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1.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 55(7-08): 494-502, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-707033

ABSTRACT

It is necessary to discuss the sometimes competing goals of sufficient critical care capacity, maintenance of regular patient care, protection of medical staff, interruption of infectious chains within the general public and individual aspects of patient care in anesthesia and the operating room in times of the SARS CoV-2 pandemic, given the uncertainty of many data on which decisions need to be based. Basic hygiene remains the cornerstone of infection prevention especially when resources are sparse and SARS-CoV-2 specific additional measures need to be taken according to a risk analysis taking the dynamic of the pandemic as well as local factors into account.


Subject(s)
Anesthesiology/methods , Coronavirus Infections/epidemiology , Infection Control/methods , Pneumonia, Viral/epidemiology , Betacoronavirus , Humans , Pandemics
3.
Ann Surg ; 272(2): e118-e124, 2020 08.
Article in English | MEDLINE | ID: covidwho-704742

ABSTRACT

OBJECTIVE: Our objective was to review the literature surrounding the risks of viral transmission during laparoscopic surgery and propose mitigation measures to address these risks. SUMMARY BACKGROUND DATA: The SARS-CoV-2 pandemic has caused surgeons the world over to re-evaluate their approach to surgical procedures given concerns over the risk of aerosolization of viral particles and exposure of operating room staff to infection. International society guidelines advise against the use of laparoscopy; however, the evidence on this topic is scant and recommendations are based on the perceived most cautious course of action. METHODS: We conducted a narrative review of the existing literature surrounding the risks of viral transmission during laparoscopic surgery and balance these risks against the benefits of minimally invasive approaches. We also propose mitigation measures to address these risks that we have adopted in our institution. RESULTS AND CONCLUSION: While it is currently assumed that open surgery minimizes operating room staff exposure to the virus, our findings reveal that this may not be the case. A well-informed, evidence-based opinion is critical when making decisions regarding which operative approach to pursue, for the safety and well-being of the patient, the operating room staff, and the healthcare system at large. Minimally invasive surgical approaches offer significant advantages with respect to both patient care, and the mitigation of the risk of viral transmission during surgery, provided the appropriate equipment and expertise are present.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional , Laparoscopy , Minimally Invasive Surgical Procedures , Operating Rooms , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Betacoronavirus , Decision Making , Humans , Pandemics , Patient Selection , Personal Protective Equipment
4.
Anasthesiol Intensivmed Notfallmed Schmerzther ; 55(7-08): 494-502, 2020 Jul.
Article in German | MEDLINE | ID: covidwho-691082

ABSTRACT

It is necessary to discuss the sometimes competing goals of sufficient critical care capacity, maintenance of regular patient care, protection of medical staff, interruption of infectious chains within the general public and individual aspects of patient care in anesthesia and the operating room in times of the SARS CoV-2 pandemic, given the uncertainty of many data on which decisions need to be based. Basic hygiene remains the cornerstone of infection prevention especially when resources are sparse and SARS-CoV-2 specific additional measures need to be taken according to a risk analysis taking the dynamic of the pandemic as well as local factors into account.


Subject(s)
Anesthesiology/methods , Coronavirus Infections/epidemiology , Infection Control/methods , Pneumonia, Viral/epidemiology , Betacoronavirus , Humans , Pandemics
5.
Ren Fail ; 42(1): 733-739, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-688758

ABSTRACT

BACKGROUND: Patients with chronic kidney disease (CKD) require specialized management. However, the current situation of CKD management is unclear during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to investigate the influence of the COVID-19 on kidney patients' follow-ups. METHODS: In April 2020, we included patients who underwent kidney biopsy from January 2017 to December 2019 in a referral center of China, and then initiated a survey via telephone on different aspects of follow-up during the COVID-19 pandemic. We collected and analyzed demographic data, diagnoses, follow-up conditions, and telemedicine experience. RESULTS: We reached 1190 CKD patients with confirmed kidney biopsies, and included 1164 patients for analysis after excluding those on dialysis. None of our patients have had COVID-19, although more than 50% of them were complicated with other comorbidities, and over 40% were currently using immunosuppressive treatments. Face-to-face clinic visits were interrupted in 836 (71.82%) participants. Medicine adjustments and routine laboratory examinations were delayed or made irregular in about 60% of patients. To continue their follow-ups, 255 (21.90%) patients utilized telemedicine, and about 80% of them were satisfied with the experience. The proportion of telemedicine users was significantly higher in patients with immunosuppressive treatments than those without (31.88% vs. 17.12%, p < 0.001). CONCLUSION: The risk of COVID-19 was mitigated in patients with CKD and other co-existing risk factors when proper protection was utilized. The routine medical care was disrupted during the pandemic, and telemedicine could be a reasonable alternative method.


