard indicators and circulated nationally to all nine cleft regions in the UK. The survey was divided into three main headings: ⢠Duration of suspended cleft services ⢠Quantification of the impact on delayed in surgery/services ⢠Changes needed to restart surgery/services RESULTS: We obtained a 60% response rate with five completed surveys from five out of nine regions. All regions reported that they suspended their cleft services in March 2020 around the time of the first wave and the first national lockdown. There has been an impact on delayed surgical and clinical interventions for cleft patients. Regions were affected differently with some on an exponential waiting list growth projection, whereas other teams are on track to recover from the backlog within 7-22 weeks. There has been an impact on the allied health professionals' services within the cleft multidisciplinary team. The cleft nurses' 24-h reviews, Speech And Language Therapy (SALT), and psychology maintained service delivery in some format. Patient-facing services such as audiology and dentistry were significantly disrupted and continue to experience delays due to reduced capacity. CONCLUSIONS: Various regions have seen a varied impact from COVID-19 on their services, from all cleft regions there seems to be an impact on achieving surgery within the national target age. The adverse effect of the COVID-19 impact is unlikely to be known for a few years to come; however, the data are a useful guide when supporting the allocation of resources within the healthcare setting. A prospective long-term study is required to assess the impact of COVID-19 on cleft surgery, follow-up, assess access to allied health professional MDT clinics, and long-term complications.
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COVID-19 , Cleft Lip , Cleft Palate , COVID-19/epidemiology , Cleft Lip/epidemiology , Cleft Lip/surgery , Cleft Palate/epidemiology , Cleft Palate/surgery , Communicable Disease Control , Humans , Northern Ireland , Prospective Studies , United Kingdom/epidemiologyABSTRACT
BACKGROUND: Cleft lip and cleft palate (CLP) are among the world's most common congenital malformation and has a higher prevalence in developing nations due to environmental and genetic factors. Global efforts have been developed in order to prevent and treat the malformation. Telemedicine has been implemented in various humanitarian global missions with success and is currently the primary means of care due to COVID-19. OBJECTIVE: To assess the benefits and barriers of telehealth in the care of patients with CLP through a global approach. METHODS: Systematic review of the PubMed and Cochrane Review databases with relevant terms related to telemedicine in cleft lip and palate surgery. RESULTS: Eight articles fit the inclusion criteria and suggested benefits with the use of telemedicine in regard to education, preoperative, and postoperative care as well as increased access to underserved populations. Barriers included connectivity and accessibility concerns. CONCLUSION: Telehealth is a beneficial way to evaluate patients with CLP in developing countries with proper care and follow-up to reduce complications and to improve health outcomes.
Subject(s)
COVID-19 , Cleft Lip , Cleft Palate , Telemedicine , Cleft Lip/therapy , Cleft Palate/therapy , Humans , SARS-CoV-2ABSTRACT
Maintaining an excellent level of service in a network Cleft Lip and Palate service in the UK has been an added challenge for both clinicians and patients throughout the COVID-19 pandemic. We describe the changes to our service, and report a high level of patient satisfaction with the changes. Some of the enforced changes may last beyond the duration of this pandemic.
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COVID-19 , Cleft Lip/surgery , Cleft Palate/surgery , Plastic Surgery Procedures , HumansABSTRACT
The Society for Craniofacial Genetics and Developmental Biology (SCGDB) held its 43rd annual meeting in a virtual format on October 19-20, 2020. The SCGDB meeting included the presentation of the SCGDB Distinguished Scientists in Craniofacial Research Awards to Marilyn Jones and Kerstin Ludwig and four scientific sessions on the molecular regulation of craniofacial development, craniofacial morphogenesis, translational craniofacial biology, and signaling during craniofacial development. The meeting also included workshops on career development, NIH/NIDCR funding, and the utility of the FaceBase database, as well as two poster sessions. Over 190 attendees from 21 states, representing over 50 different scientific institutions, participated. This diverse group of scientists included cell biologists, developmental biologists, and clinical geneticists. While in-person interactions were missed due to the virtual meeting format imposed by the COVID-19 pandemic, the meeting platform provided ample opportunities for participant interactions and discussions, thus strengthening the community.
Subject(s)
Craniofacial Abnormalities/genetics , Developmental Biology , Animals , COVID-19 , Congresses as Topic/organization & administration , Craniofacial Abnormalities/embryology , Genetics, Medical , Humans , Pandemics , Societies, Medical/organization & administration , Societies, Scientific/organization & administration , VideoconferencingABSTRACT
BACKGROUND: At the declaration of the global pandemic on March 11, 2020, many hospitals and institutions developed a tiered framework for the stratification and prioritization of elective surgery. Cleft lip and palate repair was classified as low acuity, and nasoalveolar molding (NAM) clinics were closed. Anticipating the consequences of delayed cleft care and the additional burden this would cause families, we reassessed our risk-stratification and perioperative algorithms. We hypothesized we could safely optimize nasolabial repair without burdening our care systems and without increasing COVID-19-related morbidity/mortality. METHODS: Our multidisciplinary cleft team reevaluated patient selection to maximize surgical impact. Perioperative protocols were adjusted, and COVID-19 preoperative testing was utilized before nasolabial repair and prior to suture removal under anesthesia. RESULTS: Early in the pandemic, unilateral cleft repair was prioritized and successfully completed on 9 patients. There were no complications related to COVID-19. Nasoalveolar molding clinic was reopened after total patient volume was significantly decreased. CONCLUSIONS: We offer an approach for surgical management of nasolabial clefts during a global pandemic. Although guidelines have suggested postponing all cleft care, we found that at our dedicated pediatric hospital with low burden of COVID-19 and adequate resources, we could follow a strategy to safely resume cleft care while decreasing burden on our patients' families and care delivery systems.