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1.
J Orthop Traumatol ; 22(1): 22, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1269870

ABSTRACT

BACKGROUND: Periprosthetic fractures (PPFs) are a growing matter for orthopaedic surgeons, and patients with PPFs may represent a frail target in the case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The purpose of this study is to investigate whether hospital reorganisations during the most severe phase of the SARS-CoV-2 pandemic affected standards of care and early outcomes of patients treated for PPFs in Northern Italy. MATERIALS AND METHODS: Data were retrieved from a multicentre retrospective orthopaedics and traumatology database, including 14 hospitals. The following parameters were studied: demographics, results of nasopharyngeal swabs, prevalence of coronavirus disease 2019 (COVID-19), comorbidities, general health status (EQ-5D-5L Score), frailty (Clinical Frailty Scale, CFS), pain (visual analogue scale, VAS), anaesthesiologic risk (American Society of Anaesthesiology Score, ASA Score), classification (unified classification system, UCS), type of operation and anaesthesia, in-hospital and early complications (Clavien-Dindo Classification, CDC), and length of stay (LOS). Data were analysed by means of descriptive statistics. Out of 1390 patients treated for any reason, 38 PPFs were included. RESULTS: Median age was 81 years (range 70-96 years). Twenty-three patients (60.5%) were swabbed on admission, and two of them (5.3%) tested positive; in three patients (7.9%), the diagnosis of COVID-19 was established on a clinical and radiological basis. Two more patients tested positive post-operatively, and one of them died due to COVID-19. Thirty-three patients (86.8%) presented a proximal femoral PPF. Median ASA Score was 3 (range, 1-4), median VAS score on admission was 3 (range, 0-6), median CFS was 4 (range, 1-8), median EQ-5D-5L Score was 3 in each one of the categories (range, 1-5). Twenty-three patients (60.5%) developed post-operative complications, and median CDC grade was 3 (range, 1-5). The median LOS was 12.8 days (range 2-36 days), and 21 patients (55.3%) were discharged home. CONCLUSIONS: The incidence of PPFs did not seem to change during the lockdown. Patients were mainly elderly with comorbidities, and complications were frequently recorded post-operatively. Despite the difficult period for the healthcare system, hospitals were able to provide effective conventional surgical treatments for PPFs, which were not negatively influenced by the reorganisation. Continued efforts are required to optimise the treatment of these frail patients in the period of the pandemic, minimising the risk of contamination, and to limit the incidence of PPFs in the future. LEVEL OF EVIDENCE: IV.


Subject(s)
COVID-19 , Hospital Restructuring , Infection Control , Pandemics , Periprosthetic Fractures , Standard of Care , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Communicable Disease Control/methods , Communicable Disease Control/standards , Communicable Disease Control/statistics & numerical data , Comorbidity , Female , Frailty/epidemiology , Hospital Restructuring/organization & administration , Hospital Restructuring/standards , Hospital Restructuring/statistics & numerical data , Humans , Incidence , Infection Control/methods , Infection Control/standards , Infection Control/statistics & numerical data , Italy/epidemiology , Male , Orthopedic Procedures/methods , Orthopedic Procedures/standards , Orthopedic Procedures/statistics & numerical data , Pandemics/statistics & numerical data , Periprosthetic Fractures/complications , Periprosthetic Fractures/epidemiology , Periprosthetic Fractures/surgery , Periprosthetic Fractures/therapy , Retrospective Studies , SARS-CoV-2 , Standard of Care/standards , Standard of Care/statistics & numerical data
4.
Emerg Med J ; 38(4): 308-314, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1081663

ABSTRACT

Emilia-Romagna was one of the most affected Italian regions during the COVID-19 outbreak in February 2020. We describe here the profound regional, provincial and municipal changes in response to the COVID-19 pandemic, to cope with the numbers of patients presenting with COVID-19 illness, as well as coping with the ongoing need to care for patients presenting with non-COVID-19 emergencies. We focus on the structural and functional changes in one particular hospital within the city of Bologna, the regional capital, which acted as the central emergency hub for time-sensitive pathologies for the province of Bologna. Finally, we present the admissions profile to our emergency department in relation to the massive increase of infected patients observed in our region as well as the organisational response to prepare for the second wave of the pandemic.


