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1.
Eur J Cancer Care (Engl) ; 31(3): e13570, 2022 May.
Article in English | MEDLINE | ID: covidwho-1752534

ABSTRACT

OBJECTIVE: Fast-track concepts have been implemented in hepatopancreatobiliary surgery cancer care to improve postoperative recovery. For optimal postoperative care, patient participation is also required. The aim was to investigate and analyse whether an intervention with patient-owned fast-track protocols (PFTPs) may lead to increased patient participation and improve information for patients who underwent surgery for hepatopancreatobiliary cancer. METHODS: A quantitative comparative design with a control and intervention group was used. The participants in the intervention group followed a PFTP during their admission. After discharge, the patients answered a questionnaire regarding patient participation. Data analyses were performed with descriptive statistics and ANCOVA. RESULTS: The results are based on a total of 222 completed questionnaires: 116 in the control group and 106 in the intervention group. It is uncertain whether the PFTP increased patient participation and information, but its use may indicate an improvement for the patient group. CONCLUSION: A successful implementation strategy for the use of PFTP, with daily reconciliations, could be part of the work required to improve overall satisfaction with patient participation. CLINICALTRIALS: gov ID: NCT04061902.


Subject(s)
Neoplasms , Patient Participation , Humans , Length of Stay , Patient Discharge , Patient Reported Outcome Measures , Pilot Projects , Postoperative Care/methods
3.
Dermatol Surg ; 48(2): 187-190, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1595787

ABSTRACT

BACKGROUND: The Covid-19 Pandemic prompted the widespread implementation of telemedicine across healthcare. OBJECTIVE: To analyze telemedicine adoption by Mohs Micrographic surgeons (MMS) during the COVID-19 pandemic; to analyze the attitudes and perceived barriers to its long-term continuation by MMS practices. METHODS AND MATERIALS: An online multiple-choice survey was distributed to members of the American College of Mohs Surgeons. RESULTS: 86.1% of surveyed Mohs surgeons initiated telemedicine during the pandemic surge. The most common uses for telemedicine amongst respondents were post-surgery management (77.4%), "spot checks" (60.9%), and surgical consultations (59.1%). 73.1% report patients were receptive to telemedicine. 68.6% believe that telemedicine has a place in dermatologic surgery; 49.5% plan to incorporate telemedicine into their surgical practices long-term. Physical exam limitations, fitting telemedicine into practice workflow, and patient reception/patient training were viewed as the most significant barriers to long-term implementation. CONCLUSIONS: While valuable use cases for telemedicine were identified with most Mohs surgeon respondents feeling that telemedicine has a place in their practices, there is uncertainty in how to implement telemedicine into the dermatologic surgery practice workflow.


Subject(s)
COVID-19 , Dermatology/statistics & numerical data , Mohs Surgery , Telemedicine/statistics & numerical data , Attitude of Health Personnel , COVID-19/prevention & control , Dermatology/organization & administration , Humans , Patient Education as Topic , Patient Satisfaction , Physical Examination , Pilot Projects , Postoperative Care , Referral and Consultation , SARS-CoV-2 , Surveys and Questionnaires , Workflow
5.
Br J Oral Maxillofac Surg ; 60(3): 343-349, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1544830

ABSTRACT

The COVID-19 pandemic resulted in sudden changes to the established practice of using the high dependency unit (HDU) for the first night of postoperative care following microvascular free tissue transfer. Patients were managed instead on the head and neck ward. This retrospective case-note review aimed to report outcomes in consecutive patients treated before and during the pandemic, and to reflect on the implications of ward-based rather than HDU care. A total of 235 patients had free tissue transfer between 3 January 2019 and 25 February 2021: 125 before (lockdown 23 March 2020), and 110 during the pandemic (52 ward-managed and 58 HDU-managed). There were subtle case-mix differences during the pandemic, with 92% of ward-treated patients having oral cancers compared with 64% of HDU patients, and 73% of ward patients having a tracheostomy compared with 40% of HDU patients. Ward patients were less likely to receive electrolyte replacement (45% HDU vs 0% ward) and inotropes (12% HDU vs 2% ward). There were fewer returns to theatre for evacuation of a haematoma or re-anastomosis during the pandemic than there were before it. Other than fewer haematoma complications during the pandemic, the nature of complications was similar. In conclusion, the dramatic changes imposed by the pandemic have shown that the ward is a safe place for patients to be cared for immediately postoperatively, and it alleviates the bed pressures experienced in HDU. Careful case selection and clear criteria are required to identify patients who need the HDU.


