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1.
Gut ; 71(Suppl 3):A75, 2022.
Article in English | ProQuest Central | ID: covidwho-2064232

ABSTRACT

IntroductionAcute extensive non-malignant non-cirrhotic portomesenteric thrombosis can lead to bowel infarction and frequently does not resolve with anticoagulation. In 2019 we published our first case series of a stepwise thrombolysis protocol involving the use of low dose tissue plasminogen activator (L-tPa) followed, if indicated, by Catheter-Directed Thrombolysis (CDT) and Transjugular Intrahepatic Portosystemic Shunt (TIPSS). We present an updated series, aiming to explore the recanalization rates, symptom resolution and any adverse events for patients who received this protocol.MethodWe retrospectively reviewed the clinical records of patients who received the stepwise regimen at Royal Free Hospital between December 2019 & March 2022.ResultsA total of 35 patients were included with a mean age of 47 (SD=14) years;63% were males. Thrombophilia was identified in 13 (37%) cases and 14 (40%) had other local or systemic causes for thrombosis (1 had COVID-19;3 received ChAdOx1 vaccination). Three patients had underlying chronic liver disease. All patients had ongoing abdominal pain despite anticoagulation. Occlusive portal vein thrombosis (PVT) was found in 30 (86%) patients with 18 (51%) having thrombosis of all three vessels (PVT + splenic vein + superior mesenteric vein). While all patients received L-tPa within a median of 15 (IQR =18) days of symptoms, CDT was applied in 17 (49%) patients and TIPSS was inserted in 15 (43%). CDT was delivered through EKOS™ endovascular system in 11/17 (65%). A degree of recanalization was observed in 24 (69%). TIPSS was patent at discharge in 14/15 (93%).The majority 28 (80%) were maintained on warfarin and 11 had concomitant anti-platelet therapy. Fifteen patients had imaging follow-up available [median duration of 9 (IQR = 11) months]. Recanalization was maintained in 9/15 (60%) and TIPSS remained patent in 6/9 (67%). At a median follow up of 6.5 (IQR = 9) months, complete symptom resolution was achieved in 30/34 (88%).Nine patients underwent bowel resection within a median duration of 11 (IQR= 10.5) days from presentation;mean length of bowel resected was 67 cm (SD = 50). One patient was discharged on parenteral nutrition and had a stoma. One patient died during the initial admission (related to bowel ischemia) and 1 had intracranial haemorrhage. Minor bleeding was recorded in 8 patients.ConclusionOur protocol resulted in good recanalization and patency rates with the majority achieving symptom resolution. While some patients required surgical intervention, bowel continuity was maintained and only one patient had a stoma.

