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1.
Chest ; 158(4): 1499-1514, 2020 10.
Article in English | MEDLINE | ID: covidwho-805272

ABSTRACT

BACKGROUND: The role of tracheostomy during the coronavirus disease 2019 (COVID-19) pandemic remains unknown. The goal of this consensus statement is to examine the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and offer guidance to physicians on the preparation, timing, and technique while minimizing the risk of infection to health care workers (HCWs). METHODS: A panel including intensivists and interventional pulmonologists from three professional societies representing 13 institutions with experience in managing patients with COVID-19 across a spectrum of health-care environments developed key clinical questions addressing specific topics on tracheostomy in COVID-19. A systematic review of the literature and an established modified Delphi consensus methodology were applied to provide a reliable evidence-based consensus statement and expert panel report. RESULTS: Eight key questions, corresponding to 14 decision points, were rated by the panel. The results were aggregated, resulting in eight main recommendations and five additional remarks intended to guide health-care providers in the decision-making process pertinent to tracheostomy in patients with COVID-19-related respiratory failure. CONCLUSION: This panel suggests performing tracheostomy in patients expected to require prolonged mechanical ventilation. A specific timing of tracheostomy cannot be recommended. There is no evidence for routine repeat reverse transcription polymerase chain reaction testing in patients with confirmed COVID-19 evaluated for tracheostomy. To reduce the risk of infection in HCWs, we recommend performing the procedure using techniques that minimize aerosolization while wearing enhanced personal protective equipment. The recommendations presented in this statement may change as more experience is gained during this pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/therapy , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pneumonia, Viral/therapy , Respiratory Insufficiency/therapy , Tracheostomy , Clinical Protocols , Consensus , Coronavirus Infections/complications , Coronavirus Infections/transmission , Humans , Pandemics , Patient Selection , Pneumonia, Viral/complications , Pneumonia, Viral/transmission , Respiratory Insufficiency/virology , Societies, Medical
3.
J Appl Lab Med ; 5(5): 1038-1049, 2020 09 01.
Article in English | MEDLINE | ID: covidwho-776735

ABSTRACT

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 causes coronavirus disease 2019 (COVID-19) and poses substantial challenges for healthcare systems. With a vastly expanding number of publications on COVID-19, clinicians need evidence synthesis to produce guidance for handling patients with COVID-19. In this systematic review and meta-analysis, we examine which routine laboratory tests are associated with severe COVID-19 disease. CONTENT: PubMed (Medline), Scopus, and Web of Science were searched until March 22, 2020, for studies on COVID-19. Eligible studies were original articles reporting on laboratory tests and outcome of patients with COVID-19. Data were synthesized, and we conducted random-effects meta-analysis, and determined mean difference (MD) and standard mean difference at the biomarker level for disease severity. Risk of bias and applicability concerns were evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2. SUMMARY: 45 studies were included, of which 21 publications were used for the meta-analysis. Studies were heterogeneous but had low risk of bias and applicability concern in terms of patient selection and reference standard. Severe disease was associated with higher white blood cell count (MD, 1.28 ×109/L), neutrophil count (MD, 1.49 ×109/L), C-reactive protein (MD, 49.2 mg/L), lactate dehydrogenase (MD, 196 U/L), D-dimer (standardized MD, 0.58), and aspartate aminotransferase (MD, 8.5 U/L); all p < 0.001. Furthermore, low lymphocyte count (MD -0.32 × 109/L), platelet count (MD -22.4 × 109/L), and hemoglobin (MD, -4.1 g/L); all p < 0.001 were also associated with severe disease. In conclusion, several routine laboratory tests are associated with disease severity in COVID-19.


Subject(s)
Betacoronavirus/isolation & purification , Clinical Laboratory Techniques , Coronavirus Infections , Diagnostic Tests, Routine , Pandemics , Pneumonia, Viral , Clinical Laboratory Techniques/methods , Clinical Laboratory Techniques/standards , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Diagnostic Tests, Routine/methods , Diagnostic Tests, Routine/standards , Humans , Outcome Assessment, Health Care , Patient Selection , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Reference Standards
7.
Scott Med J ; 65(4): 144-148, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-744926

ABSTRACT

BACKGROUND AND AIM: COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. METHODS: Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. RESULTS: One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. CONCLUSION: CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.


