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2.
Curr Oncol ; 27(5): e512-e515, 2020 10.
Article in English | MEDLINE | ID: covidwho-1024676

ABSTRACT

Sarcoma treatment during the covid-19 pandemic is a new challenge. This patient population is often immunocompromised and potentially more susceptible to viral complications. Government guidelines highlight the need to minimize patient exposure to unnecessary hospital visits. However, those guidelines lack practical recommendations on ways to manage triage and diagnosis expressly for new cancer patients. Furthermore, there are no reports on the efficiency of the guidelines. One of the main issues in treating musculoskeletal tumours is the complexity and variability of presentation. We offer a triage model, used in a quaternary-referral musculoskeletal oncology centre, that allows us to maintain an open pathway for referral of new patients while minimizing exposure risks. A multidisciplinary approach and analysis of existing investigations allow for a pre-clinic evaluation. The model identifies 3 groups of patients: ■ Patients with suspected high-grade malignancy, or benign cases with aggressive features, both in need of further evaluation in the clinic and prompt treatment■ Patients with low-grade malignancy, and benign cases whose treatment is not urgent, that are managed during the pandemic by telemedicine, with reassurance and information about their illness■ Patients who can be managed by their local medical professionals In comparison to a pre-pandemic period, that approach resulted in a higher ratio of malignant-to-benign conditions for new patients seen in the clinic (3:4 vs. 1:3 respectively), thus using available resources more efficiently and prioritizing patients with suspected high-grade malignancy. We believe that this triage system could be applied in other surgical oncology fields during a pandemic.


Subject(s)
Betacoronavirus/isolation & purification , Bone Neoplasms/therapy , Coronavirus Infections/complications , Pneumonia, Viral/complications , Practice Guidelines as Topic/standards , Soft Tissue Neoplasms/therapy , Telemedicine/methods , Triage/standards , Bone Neoplasms/virology , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Disease Management , Humans , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Risk Management , Soft Tissue Neoplasms/virology
3.
Curr Oncol ; 27(3): e313-e317, 2020 06.
Article in English | MEDLINE | ID: covidwho-1024671

ABSTRACT

Background: The emergence of covid-19 has the potential to change the way in which the health care system can accommodate various patient populations and might affect patients with non-covid-19 problems. The Quebec Lung Cancer Network, which oversees thoracic oncology services in the province of Quebec under the direction of the Ministère de la Santé et des Services sociaux, convened to develop recommendations to deal with the potential disruption of services in thoracic oncology in the province of Quebec. The summary provided here has been adapted from the original document posted on the Programme québécois du cancer Web site at: https://www.msss.gouv.qc.ca/professionnels/documents/coronavirus-2019-ncov/PJ1_Recommandations_oncologie-thoracique-200415.pdf. Methods: Plans to optimize the health care system and potentially to prioritize services were discussed with respect to various levels of activity. For each level-of-activity scenario, suggestions were made for the services and treatments to prioritize and for those that might have to be postponed, as well as for potential alternatives to care. Results: The principal recommendation is that the cancer centre executive committee and the multidisciplinary tumour board always try to find a solution to maintain standard-of-care therapy for all patients with thoracic tumours, using novel approaches to treatment and the adoption of a network approach to care, as needed. Conclusions: The effect of the covid-19 pandemic on the health care system remains unpredictable and requires that cancer teams unite and offer the most efficient and innovative therapies to all patients under the various conditions that might be forced upon them.


Subject(s)
Antineoplastic Agents/administration & dosage , Carcinoma, Non-Small-Cell Lung/therapy , Coronavirus Infections/epidemiology , Lung Neoplasms/therapy , Pneumonia, Viral/epidemiology , Radiotherapy , Small Cell Lung Carcinoma/therapy , Thoracic Surgical Procedures , Triage , Administration, Oral , Antineoplastic Agents/therapeutic use , Betacoronavirus , Carcinoma, Non-Small-Cell Lung/diagnosis , Disease Management , Humans , Lung Neoplasms/diagnosis , Mediastinoscopy , Medical Oncology , Molecular Diagnostic Techniques , Neoplasm Staging , Pandemics , Quebec/epidemiology , Radiosurgery , Small Cell Lung Carcinoma/diagnosis , Thoracoscopy
4.
Medicina (Kaunas) ; 56(12)2020 Dec 19.
Article in English | MEDLINE | ID: covidwho-1024607