2.
Frontline Gastroenterology ; 13(Suppl 1):A2-A3, 2022.
Article in English | ProQuest Central | ID: covidwho-2064203

ABSTRACT

O2 Table 1Number of television programmes matching each search term (original search)Table includes all matches to given term, and is not adjusted for overlap where more than one search led to the same programme.Search term Total programmes in two-year period ‘Relevant’ clips (score >6) Crohns 189 43 Colitis 92 18 ‘Inflammatory bowel disease’ 32 6 Stoma 71 4 Ileostomy 12 6 O2 Table 2Themes identified within ‘relevant’ programmesClassifications relate to the final non-overlapping list (n=58), but a given programme may feature in more than one category.Term Description Number of programmes REAL Someone on a reality TV programme mentions their IBD 12 MED A factual/reality medical programme shows IBD 13 FAM A ‘famous’ person is interviewed and discusses their IBD 11 MAG A TV magazine programme has a section about an IBD-related issue 7 DOC A documentary with main focus of IBD or related issue 10 NEWS A news programme 13 HOLB A medical drama mentioning IBD 6 COVID A person with IBD is featured in the context of the impact of the pandemic on people with chronic conditions 7 AMY Documentary, interviews etc with Strictly Come Dancing performer Amy Dowden 4 CIRCLE Episodes of The Circle and subsequent interviews featuring contestant Georgina Elliott, with IBD and previously a stoma 2 DRAMA NON medical drama or comedy with IBD mention 1 Summary and ConclusionsIBD is underrepresented on television compared to other chronic conditions. Notwithstanding different search terms may lead to the same programme, there were fewer than 396 IBD-related clips identified in a two-year period. This is significantly lower than other conditions such as diabetes (3,138), asthma (2,236) and epilepsy (959).Only 58 of the IBD-related clips were assessed as relevant for this project.Depictions of IBD mainly featured in news, factual medical or documentary programmes with few fictional portrayals in dra a or comedy.Despite focus on the fear and uncertainty of living with IBD, there were also positive messages concerning the value of open communication with family and friends, and having goals to focus on.Framing living with IBD using more extreme language may be due to television’s desire for compelling narratives, rather than an accurate reflection of people’s lived experience. However, children and young people with IBD may still benefit from seeing well-known role models discussing their condition and achieving their ambitions despite the challenges.Further research into use of and benefit of TV and social media in support and education should be considered.

3.
The Yale Journal of Biology and Medicine ; 95(3):399-403, 2022.
Article in English | ProQuest Central | ID: covidwho-2047033

ABSTRACT

Early initiation of end-of-life (EOL) conversations has been shown to improve patient agency in dying, increase early access to hospice care, and facilitate a dignified death. Despite the benefits of early initiation, EOL conversations do not occur as readily as physicians or patients wish. While medicine is commonly considered both a science and an art, increasing medicalization may narrow a clinician’s focus towards procedures or specialized clinical frameworks rather than a patient’s end-of-life wishes. Since physicians are ambassadors of clinical knowledge and are trusted patient advocates, it is important they facilitate EOL conversations early in the dying process. Patients desire their physicians to convene these conversations. However, physicians are often hesitant to do so. Notable theologians, philosophers, and physicians offer a broad framework outlining the importance of physician-led EOL conversations.

4.
The Journal of Laryngology and Otology ; 136(5):469, 2022.
Article in English | ProQuest Central | ID: covidwho-1991449
5.
Kai Tiaki : Nursing New Zealand ; : 11-15, 2022.
Article in English | ProQuest Central | ID: covidwho-1989303

ABSTRACT

The voluntary standards (https://tas.health.nz/assets/Health-of-Older-People/ARRC-Agreement-2021-22-effective-1-August-2021-.pdf) (see pp56, 58 and 70-71) for our aged-care facilities state each resident only needs half an hour of nursing care per day - but with residents in recent years coming in older, sicker and in need of more acute care, this is nowhere near enough. Aged care 'fastest-growing' sector The level of care provided in many aged residential care (ARC) facilities includes: * Hospital-level * Accident Compensation Corporation (ACC) transitional/rehabilitative/serious injury * End-of-life * Assisted dying * Mental health and addiction * Cognitive impairment requiring a secure environment We nurses who work in aged care and the community must also support our older people to stay independent as long as possible, whether in their own home or in a care home, for their own wellbeing but also to reduce pressure on hospitals and ARC facilities. [...]one man under 65 was recently admitted with end-stage lung cancer, no social or family support and a long history of trauma, mental health issues and a distrust of health professionals. The New Zealand Aged Care Association has estimated $94 million is needed to pay ARC nurses (enrolled and registered) on a par with hospital nurses - but this would rise to $166 million after the Health NZ/NZNO pay equity settlement rates are implemented.

