Management of Hand Surgery Services during the Novel Coronavirus Disease 2019 Pandemic.

Introduction The novel coronavirus disease 2019 (COVID-19) pandemic is an international public health emergency. Health systems must plan for the increasing requirements for critical care during the COVID-19 pandemic. The aim of this article is to offer strategies for hand surgeons to planning and implementing their response during the COVID-19 pandemic and in the subsequent phases to preserve health care system functioning. Materials and Methods Assessment of the principles of management related to COVID-19 management to develop pandemic preparedness and response protocols pertinent to patients, health care workers, and health systems. Results Strategies for the reorganizing hand surgery practice and a set of recommendations that should facilitate the process of rescheduling both out-patient service and surgical activities during the COVID-19 and its subsequent phases are suggested. Conclusion During the COVID-19 pandemic, management of patients requiring specialist care for hand conditions should be adapted to limit the risks associated with the virus without jeopardizing outcomes. These expedient recommendations during extraordinary circumstances are a foundation for further discussion on the topic as the COVID-19 pandemic evolves.

Low availability, long wait times, and high geographic disparity of psychiatric outpatient care in the US.

OBJECTIVE: To identify potential barriers to care, this study examined the general psychiatry outpatient new appointment availability in the US, including in-person and telepsychiatry appointments, comparing results between insurance types (Medicaid vs. private insurance), states, and urbanization levels. METHOD: This mystery shopper study investigated 5 US states selected according to Mental Health America Adult Ranking and geography to represent the US mental health care system. Clinics across five selected states were stratified sampled by county urbanization levels. Calls were made during 05/2022-07/2022. Collected data included contact information accuracy, appointment availability, wait time (days), and related information. RESULTS: Altogether, 948 psychiatrists were sampled in New York, California, North Dakota, Virginia, and Wyoming. Overall contact information accuracy averaged 85.3%. Altogether, 18.5% of psychiatrists were available to see new patients with a significantly longer wait time for in-person than telepsychiatry appointments (median = 67.0 days vs median = 43.0 days, p < 0.01). The most frequent reason for unavailability was provider not taking new patients (53.9%). Mental health resources were unevenly distributed, favoring urban areas. CONCLUSION: Psychiatric care has been severely restricted in the US with low accessibility and long wait times. Transitioning to telepsychiatry represents a potential solution for rural disparities in access.

Comparing community-driven COVID-19 vaccine distribution methods: Faith-based organizations vs. outpatient clinics.

Background: Minority and low socioeconomic communities may face practical barriers to vaccination, including decreased access to health care and less trust in healthcare organizations; however, few studies have focused on these barriers as the cause of differential vaccine uptake. We worked with community partners to implement and evaluate two community-driven approaches to COVID-19 vaccination distribution-through faith-based organizations (FBOs) and outpatient clinics-with a focus on understanding the differences between the populations who accessed each distribution method. Methodology: Participants who came to the vaccination locations were approached and asked to complete a survey during their 15 min post-vaccination observation period. Differences between distribution locations were examined using Chi-square tests. Results: The survey rendered 1,476 valid responses, with a total of 927 participants recruited at clinical locations and 519 at FBOs during vaccination events. There were significant differences by race/ethnicity, with distribution methods at FBOs reaching a higher proportion of Hispanic/Latino and Marshallese participants. The proportion of uninsured participants who had lower health literacy and had lower educational attainment was higher with the FBO distribution method. FBO participants were more likely to report "completely" trusting the COVID-19 vaccine. There was no significant difference between FBO and clinic participants with regard to the level of vaccine hesitancy. There were no statistically significant differences with regard to access. Conclusion: A higher proportion of Hispanic/Latino and Marshallese participants utilized FBOs for vaccination, suggesting collaborations with FBOs can potentially increase vaccination uptake among minority communities and help mitigate vaccination disparities.

Medical Staff Shortages and the Performance of Outpatient Clinics in Poland during the COVID-19 Pandemic.

