Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 10 de 10
Filter
1.
ANZ J Surg ; 92(1-2): 51-56, 2022 01.
Article in English | MEDLINE | ID: covidwho-1455506

ABSTRACT

BACKGROUND: The widespread adoption of minimally invasive surgery and increased use of intra-operative fluoroscopy places surgeons and trainees at risk of cumulative occupational radiation exposure. Unfortunately, there is limited published data specific to surgeons on the potential health implications. This study aims to review current literature regarding the hazards of cumulative radiation exposure among operating theatre staff. METHODS: A systematic review was conducted of four databases for studies reporting on cumulative intra-operative radiation exposure for operating theatre staff and the hazards associated with prolonged and frequent use. References from relevant studies were screened for additional texts. English language studies, controlled trials and cross-sectional studies were included. Abstracts and full-text studies were assessed for relevance and eligibility independently by two authors using Covidence. RESULTS: Six studies were included, with cancer being the most commonly reported long-term health hazard possibly associated with cumulative radiation exposure. A 1.85 fold greater prevalence of all cancers and 2.9 fold greater prevalence of breast cancer was reported amongst female orthopaedic surgeons compared to a sex- and age-adjusted population, but the results were not replicated amongst other surgical specialties. Multiple limitations of quantifying health risks of intra-operative radiation exposure were identified, including identifying a dose-effect relationship and confounders such as nulliparity and maternal age. CONCLUSION: This article highlights the lack of robust evidence regarding the potential hazards of cumulative occupational intra-operative radiation exposure. This study demonstrates the importance of developing standardised national radiation safety protocols for surgical colleges and subspecialties to minimise risks to operating theatre staff.


Subject(s)
Occupational Exposure , Radiation Exposure , Cross-Sectional Studies , Female , Fluoroscopy , Humans , Occupational Exposure/prevention & control , Operating Rooms
2.
World Neurosurg ; 154: e320-e324, 2021 10.
Article in English | MEDLINE | ID: covidwho-1309404

ABSTRACT

BACKGROUND: Increasing restrictions over trainees' working hours and the recent coronavirus disease 2019 pandemic warrant new educational methods of surgical skills. We assessed a novel video-recording system for neuroendovascular skill education, developed with the installation of a hybrid operating room (OR) at our institution. METHODS: A single-plane angiography unit with a large flat display (FlexVision XL; Philips Medical Systems) was installed in our OR. All media sources in the OR, including live fluoroscopy and ceiling-mounted camcorders, were connected to a video switcher. This video switcher laid up to 8 video images into one big image, which was transferred to the large display and the professional-use Blu-ray recorder. The recording was performed continuously during the procedure. This recording system was evaluated retrospectively with a questionnaire administered to the 5 trainees. RESULTS: Using this system, 68 interventional procedures were recorded. Among the potential merits, the trainees assigned the greatest value to the simultaneous recording of the operator's hand motions and the fluoroscopy images. Among the potential limitations of the system, the prolonged time and the increased volume of the video data bothered the trainees the most. The recorded video looked like a live demonstration. CONCLUSIONS: Our "selfie" video recording system was useful for skill training of neuroendovascular interventions.


Subject(s)
Endovascular Procedures/education , Neurosurgery/education , Neurosurgical Procedures/education , Operating Rooms , Video Recording , Angiography , COVID-19 , Clinical Competence , Education, Medical, Graduate , Fluoroscopy , Humans , Internship and Residency , Pandemics , Retrospective Studies , Surveys and Questionnaires
3.
JPEN J Parenter Enteral Nutr ; 46(3): 556-560, 2022 03.
Article in English | MEDLINE | ID: covidwho-1274732