6.
Bulletin of the Transilvania University of Brasov. Medical Sciences. Series VI ; 15(1):43-52, 2022.
Article in English | ProQuest Central | ID: covidwho-1975790

ABSTRACT

Since the Zika virus outbreak in the United States, Centers for Disease Control and Prevention (CDC) concluded that among people with confirmed or possible Zika virus infection during pregnancy, Zika-associated birth defects occured in 5% of babies [4]. According to cohorts from Colombia, Puerto Rico, and French Guiana, the cumulative risk of ZIKV infection for pregnant women living in epidemic areas ranged from 21 to 44 percent [5]. Blood donors who were asymptomatic and Zika virus RNA positive were found in Florida and Texas in 2017 [7]. [...]Zika virus sexual transmission is possbile from both asymptomatic and symptomatic infections through genital, oral and anal intercourse [7]. According to these data, pregnant women in the US are more likely than non-pregnant women of reproductive age to get SARS-CoV-2 infection and accompanying symptoms [12].

7.
International Journal of Medical Dentistry ; 26(2):178-186, 2022.
Article in English | ProQuest Central | ID: covidwho-1939847

ABSTRACT

COVID-19 was recognized by the World Health Organization (WHO) as a pandemic disease since most of the countries reported significant numbers of deaths and infected people starting with December 2019 (WHO, 2020). The diversity of COVID-19 manifestations can be attributed to the sites where the SARS-Cov-2 receptors Angiotensin-converting Enzymes 2 (ACE2) were found, which include, but were not limited to, lung, kidney, salivary glands and gastrointestinal tract [1,12-14]. Dealing with COVID-19 had shown that many oral manifestations could be in direct relation to the infection itself. [...]another study [15] reported that at least one oral manifestation concerning the oral cavity and salivary gland was found on 67.2% of the 58 observed patients, in whom a dry mouth had the highest prevalence and gingival bleeding - the lowest. A P-value < 0.05 was considered significant. 3.RESULTS The link was distributed to a total of 515 patients tested positive with COVID-19, 512 of them having responded to the questionnaire (a response rate of 99%).

9.
BMJ Leader ; 2022.
Article in English | ProQuest Central | ID: covidwho-1909803

ABSTRACT

BackgroundThe COVID-19 pandemic has posed the greatest operational challenge to the English National Health Service since its inception. Elective surgical services have struggled due to the need to protect both staff and patients from viral exposure, and perioperative COVID-19 infection has been associated with significant excess mortality.InterventionsIn this brief report, we describe how through necessity, it has provided an opportunity to redesign services for the benefit of both patients and organisations, with attendant improvement in activity compared with prepandemic metrics. We present the experience of a large district general hospital, using the department of colorectal surgery as a case study, in responding to the pandemic by restoring services and achieving improved short-term outcomes and processes in newly redesignated facilities.ConclusionsThese reorganised surgical services represent a ‘silver lining’ of the pandemic. Clinician-led service restructuring, with positive engagement with staff at all levels, has not only addressed backlogs of urgent elective patients in a safe environment, but has also led to patient benefits and high levels of patient and staff satisfaction.

10.
Archives of Disease in Childhood. Fetal and Neonatal Edition ; 107(4):343, 2022.
Article in English | ProQuest Central | ID: covidwho-1901948

ABSTRACT

The observation is similar to that of Ju Lee Oei and colleagues, who report an individual patient data meta-analysis of 3 randomised clinical trials comparing the effects on a composite of death or disability of initial resuscitation with 30% or 60% oxygen for preterm infants born <32 weeks gestation. See pages F437 and F386 Surfactant in late preterm and term infants Viraraghavan Vadakkencherry Ramaswamy and colleagues performed a systematic review and meta-analysis of studies of surfactant therapy for term and late preterm infants with respiratory distress syndrome. Most of the information in these more mature infants was derived from observational studies so there were issues with the level of certainty of the evidence showing that surfactant therapy decreased mortality, air leak, persistent pulmonary hypertension of the newborn, duration of ventilation and of hospital stay.