Subject(s)
COVID-19 , Pandemics , Communicable Disease Control , Hematoma , Humans , Postoperative Care/methods , Prospective Studies , Retrospective Studies
8.
Minerva Surg ; 77(1): 50-56, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1485663

ABSTRACT

INTRODUCTION: The aim of this systematic review was to report and to analyze if there is and what is the impact of telemedicine in the surgical practice during COVID-19 pandemic. Many authors have posited that the pandemic urged a high implementation of the telemedicine service even in surgical specialties, however, the impact of this change of the clinical practice has been variably reported and its utilization in general surgery is uncertain. EVIDENCE ACQUISITION: All articles from any country written in English, Italian, Spanish, or French, about the use of telemedicine for indication to surgical treatment or for 30-day postoperative follow-up in general surgery during the COVID 19 outbreak, from the March 1, 2020, to December 1, 2020, were included. EVIDENCE SYNTHESIS: Two hundred nine articles were fully analyzed, and 207 further articles were excluded. Finally, 2 articles, both published in October 2020, were included in the present systematic review. CONCLUSIONS: In conclusion, the rapid spread of SARS-CoV-2 pandemic has forced to review the traditional methods to deliver surgical assistance and urged surgeons to find alternative methods to continue their practice. The literature about this topic is yet scarce and many questions regarding its efficacy in improving patients' health, cost-effectiveness and user satisfaction remain unsolved.


Subject(s)
Aftercare , COVID-19 , General Surgery , Telemedicine , Aftercare/statistics & numerical data , COVID-19/epidemiology , General Surgery/statistics & numerical data , Humans , Pandemics , Postoperative Care/statistics & numerical data , SARS-CoV-2 , Telemedicine/statistics & numerical data
9.
Parkinsonism Relat Disord ; 92: 41-45, 2021 11.
Article in English | MEDLINE | ID: covidwho-1472127

ABSTRACT

BACKGROUND: The initial COVID-19 pandemic shutdown led to the canceling of elective surgeries throughout most of the USA and Canada. OBJECTIVE: This survey was carried out on behalf of the Parkinson Study Group (PSG) to understand the impact of the shutdown on deep brain stimulation (DBS) practices in North America. METHODS: A survey was distributed through RedCap® to the members of the PSG Functional Neurosurgical Working Group. Only one member from each site was asked to respond to the survey. Responses were collected from May 15 to June 6, 2020. RESULTS: Twenty-three sites participated; 19 (83%) sites were from the USA and 4 (17%) from Canada. Twenty-one sites were academic medical centers. COVID-19 associated DBS restrictions were in place from 4 to 16 weeks. One-third of sites halted preoperative evaluations, while two-thirds of the sites offered limited preoperative evaluations. Institutional policy was the main contributor for the reported practice changes, with 87% of the sites additionally reporting patient-driven surgical delays secondary to pandemic concerns. Pre-post DBS associated management changes affected preoperative assessments 96%; electrode placement 87%; new implantable pulse generator (IPG) placement 83%; IPG replacement 65%; immediate postoperative DBS programming 74%; and routine DBS programming 91%. CONCLUSION: The COVID-19 pandemic related shutdown resulted in DBS practice changes in almost all North American sites who responded to this large survey. Information learned could inform development of future contingency plans to reduce patient delays in care under similar circumstances.


Subject(s)
COVID-19/prevention & control , Deep Brain Stimulation/statistics & numerical data , Implantable Neurostimulators/statistics & numerical data , Movement Disorders/therapy , Parkinson Disease/therapy , Postoperative Care/statistics & numerical data , Preoperative Care/statistics & numerical data , Quarantine/statistics & numerical data , Telemedicine/statistics & numerical data , Academic Medical Centers , Canada , Health Care Surveys , Humans , Neurologists/statistics & numerical data , Neurosurgeons/statistics & numerical data , United States
10.
Pediatr Transplant ; 26(1): e14152, 2022 02.
Article in English | MEDLINE | ID: covidwho-1470453