Subject(s)
Communicable Diseases, Emerging/epidemiology , Coronavirus Infections/epidemiology , Infection Control/methods , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Renal Insufficiency, Chronic/epidemiology , Renal Insufficiency, Chronic/pathology , Adult , Biopsy, Needle , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Databases, Factual , Female , Follow-Up Studies , Humans , Immunohistochemistry , Incidence , Male , Middle Aged , Pneumonia, Viral/diagnosis , Renal Insufficiency, Chronic/physiopathology , Retrospective Studies , Risk Assessment , Surveys and Questionnaires
6.
Turk J Med Sci ; 50(SI-1): 585-591, 2020 04 21.
Article in English | MEDLINE | ID: covidwho-686209

ABSTRACT

Coronavirus disease 2019 (COVID-19) stands out as the major pandemic that we have experienced in the last century. As it affects every social structure, it brought the importance of intensive care support once again to the agenda of healthcare system after causing severe acute respiratory syndrome. The precautions to be taken against this virus, where our knowledge is extremely small, intensive care units take an indispensable place in pandemic planning. In this review, we aimed to emphasize the crucial points regarding intensive care management of COVID-19 patients, which we have written not only for intensivists but also for all healthcare professionals.


Subject(s)
Coronavirus Infections/therapy , Critical Illness/therapy , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus , Cardiopulmonary Resuscitation , Humans , Infection Control/methods , Pandemics , Respiratory Therapy , Sepsis/complications , Shock/complications
7.
Crit Care Med ; 48(6): e440-e469, 2020 06.
Article in English | MEDLINE | ID: covidwho-685042

ABSTRACT

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. No recommendation was provided for six questions. The topics were: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines.


Subject(s)
Coronavirus Infections/therapy , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Practice Guidelines as Topic/standards , Betacoronavirus , Critical Illness , Diagnostic Techniques and Procedures/standards , Humans , Infection Control/methods , Infection Control/standards , Intensive Care Units/standards , Pandemics , Respiration, Artificial/methods , Respiration, Artificial/standards , Shock/therapy
9.
Ann Transplant ; 25: e925755, 2020 Jul 24.
Article in English | MEDLINE | ID: covidwho-676253

ABSTRACT

Kidney transplantation at the time of the COVID-19 pandemic is challenging. Modifying the immunosuppression protocols is controversial and not evidence based. In this study, we aim to review the published literature of kidney transplant recipients who encountered COVID-19. A literature review was performed using PubMed, ScienceDirect, and World Health Organization databases to identify relevant English-language articles published up to May 7, 2020. There were 24 articles that reported 129 kidney transplant recipients who encountered COVID-19. The age mean was 54.2 years with 73.7% as males. The most commonly reported presentations in order were fever (82.3%), cough (58%), shortness of breath (33.2%), and fatigue (30.7%). Acute kidney injury was observed in 34.1% of patients. Kidney transplant patients encountered COVID-19 were maintained on tacrolimus (Tac, 92%), mycophenolate mofetil (MMF, 78.8%), and prednisone (Pred, 77%) and were manage by holding MMF in 79.1% of patients and holding Tac in 34.4% of patients. In all, 20% of patients needed Intensive Care Unit (ICU) admission and 24.6% of patients required mechanical ventilation. In all, 18.8% of patients had died compared to the reported general population COVID-19 mortality of 3.4%. The clinical presentation of COVID-19 in kidney transplant recipients may be different from the general population with a higher rate of severe disease, complications including renal failure, and mortality.