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has caused an increase in patients requiring enteral feeding access while undergoing proning for severe acute respiratory distress syndrome (ARDS). We investigated the safety and feasibility of fluoroscopy-guided nasojejunal (NJ) feeding tube placement in the prone position. METHODS: This is a retrospective cohort study of all patients who underwent fluoroscopic placement of NJ feeding tubes at a single institution between March 2020 and December 2020. Primary end points were success rate and number of attempts. Chi-squared and Fischer exact tests were used to compare prone and supine groups. RESULTS: A total of 210 patients were included in the study: 53 patients received NJ feeding tubes while prone and 157 while supine. All but one patient in the prone group had ARDS secondary to COVID-19, whereas 47 (30.3%) had COVID-19 in the supine group. The rate of successful placement was 94.3% in the prone group and 100% in the supine group. Mean number of attempts was 1.1 (SD, ±0.4) in the prone and 1.0 (SD, ±0.1) in the supine group (P = .14). Prone patients had a longer median fluoroscopy time (69 s, interquartile range [IQR] = 92; vs 48 s, IQR = 43; P < .001) and received a higher radiation dose during the procedure (47 mGy, IQR = 50; vs 25 mGy, IQR = 33; P = .004). No procedural complications were reported. CONCLUSION: Fluoroscopy-guided NJ feeding tube placement in prone patients is feasible and safe. Patient positioning should not delay obtaining postpyloric feeding access.


Subject(s)
COVID-19 , COVID-19/therapy , Fluoroscopy/methods , Humans , Intubation, Gastrointestinal/methods , Patient Positioning , Prone Position , Retrospective Studies , SARS-CoV-2
4.
Pain Pract ; 21(8): 984-990, 2021 11.
Article in English | MEDLINE | ID: covidwho-1209422

ABSTRACT

BACKGROUND: Fluoroscopic-guided lumbar procedures have increased in daily pain practice because the lumbar spine is one of the most common sources of pain. Interventional pain fellows must develop a minimum number of skills during their training in order to achieve the competences without neglecting radiological safety. However, medical training in fluoroscopic-guided interventions is being affected by the current coronavirus disease 2019 (COVID-19) situation. METHODS: The objective of this study was to evaluate the use of a phantom model for lumbar injection as a training strategy during the COVID-19 pandemic in fellows of interventional pain. The study was divided into theoretical and practical modules. The hands-on practice was performed in a lumbar model phantom where fellows were evaluated in four fluoroscopically guided approaches: intra-articular facet block (IAFB), medial branch block (MBB), transforaminal block (TFB), and interlaminar block (ILB) divided in 5 sessions. The aim was to make as many punctures as possible in every session. We measured total procedural performance (TPP), total needle hand time (TNH), and total radiation dose generated by the fluoroscopic machine (TRD) during each procedure. Additionally, a survey was applied to evaluate confidence and satisfaction before and after training. RESULTS: A total of 320 lumbar punctures were completed. The results were statistically significant in all approaches attempted (p < 0.01). The fellow's survey for satisfaction and confidence demonstrated a significant difference between pre and post-test (p < 0.01). CONCLUSIONS: The results of this study highlight the importance of adaptations and adoption of new educational models. The use of the phantom model for simulation could be a strategy for other emerging situations, like the COVID-19 pandemic. Including this practice in the interventional pain programs could lead to better results for the patient and operator radiology safety.


Subject(s)
COVID-19 , Pandemics , Fluoroscopy , Humans , Pain , SARS-CoV-2
5.
Abdom Radiol (NY) ; 46(7): 3058-3065, 2021 07.
Article in English | MEDLINE | ID: covidwho-1151997

ABSTRACT

No guidance exists on how to safely perform modified barium swallows (MBS) in the midst of the COVID-19 pandemic or other communicable airborne respiratory infections (C-ARI). MBS has the potential to become an aerosol generating procedure (AGP) as it may trigger a cough or necessitate suctioning which may result in transmission of C-ARI putting patients and health care workers at risk. Regulations and best practices from international and US governmental and commercial agencies were reviewed. This review led to the multidisciplinary development of best practices of the safety measures and structural requirements to avoid transmission of SARS-CoV-2 or other C-ARIs when performing MBS. Implementation of these best practices resulted in structural changes to the fluoroscopy suite and protocol workflows. This enabled patients with COVID-19 to undergo MBS while maintaining patient and staff safety including mitigation of potential risk of onward transmission of SARS-CoV-2 to other patients. With proper modifications, MBS can be safely performed on patients with C-ARI such as COVID-19 while maintaining patient and health care worker (HCW) safety.