Subject(s)
COVID-19/epidemiology , Disease Outbreaks , Emergency Medical Services/organization & administration , Emergency Service, Hospital/organization & administration , Air Ambulances , COVID-19/therapy , Critical Care/organization & administration , Hospital Restructuring , Hospitals, Urban/organization & administration , Humans , Intensive Care Units/organization & administration , Italy/epidemiology , Operating Rooms/organization & administration , Personal Protective Equipment
5.
Encephale ; 46(3S): S99-S106, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065056

ABSTRACT

COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.


Subject(s)
Adolescent Psychiatry , Attitude of Health Personnel , Autistic Disorder/therapy , Betacoronavirus , Child Psychiatry , Coronavirus Infections , Pandemics , Pneumonia, Viral , Psychiatry , Adolescent , Adolescent Behavior , Adolescent Psychiatry/ethics , Autistic Disorder/complications , Autistic Disorder/psychology , COVID-19 , Child , Child Behavior , Child Psychiatry/ethics , Communicable Disease Control/methods , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Coronavirus Infections/transmission , Cross Infection/complications , Cross Infection/psychology , Cross Infection/therapy , Environmental Exposure , France , Health Services Accessibility , Hospital Restructuring , Hospital Units/organization & administration , Humans , Infection Control/methods , Mental Health Services/ethics , Mental Health Services/organization & administration , Olfaction Disorders/etiology , Olfaction Disorders/psychology , Pandemics/prevention & control , Patient Acceptance of Health Care , Patient Care Team , Patient Isolation/psychology , Play Therapy , Pneumonia, Viral/complications , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Pneumonia, Viral/transmission , Professional Practice/ethics , Protective Devices , Risk Factors , SARS-CoV-2 , Stress, Psychological/etiology
6.
Encephale ; 46(3S): S81-S84, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-1065055

ABSTRACT

OBJECTIVES: The sudden changes of healthcare system due to COVID-19 particularly affect the organization of psychiatry. The objective of this review is to examine the adaptations of psychiatric care in France during this pandemic. METHOD: This narrative review is based on the observation of changes made in French psychiatric hospitals and on an analysis of the literature. RESULTS: Regarding psychiatric hospitalization, the COVID-19 epidemic required rapid measures that profoundly modified the conditions of patients' reception, forcing the medical staffs to adapt their methods of care. The authors noted the creation of at least 89 wards specifically dedicated to patients with COVID-19 needing psychiatric hospitalization, allowing dual care of general medicine and psychiatry. Regarding ambulatory care, maintaining patients with long-term follow-up was a priority. Patients recalling and teleconsultation have been precious resources but cannot entirely replace face-to-face consultations. DISCUSSION: COVID-19 epidemic created unprecedented situation of large-scale upheavals in the healthcare system and in society. Despite the absence of previous recommendations on the subject, French psychiatry has shown great adaptability. Some changes could inspire post-COVID-19 care.


Subject(s)
Betacoronavirus , Coronavirus Infections , Hospital Restructuring , Hospitals, Psychiatric/organization & administration , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral , Psychotherapy/organization & administration , Ambulatory Care/organization & administration , Bed Conversion , COVID-19 , France/epidemiology , Health Personnel/psychology , Health Services Accessibility , Humans , Mental Disorders/epidemiology , Mental Disorders/therapy , Mental Health Services/statistics & numerical data , Mental Health Services/supply & distribution , Occupational Health , Patients' Rooms , Psychotherapy/statistics & numerical data , SARS-CoV-2 , Social Change , Stress, Psychological/etiology , Stress, Psychological/therapy , Telemedicine
7.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200571, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1061149

ABSTRACT

OBJECTIVE: to report the experience of a health team in restructuring service at a mastology outpatient clinic. METHODS: an experience report in a public university service mastology outpatient in Ceará between March and April 2020. Service in this outpatient clinic is exclusively for women and who have breast changes for surgical treatments ranging from nodulectomies to mastectomies with oncoplastic. RESULTS: increased COVID-19 cases brought the need to restructure healthcare services. The following steps were followed: identification of scheduled patients, reading of clinical developments in electronic medical records, individual assessment to define whether or not appointment would remain, telephone contact to inform about unscheduling. Among the 555 consultations scheduled for March and April 2020, 316 (56.9%) were maintained. FINAL CONSIDERATIONS: restructuring consultations at a mastology outpatient clinic optimized the waiting time for consultations and avoided crowds at service, providing patient safety.