Unlike many industries, healthcare was simultaneously affected by the COVID-19 pandemic in two opposite ways. On the one hand, the industry faced shortages and overload of many medical representatives such as nurses and infectious disease professionals, but on the other, many medical professionals such as dentists were left with considerably reduced demand. The objective of this paper is to study the efficiency of medical staff allocation and the performance of small and medium sized outpatient clinics in Poland during the COVID-19 pandemic. Owing to the contemporaneity of this problem, we have employed a multiple case study approach. Our sample comprises 5 small and medium-sized outpatient clinics located in Poland in the 3-year period 2019-2021. The results indicate a considerable percentage of medical staff employed in small and medium-sized outpatient clinics remained outside the pandemic, despite their potential provision of healthcare services. Four of the five clinics studied remained passive towards the pandemic. In view of future pandemics, the indications we provide have practical implications for outpatient clinics executives and public health policymakers.

Confronting the unknown-Nursing surveillance of COVID-19-infected patients through remote telephone calls and in an on-site urgent clinic.

AIM: To describe nursing surveillance of coronavirus disease 2019 (COVID-19)-infected patients through remote telephone calls and in an on-site urgent clinic during the first wave of the pandemic as experienced by nurses providing the care. DESIGN: Qualitative descriptive study. METHODS: Data were collected through seven semi-structured, audio-recorded, focus group interviews with 24 nurses. Interviews were conducted in May and June 2020, transcribed and analysed using deductive and inductive content analysis into an overarching category, main categories and subcategories. Reporting followed the COREQ guidelines. RESULTS: Nurses relied on intensive listening when assessing and caring for COVID-19-infected patients. They realized that the patients had complex needs for nursing and healthcare which was beyond the scope of a tentatively prescribed assessment scheme. They designed their care to ensure holistic care, reflected in the overarching category, 'Confronting an unfamiliar health condition in unprecedented circumstances' and the categories: 'Digging into the unknown' and 'Ensuring holistic nursing care'. The category 'Contributing to averting catastrophe' reflects the wealth of knowledge, support and experience that the nurses used to independently deliver care, albeit in interdisciplinary collaboration, working to their greatest potential. They were proud of the significance of their work. CONCLUSION: Novel nursing surveillance through remote telephone calls and in an on-site urgent care clinic delivered to COVID-19 patients self-managing at home resulted in holistic nursing care during the first wave of the pandemic. This has relevance for professionalism in nursing. IMPACT: Findings give a unique insight into nursing surveillance of COVID-19-infected patients provided through telephone calls and in on-site urgent care clinics. The potential of intensive listening as conducted in the study suggests that it may be feasible to assess and holistically take care of COVID-19-infected patients, and other patient groups as well, with this form of healthcare. This has relevance for healthcare beyond crisis management during pandemics. PATIENT OR PUBLIC CONTRIBUTION: There was no patient or public contribution as the study only concerned the providers of the service, i.e. the nurses themselves.

Reflections on the future of telemedicine and virtual spinal clinics in the post COVID-19 era.

•Both patients and surgeons seem to show significant satisfaction with virtual spinal clinics.•Virtual spinal clinics may be an important adjunct to traditional face-to-face clinics.•Limitations in physical examination constitute main concern.•Patient selection is an important factor in deciding who is a suitable candidate for a virtual spinal clinic.•Medicolegal concerns need to be adequately addressed if spinal virtual clinics are to be routinely used.

The introduction of the trauma triage clinic at a district general hospital: safety and efficacy during the first year of implementation.

INTRODUCTION: Previously published work has shown that there are no missed injuries following the introduction of a trauma triage clinic (TTC). This study aimed to assess both the safety and efficacy of the TTC model in a district general hospital in the United Kingdom. We aimed to assess the rate of missed 'high-risk' injuries, including posterior shoulder dislocations, talar injuries, Lisfranc injuries and complex carpal instability. METHODS: Data were collected retrospectively between November 2017 and October 2018 (inclusive). During this time, 3,721 patients were reviewed (mean age 38 years, SD 25.5, range 1-103 years). Case notes and x-rays were reviewed for all patients. Compliance was assessed against British Orthopaedic Association Standards for Trauma (BOAST 7) guidelines for fracture clinic services. The standard for adherence to guidelines was 100%. RESULTS: Thirty-two of 3,721 patients had a missed injury during the study period, and 66% of these injuries were high risk. TTC was effective in reducing the number of patients seen in the fracture clinic, with 23% of patients discharged directly from the TTC. Eighty-nine per cent of patients were reviewed in clinic within 72 hours of presentation, with a median time to review of 2 days. CONCLUSION: This study has shown that TTC is efficient in reducing the burden of patients seen in the fracture clinic, but it is not as safe as reported previously. Although the prevalence of missed injuries is low, hospitals introducing a TTC model should consider departmental processes to help accurately identify and triage high-risk injuries.