11.
Diseases of the Colon and Rectum ; 65(5):56, 2022.
Article in English | EMBASE | ID: covidwho-1894145

ABSTRACT

Purpose/Background: Impact of the COVID-19 pandemic on medical practice has been often reported from Western countries, but there have been few studies in other areas especially regarding stoma surgery and stoma care. Hypothesis/Aim: We examined COVID-19-induced changes in stoma-related surgery and stoma management in Japan. Methods/Interventions: We investigated the numbers of all operations and stoma-related surgeries in our hospital in 2019 and 2020. The cumulative numbers of consultations at our ostomy clinic and patient population stratified by the period of having a stoma were compared between these calendar years. The frequency of ostomy clinic visit by individual patients within a year after stoma creation, and stoma-related complications per consultation were also analyzed. Results/Outcome(s): The number of elective surgery decreased by approximately 10% from 2019 to 2020, but the numbers of stoma creation and closure did not change. The total numbers of consultations at our ostomy clinic were also similar between these years. However, the percentage of patients with a stoma for less than a year who attended our ostomy clinic increased from 49.7% in 2019 to 53.5% in 2020, whereas other patients showed the opposite tendency. Moreover, patients with a stoma for less than a year visited ostomy clinic more frequently in 2020 (0.42/month) than in 2019 (0.30/month, p=0.032), as shown in Figure a. Grade 2 or severer peristomal complication per consultation decreased from 17% in 2019 to 11% in 2020 (11%) than in 2019 (p<0.001), as shown in Figure b. Limitations: Our situation may not represent the totality of hospitals in Japan. In addition, early postoperative care on the ward before discharge was not counted. There may be several patients too ill to visit our ostomy clinic. As stoma conditions at home were not assessed and follow-up intervals depended on individuals, the complication rates reported here may contain biases. Finally, we did not evaluate quality of life of stoma patients in relation to stoma-related complications, e.g. using questionnaires. Conclusions/Discussion: The COVID-19 outbreak has driven the shift in patient population at ostomy clinic to new stoma patients, which may have led to in a fewer peristomal complication at least in our hospital. Crises sometimes drive innovative methods in healthcare;for example in addition to the current clinic activity, online remote consultation of stoma care may function as a triage for face-to-face outpatient clinics and add a lot of advantages in terms of saving time and reducing healthcare costs. (Figure Presented).

12.
Diseases of the Colon and Rectum ; 65(5):118-119, 2022.
Article in English | EMBASE | ID: covidwho-1894130

ABSTRACT

Purpose/Background: Perioperative COVID-19 infection is associated with an increase in morbidity and mortality, in addition to the consequences on surgical pathologies due to delays in diagnosis and treatment. Hypothesis/Aim: The aim of this study it is to describe and evaluate the effects of the pandemic on patients undergoing colorectal cancer surgery in the UC-Christus Healthcare Network. Methods/Interventions: A retrospective observational cross-sectional cohort study was made. It was based on the review of the admissions and surgical protocols of patients operated due to colon and rectal cancer diagnosis between 03/18/2019 - 03/17/2021 in the UC-Christus Healthcare Network. Patients with incomplete records and follow-ups, recurrences, or endoscopic treatments were excluded. The results of patients who were operated before the sanitary restrictions were compared with those who were operated afterwards (03/18/2020). The variables of sex, age, date of surgery, procedure, approach, tumor location, TNM, biopsy, pathological stage, presence of neoadjuvant and/or adjuvant, cause of mortality, emergency admission, and ostomy requirement were recorded in a database. The descriptive and analytic statistics of the results were analyzed using the Microsoft SPSS-Statistics21 program. Proportions were compared with the Chi2 test and Fisher's exact test in variables whose frequency was less than 5. Results/Outcome(s): One hundred seven records were included in the first period (79 colon and 28 rectal tumors) and 134 in the second (100 colon and 34 rectal tumors), with no significant differences between the number of patients nor the distribution by sex in both periods. In the colon tumors group, there were no significant differences between the groups of patients with early-stage (17), locally advanced (118), and metastatic (44) tumors between both periods. Nineteen patients (10.6%) underwent emergency surgery, 36 patients (20.1%) required an ostomy to be performed without significant differences in both periods. At the rectum tumor group, there were no significant differences concerning sex, nor pathological stage, where 17 (26.9%) were in the initial stages, 29 (46%) locally advanced, and 17 (26.9%) were metastatic. The laparoscopic approach was preferred in all tumor groups, requiring conversion in 6 (4.65%) colon tumor and 1 (2.17%) rectal tumor cases. No mortalities were recorded 30, 60, nor 90 days after Limitations: Among the limitations of our study is a selection bias, since it was carried out only in one institution, so the results obtained here are not necessarily extrapolated to the general population. Conclusions/Discussion: In patients operated in the oncology program of the Healthcare Network, there were no significant differences regarding the number of operated patients, their pathological stage, mortality, or approach in the compared periods.