Subject(s)
Ambulatory Care Facilities/organization & administration , Ambulatory Care/organization & administration , Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , COVID-19/diagnosis , COVID-19/therapy , Hospital Restructuring/organization & administration , Women's Health Services/organization & administration , Adult , Aged , Aged, 80 and over , Brazil , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
8.
Vascular ; 29(6): 856-864, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1052392

ABSTRACT

BACKGROUND/OBJECTIVE: The unprecedented pandemic spread of the novel coronavirus has severely impacted the delivery of healthcare services in the United States and around the world, and has exposed a variety of inefficiencies in healthcare infrastructure. Some states have been disproportionately affected such as New York and Michigan. In fact, Detroit and its surrounding areas have been named as the initial Midwest epicenter where over 106,000 cases have been confirmed in April 2020. METHOD, RESULTS AND CONCLUSIONS: Facilities in Southeast Michigan have served as the frontline of the pandemic in the Midwest and in order to cope with the surge, rapid, and in some cases, complete restructuring of care was mandatory to effect change and attempt to deal with the emerging crisis. We describe the initial experience and response of 4 large vascular surgery health systems in Michigan to COVID-19.


Subject(s)
COVID-19 , Health Care Rationing , Hospital Restructuring , Infection Control , Resource Allocation , Vascular Diseases , Vascular Surgical Procedures , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/therapy , Civil Defense/standards , Hospital Restructuring/methods , Hospital Restructuring/organization & administration , Humans , Infection Control/methods , Infection Control/organization & administration , Michigan/epidemiology , Organizational Innovation , Patient Selection , SARS-CoV-2 , Telemedicine/organization & administration , Vascular Diseases/diagnosis , Vascular Diseases/epidemiology , Vascular Diseases/surgery , Vascular Surgical Procedures/organization & administration , Vascular Surgical Procedures/statistics & numerical data
9.
J Laryngol Otol ; 134(8): 670-679, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1049931

ABSTRACT

BACKGROUND: Coronavirus disease 2019 has demanded enormous adjustments to National Health Service provisions. Non-urgent out-patient work was initially postponed or performed virtually, but is now being re-established. In ENT surgery, aerosol-generating procedures pose a particular challenge in out-patient settings. OBJECTIVE: A rapid restructuring of ENT out-patient services is required, to safely accommodate aerosol-generating procedures and increase in-person attendances, whilst coronavirus disease 2019 persists. METHODS: Data were collected prospectively over four consecutive cycles. Two surveys were conducted. Results were analysed and disseminated, with recommendations for service restructuring implemented at cycle end-points. RESULTS: Out-patient activity increased four-fold, associated with a significant rise in aerosol-generating procedures during the study period. Mean aerosol-generating procedure duration dropped weekly, implying a learning curve. Service restructuring occurred at cycle end-points. CONCLUSION: Iterative data gathering, results analysis and outcome dissemination enabled a swift, data-driven approach to the restructuring of ENT out-patient services. Patient and staff safety was ensured, whilst out-patient capacity was optimised.


Subject(s)
Coronavirus Infections/transmission , Otolaryngology/standards , Otorhinolaryngologic Surgical Procedures/statistics & numerical data , Outpatients/statistics & numerical data , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus/isolation & purification , Body Fluids/virology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Hospital Restructuring/organization & administration , Humans , Incidence , National Health Programs/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Prospective Studies , Quality Improvement , SARS-CoV-2 , Surveys and Questionnaires , United Kingdom/epidemiology
10.
Best Pract Res Clin Anaesthesiol ; 35(3): 425-435, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1023482

ABSTRACT

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.