The Impact of COVID-19 on the Orthopaedic Patient in Slovenia: Hip and Knee Replacement Surgery, 90-Day Mortality, Outpatient Visits and Waiting Times.

Introduction: The purpose of the study was to analyse the impact of the COVID-19 pandemic on the healthcare of the orthopaedic patient, i.e. numbers of hip and knee replacement surgeries, 90-day mortality, waiting times and outpatient clinic visits. Methods: The Hip (HR) and Knee Replacement (KR) records from The National Arthroplasty Registry of Slovenia in the pandemic year 2020 were compared to the year 2019. To compare reasons for revision and 90-day mortality the Chi-square test was used. The median values of the number of operations and waiting times were compared with the 95% confidence intervals. The number of outpatient clinic visits was tested with the Wilcoxon Signed Ranked test. Results: All operations fell by 19%, from 7825 to 6335. The number of Primary Total HR declined from 3530 to 2792 (21%) and the number of Primary KR from 3191 to 2423 (24%). The number of hip revisions declined by 10% and knee revisions by 25%. We did not find differences in 90-day mortality (p=0.408). Outpatient clinic visits fell from 228682 to 196582 (14%) per year. Waiting times increased by 15% for HR and by 12% for KR. Conclusion: There was an inevitable drop in the number of surgeries and outpatient clinic visits in the spring and autumn lockdown. With the reorganisation of the orthopaedic service in Slovenia, the number of KR and HR stayed at a relatively high level despite the pandemic. An epidemiological model and mechanisms for the reduction of waiting times could overcome the impact of the epidemic.

EVALUATION OF TYPE/LOCATION OF CLINIC APPOINTMENTS IN OLDER PERSONS SERVICES PARKINSON DISEASE PATIENTS IN RURAL EAST SUFFOLK

Introduction We have 262 patients under the care of older persons movement disorders service in East Suffolk, whom due to a combination of retirement and COVID pandemic hadn’t seen a consultant for their follow up in up to 18 months. There are the facilities to see patients closer to their homes with satellite outpatient clinics in Eye, Stowmarket, Felixstowe and Aldeburgh, and via telephone and video consultation. We found that 137 of these patients live in rural areas closer to these satellite clinics. An opportunity was sensed to tailor the future service to the preferences of our patients, with the aim of improving experience and satisfaction. Method We sent a postal survey to these 137 patients asking them about the importance of having one responsible consultant, the type and location of their appointment. Results We sent a postal survey to these 137 patients, we received 81 Reponses. 91% of respondents ranked it either important, quite important or very important that they see the same consultant. It was the 1st preference to be seen at a local healthcare facility with 71% of patients choosing this as their first choice versus 22% for Ipswich hospital. 7% had a 1st preference of telephone appointment. 0 patients had a 1st choice preference of video conference it was the least favourable preference for 52% of respondents. Conclusion Our cohort of patients place a high value on continuity of care and would prefer to be seen at a community clinic that is closer to home. These preferences have been discussed with PDUK and CCG and have informed how we deliver our service as of August 2021 with all patients having a locality based clinic and named consultant. Our results are at odds with the ethos of NHSX [1] and the drive to see patients virtually.

The impact of reduced operating room capacity on the time delay of urgent surgical care for neurosurgical patients during the COVID-19 pandemic.