Subject(s)
Appendectomy , Appendicitis/diagnosis , Appendicitis/surgery , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Humans , Laparoscopy , Male , Middle Aged , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Postoperative Complications/epidemiology , Practice Patterns, Physicians' , Retrospective Studies , Young Adult
8.
Am J Gastroenterol ; 115(10): 1575-1583, 2020 10.
Article in English | MEDLINE | ID: covidwho-737627

ABSTRACT

The American Neurogastroenterology and Motility Society Task Force recommends that gastrointestinal motility procedures should be performed in motility laboratories adhering to the strict recommendations and personal protective equipment (PPE) measures to protect patients, ancillary staff, and motility allied health professionals. When available and within constraints of institutional guidelines, it is preferable for patients scheduled for motility procedures to complete a coronavirus disease 2019 (COVID-19) test within 48 hours before their procedure, similar to the recommendations before endoscopy made by gastroenterology societies. COVID-19 test results must be documented before performing procedures. If procedures are to be performed without a COVID-19 test, full PPE use is recommended, along with all social distancing and infection control measures. Because patients with suspected motility disorders may require multiple procedures, sequential scheduling of procedures should be considered to minimize need for repeat COVID-19 testing. The strategies for and timing of procedure(s) should be adapted, taking into consideration local institutional standards, with the provision for screening without testing in low prevalence areas. If tested positive for COVID-19, subsequent negative testing may be required before scheduling a motility procedure (timing is variable). Specific recommendations for each motility procedure including triaging, indications, PPE use, and alternatives to motility procedures are detailed in the document. These recommendations may evolve as understanding of virus transmission and prevalence of COVID-19 infection in the community changes over the upcoming months.


Subject(s)
Coronavirus Infections/prevention & control , Gastroenterology/standards , Gastrointestinal Diseases/diagnosis , Infection Control/standards , Laboratories/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Advisory Committees/standards , Betacoronavirus/pathogenicity , Clinical Laboratory Techniques/standards , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Gastroenterology/methods , Gastrointestinal Diseases/physiopathology , Gastrointestinal Motility/physiology , Humans , Infection Control/instrumentation , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Patient Selection , Personal Protective Equipment/standards , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Prevalence , Societies, Medical/standards , Triage/standards , United States/epidemiology
9.
Arab J Gastroenterol ; 21(3): 156-161, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-734009

ABSTRACT

BACKGROUND & STUDY AIMS: Corona virus disease-19 (COVID-19) pandemic has markedly impacted routine medical services including gastrointestinal (GI) endoscopy. We aim to report the real-life performance in high volume GI endoscopy units during the pandemic. PATIENTS AND METHODS: A web-based survey covering all aspects of daily performance in GI endoscopy units was sent to endoscopy units worldwide. Responses were collected and data were analyzed to reveal the effect of COVID-19 pandemic on endoscopy practice. RESULTS: Participants from 48 countries (n = 163) responded to the survey with response rate of 67.35%. The majority (85%) decreased procedure volume by over 50%, and four endoscopy units (2.45%) completely stopped. The top three indications for procedures included upper GI bleeding (89.6%), lower GI bleeding (65.6%) and cholangitis (62.6%). The majority (93.9%) triaged patients for COVID-19 prior to procedure. N95 masks were used in (57.1%), isolation gowns in (74.2%) and head covers in (78.5%). Most centers (65%) did not extend use of N95 masks, however 50.9% of centers reused N95 masks. Almost all (91.4%) centers used standard endoscopic decontamination and most (69%) had no negative pressure rooms. Forty-two centers (25.8%) reported positive cases of SARS-CoV-2 infection among patients and 50 (30.7%) centers reported positive cases of SARS-CoV-2 infection among their healthcare workers. CONCLUSIONS: Most GI endoscopy centers had a significant reduction in their volume and most procedures performed were urgent. Most centers used the recommended personal protective equipment (PPE) by GI societies however there is still a possibility of transmission of SARS-CoV-2 infection in GI endoscopy units.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Endoscopy, Gastrointestinal/statistics & numerical data , Infection Control/organization & administration , Pneumonia, Viral/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Facilities and Services Utilization , Humans , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Surveys and Questionnaires
10.
Eur J Cardiothorac Surg ; 58(4): 676-681, 2020 Oct 01.
Article in English | MEDLINE | ID: covidwho-732032

ABSTRACT

Early in 2020, coronavirus disease 2019 (COVID-19) quickly spread globally, giving rise to a pandemic. In this critical scenario, patients with lung cancer need to continue to receive optimal care and at the same be shielded from infection with the potentially severe acute respiratory syndrome coronavirus 2. Upgrades to the prevention and control of infection have become paramount in order to lower the risk of hospital contagion. Aerosol-generating procedures such as endotracheal intubation or endoscopic procedures may expose health care workers to a high risk of infection. Moreover, thoracic anaesthesia usually requires highly complex airway management procedures because of the need for one-lung isolation and one-lung ventilation. Therefore, in the current pandemic, providing a fast-track algorithm for scientifically standardized diagnostic criteria and treatment recommendations for patients with lung cancer is urgent. Suggestions for improving existing contagion control guidelines are needed, even in the case of non-symptomatic patients who possibly are responsible for virus spread. A COVID-19-specific intraoperative management strategy designed to reduce risk of infection in both health care workers and patients is also required.


