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2.
J Perioper Pract ; 30(6): 151, 2020 06.
Article in English | MEDLINE | ID: covidwho-1477003
4.
Br J Surg ; 108(10): 1162-1180, 2021 10 23.
Article in English | MEDLINE | ID: covidwho-1462296

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic by the WHO on 11 March 2020 and global surgical practice was compromised. This Commission aimed to document and reflect on the changes seen in the surgical environment during the pandemic, by reviewing colleagues' experiences and published evidence. METHODS: In late 2020, BJS contacted colleagues across the global surgical community and asked them to describe how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had affected their practice. In addition to this, the Commission undertook a literature review on the impact of COVID-19 on surgery and perioperative care. A thematic analysis was performed to identify the issues most frequently encountered by the correspondents, as well as the solutions and ideas suggested to address them. RESULTS: BJS received communications for this Commission from leading clinicians and academics across a variety of surgical specialties in every inhabited continent. The responses from all over the world provided insights into multiple facets of surgical practice from a governmental level to individual clinical practice and training. CONCLUSION: The COVID-19 pandemic has uncovered a variety of problems in healthcare systems, including negative impacts on surgical practice. Global surgical multidisciplinary teams are working collaboratively to address research questions about the future of surgery in the post-COVID-19 era. The COVID-19 pandemic is severely damaging surgical training. The establishment of a multidisciplinary ethics committee should be encouraged at all surgical oncology centres. Innovative leadership and collaboration is vital in the post-COVID-19 era.


Subject(s)
COVID-19/prevention & control , Perioperative Care/trends , Practice Patterns, Physicians'/trends , Surgical Procedures, Operative/trends , Adult , Biomedical Research/organization & administration , COVID-19/diagnosis , COVID-19/economics , COVID-19/epidemiology , Education, Medical, Graduate/methods , Education, Medical, Graduate/trends , Female , Global Health , Health Resources/supply & distribution , Health Services Accessibility/trends , Humans , Infection Control/economics , Infection Control/methods , Infection Control/standards , International Cooperation , Male , Middle Aged , Pandemics , Perioperative Care/education , Perioperative Care/methods , Perioperative Care/standards , Practice Patterns, Physicians'/standards , Surgeons/education , Surgeons/psychology , Surgeons/trends , Surgical Procedures, Operative/education , Surgical Procedures, Operative/methods , Surgical Procedures, Operative/standards
6.
Medicine (Baltimore) ; 100(33): e26760, 2021 Aug 20.
Article in English | MEDLINE | ID: covidwho-1367077

ABSTRACT

ABSTRACT: The present study reported early clinical outcomes and perioperative precautions for medical staffs during joint arthroplasty procedures in SARS-CoV-2-infected patients.The medical records of 8 patients with SARS-CoV-2 infection who underwent joint arthroplasty from January 19 to September 24, 2020 were retrospectively reviewed and analyzed. Perioperative precautions and follow-up (time length varies from 6 month to 13 months, 11 months in average) for SARS-CoV-2 infection of medical staffs were reported.All patients recovered well from both the primary disease and SARS-CoV-2 infection. Significant improved Visual analogue scale was observed with no major complications or recurrence of the COVID-19 at discharge. There was no evidence indicating SARS-CoV-2 infection in any health providers.Elective joint arthroplasties for patients in recovery period of SARS-CoV-2 infection could be continued under comprehensive preoperative evaluation and appropriate medical protection. For patients with currently confirmed or highly suspected COVID-19, the operation should be carried out only if it was essential.


Subject(s)
Arthroplasty, Replacement, Hip , COVID-19/transmission , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Medical Staff, Hospital , Perioperative Care/methods , Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Clinical Protocols , Female , Hip/diagnostic imaging , Humans , Male , Middle Aged , Pandemics , Personal Protective Equipment , Postoperative Care , Postoperative Complications , Retrospective Studies , SARS-CoV-2 , Treatment Outcome , Workflow
7.
Curr Opin Obstet Gynecol ; 33(5): 361-369, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1360370