Subject(s)
Cause of Death , Coronavirus Infections/epidemiology , Global Health , Infection Control/methods , Kidney Transplantation/statistics & numerical data , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Acute Kidney Injury/diagnosis , Acute Kidney Injury/surgery , Adult , Databases, Factual , Female , Graft Survival , Humans , Immunosuppression/methods , Incidence , Kidney Failure, Chronic/surgery , Kidney Transplantation/methods , Kidney Transplantation/mortality , Male , Middle Aged , Patient Selection , Prognosis , Risk Assessment , Survival Analysis , World Health Organization
10.
BMC Res Notes ; 13(1): 352, 2020 Jul 23.
Article in English | MEDLINE | ID: covidwho-671179

ABSTRACT

OBJECTIVE: Coronavirus disease 2019 (COVID-19) is a pandemic respiratory illness spreading from person-to-person caused by a novel coronavirus and poses a serious public health risk. The goal of this study was to apply a modified susceptible-exposed-infectious-recovered (SEIR) compartmental mathematical model for prediction of COVID-19 epidemic dynamics incorporating pathogen in the environment and interventions. The next generation matrix approach was used to determine the basic reproduction number [Formula: see text]. The model equations are solved numerically using fourth and fifth order Runge-Kutta methods. RESULTS: We found an [Formula: see text] of 2.03, implying that the pandemic will persist in the human population in the absence of strong control measures. Results after simulating various scenarios indicate that disregarding social distancing and hygiene measures can have devastating effects on the human population. The model shows that quarantine of contacts and isolation of cases can help halt the spread on novel coronavirus.


Subject(s)
Betacoronavirus , Coronavirus Infections/transmission , Environmental Exposure , Guideline Adherence , Infection Control/methods , Models, Theoretical , Pandemics , Pneumonia, Viral/transmission , Contact Tracing , Convalescence , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Disease Susceptibility , Forecasting , Hand Hygiene , Humans , Infection Control/statistics & numerical data , Masks , Pandemics/prevention & control , Patient Compliance , Patient Isolation , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Quarantine , Time Factors , Travel
12.
PLoS Med ; 17(7): e1003240, 2020 07.
Article in English | MEDLINE | ID: covidwho-661234

ABSTRACT

Yuming Guo and colleagues discuss the research by Teslya et al that highlights the importance of personal preventative measures in avoiding a second wave of the COVID-19 epidemic.


Subject(s)
Betacoronavirus , Coronavirus Infections , Infection Control , Pandemics , Pneumonia, Viral/epidemiology , Government , Humans , Infection Control/methods , Quarantine
13.
Am Surg ; 86(6): 599-601, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-657599

ABSTRACT

The chief of surgery of a 264-bed acute care facility and clinic system in Topeka, KS, USA, gives a chronology that illustrates the rapid and profound clinical, economic, and emotional impact of the SARS-CoV-2 outbreak on his hospital and community. In his view, the pandemic has laid bare the weaknesses of several factors basic to the modern US health care system and the resulting economic crisis: just-in-time supply chain technology; foreign sourcing of masks, gowns, and critical equipment, all at critical shortages during the crisis; rural hospital closings; lack of excess capacity through maximization of utilization for efficiency; and an overreliance on high revenue elective procedures and tests. His team was tested by an emergency operation for bowel obstruction that put all the isolation protocols into action. Despite their readiness and the success of the operation and the potential for telemedicine as an alternative to in-person evaluations and outpatient visits, the forced cancellation of all elective operations have led to the loss of revenue for both hospital system and providers, furlough and termination of workers, and financial hardship and uncertainty.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Hospitals, Community/economics , Medical Staff, Hospital/psychology , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Betacoronavirus , Clinical Protocols , Elective Surgical Procedures/economics , Health Facility Closure/economics , Humans , Infection Control/methods , Intestinal Obstruction/surgery , Kansas/epidemiology , Patient Isolation , Personal Protective Equipment/supply & distribution , Personnel Downsizing/economics , Telemedicine
14.
Rev Bras Ginecol Obstet ; 42(6): 349-355, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-657176
15.
JBJS Case Connect ; 10(3): e2000226, 2020.
Article in English | MEDLINE | ID: covidwho-646996

ABSTRACT

CASE: We report the case of a 64-year-old man who presented with a late onset of acute periprosthetic joint infection after total knee arthroplasty and a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. We describe our perioperative protocol and challenges for ensuring the safety of healthcare providers while operating on a coronavirus disease 2019 (COVID-19)-positive patient. CONCLUSIONS: Given the incredible spread of COVID-19 globally, hospitals should anticipate perioperative protocols for the surgical management of COVID-19-positive patients with concurrent pathology to ensure safety to healthcare providers.