Background: The COVID-19 pandemic raised major challenges to the management of patient flows and medical staff resource allocation. To prevent the collapse of medical facilities, elective diagnostic and surgical procedures were drastically reduced, canceled or rescheduled. Methods: We recorded all in-hospital treated patients and outpatient clinics visits of our neurosurgical department from March 2017 to February 2021. Changes of OR capacity, in-hospital neurosurgical treatments and outpatient clinics visits during the pandemic episode was compared on a monthly bases to the previous years. Results: A total of 3'214 data points from in-house treated patients and 11'400 outpatient clinics visits were collected. The ratio of elective (73.5% ± 1.5) to emergency surgeries (26.5% ± 1.5) remained unchanged from 2017 to 2021. Significantly less neurosurgical interventions were performed in April 2020 (-42%), significantly more in July 2020 (+36%). Number of outpatient clinics visits remained in the expected monthly range (mean n = 211 ± 67). Total OR capacity was reduced to 30% in April 2020 and 55% in January 2021. No significant delay of urgent surgical treatments was detected during restricted (<85%) OR capacity. On average, the delay of rescheduled consultations was 58 days (range 3 - 183 days), three (6.5%) were referred as emergencies. Conclusions: Dynamic monitoring and adjustment of resources is essential to maintain surgical care. The sharp restrictions of surgical activities resulted in significant fluctuations and 5% decrease of treated neurosurgical patients during the COVID-19 pandemic. However, urgent neurosurgical care was assured without significant time delay during periods of reduced OR capacity.

Factors Affecting Fear, Obsession, and Anxiety Associated with COVID-19: A Cross-Sectional Study in Patients Admitted to University Hospital Outpatient Clinics

Objective: During the coronavirus disease 2019 (COVID-19) pandemic, there has been a significant decrease in outpatient visits and hospital admissions. The increased risk of transmission, especially in environments with high contamination such as hospitals, may increase fear, obsession, and anxiety in patients. This study aims to investigate the factors affecting fear, obsession, and anxiety associated with COVID-19 in patients who are admitted to university hospital outpatient clinics. Materials and Methods: This study was conducted from January 2021 to February 2021 at Pamukkale University Hospitals outpatient clinics. Demographic information (age, education, sex, marital status, house sharing, employment, and work schedule) and questions related to COVID-19 (visiting a doctor regularly before the pandemic, positive test results, isolation due to contact, losing a friend/family member because of the disease, and delay/avoidance of medical care because of COVID-19-related concerns) were questioned. Fear of COVID-19 Scale, Obsession with COVID-19 Scale, Coronavirus Anxiety Scale, and Short Form-12 were filled. Results: A total of 535 patients (291 females and 244 males;mean age, 45.59 +/- 16.08 years) participated. The Fear of COVID-19 Scale score was 16.74 +/- 6.60, that of Obsession with COVID-19 Scale was 2.22 +/- 2.74, and that of Coronavirus Anxiety Scale was 0.77 +/- 2.32. Female sex, working from home or flexibly, admission to internal medical sciences, and losing a loved one due to the disease increased COVID-19 fear, obsession, and anxiety (p<0.001). Fear, obsession, and anxiety associated with COVID-19 have negatively affected SF-12 physical and mental scores (p<0.001). Conclusion: The present study suggested that to ensure that treatments can be continued uninterruptedly in patient groups who are at risk in terms of increasing COVID-19 fear, obsession, and anxiety, remote health consultations can be performed.

"There was no panic"-Nurse managers' organising work for COVID-19 patients in an outpatient clinic: A qualitative study.

AIM: To provide insight into the contribution of nursing to the establishment and running of a hospital-based outpatient clinic for COVID-19 infected patients, and thereby to inform the development of similar nursing care and healthcare more generally. DESIGN: Qualitative descriptive study centred on collaboration between nurse managers and researchers. METHODS: Drawing on Donabedian's model of quality health services and the work of Allen on "Nurses' organising work", data were collected using four semi-structured, audio-recorded, focus group interviews with five nurse managers. The interviews were conducted in May and June 2020, transcribed, and subsequently analysed using deductive and inductive content analysis into an overarching category, main categories, and sub-categories. RESULTS: "There was no panic - challenged by the unprecedented" was a strong thread, which was reflected in two categories: (a) Everyone walked in step, containing the sub-categories: Public officials set the tone, Creating order in disorder, and Mutual respect and teamwork, and (b) Inspired by extraordinary accomplishments, encompassing the sub-categories: Realising one's potential and Unexpectedly rewarding. In exceptional circumstances the nurse managers' decision-making authority grew, material and manpower resources were sufficient, promptly constructed work procedures were in place, and tasks were completed instantly in trusting and respectful interdisciplinary collaboration. With sound support and trust from hospital directors, the nurse managers utilised their expertise to the fullest and they were proud of their work. CONCLUSION: The findings portray the almost invisible work of nurse managers in organising complex care. Although the circumstances were exceptional the findings speak to the accomplishments that can be gained when nurse managers have autonomy and the opportunity to utilise their professional capacity to the fullest. IMPACT: The findings reveal the almost invisible work of nurses in organising complex care and can inform the establishment of outpatient clinics for patients infected with COVID-19 and of healthcare development more generally.