ABSTRACT

PURPOSE OF REVIEW: : The Coronavirus Disease 2019 (COVID-19) pandemic has had an unprecedented impact on pregnant women, maternity services and healthcare workers. We review recent literature on the course of COVID-19 infection in pregnancy, and recommendations for treatment and service provision. RECENT FINDINGS: It has been increasingly recognised that pregnant women are at higher risk of severe disease associated with COVID-19 infection. Early critical care input is crucial to guide respiratory support and techniques such as prone positioning, with a low threshold for intubation in critical illness. Timing of delivery remains a highly individualised decision. Following the RECOVERY trial, the use of a course of steroids in cases of severe COVID-19 infection has been widely adopted, and emerging guidance recommends vaccination in pregnant women. SUMMARY: Rapidly emerging evidence has helped guide clinicians to identify those patients most at risk of severe disease in COVID-19 and implement early interventions to reduce morbidity and mortality.


Subject(s)
Anesthesia , COVID-19/prevention & control , Pandemics , Pregnancy Complications, Infectious/prevention & control , Adult , COVID-19/epidemiology , Female , Humans , Pandemics/prevention & control , Perioperative Care , Pregnancy , Pregnancy Complications, Infectious/virology , SARS-CoV-2
8.
Ann Thorac Surg ; 112(5): 1707-1715, 2021 11.
Article in English | MEDLINE | ID: covidwho-1347031

ABSTRACT

EXECUTIVE SUMMARY: Cardiothoracic surgical patients are at risk of increased coronavirus disease severity. Several important factors influence the administration of the coronavirus disease vaccine in the perioperative period. This guidance statement outlines current information regarding vaccine types, summarizes recommendations regarding appropriate timing of administration, and provides information regarding side effects in the perioperative period for cardiac and thoracic surgical patients.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19/prevention & control , Cardiovascular Diseases/surgery , Perioperative Care/methods , Practice Guidelines as Topic , Thoracic Surgical Procedures , Vaccination/standards , COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Comorbidity , Humans , Pandemics
12.
Curr Opin Obstet Gynecol ; 33(4): 262-269, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1286605

ABSTRACT

PURPOSE OF REVIEW: This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic. RECENT FINDINGS: Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended. SUMMARY: After over a year of the COVID-19 pandemic, effective protocols and precautions have been established to decrease the morbidity and mortality of patients undergoing surgery and to promote the safety of healthcare personnel. Continued investigations are necessary as cases of new, possibly more virulent, strains of the virus arise.


Subject(s)
COVID-19/prevention & control , Disease Transmission, Infectious/prevention & control , Gynecologic Surgical Procedures/standards , Minimally Invasive Surgical Procedures/standards , Perioperative Care/standards , Practice Guidelines as Topic , Female , Humans , Laparoscopy , Personal Protective Equipment , SARS-CoV-2
13.
World Neurosurg ; 153: e187-e194, 2021 09.
Article in English | MEDLINE | ID: covidwho-1275762

ABSTRACT

OBJECTIVE: To assess organizational and technical difficulties of neurosurgical procedures during the coronavirus disease 2019 (COVID-19) pandemic and their possible impact on survival and functional outcome and to evaluate virological exposure risk of medical personnel. METHODS: Data for all urgent surgical procedures performed in the COVID-19 operating room were prospectively collected. Preoperative and postoperative variables included demographics, pathology, Karnofsky performance status (KPS) and neurological status at admission, type and duration of surgical procedures, length of stay, postoperative KPS and functional outcome comparison, and destination at discharge. We defined 5 classes of pathologies (traumatic, oncological, vascular, infection, hydrocephalus) and 4 surgical categories (burr hole, craniotomy, cerebrospinal fluid shunting, spine surgery). Postoperative SARS-CoV-2 infection was checked in all the operators. RESULTS: We identified 11 traumatic cases (44%), 4 infections (16%), 6 vascular events (24%), 2 hydrocephalus conditions (8%), and 2 oncological cases (8%). Surgical procedures included 11 burr holes (44%), 7 craniotomies (28%), 6 cerebrospinal fluid shunts (24%), and 1 spine surgery (4%). Mean patient age was 57.8 years. The most frequent clinical presentation was coma (44 cases). Mean KPS score at admission was 20 ± 10, mean surgery duration was 85 ± 63 minutes, and mean length of stay was 27 ± 12 days. Mean KPS score at discharge was 35 ± 25. Outcome comparison showed improvement in 16 patients. Four patients died. Mean follow-up was 6 ± 3 months. None of the operators developed postoperative SARS-CoV-2 infection. CONCLUSIONS: Standardized protocols are mandatory to guarantee a high standard of care for emergency and urgent surgeries during the COVID-19 pandemic. Personal protective equipment affects maneuverability, dexterity, and duration of interventions without affecting survival and functional outcome.