13.
Diseases of the Colon and Rectum ; 65(5):73-74, 2022.
Article in English | EMBASE | ID: covidwho-1893980

ABSTRACT

Purpose/Background: Historically, diversion was performed prior to resection of complex diverticular disease. This fell out of favor, but with the advent of laparoscopy, we investigated whether fecal diversion as a first step is a safe alternative in select patients who would otherwise undergo a Hartmann's procedure. Hypothesis/Aim: For select patients with acute medically-refractory diverticulitis, diversion without resection controls sepsis and is a safe option. Methods/Interventions: Single institution retrospective chart review of all patients presenting with acute complicated diverticulitis from July 2016- June 2021 was performed. The subset of patients who underwent diverting loop ileostomy or colostomy without initial resection were analyzed for demographics, reason for diversion alone and clinical course. Results/Outcome(s): Nineteen patients who underwent loop diverting ostomy (17 ileostomies, 2 colostomies) were identified. Seventeen of 19 were performed laparoscopically. The average patient age was 52.8 years old (SD 18.1) and 47% were men. Six patients had preoperative abscesses, one of which was amenable to percutaneous drainage. Several patients were initially admitted for another diagnosis and subsequently developed diverticulitis. Comorbidities included cases of severe COVID, recent bone marrow transplantation, and current chemotherapy for lymphoma. The average time from admission to operation was 3.3 days (SD 2.9), and the average postoperative length of stay was 10.1 days (SD 10.7). None of the 19 patients required resection for failure to improve during that hospitalization. Two patients (10.5%) required placement of a percutaneous drain post-operatively. Seventeen patients were discharged home (89.5%) and 2 were discharged to a rehabilitation facility. Six patients required emergency department visits or readmission, most often for dehydration. Since their diversion, 16 patients have subsequently undergone sigmoid resection (84.2%), 15 with primary anastomosis and subsequent diverting ostomy takedown, and one with conversion from loop colostomy to descending colostomy and Hartmann's pouch. Five of the 16 sigmoid resections were performed laparoscopically (31.3%). Limitations: This study is a single institution retrospective review with a small sample size. Conclusions/Discussion: Fecal diversion appears to be a safe initial surgical strategy, providing adequate control of local sepsis in patients who are felt to be poor candidates for sigmoid resection with primary anastomosis and diversion, and allows patients to avoid an initial Hartmann's procedure. All 19 patients were discharged without requiring additional surgery. For patients with severe acute confounding medical comorbidities, initial diversion may allow the patient to recover from their acute process, permit optimization of their health status, and allow an elective sigmoid resection at a more opportune time. (Table Presented).

14.
Cureus ; 14(4), 2022.
Article in English | ProQuest Central | ID: covidwho-1871970

ABSTRACT

The causes of fevers in older adults are numerous and diverse, resulting in fevers of unknown origin that complicate the diagnosis process. Compared to young adults, older adults are characterized by comorbidities, aging-induced physiological changes, decreased homeostasis, reduced activities of daily living, and a diminished quality of life due to disease and aging. Thus, diverse perspectives are required to facilitate the accurate diagnosis of fever in older adults. In this study, we experienced a case of epidermal staphylococcal bacteremia of unknown cause with a persistent fever that eventually led to the diagnosis of cervical pseudogout. A 94-year-old bedridden woman visited our hospital with a chief complaint of persistent fever. She was diagnosed with cervical pseudogout after closely examining the prolonged fever following Staphylococcus epidermidis bacteremia. Noninfectious diseases are frequent causes of unexplained fever in older adults, and systemic inflammatory diseases, such as cervical pseudogout, should be considered during examination.