Subject(s)
COVID-19 , Pandemics , Barium , Fluoroscopy , Humans , SARS-CoV-2
7.
Eur Arch Otorhinolaryngol ; 278(8): 3119-3123, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1002086

ABSTRACT

INTRODUCTION: The aim of this paper is to describe the early findings of swallowing analysis with videofluoroscopy of swallowing (VFS). METHODS: The 21 first patients (14 men and 7 women) who recovered from ARDS in context of COVID-19 were referred to VFS just before to maximum 14 days after their discharge from ICU. The swallowing impairments and the physiopathologic mechanism of them were prospectively analyzed by two swallowing experts: one radiologist, and one phoniatrician using penetration-aspiration scale (PAS) score. RESULTS: Nineteen out of 21 presented impairment in their swallowing function. Sixteen patients presented direct penetration or inhalation. All but one were silent. Some stases were also observed in 13 patients. Five patients presented secondary penetration/aspiration, among these inhalations, and all were silent. The most frequent findings are the delayed pharyngeal phase, the reduced propulsion of the tongue root, the posterior oral leaks, the default of laryngeal closure, and the impaired pharyngeal peristaltism. DISCUSSION: The very high prevalence of swallowing disorders with inhalation and the lack of protective reflexes are the main findings. This emphasizes the need of high caution with bedside screening in these patients with severely injured lungs.


Subject(s)
COVID-19 , Deglutition Disorders , Cineradiography , Deglutition , Deglutition Disorders/diagnostic imaging , Deglutition Disorders/etiology , Female , Fluoroscopy , Humans , Male , SARS-CoV-2
8.
Clin Spine Surg ; 34(3): 87-91, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-835180

ABSTRACT

Safe spine surgery is possible during the COVID-19 pandemic. Certain urgent procedures must still be performed during this challenging time to prevent permanent long-term disability or death for patients. Precautions must be taken in the operating room to optimize safety, including the use of personal protective equipment and appropriate room setup and anesthesia and equipment optimization. Evidence-based guidelines to create a safe operative paradigm for use in future viral outbreaks are paramount.


Subject(s)
COVID-19/prevention & control , Orthopedic Procedures/methods , Practice Guidelines as Topic , Spinal Diseases/surgery , Air Filters , Airway Extubation , Electrocoagulation , Fluoroscopy , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intraoperative Neurophysiological Monitoring , Intubation, Intratracheal , N95 Respirators , Operating Rooms , Personal Protective Equipment , Postoperative Care , SARS-CoV-2 , Ventilation
10.
Head Neck ; 42(7): 1491-1496, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-291715

ABSTRACT

The global pandemic of 2019 novel coronavirus disease (COVID-19) has tremendously altered routine medical service provision and imposed unprecedented challenges to the health care system. This impacts patients with dysphagia complications caused by head and neck cancers. As this pandemic of COVID-19 may last longer than severe acute respiratory syndrome (SARS) in 2003, a practical workflow for managing dysphagia is crucial to ensure a safe and efficient practice to patients and health care personnel. This document provides clinical practice guidelines based on available evidence to date to balance the risks of SARS-CoV-2 exposure with the risks associated with dysphagia. Critical considerations include reserving instrumental assessments for urgent cases only, optimizing the noninstrumental swallowing evaluation, appropriate use of personal protective equipment (PPE), and use of telehealth when appropriate. Despite significant limitations in clinical service provision during the pandemic of COVID-19, a safe and reasonable dysphagia care pathway can still be implemented with modifications of setup and application of newer technologies.


Subject(s)
Betacoronavirus , Coronavirus Infections , Deglutition Disorders/diagnosis , Head and Neck Neoplasms/complications , Infection Control/organization & administration , Pandemics , Pneumonia, Viral , Air Filters , Barium Sulfate , COVID-19 , Contrast Media , Deglutition Disorders/etiology , Environmental Exposure/prevention & control , Esophagoscopy , Fluoroscopy , Humans , Occupational Exposure/prevention & control , Personal Protective Equipment , Quarantine , SARS-CoV-2 , Telemedicine , Video Recording
SELECTION OF CITATIONS
SEARCH DETAIL