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1.
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
2.
Ann R Coll Surg Engl ; 103(7): 487-492, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1288676

ABSTRACT

INTRODUCTION: In response to the COVID-19 pandemic, our emergency general surgery (EGS) service underwent significant restructuring, including establishing an enhanced ambulatory service and undertaking nonoperative management of selected pathologies. The aim of this study was to compare the activity of our EGS service before and after these changes. METHODS: Patients referred by the emergency department were identified prospectively over a 4-week period beginning from the date our EGS service was reconfigured (COVID) and compared with patients identified retrospectively from the same period the previous year (Pre-COVID), and followed up for 30 days. Data were extracted from handover documents and electronic care records. The primary outcomes were the rate of admission, ambulation and discharge. RESULTS: There were 281 and 283 patients during the Pre-COVID and COVID periods respectively. Admission rate decreased from 78.7% to 41.7%, while there were increased rates of ambulation from 7.1% to 17.3% and discharge from 6% to 22.6% (all p<0.001). For inpatients, mean duration of admission decreased (6.9 to 4.8 days), and there were fewer operative or endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39) and telephone reviews (0 to 39), while early computed tomography scan was increasingly used to facilitate discharge (5% vs 34.7%). There were no differences in 30-day readmission or mortality. CONCLUSIONS: Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, achieving a decrease of 952 inpatient bed days in this critical period, while maintaining patient safety.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/organization & administration , Emergency Treatment/statistics & numerical data , General Surgery/organization & administration , Surgery Department, Hospital/organization & administration , Adult , Aged , Ambulatory Surgical Procedures/statistics & numerical data , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , Conservative Treatment/statistics & numerical data , Emergency Service, Hospital/standards , Emergency Service, Hospital/statistics & numerical data , Emergency Treatment/methods , Emergency Treatment/standards , Female , Follow-Up Studies , General Surgery/standards , General Surgery/statistics & numerical data , Hospital Mortality , Humans , Infection Control/organization & administration , Infection Control/standards , Male , Middle Aged , Pandemics/prevention & control , Patient Readmission/statistics & numerical data , Patient Safety/standards , Prospective Studies , Referral and Consultation/organization & administration , Referral and Consultation/standards , Referral and Consultation/statistics & numerical data , Retrospective Studies , SARS-CoV-2/isolation & purification , Surgery Department, Hospital/standards , Surgery Department, Hospital/statistics & numerical data
4.
Australas Emerg Care ; 24(3): 186-196, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1157136

ABSTRACT

BACKGROUND: Emergency clinicians have a crucial role during public health emergencies and have been at the frontline during the COVID-19 pandemic. This study examined the knowledge, preparedness and experiences of Australian emergency nurses, emergency physicians and paramedics in managing COVID-19. METHODS: A voluntary cross-sectional study of members of the College of Emergency Nursing Australasia, the Australasian College for Emergency Medicine, and the Australasian College of Paramedicine was conducted using an online survey (June-September 2020). RESULTS: Of the 159 emergency nurses, 110 emergency physicians and 161 paramedics, 67.3-78% from each group indicated that their current knowledge of COVID-19 was 'good to very good'. The most frequently accessed source of COVID-19 information was from state department of health websites. Most of the respondents in each group (77.6-86.4%) received COVID-19 specific training and education, including personal protective equipment (PPE) usage. One-third of paramedics reported that their workload 'had lessened' while 36.4-40% of emergency nurses and physicians stated that their workload had 'considerably increased'. Common concerns raised included disease transmission to family, public complacency, and PPE availability. CONCLUSIONS: Extensive training and education and adequate support helped prepare emergency clinicians to manage COVID-19 patients. Challenges included inconsistent and rapidly changing communications and availability of PPE.