Subject(s)
Anesthesia/methods , Betacoronavirus , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Lung Neoplasms/surgery , Pandemics/prevention & control , Pneumonectomy/methods , Pneumonia, Viral/prevention & control , Airway Management/methods , Coronavirus Infections/transmission , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Italy , Lung Neoplasms/diagnosis , Patient Selection , Perioperative Care/methods , Pneumonia, Viral/transmission
11.
BMC Surg ; 20(1): 190, 2020 Aug 26.
Article in English | MEDLINE | ID: covidwho-730210

ABSTRACT

BACKGROUND: Novel coronavirus pneumonia (NCP) outbreak in Wuhan, China in early 2020, resulted in over 80 thousand infections in China. At present, NCP has an explosive growth in the world. Surgeons could refuse selective operation during the outbreak, but they must face the emergency operation. We hope to avoid the spread of NCP while ensuring efficient treatment of emergency cases. METHODS: The data of patients with incarcerated hernia admitted to Beijing Chaoyang Hospital during NCP epidemic were analyzed and compared with those in 2019. All cases were divided into NCP group and 2019 group. The operation data and inpatient protection process of emergency cases were analyzed. Result During the NCP epidemic, 17 cases with incarcerated hernia were treated in our department. A Total of 263 cases of the same disease were admitted in 2019. There was no significant difference in age, gender, BMI and hernia type between two groups. No significant difference was observed between the two groups in operation method and hospital stay. The waiting time for emergency operation of NCP group was significantly longer than that of 2019 group (P = 0.002). A buffer ward was set up by administrator of hospital during NCP outbreak. Hospitals were divided into "Red area, Yellow area and Green area" artificially, and strict screening consultation system was implemented. There was no case of SARS-nCoV-2 infection in medical staff. CONCLUSION: It was safe and effective to carry out emergency operation on the premise of screening, protection and isolation during the NCP epidemic. The increased waiting time for operation due to NCP screening did not threaten medical safety of emergency incarcerated hernia patients.


Subject(s)
Betacoronavirus , Coronavirus Infections/prevention & control , Hernia, Abdominal/surgery , Herniorrhaphy , Hospitals, General , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aged , Aged, 80 and over , China/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Emergencies , Emergency Service, Hospital , Female , Humans , Length of Stay , Male , Middle Aged , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Retrospective Studies
12.
BMC Med Res Methodol ; 20(1): 215, 2020 08 26.
Article in English | MEDLINE | ID: covidwho-730204

ABSTRACT

BACKGROUND: Collection of biospecimens is a critical first step to understanding the impact of COVID-19 on pregnant women and newborns - vulnerable populations that are challenging to enroll and at risk of exclusion from research. We describe the establishment of a COVID-19 perinatal biorepository, the unique challenges imposed by the COVID-19 pandemic, and strategies used to overcome them. METHODS: A transdisciplinary approach was developed to maximize the enrollment of pregnant women and their newborns into a COVID-19 prospective cohort and tissue biorepository, established on March 19, 2020 at Massachusetts General Hospital (MGH). The first SARS-CoV-2 positive pregnant woman was enrolled on April 2, and enrollment was expanded to SARS-CoV-2 negative controls on April 20. A unified enrollment strategy with a single consent process for pregnant women and newborns was implemented on May 4. SARS-CoV-2 status was determined by viral detection on RT-PCR of a nasopharyngeal swab. Wide-ranging and pregnancy-specific samples were collected from maternal participants during pregnancy and postpartum. Newborn samples were collected during the initial hospitalization. RESULTS: Between April 2 and June 9, 100 women and 78 newborns were enrolled in the MGH COVID-19 biorepository. The rate of dyad enrollment and number of samples collected per woman significantly increased after changes to enrollment strategy (from 5 to over 8 dyads/week, P < 0.0001, and from 7 to 9 samples, P < 0.01). The number of samples collected per woman was higher in SARS-CoV-2 negative than positive women (9 vs 7 samples, P = 0.0007). The highest sample yield was for placenta (96%), umbilical cord blood (93%), urine (99%), and maternal blood (91%). The lowest-yield sample types were maternal stool (30%) and breastmilk (22%). Of the 61 delivered women who also enrolled their newborns, fewer women agreed to neonatal blood compared to cord blood (39 vs 58, P < 0.0001). CONCLUSIONS: Establishing a COVID-19 perinatal biorepository required patient advocacy, transdisciplinary collaboration and creative solutions to unique challenges. This biorepository is unique in its comprehensive sample collection and the inclusion of a control population. It serves as an important resource for research into the impact of COVID-19 on pregnant women and newborns and provides lessons for future biorepository efforts.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Coronavirus Infections/psychology , Patient Participation , Pneumonia, Viral/diagnosis , Pneumonia, Viral/psychology , Pregnancy Complications, Infectious/diagnosis , Specimen Handling , Adult , Female , Humans , Infant, Newborn , Pandemics , Patient Selection , Perinatal Care , Pregnancy , Pregnancy Complications, Infectious/psychology
15.
Heart Rhythm ; 17(9): e242-e254, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-728577