ABSTRACT

The interplay between coronavirus disease 2019 (COVID-19) and pulmonary hypertension (PH) in children is unknown. Adults with PH are at potential risk for severe complications and high mortality due to associated comorbidities. It is difficult to extrapolate the outcomes of COVID-19 in adults to pediatric PH patients. Overall, a small number of COVID-19 cases is reported in patients with preexisting PH. Several factors may be responsible for the low incidence of COVID-19 in children with PH. Pulmonary hypertension is a rare disease, testing is not universal, and patients may have followed more rigorously the Center for Disease Control's guidelines recommended for personal protection with mask-wearing, social distancing, and hand sanitization through ongoing health education. The small number of COVID-19 cases in patients with preexisting PH does not support that PH is protective for COVID-19. However, medications used to treat PH may have some protection against COVID-19. This review discusses the pathophysiology of PH occurring with COVID-19, differences between children and adults with COVID-19, strategies for management of preexisting PH in children during the ongoing pandemic, and its impact within the field of PH.


Subject(s)
/complications , Hypertension, Pulmonary/complications , Hypertension, Pulmonary/physiopathology , /epidemiology , Child , Humans , Hypertension, Pulmonary/epidemiology , Hypertension, Pulmonary/therapy , Incidence , Pandemics
5.
Medicina (Kaunas) ; 56(12)2020 Dec 09.
Article in English | MEDLINE | ID: covidwho-1024604

ABSTRACT

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) gained worldwide attention at the end of 2019 when it was identified to cause severe respiratory distress syndrome. While it primarily affects the respiratory system, we now have evidence that it affects multiple organ systems in the human body. Cardiac manifestations may include myocarditis, life threatening arrhythmias, acute coronary syndrome, systolic heart failure, and cardiogenic shock. Myocarditis is increasingly recognized as a complication of Coronavirus-19 (COVID-19) and may result from direct viral injury or from exaggerated host immune response. The diagnosis is established similar to other etiologies, and is based on detailed history, clinical exam, laboratory findings and non-invasive imaging studies. When available, cardiac MRI is the preferred imaging modality. Endomyocardial biopsy may be performed if the diagnosis remains uncertain. Current management is mainly supportive with the potential addition of interventions recommended for severe COVID-19 disease, such as remdesivir, steroids, and convalescent plasma. In the setting of cardiogenic shock and refractory, life-threatening arrhythmias that persist despite medical therapy, advanced mechanical circulatory support devices should be considered. Ultimately, early recognition and aggressive intervention are key factors in reducing morbidity and mortality. Our management strategy is expected to evolve further as we learn more about COVID-19 disease and the associated cardiac complications.


Subject(s)
/complications , /therapy , Myocarditis/virology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Humans , Immunization, Passive , Myocarditis/mortality , Myocarditis/therapy , Steroids/therapeutic use
6.
Recenti Prog Med ; 111(4): 212-222, 2020 Apr.
Article in Italian | MEDLINE | ID: covidwho-1024443

ABSTRACT

On 6 March 2020, the Italian Society of Anaesthesia Analgesia Resuscitation and Intensive care (SIAARTI) published the document "Clinical Ethics Recommendations for Admission to and Suspension of Intensive Care in Exceptional Conditions of Imbalance between Needs and Available Resources". The document, which aims to propose treatment decision-making criteria in the face of exceptional imbalances between health needs and available resources, has produced strong reactions, within the medical-scientific community, in the academic world, and in the media. In the current context of international public health emergency caused by the CoViD-19 epidemic, this work aims to explain the ethical, deontological and legal bases of the SIAARTI Document and to propose methodologic and argumentative integrations that are useful for understanding and placing in context the decision-making criteria proposed. The working group that contributed to the drafting of this paper agrees that it is appropriate that healthcare personnel, who is particularly committed to taking care of those who are currently in need of intensive or sub-intensive care, should benefit from clear operational indications that are useful to orient care and, at the same time, that the population should know in advance which criteria will guide the tragic choices that may fall on each one of us. This contribution therefore firstly reflects on the appropriateness of the SIAARTI standpoint and the objectives of the SIAARTI Document. It then turns to demonstrate how the recommendations it proposes can be framed within a shared interdisciplinary, ethical, deontological and legal perspective.