Subject(s)
Attitude of Health Personnel , COVID-19/prevention & control , Clinical Competence/statistics & numerical data , Emergency Service, Hospital/organization & administration , Health Knowledge, Attitudes, Practice , Infection Control/organization & administration , Adult , Australia , COVID-19/epidemiology , Cross-Sectional Studies , Emergency Medical Services/standards , Emergency Treatment/standards , Female , Humans , Male , Middle Aged , Personal Protective Equipment/statistics & numerical data
5.
BMC Public Health ; 20(1): 1919, 2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-979738

ABSTRACT

BACKGROUND: Emergency risk communication is a critical component in emergency planning and response. It has been recognised as significant for planning for and responding to public health emergencies. While there is a growing body of guidelines and frameworks on emergency risk communication, it remains a relatively new field. There has also been limited attention on how emergency risk communication is being performed in public health organisations, such as acute hospitals, and what the associated challenges are. This article seeks to examine the perception of crisis and emergency risk communication in an acute hospital in response to COVID-19 pandemic in Singapore and to identify its associated enablers and barriers. METHODS: A 13-item Crisis and Emergency Risk Communication (CERC) Survey, based on the US Centers for Disease and Control (CDC) CERC framework, was developed and administered to hospital staff during February 24-28, 2020. The survey also included an open-ended question to solicit feedback on areas of CERC in need of improvement. Chi-square test was used for analysis of survey data. Thematic analysis was performed on qualitative feedback. RESULTS: Of the 1154 participants who responded to the survey, most (94.1%) reported that regular hospital updates on COVID-19 were understandable and actionable. Many (92.5%) stated that accurate, concise and timely information helped to keep them safe. A majority (92.3%) of them were clear about the hospital's response to the COVID-19 situation, and 79.4% of the respondents reported that the hospital had been able to understand their challenges and address their concerns. Sociodemographic characteristics, such as occupation, age, marital status, work experience, gender, and staff's primary work location influenced the responses to hospital CERC. Local leaders within the hospital would need support to better communicate and translate hospital updates in response to COVID-19 to actionable plans for their staff. Better communication in executing resource utilization plans, expressing more empathy and care for their staff, and enhancing communication channels, such as through the use of secure text messaging rather than emails would be important. CONCLUSION: CERC is relevant and important in the hospital setting to managing COVID-19 and should be considered concurrently with hospital emergency response domains.


Subject(s)
COVID-19/therapy , Communicable Disease Control/standards , Emergency Medical Service Communication Systems/standards , Emergency Service, Hospital/organization & administration , Emergency Treatment/standards , Centers for Disease Control and Prevention, U.S. , Humans , Information Dissemination/methods , Pandemics/prevention & control , Singapore , United States
6.
Emerg Med J ; 37(12): 778-780, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-868343

ABSTRACT

BACKGROUND: It has been reported that patients attending the emergency department with other pathologies may not have received optimal medical care due to the lockdown measures in the early phase of the COVID-19 pandemic. METHODS: This was a retrospective study of patients presenting with cardiovascular emergencies to four tertiary regional emergency departments in western India during the government implementation of complete lockdown. RESULTS: 25.0% of patients during the lockdown period and 17.4% of patients during the pre-lockdown period presented outside the window period (presentation after 12 hours of symptom onset) compared with only 6% during the pre-COVID period. In the pre-COVID period, 46.9% of patients with ST elevation myocardial infarction underwent emergent catheterisation, while in the pre-lockdown and lockdown periods, these values were 26.1% and 18.8%, respectively. The proportion of patients treated with intravenous thrombolytic therapy increased from 18.4% in the pre-COVID period to 32.3% in the post-lockdown period. Inhospital mortality for acute coronary syndrome (ACS) increased from 2.69% in the pre-COVID period to 7.27% in the post-lockdown period. There was also a significant decline in emergency admissions for non-ACS conditions, such as acute decompensated heart failure and high degree or complete atrioventricular block. CONCLUSION: The COVID-19 pandemic has led to delays in patients seeking care for cardiac problems and also affected the use of optimum therapy in our institutions.


