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1.
Ann Surg ; 272(2): e168-e169, 2020 08.
Article in English | MEDLINE | ID: covidwho-705410

ABSTRACT

: The spread of COVID-19 has challenged practices across the United States to dramatically change inpatient and outpatient practices to focus on containing spread of the virus and accommodate the anticipated increase in volume of acute illness. Despite this transition, practices will need to continue to accommodate evaluation of newly diagnosed malignancies, routine postoperative visits, and acute postoperative issues. Building on an existing telemedicine framework, we aim to describe rapid transition in our outpatient care to a telehealth model in a general thoracic surgery practice during COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Postoperative Care , Preoperative Care , Telemedicine/organization & administration , Thoracic Surgery , Betacoronavirus , Humans , Pandemics , Philadelphia/epidemiology
3.
J Cardiovasc Med (Hagerstown) ; 21(9): 654-659, 2020 09.
Article in English | MEDLINE | ID: covidwho-681583

ABSTRACT

OBJECTIVE: By the end of February 2020, the COVID-19 pandemic infection had spread in Northern Italy, with thousands of patients infected. In Lombardy, the most affected area, the majority of public and private hospitals were dedicated to caring for COVID-19 patients and were organized following the 'Hub-and-Spoke' model for other medical specialties, like cardiac surgery and interventional procedures for congenital cardiac disease (CHD). Here, we report how the congenital cardiac care system was modified in Lombardy and the first results of this organization. METHODS: We describe a modified 'Hub-and-Spoke' model - that involves 59 birthplaces and three specialized Congenital Cardiac Centers -- and how the hub center organized his activity. We also reported the data of the consecutive cases hospitalized during this period. RESULTS: From 9 March to 15 April, we performed: a total of 21 cardiac surgeries, 4 diagnostic catheterizations, 3 CT scans, and 2 CMR. In three cases with prenatal diagnosis, the birth was scheduled. The spoke centers referred to our center six congenital cardiac cases. The postop ExtraCorporeal Membrane Oxygenation support was required in two cases; one case died. None of these patients nor their parents or accompanying person was found to be COVID-19-positive; 2 pediatric intensivists were found to be COVID-19-positive, and needed hospitalization without mechanical ventilation; 13 nurses had positive COVID swabs (4 with symptoms), and were managed and isolated at home. CONCLUSION: Our preliminary data suggest that the model adopted met the immediate needs with a good outcome without increased mortality, nor COVID-19 exposure for the patients who underwent procedures.


Subject(s)
Cardiac Surgical Procedures , Cardiology Service, Hospital , Coronavirus Infections , Heart Defects, Congenital , Infection Control , Pandemics , Perinatal Care , Pneumonia, Viral , Betacoronavirus/isolation & purification , Cardiac Surgical Procedures/methods , Cardiac Surgical Procedures/statistics & numerical data , Cardiology Service, Hospital/organization & administration , Cardiology Service, Hospital/trends , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Female , Heart Defects, Congenital/epidemiology , Heart Defects, Congenital/surgery , Humans , Infant, Newborn , Infection Control/methods , Infection Control/organization & administration , Italy/epidemiology , Male , Models, Organizational , Organizational Innovation , Pandemics/prevention & control , Perinatal Care/methods , Perinatal Care/organization & administration , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Postoperative Care/methods , Pregnancy
6.
Br J Oral Maxillofac Surg ; 58(7): 843-847, 2020 09.
Article in English | MEDLINE | ID: covidwho-612098

ABSTRACT

The COVID-19 crisis has caused many issues across healthcare. In surgery, many operations have been cancelled with some surgeons losing their regular operating lists. During this time, technical expertise and decision making can deteriorate. In aviation after a prolonged period of absence from flying, this deficit in keeping skills and thinking up to date is known as being "out of currency" or "not current". Although aviation and healthcare cannot be compared, numerous human factors concepts are applicable to both. In this article, we explore the likely impact of potentially prolonged absences in operating on surgical skills and psyche, and introduce the concept of a Surgical Skills Currency Barometer. We also discuss a "task-o-meter" thought experiment, and suggest practices which could be adopted to help protect surgeon workload from exceeding surgical capability when returning to operating following a period of prolonged absence.


