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2.
Gastroenterol Nurs ; 43(5): 375-381, 2020.
Article in English | MEDLINE | ID: covidwho-817553

ABSTRACT

Elective surgical and endoscopic procedures were suspended nationwide during the March 2020 COVID-19 pandemic to minimize exposure and healthcare resource utilization. This resulted in an unprecedented backlog of procedures in most clinical practices including pediatrics. Our group developed an internal process toward the rational development of an algorithm prioritizing elective procedures. This was based on patient disease severity defined by the presence of alert symptoms, symptom severity for dysphagia and abdominal pain, and diagnostic investigation findings. The underlying rationale is to prioritize patients in whom suspected disease course would be greatest impacted by endoscopy. We developed a nurse phone call-based process utilizing REDCap®, identifying relevant symptoms categorized by severity, and a validated functional impairment questionnaire for abdominal pain. We abstracted key laboratory and radiological findings also categorized by severity. The order of priority of procedures was established on the basis of a 4-tiered system factoring both presence and severity of symptoms or prior diagnostic testing results. We present the framework that we have adopted toward prioritizing procedures with the assumption that it offers an objective methodology and that can be efficiently and more broadly applied to other similar practice scenarios. Our tool may have wide-ranging implications both in the current COVID-19 pandemic and in other scenarios of limited resource allocation and deserves further investigation.


Subject(s)
Appointments and Schedules , Betacoronavirus , Communicable Disease Control/organization & administration , Coronavirus Infections/prevention & control , Digestive System Surgical Procedures , Elective Surgical Procedures , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Adolescent , Algorithms , Child , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Endoscopy , Female , Humans , Male , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Symptom Assessment , Triage
5.
Rev Assoc Med Bras (1992) ; 66Suppl 2(Suppl 2): 55-57, 2020.
Article in English | MEDLINE | ID: covidwho-788973

ABSTRACT

In the context of the COVID-19 pandemic, endoscopy services must adopt preventive measures to maintain proper functioning due to a high risk of disease contagion. Triage protocols before and after the procedure, personal protective equipment, and environmental contamination control are some of the endoscopy society's recommendations. However, the risk of infection may remain high due to poor control over the source of contamination.Using a combination of standardized supplies and accessories in a hospital, a ventilation mask adapted to be used in endoscopic procedures is proposed to reduce COVID-19 contamination.


Subject(s)
Aerosols/adverse effects , Coronavirus Infections/prevention & control , Disease Transmission, Infectious/prevention & control , Endoscopy , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Equipment Design , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission
6.
Gastrointest Endosc ; 92(4): 988, 2020 10.
Article in English | MEDLINE | ID: covidwho-778865
8.
Korean J Intern Med ; 35(5): 1027-1030, 2020 09.
Article in English | MEDLINE | ID: covidwho-646555

ABSTRACT

Following the coronavirus disease 2019 outbreak in China, more than 10,765 patients tested positive for severe acute respiratory syndrome coronavirus 2 from February 18, 2020 to April 30, 2020 in South Korea. Performing emergency endoscopy is extremely challenging from the clinicians' viewpoint during the viral outbreak. There are no available guidelines for emergency endoscopy in tertiary hospitals during this pandemic. We set up an algorithm as a guide for emergency endoscopy in patients presenting to the emergency room with bleeding, foreign body, or impending cholangitis. From February 18, 2020 to April 30, 2020 of outbreak, 130 patients underwent emergency endoscopy in our center. Owing to the simple and streamlined algorithm for performing emergency endoscopy, no endoscopy-related infection to other patients or medical workers was reported in our center.


Subject(s)
Algorithms , Betacoronavirus , Coronavirus Infections/epidemiology , Emergency Service, Hospital , Endoscopy , Patient Selection , Pneumonia, Viral/epidemiology , Cholangitis/diagnosis , Cholangitis/etiology , Cholangitis/therapy , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Foreign Bodies/diagnosis , Foreign Bodies/etiology , Foreign Bodies/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Republic of Korea , Retrospective Studies , Tertiary Care Centers
9.
Surg Endosc ; 34(10): 4225-4232, 2020 10.
Article in English | MEDLINE | ID: covidwho-694404