ABSTRACT

BACKGROUND: Since the start of the COVID-19 pandemic and consequent lockdowns, the use of telehealth interventions has rapidly increased both in the general population and among transplant recipients. Among pediatric transplant recipients, this most frequently takes the form of interventions on mobile devices, or mHealth, such as remote visits via video chat or phone, phone-based monitoring, and mobile apps. Telehealth interventions may offer the opportunity to provide care that minimizes many of the barriers of in-person care. METHODS: The present review followed the PRISMA guidelines. Sources up until October 2020 were initially identified through searches of PsycInfo® and PubMed® . RESULTS: We identified ten papers that reported findings from adult interventions and five studies based in pediatrics. Eight of the adult publications stemmed from the same two trials; within the pediatric subset, this was the case for two papers. Studies that have looked at mHealth interventions have found high acceptability rates over the short run, but there is a general lack of data on long-term use. CONCLUSIONS: The literature surrounding pediatric trials specifically is sparse with all findings referencing interventions that are in early stages of development, ranging from field tests to small feasibility trials. The lack of research highlights the need for a multi-center RCT that utilizes robust measures of medication adherence and other outcome variables, with longer-term follow-up before telehealth interventions should be fully embraced.


Subject(s)
COVID-19/prevention & control , Health Services Accessibility , Organ Transplantation , Pediatrics/methods , Postoperative Care/methods , Telemedicine/methods , Adult , Attitude to Health , Canada , Child , Europe , Health Care Costs/statistics & numerical data , Humans , Pediatrics/economics , Pediatrics/trends , Postoperative Care/economics , Postoperative Care/trends , Telemedicine/economics , Telemedicine/trends , United States
11.
Interact Cardiovasc Thorac Surg ; 31(1): 42-47, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-1455304

ABSTRACT

OBJECTIVES: The use of digital chest drainage units (CDUs) has become increasingly common in thoracic surgery due to several advantages. However, in cardiac surgery, its use is still limited in favour of conventional analogue CDUs. In order to investigate the potential benefit of digital CDUs in cardiac surgery, we compared the safety and efficacy of both systems in patients undergoing cardiac surgery at our centre. METHODS: We retrospectively investigated 265 consecutive patients who underwent cardiac surgery at our institution between June 2017 and October 2017. These patients were divided into 2 groups: patients with analogue (A, n = 65) and digital CDUs (D, n = 200). Postoperative outcome was analysed and compared between both groups. In addition, the 'user experience' was evaluated by means of a questionnaire. RESULTS: The median age of the cohort was 70 years (P = 0.167), 25.3% of patients were female (P = 0.414). There were no differences in terms of re-explorative surgery or use of blood products. Nor was there a difference in the overall amount of fluid collected. However, during the first 6 h, more fluid was collected by the digital CDUs. The overall rate of technical failure was 0.4%. We observed a significantly higher rate of clotting in the tubing system of the digital CDUs (P = 0.042). Concerning the user experience, the digital CDUs were associated with a more favourable ease of use on the regular wards (P < 0.001). With regard to the overall user experience, the digital CDUs outperformed the analogue systems (P = 0.002). CONCLUSIONS: Digital CDUs can be safely and effectively applied in patients after cardiac surgery. Due to the improved patient mobility and simplified chest tube management, the use of digital CDUs may be advantageous for patients after cardiac surgery. However, the issue of clotting of the tubing systems should be addressed by further technical improvements.


Subject(s)
Cardiac Surgical Procedures/methods , Chest Tubes , Drainage/methods , Postoperative Care/methods , Aged , Female , Humans , Male , Middle Aged , Prospective Studies , Surveys and Questionnaires
12.
Eur J Vasc Endovasc Surg ; 60(1): 108-117, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1454123

ABSTRACT

OBJECTIVE: Post-procedure limb compression, hitherto routine following open varicose vein surgery, has been extended to endovenous procedures. However, no robust evidence exists to support this practice. Most of the previous studies have focused on the ideal duration of compression. This study evaluates the clinical and patient reported outcomes with and without post-procedure leg compression following radiofrequency ablation (RFA). METHODS: This single centre, prospective, non-inferiority randomised controlled trial recruited adult patients, into two groups (A: RFA with compression stocking for two weeks, B: RFA alone). The primary outcome was ultrasound determined target vein obliteration at 12 weeks. Secondary outcome measures included a Quality of Life (QoL) score [Aberdeen Varicose Vein Severity Score (AVSS) and Revised Venous Clinical Severity Score (RVCSS)], patient satisfaction, pain score, and complications. RESULTS: In total, 100 consecutive patients were recruited (A: 51; B: 49) classified as clinical class C2-C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification. At 12 weeks the occlusion rate of the target vein was similar in both groups at 98% (n = 47) and 98% (n = 45), respectively (p = 1.0). There was no statistically significant difference in mean AVSS 6 vs. 5.0 (mean difference -1, 95% CI -2 - 3, p = .57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1 - 2, p = .46) scores at 12 weeks. Comparable patient satisfaction scores were observed (p = .72) and pain score 2.0 vs. 2.0 (p = .92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two weeks follow up (p = 1.0 for above the knee and p = 1.0 for below the knee). CONCLUSION: The clinical and patient reported outcomes following RFA without compression are no worse than with compression. This trial supports the conclusion that the widely practised use of compression after RFA adds no clinical benefit for the patients. However, a much larger study, preferably a multicentre trial, may be required to confirm this conclusion.


