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1.
Oncology (Williston Park) ; 34(7): 270-271, 2020 07 15.
Article in English | MEDLINE | ID: covidwho-648015

ABSTRACT

Patients with cancer represent a vulnerable population and are at greater risk of developing serious complications as a result of a COVID-19 infection. In response, oncology societies around the world have proposed changes to their standards of care. These changes have helped guide health care providers in prioritizing clinical management of patients with cancer: identifying situations in which urgent intervention is needed and those that can be triaged until the risk of infection has lessened.


Subject(s)
Coronavirus Infections , Critical Pathways/trends , Delivery of Health Care/organization & administration , Neoplasms , Pandemics , Patient Care Management , Pneumonia, Viral , Psycho-Oncology , Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Delivery of Health Care/methods , Humans , Neoplasms/epidemiology , Neoplasms/psychology , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Psycho-Oncology/methods , Psycho-Oncology/trends , Psychological Distress
2.
RMD Open ; 6(2)2020 06.
Article in English | MEDLINE | ID: covidwho-617044

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare providers and patients alike. In addition to the direct burden it has placed on societies and health systems, it had a significant impact in the care of patients with chronic diseases, as healthcare resources were deployed to fight the crisis, and major travel and social restrictions were adopted. In the field of rheumatology, this has required notable efforts from departments and clinicians to adapt to the novel status quo and assure the follow-up of patients with rheumatic and musculoskeletal diseases. In the present viewpoint, we provide a practical approach to tackle this reality. Key measures include setting up preventive team management strategies, optimising communication with patients and reorganising patient care in all its dimensions. We then anticipate the nuances of rheumatology practice as restrictive measures are progressively lifted, while an effective vaccine is still pending. This includes the need to reimpose the same strategy as further waves unfold. Finally, we look ahead and address the lessons we can incorporate into post-COVID-19 rheumatology.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Organizational Innovation , Pandemics , Patient Care Management , Pneumonia, Viral , Rheumatic Diseases , Rheumatology/methods , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/immunology , Coronavirus Infections/prevention & control , Critical Pathways/organization & administration , Critical Pathways/trends , Humans , Immunity , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Rheumatic Diseases/epidemiology , Rheumatic Diseases/therapy , Telemedicine/methods
3.
Anesth Analg ; 131(1): 86-92, 2020 07.
Article in English | MEDLINE | ID: covidwho-606367

ABSTRACT

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.


Subject(s)
Coronavirus Infections/economics , Developing Countries , Pandemics/economics , Pneumonia, Viral/economics , Poverty , Coronavirus Infections/therapy , Humans , International Cooperation , Patient Care Management/economics , Patient Care Management/organization & administration , Personal Protective Equipment , Pneumonia, Viral/therapy
5.
J Thorac Oncol ; 15(7): 1119-1136, 2020 07.
Article in English | MEDLINE | ID: covidwho-478255

ABSTRACT

The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, especially as they are more likely to present with an immunocompromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close proximity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer patients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respiratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available.


Subject(s)
Coronavirus Infections , Infection Control/organization & administration , Lung Neoplasms/therapy , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Humans , Interdisciplinary Communication , International Cooperation , Lung Neoplasms/epidemiology , Lung Neoplasms/pathology , Neoplasm Staging , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Prognosis
8.
Dig Liver Dis ; 52(6): 597-603, 2020 06.
Article in English | MEDLINE | ID: covidwho-295511

ABSTRACT

INTRODUCTION: Patients treated for malignancy are considered at risk of severe COVID-19. This exceptional pandemic has affected countries on every level, particularly health systems which are experiencing saturation. Like many countries, France is currently greatly exposed, and a complete reorganization of hospitals is ongoing. We propose here adaptations of diagnostic procedures, therapies and care strategies for patients treated for digestive cancer during the COVID-19 epidemic. METHODS: French societies of gastroenterology and gastrointestinal (GI) oncology carried out this study to answer two main questions that have arisen (i) how can we limit high-risk situations for GI-cancer patients and (ii) how can we limit contact between patients and care centers to decrease patients' risk of contamination while continuing to treat their cancer. All recommendations are graded as experts' agreement according to the level of evidence found in the literature until March 2020. RESULTS: A proposal to adapt treatment strategies was made for the main GI oncology situations. Considering the level of evidence and the heterogeneous progression of the COVID-19 epidemic, all proposals need to be considered by a multidisciplinary team and implemented with patient consent. CONCLUSION: COVID-19 epidemic may significantly affect patients treated for digestive malignancies. Healthcare teams need to consider adapting treatment sequences when feasible and according to the epidemic situation.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Gastrointestinal Neoplasms , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Antineoplastic Agents/therapeutic use , Betacoronavirus/isolation & purification , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Digestive System Surgical Procedures/methods , France/epidemiology , Gastrointestinal Neoplasms/epidemiology , Gastrointestinal Neoplasms/therapy , Humans , Infection Control/methods , Infection Control/organization & administration , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Societies, Medical
9.
J Thorac Oncol ; 15(7): 1119-1136, 2020 07.
Article in English | MEDLINE | ID: covidwho-276786