Subject(s)
Cardiovascular Diseases/therapy , Communicable Disease Control/standards , Coronavirus Infections/prevention & control , Emergency Service, Hospital/organization & administration , Pandemics/prevention & control , Patient Admission/standards , Pneumonia, Viral/prevention & control , Aged , Angioplasty/standards , Angioplasty/statistics & numerical data , Betacoronavirus/pathogenicity , COVID-19 , Cardiovascular Diseases/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Emergencies , Emergency Service, Hospital/standards , Emergency Treatment/standards , Emergency Treatment/statistics & numerical data , Female , Health Services Accessibility/organization & administration , Health Services Accessibility/standards , Humans , India/epidemiology , Male , Middle Aged , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2 , Thrombectomy/standards , Thrombectomy/statistics & numerical data
7.
J Vasc Surg ; 72(3): 790-798, 2020 09.
Article in English | MEDLINE | ID: covidwho-701461

ABSTRACT

The global SARS-CoV-2/COVID-19 pandemic has required a reduction in nonemergency treatment for a variety of disorders. This report summarizes conclusions of an international multidisciplinary consensus group assembled to address evaluation and treatment of patients with thoracic outlet syndrome (TOS), a group of conditions characterized by extrinsic compression of the neurovascular structures serving the upper extremity. The following recommendations were developed in relation to the three defined types of TOS (neurogenic, venous, and arterial) and three phases of pandemic response (preparatory, urgent with limited resources, and emergency with complete diversion of resources). • In-person evaluation and treatment for neurogenic TOS (interventional or surgical) are generally postponed during all pandemic phases, with telephone/telemedicine visits and at-home physical therapy exercises recommended when feasible. • Venous TOS presenting with acute upper extremity deep venous thrombosis (Paget-Schroetter syndrome) is managed primarily with anticoagulation, with percutaneous interventions for venous TOS (thrombolysis) considered in early phases (I and II) and surgical treatment delayed until pandemic conditions resolve. Catheter-based interventions may also be considered for selected patients with central subclavian vein obstruction and threatened hemodialysis access in all pandemic phases, with definitive surgical treatment postponed. • Evaluation and surgical treatment for arterial TOS should be reserved for limb-threatening situations, such as acute upper extremity ischemia or acute digital embolization, in all phases of pandemic response. In late pandemic phases, surgery should be restricted to thrombolysis or brachial artery thromboembolectomy, with more definitive treatment delayed until pandemic conditions resolve.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Thoracic Outlet Syndrome/diagnosis , Triage/standards , COVID-19 , Consensus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Coronavirus Infections/virology , Decompression, Surgical/standards , Elective Surgical Procedures/methods , Elective Surgical Procedures/standards , Emergency Treatment/methods , Emergency Treatment/standards , Humans , Infection Control/standards , Interdisciplinary Communication , Limb Salvage/methods , Limb Salvage/standards , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , SARS-CoV-2 , Telemedicine/standards , Thoracic Outlet Syndrome/etiology , Thoracic Outlet Syndrome/therapy , Thrombolytic Therapy/methods , Thrombolytic Therapy/standards , Time-to-Treatment/standards
8.
Prehosp Disaster Med ; 35(4): 451-453, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-546918

ABSTRACT

Coronavirus Disease 2019 (COVID-19), a new respiratory disease, is spreading globally. In France, Emergency Medical Service (EMS) teams are mobile medicalized resuscitation teams composed of emergency physician, nurse or anesthesiologist nurse, ambulance driver, and resident. Four types of clinical cases are presented here because they have led these EMS teams to change practices in their management of patients suspected of COVID-19 infection: cardiac arrest, hypoxia on an acute pneumonia, acute chronic obstructive pulmonary disease (COPD) exacerbation with respiratory and hemodynamic disorders, and upper function disorders in a patient in a long-term care facility. The last case raised the question of COVID-19 cases with atypical forms in elderly subjects. Providers were contaminated during the management of these patients. These cases highlighted the need to review the way these EMS teams are responding to the COVID-19 pandemic, in view of heightening potential for early identification of suspicious cases, and of reinforcing the application of staff protection equipment to limit risk of contamination.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Emergency Medical Services/organization & administration , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Aged , Betacoronavirus , COVID-19 , Coronavirus Infections/epidemiology , Disaster Planning , Emergency Medical Services/standards , Emergency Treatment/standards , Female , France/epidemiology , Humans , Male , Pandemics , Personal Protective Equipment , Planning Techniques , Pneumonia, Viral/epidemiology , SARS-CoV-2
11.
Oral Oncol ; 107: 104784, 2020 08.
Article in English | MEDLINE | ID: covidwho-271026
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