Subject(s)
Coronavirus Infections , Critical Care , Pandemics , Pneumonia, Viral , Resource Allocation/ethics , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Critical Care/ethics , Critical Care/legislation & jurisprudence , Health Resources , Health Services Needs and Demand , Humans , Intensive Care Units , Interdisciplinary Communication , Italy , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Practice Guidelines as Topic , Resource Allocation/legislation & jurisprudence
7.
Recenti Prog Med ; 111(4): 184-185, 2020 04.
Article in Italian | MEDLINE | ID: covidwho-1024442

ABSTRACT

A position statement published by the Italian Society of Anesthesia Analgesia Resuscitation and Intensive Care (SIAARTI) is fostering a vibrant debate, crossed by deep fears. These are recommendations addressed to ICU doctors who must decide whether to implement intensive treatments for patients who need them to survive. Specifically, the reference is to the patients to whom the CoViD-19 epidemic has compromised respiratory capacity. We still do not have clear what positive criteria can help make clinical decisions in contexts of insufficient resources that force us to make choices.


Subject(s)
Coronavirus Infections , Decision Making , Health Resources , Pandemics , Pneumonia, Viral , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/therapy , Decision Making/ethics , Health Resources/supply & distribution , Hospitals, Group Practice , Humans , Informed Consent , Patient Rights , Physicians , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Severity of Illness Index
8.
Nephron ; 144(5): 245-247, 2020.
Article in English | MEDLINE | ID: covidwho-1024277

ABSTRACT

Since December 2019, the epidemic of coronavirus disease 2019 (COVID-19) has spread very rapidly in China and worldwide. In this article, we report on a 75-year-old man infected with 2019 novel coronavirus who has end-stage kidney disease (ESKD). COVID-19 patients with ESKD need isolation dialysis, but most of them cannot be handled in time due to limited continuous renal replacement therapy (CRRT) machines. CRRT provided benefits for this patient by removing potentially damaging toxins and stabilizing his metabolic and hemodynamic status. With the control of uremia and fluid status, this patient ended up with an uneventful post-CRRT course, absence of clinical symptoms, and negative PCR tests. Greater efforts are needed to decrease the mortality of COVID-19-infected ESKD patients.


Subject(s)
Coronavirus Infections/complications , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Pneumonia, Viral/complications , Renal Dialysis , Aged , Betacoronavirus , Humans , Kidney Failure, Chronic/virology , Male , Pandemics
9.
Emerg Med J ; 37(9): 572-575, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1024251

ABSTRACT

The COVID-19 pandemic has led to a surge of information being presented to clinicians regarding this novel and deadly disease. There is a clear urgency to collate, review, appraise and act on this information if we are to do the best for clinicians and patients. However, the speed of the pandemic is a threat to traditional models of knowledge translation and practice change. In this concepts paper, we argue that clinicians need to be agile in their thinking and practice in order to find the right time to change. Adoption of new methods should be based on clinical judgement, the weight of evidence and the balance of probabilities that any new technique, test or treatment might work. The pandemic requires all of us to reach a new level of evidence-based medicine characterised by scepticism, thoughtfulness, responsiveness and clinically agility in practice.


Subject(s)
Coronavirus Infections , Critical Pathways , Evidence-Based Medicine , Pandemics , Pneumonia, Viral , Translational Medical Research , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Critical Pathways/organization & administration , Critical Pathways/trends , Evidence-Based Medicine/education , Evidence-Based Medicine/methods , Evidence-Based Medicine/organization & administration , Humans , Knowledge Management , Organizational Innovation , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Quality Improvement , Surge Capacity , Translational Medical Research/education , Translational Medical Research/trends
10.
Emerg Med J ; 37(9): 565-566, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-1024248

ABSTRACT

We report the experience of prone ventilation in selected patients treated with helmet non-invasive ventilation (NIV) continuous positive airway pressure (CPAP) for acute respiratory failure in COVID-19 pneumonia. Preliminary results showed an improvement in the PaO2 value and PaO2/FiO2 ratio after 1 hour of prone ventilation. No variation of the lung ultrasound pattern before and after prone ventilation has been detected. At the time of writing, we attempted proning with helmet NIV CPAP in 10 patients. In 4 out of 10 patients, the attempt failed due to lack of compliance of the patient, scarce pain control even with ongoing treatment and refusal by the patient to prone positioning.