Design and Evaluation of a Smartphone Medical Guidance App for Outpatients of Large-Scale Medical Institutions: Retrospective Observational Study.

BACKGROUND: The greatest stressor for outpatients is the waiting time before an examination. If the patient is able to use their smartphone to check in with reception, the patient can wait for their examination at any location, and the burden of waiting can be reduced. OBJECTIVE: This study aimed to report the system design and postintroductory outcomes of the Tori RinRin (TR2) system that was developed to reduce outpatient burden imposed by wait times before examination. METHODS: The TR2 system was introduced at Tottori University Hospital, a large medical facility that accepts a daily average of 1500 outpatients. The system, which links the hospital's electronic medical record database with patients' mobile devices, has the following functions: (1) GPS-based examination check-in processing and (2) sending appointment notification messages via a cloud notification service. In order to evaluate the usefulness of the TR2 system, we surveyed the utilization rate of the TR2 system among outpatients, implemented a user questionnaire, and polled the average time required for patients to respond to call notifications about their turn. RESULTS: The 3-month average of TR2 users 9 months after the TR 2 system introduction was 17.9% (14,536/81,066). In an investigation of 363 subjects, the mean examination call message response time using the TR2 system was 31 seconds (median 14 seconds). Among 166 subjects who responded to a user survey, 86.7% (144/166) said that the system helped reduce the burden of waiting time. CONCLUSIONS: The app allowed 17.9% of outpatients at a large medical facility to check in remotely and wait for examinations anywhere. Hence, it is effective in preventing the spread of infection, especially during pandemics such as that of coronavirus disease. The app reported in this study is beneficial for large medical facilities striving to reduce outpatient burden imposed by wait times.

Rapid Telepsychiatry Implementation During COVID-19: Increased Attendance at the Largest Health System in the United States.

OBJECTIVE: This study aimed to examine differences in completion rates between telepsychiatry and in-person visits during the COVID-19 pandemic and a prior reference period. METHODS: The authors used electronic medical record data along with chi-squared or t tests to compare patients' demographic characteristics. Generalized estimating equations for estimating the odds of primary and secondary outcomes were used, controlling for demographic characteristics. RESULTS: During COVID-19, the odds of completing a telepsychiatry visit (N=26,715) were 6.68 times the odds of completing an in-person visit (N=11,094). The odds of completing a telepsychiatry visit during COVID-19 were 3.00 times the odds of completing an in-person visit during the pre-COVID-19 reference period (N=40,318). CONCLUSIONS: In this cross-sectional study, outpatient adult mental health clinic telepsychiatry appointments, largely by telephone, were strongly associated with a higher rate of visit completion compared with in-person visits during and prior to the COVID-19 pandemic. Regulators should consider permanently enabling reimbursement for telephone-only telepsychiatry visits.

Resuming Breast Imaging Services in the Aftermath of the COVID-19 Pandemic: Safety and Beyond.

As the Coronavirus disease 2019 (COVID-19) epidemic begins to stabilize, different medical imaging facilities not directly involved in the COVID-19 epidemic face the dilemma of how to return to regular operation. We hereby discuss various fields of concern in resuming breast imaging services. We examine the concerns for resuming functions of breast imaging services in 2 broad categories, including safety aspects of operating a breast clinic and addressing potential modifications needed in managing common clinical scenarios in the COVID-19 aftermath. Using a stepwise approach in harmony with the relative states of the epidemic, health care system capacity, and the current state of performing breast surgeries (and in compliance with the recommended surgical guidelines) can ensure avoiding pointless procedures and ensure a smooth transition to a fully operational breast imaging facility.

Remote consultations in paediatric urology-Not just for pandemics?

Although some centres have successfully integrated remote clinics into their paediatric urological practice, for many, remote clinics have developed due to the COVID-19 pandemic. One UK-based institution has integrated remote clinics in their practice for over two years and has developed guidelines considering which conditions may be suitable for remote consultations. These guidelines have been appraised by the European Association of Urology Young Academic Urologists paediatric working group. Through practical experience and anticipated difficulties, we have discussed considerations that paediatric urology departments should ponder when integrating remote clinics into their practice as we move forward from the pandemic.