Subject(s)
Arthritis, Infectious/surgery , Betacoronavirus , Coronavirus Infections , Infection Control/methods , Pandemics , Pneumonia, Viral , Prosthesis-Related Infections/surgery , Arthritis, Infectious/complications , Humans , Knee Prosthesis/adverse effects , Male , Middle Aged , Prosthesis-Related Infections/complications
17.
Influenza Other Respir Viruses ; 14(4): 365-373, 2020 07.
Article in English | MEDLINE | ID: covidwho-637288

ABSTRACT

BACKGROUND: Respiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID-19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID-19 are limited. PURPOSE: To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES: MEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014. STUDY SELECTION: Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION: Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS: Four RCTs were meta-analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory-confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90-1.25; I2  = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2  = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS: Indirectness and imprecision of available evidence. CONCLUSIONS: Low certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non-aerosol-generating care. Preservation of N95 respirators for high-risk, aerosol-generating procedures in this pandemic should be considered when in short supply.


Subject(s)
Coronavirus Infections/prevention & control , Masks/standards , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Respiratory Tract Infections/prevention & control , Ventilators, Mechanical/standards , Health Personnel , Humans , Infection Control/methods , Randomized Controlled Trials as Topic , Respiratory Protective Devices/standards , Respiratory Protective Devices/supply & distribution , Respiratory Tract Infections/virology
18.
Int J Environ Res Public Health ; 17(13)2020 07 02.
Article in English | MEDLINE | ID: covidwho-635459

ABSTRACT

COVID-19 is the disease supported by SARS-CoV-2 infection, which causes a severe form of pneumonia. Due to the pathophysiological characteristics of the COVID-19 syndrome, the particular transmissibility of SARS-CoV-2, and the high globalization of our era, the epidemic emergency from China has spread rapidly all over the world. Human-to-human transmission seems to occur mainly through close contact with symptomatic people affected by COVID-19, and the main way of contagion is via the inhalation of respiratory droplets, for example when patients talk, sneeze or cough. The ability of the virus to survive outside living organisms, in aerosol or on fomites has also been recognized. The dental practitioners are particularly exposed to a high risk of SARS-CoV-2 infection because they cannot always respect the interpersonal distance of more than a meter and are exposed to saliva, blood, and other body fluids during surgical procedures. Moreover, many dental surgeries can generate aerosol, and the risk of airborne infection is to be considered higher. The aim of this paper is to provide practical advice for dentists based on the recent literature, which may be useful in reducing the risk of spreading COVID-19 during clinical practice.


Subject(s)
Coronavirus Infections/prevention & control , Dental Care/methods , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Patterns, Dentists'/standards , Betacoronavirus , Dental Care/standards , Dentists , Humans , Infection Control/standards , Mass Screening , Personal Protective Equipment , Professional Role
19.
J Appl Behav Anal ; 53(3): 1219-1224, 2020 07.
Article in English | MEDLINE | ID: covidwho-635455

ABSTRACT

Personal hygiene is critical for preventing the spread of infection. One important component of personal hygiene is handwashing. This review summarizes research on behavioral strategies to address handwashing in children, offers areas for additional research, and suggests a treatment package to teach handwashing to young children.


Subject(s)
Hand Disinfection , Child , Child, Preschool , Coronavirus Infections/prevention & control , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Teaching
20.
Encephale ; 46(3S): S3-S13, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-634328

ABSTRACT

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.


Subject(s)
Betacoronavirus , Continuity of Patient Care/organization & administration , Coronavirus Infections/epidemiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Aftercare , Age Factors , Aged, 80 and over , Antiviral Agents/pharmacokinetics , Antiviral Agents/therapeutic use , Child , Cognition Disorders/epidemiology , Cognition Disorders/therapy , Comorbidity , Coronavirus Infections/psychology , Drug Interactions , France/epidemiology , Hospital Units/organization & administration , Hospitals, Psychiatric/organization & administration , Humans , Infection Control/methods , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Health Services/supply & distribution , Patient Care Team , Patient Compliance , Pneumonia, Viral/psychology , Prisoners/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/etiology , Stress, Psychological/therapy , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Suicide/prevention & control , Vulnerable Populations
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