Subject(s)
Academic Medical Centers/trends , Anesthesiology/trends , COVID-19/epidemiology , Critical Care/trends , Hospital Restructuring/trends , Personnel Staffing and Scheduling/trends , Academic Medical Centers/standards , Anesthesiology/standards , COVID-19/therapy , Critical Care/standards , Health Personnel/standards , Health Personnel/trends , Hospital Restructuring/standards , Humans , New York City , Pandemics , Personnel Staffing and Scheduling/standards
12.
Arq. bras. cardiol ; 115(3): 558-568, out. 2020. ilus, tab, graf
Article in English, Portuguese | WHO COVID, LILACS (Americas) | ID: covidwho-910600

ABSTRACT

Introdução A pandemia global da doença de coronavírus 2019 (COVID-19) causada pelo novo vírus de síndrome respiratória aguda grave coronavírus 2 (SARS-CoV-2) começou em Wuhan, China, em dezembro de 2019 e afetou mais de 4,4 milhões de pessoas em todo o mundo, com 302.169 mortes até o dia 16 de maio de 2020.1 Embora os sintomas respiratórios sejam a apresentação mais comum de COVID-19, o envolvimento cardíaco é uma característica proeminente dessa doença, ocorrendo em 20% a 30% dos pacientes hospitalizados e contribuindo para 40% dos óbitos.2-4 O envolvimento cardíaco relacionado à COVID-19 tem sido documentado por elevações em biomarcadores cardíacos e frequentemente apresenta alterações no segmento ST-T no eletrocardiograma (ECG) de 12 derivações, motivo pelo qual a equipe do laboratório de cateterismo é frequentemente ativada. Além disso, as atividades do laboratório de cateterismo devem continuar no atendimento a pacientes não COVID-19 que apresentam síndrome coronariana aguda (SCA) verdadeira, infarto do miocárdio com supradesnivelamento do segmento ST (IAMCSST) e doença cardíaca isquêmica estável muito sintomática. Devido à escalada no número de casos de COVID-19 na cidade de São Paulo, epicentro da doença no Brasil, reformularam-se a logística e as práticas no laboratório de cateterismo cardíaco do Instituto Dante Pazzanese de Cardiologia, que entraram em vigor em abril de 2020 e continuarão durante o período da pandemia. Os objetivos são fornecer atendimento otimizado à população que necessita de procedimentos cardíacos invasivos durante a pandemia, com a proteção adequada aos profissionais de saúde (PS), pacientes e seus familiares. Os protocolos aqui descritos representam os esforços multidisciplinares e dinâmicos do Departamento de Cardiologia Invasiva do Instituto Dante Pazzanese de Cardiologia validados pelo Comitê de Controle de Infecção da instituição. Essas práticas estão sujeitas a alterações em função do estado epidemiológico local, a fase da epidemia e a disponibilidade de equipamento de proteção individual (EPI). Estes protocolos podem não se aplicar a outras localidades sem casos (ou casos esporádicos) de COVID-19 ou a serviços que atendem diferentes perfis populacionais com logísticas e disponibilidade de EPI diversas.


Subject(s)
Coronavirus Infections , Betacoronavirus , Cardiovascular Diseases , Practice Guideline , Test Taking Skills , Hospital Restructuring
17.
Oncology ; 98(12): 827-835, 2020.
Article in English | MEDLINE | ID: covidwho-655986

ABSTRACT

On March 11, 2020, the WHO director general declared COVID-19 a pandemic. This pandemic evolves in successive phases, i.e., phase 1 (the start phase), phase 2 ("the storm"), and phase 3 (the recession). To date, oncology and surgery groups have only given instructions for addressing phases 1 and 2. To prevent excess cancer mortality, health care systems (HCS) need to be restructured. Our aim is to detail the specificities of each epidemic phase and discuss several methods of organization to optimize cancer patient flow during the COVID-19 pandemic, particularly during phase 3. Hospitals must be reorganized in order to create a cancer hub that is free of infection, allowing for the safe treatment of patients. Hospital structures are different, but all allow for the creation of virus-free areas. Screening programs are critical and need to be applied to all people entering the virus-free zone, including health care workers. Some reorganization proposals are internal to a hospital, while others require interhospital collaboration. The heterogeneity and complexity of HCS will make interhospital management difficult. The ministry of health has an important role in managing the cancer crisis. Cancer management should be declared a priority. Oncological and surgical societies must coordinate their efforts to facilitate this prioritization. The anticipation of oncological management during phase 3 of the pandemic is necessary because it requires a complete readjustment of HCS. This adaptation should allow for the continuation of cancer care to prevent excess cancer mortality, as the virus will still be present for a currently undetermined period of time.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Delivery of Health Care/organization & administration , Neoplasms/therapy , Pandemics , SARS-CoV-2 , Awareness , COVID-19/psychology , COVID-19/virology , Hospital Restructuring , Hospitalization , Humans , Infection Control/methods , Telemedicine/methods
18.
J Card Surg ; 35(8): 1761-1764, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-644752