15.
Cureus ; 14(4), 2022.
Article in English | ProQuest Central | ID: covidwho-1871141

ABSTRACT

Background: Tibial plateau fractures are often significant injuries that can require complex surgical interventions with prolonged perioperative immobilization, thereby increasing the risk of developing venous thromboembolic (VTE) events, specifically, deep vein thrombosis (DVT) and pulmonary embolism (PE). Risk stratification is paramount for guiding VTE prophylaxis. Although high altitude has been suggested to create a prothrombotic state, virtually no studies have explored its clinical effects in lower extremity trauma. The purpose of this study was to compare surgical fixation of tibial plateau fractures at high and low altitudes and its effects on post-operative VTE development.Methods: The Truven MarketScan claims database was used to retrospectively identify patients who underwent surgical fixation of isolated and closed tibial plateau fractures using Current Procedural Terminology (CPT) codes over a 10-year period. Extraneous injuries were excluded using the International Classification of Diseases, 10th edition (ICD-10), and CPT codes. Patient demographics, comorbidities, and DVT chemoprophylaxis prescriptions were obtained. Patients were partitioned into high altitude (>4000 feet) or low altitude (<100 feet) cohorts based on the zip codes of their surgery locations. One-to-one matching and univariate analysis were used to assess and control any baseline discrepancies between cohorts;multivariate regression was then performed between cohorts to determine the odds ratios (OR) for developing VTEs post-operatively.Results: There were 7,832 patients included for analysis. There was no statistical difference between high and low altitude cohorts in developing VTEs within 30 days post-operatively. Higher altitudes were associated with increased odds of developing DVT (OR 1.21, p = 0.043) and PE (OR 1.27, p = 0.037) within 90 days post-operatively.Conclusions: Surgical fixation of tibial plateau fractures is associated with an increased risk of developing VTEs at high altitudes within 90 days post-operatively. Understanding such risk factors in specific orthopaedic patient populations is essential for optimizing DVT prophylaxis protocols. Further studies should investigate this relationship and the role of DVT prophylaxis regimens in this population. 

16.
Children ; 9(5):643, 2022.
Article in English | ProQuest Central | ID: covidwho-1870752

ABSTRACT

Enterovirus infection is endemic in many areas, especially in Southeast Asia. Enterovirus infection with severe complications (EVSC) is life-threatening, and timely diagnosis and management are crucial for successful management. Here, we report on a 2-year-old boy with hand, foot, and mouth disease. Myoclonic jerks developed and left abducens nerve palsy followed. Brain magnetic resonance imaging (MRI) showed rhombencephalitis. Pulmonary edema and cardiopulmonary failure developed, and intravenous immunoglobulin and extracorporeal membrane oxygenation were administered. He had a tracheostomy with home ventilator use after 64 days of hospitalization. At a 5-year follow-up, his neurodevelopment was normal with complete recovery from the abducens nerve palsy. The progress of EVSC may be rapid and fulminant, and timely diagnosis is critical for patient prognosis and outcomes. The presence of abducens nerve palsy is an indicator of enteroviral rhombencephalitis, and immediate and appropriate management is suggested.