ABSTRACT

BACKGROUND: Healthcare systems and general surgeons are being challenged by the current pandemic. The European Association for Endoscopic Surgery (EAES) aimed to evaluate surgeons' experiences and perspectives, to identify gaps in knowledge, to record shortcomings in resources and to register research priorities. METHODS: An ad hoc web-based survey of EAES members and affiliates was developed by the EAES Research Committee. The questionnaire consisted of 69 items divided into the following sections: (Ι) demographics, (II) institutional burdens and management strategies, and (III) analysis of resource, knowledge, and evidence gaps. Descriptive statistics were summarized as frequencies, medians, ranges,, and interquartile ranges, as appropriate. RESULTS: The survey took place between March 25th and April 16th with a total of 550 surgeons from 79 countries. Eighty-one percent had to postpone elective cases or suspend their practice and 35% assumed roles not related to their primary expertise. One-fourth of respondents reported having encountered abdominal pathologies in COVID-19-positive patients, most frequently acute appendicitis (47% of respondents). The effect of protective measures in surgical or endoscopic procedures on infected patients, the effect of endoscopic surgery on infected patients, and the infectivity of positive patients undergoing laparoscopic surgery were prioritized as knowledge gaps and research priorities. CONCLUSIONS: Perspectives and priorities of EAES members in the era of the pandemic are hereto summarized. Research evidence is urgently needed to effectively respond to challenges arisen from the pandemic.


Subject(s)
Betacoronavirus , Biomedical Research , Coronavirus Infections , Endoscopy , Pandemics , Pneumonia, Viral , Biomedical Research/methods , Biomedical Research/organization & administration , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Europe , Health Care Rationing/methods , Health Care Rationing/statistics & numerical data , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Practice Patterns, Physicians'/trends , Societies, Medical , Surgeons , Surveys and Questionnaires
12.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(5): 501-506, 2020 May 28.
Article in English, Chinese | MEDLINE | ID: covidwho-745316

ABSTRACT

OBJECTIVES: To establish a system for control of cross-infection and workflow for preventing severe acute respiratory syndrome coronavirus 2 spread and ensuring the safety of medical staffs and patients in endoscopy center during the pandemic of the coronavirus disease 2019 (COVID-19). METHODS: Based on the national publication of relevant documents and relevant guidance of Digestive Endoscopy Branch of Chinese Medical Association, we explored and optimized the workflow, staff protection and sterilization of endoscope in digestive endoscopy center during the pandemic of the COVID-19. RESULTS: The prevention system of cross-infection and workflow in endoscopy during the pandemic of the COVID-19 were developed. The optimized workflow in endoscopy was conducted in 106 patients with necessary endoscopy from the Department of Gastroenterology, Third Xiangya Hospital, Central South University between January 24, 2020 and February 26, 2020, and no case of cross-infection was presented among the medical staffs, patients and family members. CONCLUSIONS: Measures on control of cross-infection and workflow in digestive endoscopy center during the pandemic of the COVID-19 are effective, which are beneficial to preventing cross-infection in hospital and provide a scientific guidance for the general work in the digestive endoscopy centers during the pandemic of the COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Cross Infection/prevention & control , Endoscopy , Gastroenterology/organization & administration , Pneumonia, Viral/epidemiology , Workflow , Betacoronavirus , China , Coronavirus Infections/prevention & control , Humans , Pandemics/prevention & control , Pneumonia, Viral/prevention & control
14.
Eur J Obstet Gynecol Reprod Biol ; 253: 133-140, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-733869