ABSTRACT

Coronavirus disease 2019 (COVID-19) has presented substantial challenges to patient care and impacted health care delivery, including cardiac electrophysiology practice throughout the globe. Based upon the undetermined course and regional variability of the pandemic, there is uncertainty as to how and when to resume and deliver electrophysiology services for arrhythmia patients. This joint document from representatives of the Heart Rhythm Society, American Heart Association, and American College of Cardiology seeks to provide guidance for clinicians and institutions reestablishing safe electrophysiological care. To achieve this aim, we address regional and local COVID-19 disease status, the role of viral screening and serologic testing, return-to-work considerations for exposed or infected health care workers, risk stratification and management strategies based on COVID-19 disease burden, institutional preparedness for resumption of elective procedures, patient preparation and communication, prioritization of procedures, and development of outpatient and periprocedural care pathways.


Subject(s)
Betacoronavirus , Cardiac Electrophysiology/organization & administration , Coronavirus Infections/prevention & control , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Patient Selection , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Telemedicine
17.
World J Surg Oncol ; 18(1): 220, 2020 Aug 22.
Article in English | MEDLINE | ID: covidwho-725262

ABSTRACT

BACKGROUND: Healthcare is an essential service at any time more so in the crisis like Covid. With increase in number of cases and mortality from Covid, the primary focus is shifted to the management of the Covid crisis and other health emergencies thus affecting normal health services and routine treatment of other diseases like cancer. METHODS: This article reviews the published literature and guidelines on Covid and cancer and discusses them to optimize the care of cancer patients during Covid pandemic to improve treatment outcomes. RESULTS: The results of the review of published literature show a twofold increase in probability of getting CoV2 infection by the cancer patients and a four-fold increase in chance of death. On the other hand, if left untreated a 20% increase in cancer death is expected. Data further show that none of the medicines like remdesivir, hydroxy chloroquin, dexamethasone, or azithromycin improves survival and response to Covid in cancer patients. Surgical results too show similar outcome before and after the pandemic though most of these report on highly selected patients populations. CONCLUSIONS: The Covid 2019 pandemic places cancer patients in a very difficult situation wherein if they seek treatment, they are exposing themselves to a risk of developing CoV2 infection and if they do not, the probability of dying without treatment increases. Hence, for them it is a choice between the devil and deep sea, and it is for the healthcare providers to triage patients and treat who cannot wait even though the data from the carefully selected cohort of patients show no increase in mortality or morbidity from treatment during Covid.


Subject(s)
Coronavirus Infections/prevention & control , Delivery of Health Care/organization & administration , Infection Control/organization & administration , Neoplasms/epidemiology , Neoplasms/therapy , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Coronavirus Infections/epidemiology , Disease Management , Female , Global Health , Humans , Male , Medical Oncology/organization & administration , Neoplasms/pathology , Occupational Health , Pandemics/statistics & numerical data , Patient Care/methods , Patient Care/statistics & numerical data , Patient Safety , Patient Selection , Pneumonia, Viral/epidemiology , Risk Assessment , Safety Management , Surgical Oncology/organization & administration
18.
Cancer Discov ; 10(10): 1432-1433, 2020 10.
Article in English | MEDLINE | ID: covidwho-723947
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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