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1.
Am J Otolaryngol ; 42(6): 103162, 2021.
Article in English | MEDLINE | ID: covidwho-1321975

ABSTRACT

OBJECTIVE: Restriction in healthcare services during the COVID-19 pandemic caused delays in the diagnosis and treatment of several diseases. To overcome the risk of missed diagnosis of head and neck cancers, before deleting the scheduled appointments, we have introduced a selection of the patients by examining the clinical presenting issue and previous medical history. The aim of this study is to show the effects of the abovementioned strategy on the diagnosis and management of laryngeal cancer. METHODS: Data were extracted from the Hospital software regarding the new diagnosis of laryngeal SCC in the periods from March 2020 to December 2020 during the pandemic (study group) and from March 2019 to December 2019 (control group) were collected. Data were compared regarding: TNM stage, time from first medical examination to histological diagnosis (Time-1), and time form histological diagnosis to beginning of treatments (Time-2). RESULTS: The final study group was composed by 19 laryngeal cancers, the control group by 25 cases. No significant differences were found in the tumour stage between the groups. In the study group, Time-1 was shorter (24 days versus 43 days, p = 0.012), while Time-2 in surgically-treated patients was longer (20 days versus 9 days, p = 0.012). CONCLUSION: During the pandemic, there was a dramatic lack of medical and nurse staff needed for surgical procedures. As consequence, the time between the diagnosis of malignancy and surgical treatment increased. In our unit, an efficient patient selection strategy to reschedule medical appointments avoided a dangerous shift toward higher laryngeal cancer stages.


Subject(s)
COVID-19 , Delayed Diagnosis/prevention & control , Delivery of Health Care/statistics & numerical data , Laryngeal Neoplasms/diagnosis , Laryngeal Neoplasms/prevention & control , Aged , Appointments and Schedules , Female , Humans , Laryngeal Neoplasms/pathology , Laryngeal Neoplasms/surgery , Male , Middle Aged , Neoplasm Staging , Time Factors
2.
Am J Emerg Med ; 49: 367-372, 2021 11.
Article in English | MEDLINE | ID: covidwho-1293514

ABSTRACT

BACKGROUND: The COVID-19 pandemic has been associated with ST-Elevation Myocardial Infarction (STEMI) reperfusion delays despite reduced emergency department (ED) volumes. However, little is known about ED contributions to these delays. We sought to measure STEMI delays and ED quality benchmarks over the course of the first two waves of the pandemic. STUDY: This study was a multi-centre, retrospective chart review from two urban, academic medical centres. We obtained ED volumes, COVID-19 tests and COVID-19 cases from the hospital databases and ED Code STEMIs with culprit lesions from the cath lab. We measured door-to-ECG (DTE) time and ECG-to-Activation (ETA) time during the phases of the pandemic in our jurisdiction: pre-first wave (Jan-Mar 2020), first wave (Apr-June 2020), post-first wave (July-Nov 2020), and second wave (Dec 2020 to Feb 2021). We calculated median DTE and ETA times and compared them to the 2019 baseline using Wilcox rank-sum test. We calculated the percentages of DTE ≤10 min and of ETA ≤10 min and compared them to baseline using chi-square test. We also utilized Statistical Process Control (SPC) Xbar-R charts to assess for special cause variation. RESULTS: COVID-19 cases began during the pre-wave phase, but there was no change in ED volumes or STEMI quality metrics. During the first wave ED volumes fell by 40%, DTE tripled (10.0 to 29.5 min, p = 0.016), ETA doubled (8.5 to 17.0 min, p = 0.04), and percentages for both DTE ≤10 min and ETA ≤10 min fell by three-quarters (each from more than 50%, to both 12.5%, both p < 0.05). After the first wave all STEMI quality benchmarks returned to baseline and did not significantly change during the second wave. A brief period of special cause variation was noted for DTE during the first wave. CONCLUSIONS: Both DTE and ETA metrics worsened during the first wave of the pandemic, revealing how it negatively impacted the triage and diagnosis of STEMI patients. But these normalized after the first wave and were unaffected by the second wave, indicating that nurses and physicians adapted to the pandemic to maintain STEMI quality of care. DTE and ETA metrics can help EDs identify delays to reperfusion during the pandemic and beyond.