ABSTRACT

The global coronavirus disease 2019 pandemic continues to escalate at a rapid pace inundating medical facilities and creating substantial challenges globally. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with cancer seems to be higher, especially as they are more likely to present with an immunocompromised condition, either from cancer itself or from the treatments they receive. A major consideration in the delivery of cancer care during the pandemic is to balance the risk of patient exposure and infection with the need to provide effective cancer treatment. Many aspects of the SARS-CoV-2 infection currently remain poorly characterized and even less is known about the course of infection in the context of a patient with cancer. As SARS-CoV-2 is highly contagious, the risk of infection directly affects the cancer patient being treated, other cancer patients in close proximity, and health care providers. Infection at any level for patients or providers can cause considerable disruption to even the most effective treatment plans. Lung cancer patients, especially those with reduced lung function and cardiopulmonary comorbidities are more likely to have increased risk and mortality from coronavirus disease 2019 as one of its common manifestations is as an acute respiratory illness. The purpose of this manuscript is to present a practical multidisciplinary and international overview to assist in treatment for lung cancer patients during this pandemic, with the caveat that evidence is lacking in many areas. It is expected that firmer recommendations can be developed as more evidence becomes available.


Subject(s)
Coronavirus Infections , Infection Control/organization & administration , Lung Neoplasms/therapy , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Humans , Interdisciplinary Communication , International Cooperation , Lung Neoplasms/epidemiology , Lung Neoplasms/pathology , Neoplasm Staging , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Prognosis
12.
Int J Cardiol ; 312: 24-26, 2020 08 01.
Article in English | MEDLINE | ID: covidwho-135706
13.
Dig Liver Dis ; 52(6): 606-612, 2020 06.
Article in English | MEDLINE | ID: covidwho-125330

ABSTRACT

A dramatic SARS-Cov-2 outbreak is hitting Italy hard. To face the new scenario all the hospitals have been re-organised in order to reduce all the outpatient services and to devote almost all their personnel and resources to the management of Covid-19 patients. As a matter of fact, all the services have undergone a deep re-organization guided by: the necessity to reduce exams, to create an environment that helps reduce the virus spread, and to preserve the medical personnel from infection. In these days a re-organization of the endoscopic unit, sited in a high-incidence area, has been adopted, with changes to logistics, work organization and patients selection. With the present manuscript, we want to support gastroenterologists and endoscopists in the organization of a "new" endoscopy unit that responds to the "new" scenario, while remaining fully aware that resources, availability and local circumstances may extremely vary from unit to unit.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Endoscopy/methods , Gastrointestinal Diseases , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Gastrointestinal Diseases/diagnosis , Gastrointestinal Diseases/epidemiology , Gastrointestinal Diseases/surgery , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/organization & administration , Patient Care Management/trends , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Risk Adjustment/methods , Risk Adjustment/organization & administration
16.
Am J Geriatr Psychiatry ; 28(7): 712-721, 2020 07.
Article in English | MEDLINE | ID: covidwho-72500

ABSTRACT

The COVID-19 pandemic is causing global morbidity and mortality, straining health systems, and disrupting society, putting individuals with Alzheimer's disease and related dementias (ADRD) at risk of significant harm. In this Special Article, we examine the current and expected impact of the pandemic on individuals with ADRD. We discuss and propose mitigation strategies for: the risk of COVID-19 infection and its associated morbidity and mortality for individuals with ADRD; the impact of COVID-19 on the diagnosis and clinical management of ADRD; consequences of societal responses to COVID-19 in different ADRD care settings; the effect of COVID-19 on caregivers and physicians of individuals with ADRD; mental hygiene, trauma, and stigma in the time of COVID-19; and the potential impact of COVID-19 on ADRD research. Amid considerable uncertainty, we may be able to prevent or reduce the harm of the COVID-19 pandemic and its consequences for individuals with ADRD and their caregivers.