Subject(s)
Clinical Competence/standards , Coronavirus Infections , Elective Surgical Procedures/standards , Pandemics , Patient Safety , Personal Protective Equipment , Pneumonia, Viral , Aviation , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , Postoperative Care , Preoperative Care , Return to Work
10.
Int J Surg ; 79: 103-104, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-399827

ABSTRACT

The end of 2019 was marked by the emergence of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Our problem is centered in the post operative follow up of those patients who underwent an elective procedure immediately before the isolation and those who require an emergency surgery. We outline the measures we have taken to reduce the possibility of spread of the virus.


Subject(s)
Coronavirus Infections/epidemiology , Herniorrhaphy , Pandemics , Pneumonia, Viral/epidemiology , Postoperative Care , Betacoronavirus , Elective Surgical Procedures , Emergency Medical Services , Humans
11.
Int J Colorectal Dis ; 35(9): 1797-1800, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-378220

ABSTRACT

INTRODUCTION: Since the outbreak of novel coronavirus (2019-nCoV), it became evident that a proportion of patients may present with gastrointestinal symptoms. CASE: We report the case of a Covid-19-infected patient who, during recovery from the pulmonary pneumonia, had gastrointestinal symptoms followed by a diastasic right colon perforation due to acute over distension of the bowel. CONCLUSION: This case highlights the importance of paying attention to initial gastrointestinal symptoms in order to prevent possible complications.


Subject(s)
Colectomy/methods , Coronavirus Infections/complications , Intestinal Perforation/complications , Intestinal Perforation/diagnostic imaging , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Anastomosis, Surgical/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Emergencies , Follow-Up Studies , Humans , Intestinal Perforation/surgery , Laparotomy/methods , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Postoperative Care/methods , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
12.
Int J Obstet Anesth ; 43: 1-8, 2020 08.
Article in English | MEDLINE | ID: covidwho-358204

ABSTRACT

SARS-CoV-2 is a novel coronavirus causing a global pandemic of a severe respiratory illness known as COVID-19. To date, globally, over 30,000 people have died from this emerging disease. As clinicians and healthcare systems around the world are rapidly adapting to manage patients with COVID-19, limited data are emerging from different patient populations to support best-practice and improve outcomes. In this review, we present a summary of emerging data in the obstetric population and offer obstetric and anaesthetic clinicians around the world a set of evidence-driven, practice-based recommendations for the anaesthetic management of pregnant women with suspected or confirmed COVID-19.


Subject(s)
Anesthesia, Obstetrical , Betacoronavirus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Adult , Analgesia, Obstetrical , Cesarean Section , Coronavirus Infections/prevention & control , Female , Humans , Intraoperative Care , Pandemics/prevention & control , Personal Protective Equipment , Pneumonia, Viral/prevention & control , Postoperative Care , Pregnancy
15.
Aesthetic Plast Surg ; 44(3): 1014-1042, 2020 06.
Article in English | MEDLINE | ID: covidwho-260360

ABSTRACT

BACKGROUND: The worldwide spread of a novel coronavirus disease (COVID-19) has led to a near total stop of non-urgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the self-imposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. METHODS: We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19-positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of cross-contamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. CONCLUSION: The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a risk-minimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare the elective surgical specialties better for a possible second wave of the pandemic. LEVEL OF EVIDENCE V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.


Subject(s)
Coronavirus Infections/prevention & control , Elective Surgical Procedures/methods , Infection Control/methods , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , Surgery, Plastic/methods , Adult , Age Factors , Aged , Aged, 80 and over , Clinical Laboratory Techniques/methods , Communicable Disease Control/organization & administration , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Disease Management , Feasibility Studies , Female , Humans , Longitudinal Studies , Male , Middle Aged , Occupational Health , Personal Protective Equipment/statistics & numerical data , Pneumonia, Viral/epidemiology , Postoperative Care/methods , Preoperative Care/methods , Sex Factors
18.
A A Pract ; 14(7): e01227, 2020 May.
Article in English | MEDLINE | ID: covidwho-201374