Subject(s)
COVID-19 , Delayed Diagnosis/prevention & control , Emergency Service, Hospital/statistics & numerical data , Emergency Service, Hospital/standards , ST Elevation Myocardial Infarction/diagnosis , Aged , Canada , Electrocardiography , Female , Humans , Male , Middle Aged , Quality Improvement , Retrospective Studies , Time Factors , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data
5.
Nurse Pract ; 46(2): 44-49, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1072431

ABSTRACT

ABSTRACT: Misdiagnosis and delayed diagnosis are common problems in healthcare and are typically related to patient, provider, and socioeconomic factors. A syndemics model of COVID-19 is used to analyze the synergistic relationship between diseases and influences that impact patients' living conditions and health. NPs can use this approach to promote patient safety and equitable healthcare.


Subject(s)
COVID-19/diagnosis , Delayed Diagnosis , Diagnostic Errors , COVID-19/nursing , Delayed Diagnosis/prevention & control , Diagnostic Errors/prevention & control , Healthcare Disparities , Humans , Nurse Practitioners , Risk Assessment , Socioeconomic Factors , Syndemic
6.
J Intensive Care Med ; 36(5): 511-523, 2021 May.
Article in English | MEDLINE | ID: covidwho-1029763

ABSTRACT

Point-of-Care (POC) transthoracic echocardiography (TTE) is transforming the management of patients with cirrhosis presenting with septic shock, acute kidney injury, hepatorenal syndrome and acute-on-chronic liver failure (ACLF) by correctly assessing the hemodynamic and volume status at the bedside using combined echocardiography and POC ultrasound (POCUS). When POC TTE is performed by the hepatologist or intensivist in the intensive care unit (ICU), and interpreted remotely by a cardiologist, it can rule out cardiovascular conditions that may be contributing to undifferentiated shock, such as diastolic dysfunction, myocardial infarction, myocarditis, regional wall motion abnormalities and pulmonary embolism. The COVID-19 pandemic has led to a delay in seeking medical treatment, reduced invasive interventions and deferment in referrals leading to "collateral damage" in critically ill patients with liver disease. Thus, the use of telemedicine in the ICU (Tele-ICU) has integrated cardiology, intensive care, and hepatology practices across the spectrum of ICU, operating room, and transplant healthcare. Telecardiology tools have improved bedside diagnosis when introduced as part of COVID-19 care by remote supervision and interpretation of POCUS and echocardiographic data. In this review, we present the contemporary approach of using POC echocardiography and offer a practical guide for primary care hepatologists and gastroenterologists for cardiac assessment in critically ill patients with cirrhosis and ACLF. Evidenced based use of Tele-ICU can prevent delay in cardiac diagnosis, optimize safe use of expert resources and ensure timely care in the setting of critically ill cirrhosis, ACLF and liver transplantation in the COVID-19 era.


Subject(s)
Acute-On-Chronic Liver Failure , COVID-19 , Critical Care , Echocardiography/methods , Liver Cirrhosis , Point-of-Care Systems , Remote Consultation , Shock , Acute-On-Chronic Liver Failure/etiology , Acute-On-Chronic Liver Failure/physiopathology , Acute-On-Chronic Liver Failure/therapy , COVID-19/epidemiology , COVID-19/prevention & control , Cardiology/trends , Critical Care/methods , Critical Care/organization & administration , Critical Illness/therapy , Delayed Diagnosis/prevention & control , Hemodynamic Monitoring/instrumentation , Hemodynamic Monitoring/methods , Humans , Infection Control , Liver Cirrhosis/complications , Liver Cirrhosis/physiopathology , Liver Cirrhosis/therapy , Organizational Innovation , Remote Consultation/instrumentation , Remote Consultation/methods , Remote Consultation/organization & administration , SARS-CoV-2 , Shock/diagnosis , Shock/etiology , Shock/therapy
11.
JBJS Case Connect ; 10(3): e2000288, 2020.
Article in English | MEDLINE | ID: covidwho-682759

ABSTRACT

CASE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease. Patients typically present with fever, cough, and radiological lung changes. However, a significant proportion of these patients are asymptomatic. To date, we have limited information on the operations performed on these patients. We report our experience of a relatively asymptomatic elderly patient who underwent surgery for a hip fracture and was confirmed postoperatively to have COVID-19. CONCLUSION: Meticulous hand hygiene and use of surgical mask in daily practice is crucial to protect against asymptomatic and undiagnosed patients.