Subject(s)
Continuous Positive Airway Pressure/methods , Coronavirus Infections , Noninvasive Ventilation/methods , Pandemics , Pneumonia, Viral , Prone Position , Respiratory Insufficiency , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Italy/epidemiology , Male , Oxygen Consumption , Oxygen Inhalation Therapy/methods , Patient Positioning , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , Treatment Outcome
11.
J Cosmet Dermatol ; 19(11): 2974-2981, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1024197

ABSTRACT

BACKGROUND: Hair loss affects most people at some point in their lifetime, causing anxiety and decreased self-esteem. There are multiple surgical and nonsurgical treatments available, with the surgical options having greater and longer-lasting effects. Such treatments have evolved over time with advances in technology and research, with numerous patients researching these treatments on Google. Many surgeons who provide these treatments belong to the International Society of Hair Restoration Surgeons (ISHRS). AIMS: To investigate trends in surgical hair restoration treatment from both the surgeon and patient perspectives. METHODS: Patient epidemiological and surgical data from the ISHRS were combined with search trend data from Google to analyze changing trends in surgical hair restoration treatment. RESULTS: Worldwide Internet searches for "hair transplant" have increased from 2004 to the present. Follicular unit excision (FUE) has supplanted follicular unit transplant (FUT) as the most popular hair transplant performed. Since 2004, there has been an increase in both nonsurgical and surgical female patients. Beard and eyebrow transplants have increased in popularity. Google searches follow this trend. Nonsurgical treatments such as platelet-rich plasma (PRP) are being searched more frequently. Hair restoration clinics and Google searches were affected adversely by the COVID-19 pandemic. CONCLUSION: Technological advances in available therapies, improvement in delivery systems, changes in hair fashion, and global events have direct impact on hair restoration treatments offered by physicians and researched by patients. It is in the best interest of all hair restoration providers to keep abreast of changing technologies and treatment trends to stay at the forefront of their profession.


Subject(s)
Alopecia/therapy , Betacoronavirus , Coronavirus Infections/epidemiology , Cosmetic Techniques/statistics & numerical data , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Humans , Pandemics , Social Media , Surveys and Questionnaires
12.
Curr Opin Nephrol Hypertens ; 30(1): 93-96, 2021 01.
Article in English | MEDLINE | ID: covidwho-1024165

ABSTRACT

PURPOSE OF REVIEW: The novel corona virus (SARS-CoV2) has been demonstrated to cause acute kidney injury due to direct cellular toxicity as well as due to a variety of autoimmune glomerular diseases. The concept of a surge of infected patients resulting in an overwhelming number of critical patients has been a central concern in healthcare planning during the COVID-19 era. RECENT FINDINGS: One crucial question remains as to how to manage patients with end stage renal disease and acute kidney injury in case of a massive surge of critically ill infected patients. Some publications address practical and ingenious solutions for just such a surge of need for renal replacement therapy. We present a plan for using a blood pump, readily available dialysis filter, and a prefilter and postfilter replacement fluid set up. This is in conjunction with multiple intravenous pumps to develop a simple hemofiltration apparatus. SUMMARY: The current set up may be a readily available option for use in critical situations where the need for renal replacement therapy outstrips the capacity of traditional hemodialysis services in a hospital or region.


Subject(s)
Acute Kidney Injury/therapy , Continuous Renal Replacement Therapy , Disasters , Hemodiafiltration , Acute Kidney Injury/etiology , Humans
13.
J Occup Environ Med ; 62(11): 898-903, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1024146

ABSTRACT

OBJECTIVES: To explore the level and influencing factors of help-seeking behavior of returning to work in healthcare workers (HCWs). METHODS: A total of 861 HCWs were surveyed. A structured self-administered questionnaire was used to collect data. Multivariable logistic regression was performed to examine the influencing factors of help-seeking behavior. RESULTS: HCWs sought help with respect to COVID-19-diagnosized problem most. Help-seeking intention, problems encountered after return, test for return, work condition during COVID-19, relatives or friends diagnosed or suspected as COVID-19, and socio-demographic characteristics such as occupation, education, title, and marriage status are predictors of help-seeking behavior. CONCLUSIONS: Education and intervention should lay particular stress on HCWs featured rest at home before return, doctor, lower education and lower title to ensure the safety, accuracy, and quality of work after they return to work for a better occupational environment.