ABSTRACT

On 11 March 2020, the World Health Organization declared the SARS-CoV-2 outbreak a pandemic. At the time of writing, 24 May 2020 more than 5 million individuals have been tested positive and the death toll was over 330 000 deaths worldwide. The initial data pointed out the tight bond between cardiovascular diseases and worse health outcomes in COVID19-patients. Epidemiologically speaking, there is an overlap between the age-groups more affected by COVID-related death and the age-groups in which Cardiac Surgery has its usual base of patients. The Cardiac Surgery Departments have to think to a new normal: since the virus will remain endemic in the society, dedicated pathways or even dedicated Teams are pivotal to treat safely the patients, in respect of the safety of the health care workers. Moreover, we need a keen eye on deciding which pathologies have to be treated with priority: Coronary artery Disease showed a higher mortality rate in patients affected by COVID19, but it is, however, reasonable to think that all the cardiac pathologies affecting the lung circulation-such as symptomatic severe mitral diseases or aortic stenosis-might deserve a priority access to treatment, to increase the survival rate in case of an acquired-Coronavirus infection later on.


Subject(s)
Cardiac Surgical Procedures , Coronavirus Infections/prevention & control , Hospital Restructuring , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Triage/organization & administration , Betacoronavirus , COVID-19 , Cardiovascular Diseases , Comorbidity , Coronavirus Infections/epidemiology , Hospital Units , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2
19.
Eur J Orthop Surg Traumatol ; 30(6): 951-954, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-615373
20.
J Vasc Surg ; 72(1): 8-11, 2020 07.
Article in English | MEDLINE | ID: covidwho-611319

ABSTRACT

BACKGROUND: Spreading of the COVID-19 pandemic in Italy forced health facilities to drastically change their organization to face the overwhelming number of infected patients needing hospitalization. The aim of this paper is to share with all the vascular community the protocol developed by the USL (Unità Sanitaria Locale) Toscana Centro for the reorganization of the Vascular Surgery Unit during the COVID-19 emergency, hoping to help other institutions to face the emergency during the hard weeks coming. METHODS: The USL Toscana Centro is a public Italian health care institution including four districts (Empoli, Florence, Pistoia, Prato) with 13 different hospitals, serving more than 1,500,000 people in a 5000 km2 area. The USL adopted a protocol of reorganization of the Vascular Surgery Unit during the first difficult weeks of the epidemic, consisting in the creation of a Vascular Hub for urgent cases, with a profound reorganization of activities, wards, surgical operators, operating blocks, and intensive care unit (ICU) beds. RESULTS: All 13 hospitals are now COVID-19 as the first days of April passed. The San Giovanni di Dio Hospital (Florence) has more than 80 COVID-19 patients in different settings (ICU, medical and surgical ward), which at the time of writing is almost one-third of the total hospital capacity (80/260 beds). It has been identified as the Surgical Hub for urgent vascular COVID-19 cases. Therefore, the elective surgical and office activities were reduced by 30% and 80%, respectively, and reserved to priority cases. A corner of the whole operating block, well separate from the remaining operating rooms, was rapidly converted into one operating room and six ICU beds dedicated to COVID patients. The COVID-19 surgical path now includes an emergency room for suspected COVID-19 patients directly connected to an elevator for the transfer of COVID patients in the COVID operating block and dedicated COVID-19 ward and ICU beds. CONCLUSIONS: Rapid modification of hospital settings, a certain "flexibility" of the medical personnel, a stepwise shutdown of vascular surgical and office activity, and the necessity of a strong leadership are mandatory to cope with the tsunami of the COVID-19 outbreak.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Care/organization & administration , Hospital Restructuring , Hospitals, Public/organization & administration , Models, Organizational , Pneumonia, Viral/therapy , COVID-19 , Clinical Protocols , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/virology , Emergencies/epidemiology , Emergency Service, Hospital/organization & administration , Humans , Intensive Care Units/organization & administration , Italy/epidemiology , Operating Rooms/organization & administration , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , SARS-CoV-2
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