Subject(s)
Asymptomatic Diseases , Betacoronavirus/isolation & purification , Coronavirus Infections , Delayed Diagnosis/prevention & control , Femoral Neck Fractures/diagnosis , Hemiarthroplasty/methods , Infection Control , Pandemics , Pneumonia, Viral , Aged, 80 and over , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Female , Humans , Infection Control/methods , Infection Control/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Postoperative Period , SARS-CoV-2 , Treatment Outcome , Universal Precautions/methods
14.
J Laryngol Otol ; 134(8): 680-683, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-604803

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic requires urgent modification to existing head and neck cancer diagnosis and management practices. A protocol was established that utilises risk stratification, early investigation prior to clinical review and a reduction in aerosol generating procedures to lessen the risk of coronavirus disease 2019 spread. METHODS: Two-week wait referrals were stratified into low, intermediate and high risk. Low risk patients were referred back to primary care with advice; intermediate and high risk patients underwent investigation. Clinical encounters and aerosol generating procedures were minimised. A combined diagnostic and therapeutic surgical approach was undertaken where possible. RESULTS: Forty-one patients were used to assess feasibility. Thirty-one per cent were low risk, 35 per cent were intermediate and 33 per cent were high risk. Thirty-three per cent were discharged with no imaging. CONCLUSION: Implementing this protocol reduces the future burden on tertiary services, by empowering primary care physicians to re-refer low risk patients. The protocol is applicable across the UK and avoids diagnostic delay.


Subject(s)
Coronavirus Infections/transmission , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/pathology , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus/isolation & purification , Biopsy, Fine-Needle/instrumentation , COVID-19 , Clinical Protocols , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Delayed Diagnosis/prevention & control , Feasibility Studies , Head and Neck Neoplasms/surgery , Humans , London/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Positron Emission Tomography Computed Tomography/methods , Referral and Consultation , Risk Assessment , SARS-CoV-2 , Thyroid Neoplasms/diagnostic imaging , Thyroid Neoplasms/pathology , Thyroid Neoplasms/surgery , Ultrasonography, Interventional/methods
15.
Postgrad Med J ; 96(1137): 392-398, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-596194

ABSTRACT

Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Delayed Diagnosis/prevention & control , Diagnostic Errors/prevention & control , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/virology , Coronavirus Infections/immunology , Coronavirus Infections/virology , Cytokine Release Syndrome/physiopathology , Cytokine Release Syndrome/virology , Delayed Diagnosis/statistics & numerical data , Diagnosis, Differential , Diagnostic Errors/statistics & numerical data , Diarrhea/virology , Dysgeusia/virology , Humans , Nervous System Diseases/virology , Olfaction Disorders/virology , Pneumonia, Viral/immunology , Pneumonia, Viral/virology , SARS-CoV-2 , Virus Replication
17.
World J Urol ; 39(6): 1985-1989, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-343043

ABSTRACT

PURPOSE: COVID-19 pandemic represents a novel challenge for healthcare systems, and it affects even the daily urological practice. Italy was the first country after China to experience a lock-down period. Our objective is to determine whether, during the COVID-19 period, there has been any modification in urological emergencies. METHODS: we retrospectively reviewed urgent urological consultations requested by the Emergency Department (ED) of Padua University Hospital in the 36-day period between February 22nd and March 30th, 2020 and compared them to the prior year cases within a similar time frame (February 24th to March 31st, 2019). Pediatric population (age < 15 years); surgical complications and traumas were excluded to avoid confounding from the reduction of activities during the lockdown. The number of daily consultations, the number of invasive procedures performed and admissions were evaluated, together with the predictors of admission were identified through multivariate logistic regression models. RESULTS: The final sample resulted in 107 consultations performed in 2020 and 266 in 2019. A higher number of daily consultations was performed during 2019 (7.33 vs 2.97, p < 0.001). Similarly, the number of daily-invasive procedures was higher in 2019 (p = 0.006), while there was no difference in the number of daily admissions (15 vs 12, p = 0.80). On multivariate analysis, the year (2020 vs 2019, OR 2.714, 95% CI 1.096-6.757, p = 0.0297) was a significant predictor of admission. CONCLUSIONS: Urgent urology practice was affected during COVID-19 pandemic with a remarkable reduction in urgent urological consultations; furthermore, a higher risk of admissions was observed in 2020. The consequences of a potentially delayed diagnosis remain to be determined.


Subject(s)
COVID-19 , Diagnostic Techniques, Urological/statistics & numerical data , Emergencies/epidemiology , Emergency Service, Hospital , Referral and Consultation , Urologic Diseases , Aged , COVID-19/epidemiology , COVID-19/prevention & control , Delayed Diagnosis/prevention & control , Emergency Service, Hospital/statistics & numerical data , Emergency Service, Hospital/trends , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Patient Admission/statistics & numerical data , Referral and Consultation/statistics & numerical data , Referral and Consultation/trends , Risk Assessment , SARS-CoV-2 , Urologic Diseases/diagnosis , Urologic Diseases/epidemiology , Urology Department, Hospital/statistics & numerical data
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