Subject(s)
COVID-19/prevention & control , COVID-19/transmission , Infection Control , Neurosurgical Procedures/mortality , Aged , Aged, 80 and over , COVID-19/epidemiology , COVID-19 Testing , Emergencies , Female , Humans , Infant , Infection Control/instrumentation , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Italy/epidemiology , Length of Stay/statistics & numerical data , Male , Middle Aged , Operating Rooms/organization & administration , Pandemics , Perioperative Care , Personal Protective Equipment/adverse effects , Personal Protective Equipment/virology , Prospective Studies , SARS-CoV-2 , Survival Analysis , Treatment Outcome
15.
Int J Health Plann Manage ; 36(5): 1397-1406, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1245422

ABSTRACT

During the on-going COVID-19 pandemic a number of key public health services have been severely impacted. These include elective surgical services due to the synergetic resources required to provide both perioperative surgical care whilst also treating acute COVID-19 patients and also the poor outcomes associated with surgical patients who develop COVID-19 in the perioperative period. This article discusses the important principles and concepts for providing important surgical services during the COVID-19 pandemic based on the model of the RMCancerSurgHub which is providing surgical cancer services for a population of approximately 2 million people across London during the pandemic. The model focusses on creating local and regional hub centres which provide urgent treatment for surgical patients in an environment that is relatively protected from the burden of COVID-19 illness. The model extensively utilises the extended multidisciplinary team to allow for a flexible approach with core services delivered in 'clean' sites which can adapt to viral surges. A key requirement is that of a clinical prioritisation process which allows for equity in access within and between specialties ensuring that patients are treated on the basis of greatest need, while at the same time protecting those whose conditions can safely wait from exposure to the virus. Importantly, this model has the ability to scale-up activity and lead units and networks into the recovery phase. The model discussed is also broadly applicable to providing surgical services during any viral pandemic.


Subject(s)
COVID-19 , Elective Surgical Procedures , Pandemics , Humans , Pandemics/prevention & control , Perioperative Care , SARS-CoV-2
20.
Am Soc Clin Oncol Educ Book ; 41: 1-11, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1218295

ABSTRACT

In the care of patients with operable breast cancer, there has been a shift toward increasing use of neoadjuvant therapy. There are benefits to neoadjuvant therapy, such as monitoring for response, as well as an increased rate of breast conservation and reduction of potential morbidity associated with breast surgery, including axillary management. Among patients with highly proliferative tumors, such as HER2-positive or triple-negative breast cancer, those with residual disease are at higher risk of recurrence, which informs the recommended systemic therapy in the adjuvant setting. For instance, in patients with residual disease after neoadjuvant chemotherapy and HER2-targeted therapy, there is a role for adjuvant trastuzumab emtansine for those with residual disease at the time of surgery. The same holds true regarding the role of adjuvant capecitabine in patients with residual disease after neoadjuvant chemotherapy. With the added complexities of treating patients in the era of the COVID-19 outbreak, additional considerations are critical, including initiation of surgery within an appropriate time from completion of neoadjuvant therapy. National consensus guidelines on time to surgery must be developed to improve measurement and comparison across systems. In addition, there is emerging radiation treatment management research addressing a number of factors, including hypofractionation, role of proton beam therapy, safe omission of radiotherapy, and preoperative radiotherapy with or without drug combination. In this article, the multidisciplinary approach of treating patients with operable breast cancer is highlighted, with updates and future considerations described.


Subject(s)
Breast Neoplasms/diagnosis , Breast Neoplasms/therapy , Biomarkers, Tumor , Breast Neoplasms/etiology , Clinical Decision-Making , Combined Modality Therapy/adverse effects , Combined Modality Therapy/methods , Comorbidity , Disease Management , Disease Susceptibility , Female , Humans , Outcome Assessment, Health Care , Perioperative Care , Time-to-Treatment
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