Subject(s)
Alzheimer Disease , Caregivers/psychology , Communicable Disease Control , Coronavirus Infections , Dementia , Pandemics , Patient Care Management , Pneumonia, Viral , Aged , Alzheimer Disease/epidemiology , Alzheimer Disease/therapy , Alzheimer Disease/virology , Betacoronavirus , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Comorbidity , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/psychology , Critical Pathways/trends , Dementia/epidemiology , Dementia/therapy , Dementia/virology , Humans , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Patient Care Management/trends , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/psychology , Risk Assessment , Risk Factors , Social Stigma , Vulnerable Populations/psychology
17.
Can J Cardiol ; 36(6): 961-964, 2020 06.
Article in English | MEDLINE | ID: covidwho-72378

ABSTRACT

Owing to the COVID-19 outbreak in Lombardy, Italy) there is an urgent need to manage cardiovascular emergencies, including acute coronary syndrome (ACS), with appropriate standards of care and dedicated preventive measures and pathways against the risk of SARS-CoV-2 infection. For this reason, the Government of Lombardy decided to centralize the treatment of ACS patients in a limited number of centers, including our university cardiology institute, which in the past 4 weeks became a cardiovascular emergency referral center in a regional hub-and-spoke system. Therefore, we rapidly developed a customized pathway to allocate patients to the appropriate hospital ward, and treat them according to ACS severity and risk of suspected SARS-CoV-2 infection. We present here the protocol dedicated to ACS patients adopted in our center since March 13, 2020, and our initial experience in the management of ACS patients during the first 4 weeks of its use. Certainly, the protocol has room for further improvement as everyone's experience grows, but we hope that it could be a starting point, adaptable to different realities and local resources.


Subject(s)
Acute Coronary Syndrome , Coronavirus Infections , Critical Pathways , Emergency Service, Hospital , Infection Control , Pandemics , Patient Care Management , Pneumonia, Viral , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/therapy , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Female , Humans , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Organizational Innovation , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Risk Management/methods
18.
Can J Cardiol ; 36(6): 915-930, 2020 06.
Article in English | MEDLINE | ID: covidwho-72377

ABSTRACT

With more than 1,800,000 cases and 110,000 deaths globally, COVID-19 is one of worst infectious disease outbreaks in history. This paper provides a critical review of the available evidence regarding the lessons learned from the Chinese experience with COVID-19 prevention and management. The steps that have led to a near disappearance of new cases in China included rapid sequencing of the virus to establish testing kits, which allowed tracking of infected persons in and out of Wuhan. In addition, aggressive quarantine measures included the complete isolation of Wuhan and then later Hubei Province and the rest of the country, as well as closure of all schools and nonessential businesses. Other measures included the rapid construction of two new hospitals and the establishment of "Fangcang" shelter hospitals. In the absence of a vaccine, the management of COVID-19 included antivirals, high-flow oxygen, mechanical ventilation, corticosteroids, hydroxychloroquine, tocilizumab, interferons, intravenous immunoglobulin, and convalescent plasma infusions. These measures appeared to provide only moderate success. Although some measures have been supported by weak descriptive data, their effectiveness is still unclear pending well controlled clinical trials. In the end, it was the enforcement of drastic quarantine measures that stopped SARS-CoV-2 from spreading. The earlier the implementation, the less likely resources will be depleted. The most critical factors in stopping a pandemic are early recognition of infected individuals, carriers, and contacts and early implementation of quarantine measures with an organised, proactive, and unified strategy at a national level. Delays result in significantly higher death tolls.


Subject(s)
Betacoronavirus , Communicable Disease Control , Coronavirus Infections , Pandemics , Patient Care Management , Pneumonia, Viral , Betacoronavirus/isolation & purification , Betacoronavirus/pathogenicity , China/epidemiology , Communicable Disease Control/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Humans , Pandemics/prevention & control , Patient Care Management/methods , Patient Care Management/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission
19.
Anesth Analg ; 131(1): 86-92, 2020 07.
Article in English | MEDLINE | ID: covidwho-23186

ABSTRACT

Coronavirus disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.


Subject(s)
Coronavirus Infections/economics , Developing Countries , Pandemics/economics , Pneumonia, Viral/economics , Poverty , Coronavirus Infections/therapy , Humans , International Cooperation , Patient Care Management/economics , Patient Care Management/organization & administration , Personal Protective Equipment , Pneumonia, Viral/therapy
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