COVID-19 driven care changes in high risk patients from an outpatient to a community setting - A cross-sectional study.

Background: COVID-19 has led to a change in care for patients with chronic conditions, involving a transfer of drug administration from an outpatient to a community setting. AIM: To investigate patient preferences for treatment settings in the light of the current pandemic. METHODS: Patients, who prior to the pandemic had attended two different outpatient clinics in a university hospital for their infusions or injections, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. RESULTS: Out of 49 patients with either anti-inflammatory or immunoglobulin treatments (response rate: 83 %), 24 (49.0 %) switched from subcutaneous (sc) injections in the hospital to the community setting, 18 (36.7 %) from intravenous infusions (iv) in the hospital to sc administration at home and 7 (14.3 %) moved to iv at home. During the pandemic 38 (80.9 %) wanted to continue their treatment at home, but after the pandemic 22 (46.8 %) would opt to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team, had increased concerns about safety as a result of COVID-19. CONCLUSIONS: The experience during the COVID-19 pandemic has increased self-management-skills in some patients, but long-term follow-up is needed. It has repercussions for future shared decision making for patients and their healthcare teams.

Virtual consultations: delivering outpatient clinics in paediatric surgery during the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has resulted in many changes to clinical practice, including the introduction of remote clinics. Those familiar with remote clinics have reported benefits to their use, such as patient satisfaction and cost benefits; however, ongoing challenges exist, including delivering optimal patient-centred care. As a tertiary paediatric surgery unit in the UK, completing remote clinics was a new experience for most of our surgical team. We completed a service evaluation early into the COVID-19 pandemic aiming to define and address issues when delivering remote clinics in paediatric surgery. Remote clinics were observed (telephone and video), with follow-up calls to families following the consultations. RESULTS: Eight paediatric surgeons were observed during their remote clinics (telephone n = 6, video n = 2). Surgeons new to remote clinics felt their consultations took longer and were reluctant to discharge patients. The calls did not always occur at the appointed time, causing some upset by parents. Prescription provision and outpatient investigations led to some uncertainty within the surgical team. Families (n = 11) were called following their child's appointment to determine how our remote clinics could be optimised. The parents all liked remote clinics, either as an intermediate until a face-to-face consultation or for continued care if appropriate.Our findings, combined by discussions with relevant managers and departments, led to the introduction of recommendations for the surgical team. An information sheet was introduced for the families attending remote clinics, which encouraged them to take notes before and during their consultations. CONCLUSIONS: There must be strong support from management and appropriate departments for successful integration of remote clinics. Surgical trainees and their training should be considered when implementing remote clinics. Our learning from the pandemic may support those considering integrating remote clinics in the future.

Challenges and countermeasures of thoracic surgery in the epidemic of novel coronavirus pneumonia / 中国胸心血管外科临床杂志

@#Since December 2019, a novel coronavirus (2019-nCoV, SARS-CoV-2) pneumonia (COVID-19) outbreak has occurred in Wuhan, Hubei Province, and the epidemic situation has continued to spread. Such cases have also been found in other parts of the country. The spread of the novel coronavirus pneumonia epidemic has brought great challenges to the clinical practice of thoracic surgery. Outpatient clinics need to strengthen the differential diagnosis of ground glass opacity and pulmonary plaque shadows. During the epidemic, surgical indications are strictly controlled, and selective surgery is postponed. Patients planning to undergo a limited period of surgery should be quarantined for 2 weeks and have a nucleic acid test when necessary before surgery. For patients who are planning to undergo emergency surgery, nucleic acid testing should be carried out before surgery, and three-level protection should be performed during surgery. Patients who are planning to undergo emergency surgery in the epidemic area should be confirmed with or without novel coronavirus pneumonia before operation, and perform nucleic acid test if necessary. Surgical disinfection and isolation measures should be strictly carried out. Among postoperative patients, cases with new coronavirus infection were actively investigated. For the rescue of patients with novel coronavirus infection, attention needs to be paid to prevention and treatment and related complications, including mechanical ventilation-related pneumothorax or mediastinal emphysema, and injury after tracheal intubation.