Subject(s)
Betacoronavirus , Coronavirus Infections/psychology , Health Personnel/psychology , Help-Seeking Behavior , Pneumonia, Viral/psychology , Return to Work/psychology , Adult , China , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Female , Humans , Intention , Logistic Models , Male , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Socioeconomic Factors , Surveys and Questionnaires
14.
Crit Care Med ; 49(1): 102-111, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1024138

ABSTRACT

OBJECTIVES: To identify characteristics that predict 30-day mortality among patients critically ill with coronavirus disease 2019 in England, Wales, and Northern Ireland. DESIGN: Observational cohort study. SETTING: A total of 258 adult critical care units. PATIENTS: A total of 10,362 patients with confirmed coronavirus disease 2019 with a start of critical care between March 1, 2020, and June 22, 2020, of whom 9,990 were eligible (excluding patients with a duration of critical care less than 24 hr or missing core variables). MEASUREMENTS AND MAIN RESULTS: The main outcome measure was time to death within 30 days of the start of critical care. Of 9,990 eligible patients (median age 60 yr, 70% male), 3,933 died within 30 days of the start of critical care. As of July 22, 2020, 189 patients were still receiving critical care and a further 446 were still in acute hospital. Data were missing for between 0.1% and 7.2% of patients across prognostic factors. We imputed missing data ten-fold, using fully conditional specification and continuous variables were modeled using restricted cubic splines. Associations between the candidate prognostic factors and time to death within 30 days of the start of critical care were determined after adjustment for multiple variables with Cox proportional hazards modeling. Significant associations were identified for age, ethnicity, deprivation, body mass index, prior dependency, immunocompromise, lowest systolic blood pressure, highest heart rate, highest respiratory rate, Pao2/Fio2 ratio (and interaction with mechanical ventilation), highest blood lactate concentration, highest serum urea, and lowest platelet count over the first 24 hours of critical care. Nonsignificant associations were found for sex, sedation, highest temperature, and lowest hemoglobin concentration. CONCLUSIONS: We identified patient characteristics that predict an increased likelihood of death within 30 days of the start of critical care for patients with coronavirus disease 2019. These findings may support development of a prediction model for benchmarking critical care providers.


Subject(s)
/mortality , Critical Illness/mortality , Severity of Illness Index , Adult , Cohort Studies , Critical Illness/therapy , England , Female , Hospital Mortality , Humans , Male , Middle Aged , Northern Ireland , Prognosis , Respiration, Artificial/mortality , Wales
20.
Br Dent J ; 229(6): 363-370, 2020 09.
Article in English | MEDLINE | ID: covidwho-1023873

ABSTRACT

The management of odontogenic infections has improved over recent decades, but further improvements are still required. The ongoing education of GDPs and their dental teams on this issue continues to be important, especially during the current COVID-19 pandemic, where remote triage poses additional difficulties and challenges.Odontogenic infections can lead to sepsis, a potentially life-threatening condition caused by the body's immune system responding in an abnormal way. This can lead to tissue damage, organ failure and death. A patient with non-odontogenic-related infection could also present with sepsis at a dental practice. Early recognition and prompt management of sepsis improves outcomes. GDPs and their dental teams should be trained in the recognition and management of sepsis. Age-specific sepsis decision support tools have been developed by the UK Sepsis Trust to help dental staff recognise and manage patients with suspected sepsis.The aim of this article is to provide an update on the management of odontogenic infections and sepsis.


Subject(s)
Coronavirus Infections , Pandemics , Pneumonia, Viral , Sepsis , Tooth Diseases , Betacoronavirus , Humans , Infections/complications , Sepsis/diagnosis , Sepsis/therapy
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