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1.
Ann R Coll Surg Engl ; 103(7): 496-498, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288680

ABSTRACT

As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.


Subject(s)
Ambulatory Surgical Procedures/trends , COVID-19/prevention & control , Otorhinolaryngologic Surgical Procedures/trends , Patient Admission/trends , Surgery Department, Hospital/trends , Ambulatory Surgical Procedures/standards , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Epistaxis/surgery , Humans , Infection Control/standards , Northern Ireland/epidemiology , Otorhinolaryngologic Surgical Procedures/standards , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Pandemics/prevention & control , Patient Admission/standards , Patient Admission/statistics & numerical data , Peritonsillar Abscess/surgery , Retrospective Studies , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
2.
Ann R Coll Surg Engl ; 103(7): 478-480, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288679

ABSTRACT

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.


Subject(s)
Ambulatory Surgical Procedures/mortality , COVID-19/epidemiology , Elective Surgical Procedures/mortality , Emergency Treatment/mortality , Ambulatory Surgical Procedures/standards , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/complications , COVID-19/diagnosis , COVID-19/transmission , COVID-19 Testing/standards , COVID-19 Testing/statistics & numerical data , Elective Surgical Procedures/standards , Elective Surgical Procedures/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/standards , Emergency Treatment/statistics & numerical data , England/epidemiology , Female , Hospital Mortality , Humans , Incidence , Infection Control/standards , Infection Control/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Admission/standards , Patient Admission/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , State Medicine/standards , State Medicine/statistics & numerical data
4.
Neurosurg Focus ; 49(6): E13, 2020 12.
Article in English | MEDLINE | ID: covidwho-953767

ABSTRACT

OBJECTIVE: Telemedicine has rapidly expanded in the recent years as technologies have afforded healthcare practitioners the ability to diagnose and treat patients remotely. Due to the COVID-19 pandemic, nonessential clinical visits were greatly limited, and much of the outpatient neurosurgical practice at the authors' institution was shifted quickly to telehealth. Although there are prior data suggesting that the use of telemedicine is satisfactory in other surgical fields, data in neurosurgery are limited. This study aimed to investigate both patient and provider satisfaction with telemedicine and its strengths and limitations in outpatient neurosurgery visits. METHODS: This quality improvement study was designed to analyze provider and patient satisfaction with telemedicine consultations in an outpatient neurosurgery clinic setting at a tertiary care, large-volume, academic center. The authors designed an 11-question survey for neurosurgical providers and a 13-question survey for patients using both closed 5-point Likert scale responses and multiple choice responses. The questionnaires were administered to patients and providers during the period when the clinic restricted in-person visits. At the conclusion of the study, the overall data were analyzed qualitatively and quantitatively. RESULTS: During the study period, 607 surveys were sent out to patients seen by telehealth at the authors' academic center, and 122 responses were received. For the provider survey, 85 surveys were sent out to providers at the authors' center and other academic centers, and 40 surveys were received. Ninety-two percent of patients agreed or strongly agreed that they were satisfied with that particular telehealth visit. Eighty-eight percent of patients agreed that their telehealth visit was more convenient for them than an in-person visit, but only 36% of patients stated they would like their future visits to be telehealth. Sixty-three percent of providers agreed that telehealth visits were more convenient for them than in-person visits, and 85% of responding providers stated that they wished to incorporate telehealth into their future practice. CONCLUSIONS: Although the authors' transition to telehealth was both rapid and unexpected, most providers and patients reported positive experiences with their telemedicine visits and found telemedicine to be an effective form of ambulatory neurosurgical care. Not all patients preferred telemedicine visits over in-person visits, but the high satisfaction with telemedicine by both providers and patients is promising to the future expansion of telehealth in ambulatory neurosurgery.


Subject(s)
Ambulatory Surgical Procedures/psychology , COVID-19/psychology , Health Personnel/psychology , Neurosurgical Procedures/psychology , Patient Satisfaction , Telemedicine , Adolescent , Adult , Aged , Aged, 80 and over , Ambulatory Surgical Procedures/standards , Attitude of Health Personnel , COVID-19/epidemiology , Female , Health Personnel/standards , Humans , Male , Middle Aged , Neurosurgical Procedures/standards , Telemedicine/standards , Young Adult
5.
Best Pract Res Clin Anaesthesiol ; 35(3): 415-424, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-938789

ABSTRACT

The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Reopening of the economy and the return to ambulatory surgery and OBS and procedures have created a challenge due to COVID-19 and the infectious disease precautions that must be taken. Patients may be more apt to return to the outpatient setting to avoid the hospital, especially with the resurgence of COVID-19 cases locally, nationally, and worldwide. This review provides algorithms for screening and testing patients, selecting patients for procedures, choosing appropriate procedures, and selecting suitable personal protective equipment in this unprecedented period.