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has raised some important interrogations on minimally invasive gynaecological surgery. The International Society for Gynecologic Endoscopy (ISGE) has taken upon itself the task of providing guidance and best practice policies for all practicing gynaecological endoscopists. Factors affecting decision making processes in minimal invasive surgery (MIS) vary depending on factors such as the phase of the pandemic, policies on control and prevention, expertise and existing infrastructure. Our responsibility remains ensuring the safety of all health care providers, ancillary staff and patients during this unusual period. We reviewed the current literature related to gynecological and endoscopic surgery during the Coronavirus Disease 19 (COVID-19) crisis. Regarding elective surgery, universal testing for SARS-CoV-2 infection should be carried out wherever possible 40 h prior to surgery. In case of confirmed positive case of SARS-CoV-2, surgery should be delayed. Priority should be given to relatively urgent cases such as malignancies. ISGE supports medical optimization and delaying surgery for benign non-life-threatening surgeries. When possible, we recommend to perform cases by laparoscopy and to allow early discharges. Any procedure with risk of bowel involvement should be performed by open surgery as studies have found a high amount of viral RNA (ribonucleic acid) in stool. Regarding urgent surgery, each unit should create a risk assessment flow chart based on capacity. Patients should be screened for symptoms and symptomatic patients must be tested. In the event that a confirmed case of SARS-CoV-2 is found, every attempt should be made to optimize medical management and defer surgery until the patient has recovered and only emergency or life-threatening surgery should be performed in these cases. We recommend to avoid intubation and ventilation in SARS-CoV-2 positive patients and if at all possible local or regional anesthesia should be utilized. Patients who screen or test negative may have general anesthesia and laparoscopic surgery while strict protocols of infection control are upheld. Surgery in screen-positive as well as SARS-CoV-2 positive patients that cannot be safely postponed should be undertaken with full PPE with ensuring that only essential personnel are exposed. If available, negative pressure theatres should be used for patients who are positive or screen high risk. During open and vaginal procedures, suction can be used to minimize droplet and bioaerosol spread. In a patient who screens low risk or tests negative, although carrier and false negatives cannot be excluded, laparoscopy should be strongly considered. We recommend, during minimal access surgeries, to use strategies to reduce production of bioaerosols (such as minimal use of energy, experienced surgeon), to reduce leakage of smoke aerosols (for example, minimizing the number of ports used and size of incisions, as well as reducing the operating pressures) and to promote safe elimination of smoke during surgery and during the ports' closure (such as using gas filters and smoke evacuation systems). During the post-peak period of pandemic, debriefing and mental health screening for staff is recommended. Psychological support should be provided as needed. In conclusion, based on the existent evidence, ISGE largely supports the current international trends favoring laparoscopy over laparotomy on a case by case risk evaluation basis, recognizing the different levels of skill and access to minimally invasive procedures across various countries.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy/standards , Gynecologic Surgical Procedures/standards , Infection Control/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic , Betacoronavirus , Coronavirus Infections/etiology , Elective Surgical Procedures/adverse effects , Elective Surgical Procedures/standards , Female , Gynecologic Surgical Procedures/adverse effects , Humans , Pneumonia, Viral/etiology , Societies, Medical
20.
Dis Esophagus ; 33(9)2020 Sep 04.
Article in English | MEDLINE | ID: covidwho-723451

ABSTRACT

BACKGROUND: The COVID-19 pandemic continues to have a significant impact on the provision of medical care. Planning to ensure there is capability to treat those that become ill with the virus has led to an almost complete moratorium on elective work. This study evaluates the impact of COVID-19 on cancer, in particular surgical intervention, in patients with esophago-gastric cancer at a high-volume tertiary center. METHODS: All patients undergoing potential management for esophago-gastric cancer from 12 March to 22 May 2020 had their outcomes reviewed. Multi-disciplinary team (MDT) decisions, volume of cases, and outcomes following resection were evaluated. RESULTS: Overall 191 patients were discussed by the MDT, with a 12% fall from the same period in 2019, including a fall in new referrals from 120 to 83 (P = 0.0322). The majority of patients (80%) had no deviation from the pre-COVID-19 pathway. Sixteen patients had reduced staging investigations, 4 had potential changes to their treatment only, and 10 had a deviation from both investigation and potential treatment. Only one patient had palliation rather than potentially curative treatment. Overall 19 patients underwent surgical resection. Eight patients (41%) developed complications with two (11%) graded Clavien-Dindo 3 or greater. Two patients developed COVID-19 within a month of surgery, one spending 4 weeks in critical care due to respiratory complications; both recovered. Twelve patients underwent endoscopic resections with no complications. CONCLUSION: Care must be taken not to compromise cancer treatment and outcomes during the COVID-19 pandemic. Excellent results can be achieved through meticulous logistical planning, good communication, and maintaining high-level clinical care.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Esophageal Neoplasms/surgery , Pneumonia, Viral/epidemiology , Stomach Neoplasms/surgery , Adult , Aged , Aged, 80 and over , Coronavirus Infections/prevention & control , Critical Pathways , Endoscopy , Female , Humans , Infection Control , Male , Middle Aged , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , United Kingdom/epidemiology
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