17.
Health Science Reports ; 5(3), 2022.
Article in English | ProQuest Central | ID: covidwho-1857244

ABSTRACT

Background and AimsAs the coronavirus disease 2019 (COVID‐19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID‐19‐related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy.MethodsA multicenter, retrospective observational study was conducted in Jönköping County, Sweden. Between 14 March 2020 and 13 March 2021, 117 patients were included. All patients ≥18 years of age with confirmed COVID‐19, who underwent tracheostomy were divided into two groups based on the timing of the procedure (≤/>7 days). Outcomes including the time on IMV, intensive care unit (ICU) length of stay, and mortality 30 days after ICU admission, as well as complications due to tracheostomy were compared between the groups.ResultsEarly tracheostomy (<7 days, n = 56) was associated with a shorter median duration of mechanical ventilation (7 [12], p = 0.001) as well as a shorter median ICU stay (8 [14], p = 0.001). The most frequent complication of tracheostomy was minor bleeding. With the exception of a higher rate of obesity in the group receiving late tracheostomy, the patient characteristics were similar between the groups.ConclusionThis study showed that early tracheostomy was safe and associated with a shorter time on IMV as well as a shorter ICU length of stay, implicating possible clinical benefits in critically ill COVID‐19 patients. However, it is necessary to verify these findings in a randomized controlled trial.

18.
BMJ Open ; 11(9), 2021.
Article in English | ProQuest Central | ID: covidwho-1842841

ABSTRACT

IntroductionPatients requiring invasive mechanical ventilation via an artificial airway experience sudden voicelessness placing them at risk for adverse outcomes and increasing provider workload. Infection control precautions during the COVID-19 pandemic, including the use of personal protective equipment (eg, gloves, masks, etc), patient isolation, and visitor restrictions may exacerbate communication difficulty. The objective of this study is to evaluate the acceptability of a codesigned communication intervention for use in the adult intensive care unit when infection control precautions such as those used during COVID-19 are required.Methods and analysisThis three-phased, prospective study will take place in a medical surgical ICU in a community teaching hospital in Toronto. Participants will include ICU healthcare providers, adult patients and their family members. Qualitative interviews (target n: 20–25) will explore participant perceptions of the barriers to and facilitators for supporting patient communication in the adult ICU in the context of COVID-19 and infection control precautions (phase 1). Using principles of codesign, a stakeholder advisory council of 8–10 participants will iteratively produce an intervention (phase 2). The codesigned intervention will then be implemented and undergo a mixed method acceptability evaluation in the study setting (phase 3). Acceptability, feasibility and appropriateness will be evaluated using validated measures (target n: 60–65). Follow-up semistructured interviews will be analysed using the theoretical framework of acceptability (TFA). The primary outcomes of this study will be acceptability ratings and descriptions of a codesigned COmmunication intervention for use during and beyond the COVID-19 PandEmic.Ethics and disseminationThe study protocol has been reviewed, and ethics approval was obtained from the Michael Garron Hospital. Results will be made available to healthcare providers in the study setting throughout the study and through publications and conference presentations.

19.
Encyclopedia ; 1(4):1058, 2021.
Article in English | ProQuest Central | ID: covidwho-1834756

ABSTRACT

DefinitionCoronavirus disease 2019 (COVID-19), a respiratory syndrome caused by SARS-CoV-2, can be transmitted through respiratory droplets and aerosols of droplet nuclei. Aerosol-generating medical procedures (AGMP) are needed to take care of critically ill patients but place health care providers at risk of infection. With limited supplies of personal protective equipment (PPE), barrier systems were developed to help protect health care providers during tracheal intubation. The video intubating stylet shows promise to become the preferred intubation device in conjunction with plastic sheet barriers during the COVID-19 pandemic.

20.
Colorectal Dis ; 24(8): 925-932, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1774771

ABSTRACT

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.


Subject(s)
COVID-19 , Colonic Neoplasms , Laparoscopy , COVID-19/drug therapy , COVID-19/epidemiology , Colonic Neoplasms/epidemiology , Colonic Neoplasms/surgery , Humans , Laparoscopy/methods , Length of Stay , Pandemics , Postoperative Complications/etiology , Retrospective Studies , Sweden/epidemiology
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