ABSTRACT

A 17-year-old healthy girl underwent an uneventful esthetic septorhinoplasty. She was easily extubated and transferred to the postanesthesia care unit (PACU) with oxygen saturation (SpO2) of 96%. About 30 minutes after arrival in the PACU, she developed dyspnea with SpO2 of 84% and promptly received oxygen with bilevel positive airway pressure in conjunction with low-dose corticosteroid. The subsequent chest computed tomography (CT) revealed bilateral patchy infiltrates similar to the radiologic findings of Coronavirus Disease 2019 (COVID-19). Finally, a reverse transcriptase polymerase chain reaction (RT-PCR) of a pharyngeal specimen confirmed the diagnosis of COVID-19.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus/isolation & purification , Dyspnea/diagnostic imaging , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Respiratory Distress Syndrome, Adult/complications , Tomography, X-Ray Computed/methods , Adolescent , Airway Extubation , Betacoronavirus , Clinical Laboratory Techniques , Coronavirus/genetics , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Dyspnea/etiology , Female , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/therapeutic use , Oxygen/therapeutic use , Pandemics , Pharynx/virology , Postoperative Care , Reverse Transcriptase Polymerase Chain Reaction , Treatment Outcome
19.
Lancet Diabetes Endocrinol ; 8(7): 640-648, 2020 07.
Article in English | MEDLINE | ID: covidwho-197827

ABSTRACT

The coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Hence, surgical candidates face prolonged delays of beneficial treatment. Because of the progressive nature of obesity and diabetes, delaying surgery increases risks for morbidity and mortality, thus requiring strategies to mitigate harm. The risk of harm, however, varies among patients, depending on the type and severity of their comorbidities. A triaging strategy is therefore needed. The traditional weight-centric patient-selection criteria do not favour cases based on actual clinical needs. In this Personal View, experts from the Diabetes Surgery Summit consensus conference series provide guidance for the management of patients while surgery is delayed and for postoperative surveillance. We also offer a strategy to prioritise bariatric and metabolic surgery candidates on the basis of the diseases that are most likely to be ameliorated postoperatively. Although our system will be particularly germane in the immediate future, it also provides a framework for long-term clinically meaningful prioritisation.


Subject(s)
Bariatric Surgery/methods , Betacoronavirus , Coronavirus Infections/surgery , Obesity/surgery , Pandemics , Pneumonia, Viral/surgery , Postoperative Care/methods , Bariatric Surgery/trends , Coronavirus Infections/epidemiology , Disease Management , Humans , Obesity/epidemiology , Pneumonia, Viral/epidemiology , Postoperative Care/trends , Postoperative Complications/epidemiology , Postoperative Complications/prevention & control
20.
Head Neck ; 42(6): 1305-1307, 2020 06.
Article in English | MEDLINE | ID: covidwho-141702

ABSTRACT

BACKGROUND: Telehealth postoperative visits are an attractive strategy to minimize exposure, especially during the SARS-CoV-2 (COVID-19) pandemic. The use of a surgical drain often prevents this minimal-exposure approach in that patients return to the outpatient clinic for drain removal. METHODS AND RESULTS: Following unilateral neck dissection, the customary closed-suction drain was replaced with a self-removing, passive drain dressing to facilitate same-day discharge and telehealth postoperative follow-up. The patient removed the dressing and drain at home during a telehealth visit on postoperative day 4 and she healed favorably without any signs of infection or seroma. CONCLUSIONS: When thoughtfully applied in the appropriate clinical context, small practice adaptations like this can facilitate telehealth solutions that diminish unnecessary exposure for patients, their caregivers, and health care staff.


Subject(s)
Bandages , Coronavirus Infections/epidemiology , Drainage , Pneumonia, Viral/epidemiology , Postoperative Care , Self Care , Telemedicine , Betacoronavirus , Carcinoma, Adenoid Cystic/surgery , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Female , Humans , Middle Aged , Neck Dissection , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Submandibular Gland Neoplasms/surgery
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