Subject(s)
Ambulatory Surgical Procedures/standards , Anesthesia/standards , COVID-19/prevention & control , Patient Care/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Ambulatory Surgical Procedures/trends , Anesthesia/trends , COVID-19/epidemiology , Humans , Patient Care/trends , Personal Protective Equipment/trends
6.
Plast Reconstr Surg ; 146(2): 437-446, 2020 08.
Article in English | MEDLINE | ID: covidwho-692689

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has confronted the U.S. health care system with unprecedented challenges amidst a tenuous economic environment. As inpatient hospitals across the country prepare for an overwhelming influx of highly contagious COVID-19 cases, many nonemergent procedures have been cancelled or indefinitely postponed without guidance regarding eventual safe accommodation of these procedures in the future. Given the potentially prolonged impact of the COVID-19 pandemic on health care use, it is imperative for plastic surgeons to collaborate with other medical and surgical specialties to develop surge capacity protocols that allow continuation of safe, high-quality, nonemergent procedures. The purpose of this article is to provide necessary and timely public health information relevant to plastic surgery and also share a conceptual framework to guide surge capacity protocols for nonemergent surgery.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Regional Health Planning/organization & administration , Surge Capacity/organization & administration , Surgery, Plastic/organization & administration , Ambulatory Surgical Procedures/standards , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Elective Surgical Procedures/standards , Humans , Infection Control/standards , Intersectoral Collaboration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Reconstructive Surgical Procedures/standards , Regional Health Planning/standards , SARS-CoV-2 , Surgery, Plastic/standards , Surgicenters/organization & administration , Surgicenters/standards , Telemedicine/organization & administration , Telemedicine/standards , United States
8.
World Neurosurg ; 139: e859-e863, 2020 07.
Article in English | MEDLINE | ID: covidwho-367037

ABSTRACT

BACKGROUND: The coronavirus 2019 (COVD-19) pandemic has drastically disrupted the delivery of neurosurgical care, especially for the already at-risk neuro-oncology population. The sudden change to clinic visits has rapidly spurned the implementation of telemedicine. A recommendation care paradigm of neuro-oncologic patients limited by telemedicine has not been reported. METHODS: A summary of a multi-institution experience detailing the potential benefits, pitfalls, and the necessary considerations to outpatient care of neurosurgical oncology patients. RESULTS: There are limitations and advantages to incorporating telemedicine into the outpatient care of neuro-oncology patients. Telemedicine-specific considerations for each step and stakeholder of the appointment (physician, patient, scheduling, previsit, imaging, and physical examination) are examined. CONCLUSIONS: Telemedicine, pushed to prominence during this COVID-19 pandemic, is a powerful and possibly preferential tool for the future of outpatient neuro-oncologic care.


Subject(s)
Ambulatory Surgical Procedures/trends , Betacoronavirus , Coronavirus Infections/surgery , Medical Oncology/trends , Neurosurgery/trends , Pneumonia, Viral/surgery , Telemedicine/trends , Ambulatory Surgical Procedures/standards , COVID-19 , Coronavirus Infections/epidemiology , Forecasting , Humans , Medical Oncology/standards , Neurosurgery/standards , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/standards
11.
Int J Gynaecol Obstet ; 149(3): 269-272, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-47598

ABSTRACT

In the context of the COVID-19 pandemic, patients need to be evaluated within 2-4 weeks in the following cases: cytology result of "squamous cell carcinoma," "atypical glandular cells, favor neoplastic," "endocervical adenocarcinoma in situ," or "adenocarcinoma"; histopathological diagnosis of suspected invasion from cervical/vaginal biopsy, or invasive disease after a cervical excision procedure, vaginal excision, or vulvar biopsy/excision; sudden onset of strongly suggestive symptoms for malignancy. Digital imaging technologies represent an important opportunity during the COVID-19 pandemic to share colposcopic images with reference centers, with the aim of avoiding any concentration of patients. All patients must undergo screening for COVID-19 exposure and should wear a surgical mask. A high-efficiency filter smoke evacuation system is mandatory to remove surgical smoke. Electrosurgical instruments should be set at the lowest possible power and not be used for long continuous periods to reduce the amount of surgical smoke. The following personal protective equipment should be used: sterile fluid-repellant surgical gloves, an underlying pair of gloves, eye protection, FFP3 mask, surgical cap, and gown. The colposcope should be protected by a disposable transparent cover. A protective lens that must be disinfected after each use should be applied. The use of a video colposcope should be preferred.


Subject(s)
Ambulatory Surgical Procedures/standards , Colposcopy/standards , Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Genital Diseases, Female/surgery , Infection Control/standards , Pandemics , Pneumonia, Viral , Adult , Biopsy , COVID-19 , Consensus , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Genital Diseases, Female/diagnosis , Genital Diseases, Female/pathology , Humans , Italy , Mass Screening , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Practice Guidelines as Topic , Pregnancy , Time Factors
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