Principles of management for patients with oral cancer during the COVID-19 pandemic

The outbreak of coronavirus disease 2019 (COVID-19) affects the world. It is highly contagious and spreads quickly. COVID-19 severely increases the medical burden and interferes with our normal work. This article introduces our experience on treat oral cancer patients during the epidemic. The negative impact can be minimized through reasonable and orderly arrangement.Copyright © 2021 The Authors

Impact of COVID-19 pandemic on oral and maxillofacial surgery in Japan: A report from a questionnaire survey during the different phases of the pandemic

COVID-19 pandemic has provided a new challenge to healthcare systems and medical care providers. In the current study, we describe the challenges faced and actions taken to provide optimum healthcare in Japan during the COVID-19 pandemic based on the results of a questionnaire survey that was conducted by oral and maxillofacial surgeons. A total of 24 Japanese institutions participated in the study. The first survey was conducted between June 22, 2020 and June 26, 2020, and the second survey was conducted between October 23, 2020 and November 8, 2020. The questionnaire focused on the practical situation in the respondent's hospital, personal protective equipment (PPE) availability, and what alterations had occurred compared to the situation before the COVID-19 pandemic. The commonest reported duration of restrictions to the outpatient clinic was 1-2 months. All of the institutions had lifted their restrictions on outpatient services by September 2020. Surgical procedures in the operating room were restricted in 74% of hospitals in the first wave of the pandemic;however, 88% lifted their restrictions and restarted their regular surgical services by November 2020. Although, non-urgent or elective procedures were delayed, surgeries for malignant tumors, maxillofacial infections, and trauma were performed at almost all hospitals during the pandemic. Health care institutions will require a new approach to maintain patient volume and recover from the pandemic. Going forward, it is also necessary to minimize the risk of exposure and transmission to health care personnel as well as patients.Copyright © 2021 The Authors

Evaluation of telephone consultations prior to Mohs surgery: the importance of informed consent

The updated General Medical Council (GMC) guidance on consent (2020) states that 'decision making is an ongoing process focused on meaningful dialogue: the exchange of relevant information specific to the individual patient'. In the UK there are several barriers to this process in dermatology, including short clinic appointments and loss of continuity of care (the surgeon may not have seen the patient in clinic). Many barriers have been exacerbated by the COVID-19 pandemic with the additional challenges of telephone consultations. In light of the GMC guidance we conducted a survey to see what patients recalled of their clinic discussion prior to surgery. Seventy-six responses were received over 2 weeks from patients attending day surgery. The results showed that although the majority of patients received an information sheet on skin surgery there were significant inconsistencies in what was discussed in clinic with regard to alternative options, risks and benefits of surgery and the likely repair. We addressed the problem of inadequate preparation for complex surgery by implementing a new process for patients awaiting Mohs surgery. A senior registrar on the Mohs team contacted patients by telephone 2-3 days before surgery. During the telephone call the process of Mohs surgery, the risks and benefits (including the risk of attending the department during the COVID-19 pandemic), and alternative options to Mohs were discussed. The repair options were discussed in detail. Patients were also advised on transport, provision of victuals, postoperative wound care and the potential necessity of future appointments. The telephone calls lasted 5-12 min (average 6 min 48 s). When patients attended for surgery they were asked to complete a patient survey to evaluate their telephone consultation. Seventeen responses were received from the second survey over 2 weeks. Fifteen patients recalled alternative options to Mohs surgery being discussed prior to attending surgery and 15 recalled the risks of surgery being discussed. All patients recalled discussing the potential options for repair, and all patients felt that they had received adequate information prior to attending their surgical appointment. On a scale of 1-5 (1 being very uncertain and 5 being very confident) patients were asked to rate their confidence in the procedure after their telephone call with the surgeon. The majority rated 5 (n = 13), three scored 4 and one scored 2. Shared decisionmaking and fully informed consent is critical to effective patient care. It is particularly important prior to complex skin surgery such as Mohs, and patients should have the opportunity to discuss their procedure with a Mohs specialist before surgery. We demonstrated that a telephone call before surgery is an effective and time-efficient method that ensures patients are fully informed and increases their confidence in the procedure.

Effect of coronavirus pandemic on oral and maxillofacial surgical education and training: Developing standards for effective online training

Oral and maxillofacial surgery deals with the diagnosis and treatment of dentofacial problems and usually requires a four year specialized training after a bachelor's degree in dental surgery. The COVID 19 pandemic in early 2020 led to disruptions in the training programs worldwide and urged the supervisors and faculty to devise ways and means to continue the residents' learning experience utilizing different online teaching modalities. An account of some strategies for developing standards for effective online training to equip oral and maxillofacial training programs for similar future emergencies.Copyright © 2022 The Authors

Colon cancer treatment in Sweden during the COVID-19 pandemic: A nationwide register-based study.

AIM: The COVID-19 pandemic has reduced the capacity to diagnose and treat cancer worldwide due to the prioritization of COVID-19 treatment. The aim of this study was to investigate treatment and outcomes of colon cancer in Sweden before and during the COVID-19 pandemic. METHODS: In an observational study, using the Swedish Colorectal Cancer Registry, we included (i) all Swedish patients diagnosed with colon cancer, and (ii) all patients undergoing surgery for colon cancer, in 2016-2020. Incidence of colon cancer, treatments and outcomes in 2020 were compared with 2019. RESULTS: The number of colon cancer cases in Sweden in April-May 2020 was 27% lower than the previous year, whereas no difference was observed on an annual level (4,589 vs. 4,763 patients [-4%]). Among patients with colon cancer undergoing surgery in 2020, the proportion of resections was 93 vs. 94% in 2019, with no increase in acute resections. Time from diagnosis to elective surgery decreased (29 days vs. 33 days in 2020 vs. 2019). In 2020, more patients underwent a two-stage procedure with a diverting stoma as first surgery (6.1%) vs. (4.4%) in 2019 (p = 0.0020) and more patients were treated with preoperative chemotherapy (5.1%) vs. (3,5%) 2019 (p = 0.0016). The proportion of patients that underwent laparoscopic surgery increased from 54% to 58% (p = 0.0017) There were no differences in length of stay, surgical complications, reoperation, ICU-stay or 30-day mortality between the years. CONCLUSION: Based on nationwide annual data, we did not observe adverse effects of the COVID-19 pandemic on colon cancer treatment and short time outcomes in Sweden.