Subject(s)
Compression Bandages , Radiofrequency Ablation , Varicose Veins/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Postoperative Care/methods , Radiofrequency Ablation/methods , Treatment Outcome , Young Adult
15.
Pediatr Transplant ; 26(1): e14138, 2022 02.
Article in English | MEDLINE | ID: covidwho-1402967

ABSTRACT

BACKGROUND: The delivery of healthcare services by telemedicine decreases costs of traveling for patients, is less time-consuming, and most importantly permits the connection between highly skilled specialists and patients. However, whether the use of telemedicine (text messaging) for LT patients was affected by the COVID-19 pandemic is unknown. METHODS: We collected data (following consent from patients and parents) from 57 patients (33 male/24 female) with a median age of 47 (IQR: 9-91) months, whom we followed up with text messaging between September 2019 and September 2020, spanning the 6 months prior to COVID-19 and during this period. RESULTS: In total, 723 text message mediated consultations occurred during this period, henceforth simply referred to as "messages." Three hundred and twenty-eight (45%) messages occurred during the 6 months up to the start of the pandemic. Following the COVID-19 outbreak, the number of messages increased to 395 (55%). The three most common reasons of messaging were post-liver-LT follow-up messages (n = 215/723, 29.7%), consultations for drug use (n = 157/723, 21.7%), and medication prescriptions (n = 113/723, 15.6%). Protocol biopsy discussions (n = 33/723, 4.6%) and fever (n = 27/723, 3.7%) were among others (vaccination, rash, diarrhea, cough, fatigue, acne). During the COVID-19 outbreak, only post-LT follow-up messages increased significantly to 132/395 (33%) from 83/328 (25%) (p-value: .02). CONCLUSIONS: We found that the pandemic resulted in an increase in the total number of text message mediated consultations and specifically for the use of post-LT follow-up. Messaging was effective for post-LT follow-ups and all patients were at least satisfied.


Subject(s)
COVID-19/prevention & control , Liver Transplantation , Patient Acceptance of Health Care/statistics & numerical data , Postoperative Care/trends , Practice Patterns, Physicians'/trends , Telemedicine/trends , Text Messaging/trends , Child , Child, Preschool , Female , Follow-Up Studies , Health Services Accessibility , Humans , Infant , Male , Patient Satisfaction , Postoperative Care/methods , Retrospective Studies
17.
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
18.
World Neurosurg ; 154: e781-e789, 2021 10.
Article in English | MEDLINE | ID: covidwho-1347859

ABSTRACT

OBJECTIVE: To assess the feasibility, patient/provider satisfaction, and perceived value of telehealth spine consultation after rapid conversion from traditional in-office visits during the COVID-19 pandemic. METHODS: Data were obtained for patients undergoing telehealth visits with spine surgeons in the first 3 weeks after government restriction of elective surgical care at 4 sites (March 23, 2020, to April 17, 2020). Demographic factors, technique-specific elements of the telehealth experience, provider confidence in diagnostic and therapeutic assessment, patient/surgeon satisfaction, and perceived value were collected. RESULTS: A total of 128 unique visits were analyzed. New (74 [58%]), preoperative (26 [20%]), and postoperative (28 [22%]) patients were assessed. A total of 116 (91%) visits had successful connection on the first attempt. Surgeons felt very confident 101 times (79%) when assessing diagnosis and 107 times (84%) when assessing treatment plan. The mean and median patient satisfaction was 89% and 94%, respectively. Patient satisfaction was significantly higher for video over audio-only visits (P < 0.05). Patient satisfaction was not significantly different with patient age, location of chief complaint (cervical or thoracolumbar), or visit type (new, preoperative, or postoperative). Providers reported that 76% of the time they would choose to perform the visit again in telehealth format. Sixty percent of patients valued the visit cost as the same or slightly less than an in-office consultation. CONCLUSIONS: This is the first study to demonstrate the feasibility and high patient/provider satisfaction of virtual spine surgical consultation, and appropriate reimbursement and balanced regulation for spine telehealth care is essential to continue this existing work.


Subject(s)
COVID-19 , Feasibility Studies , Neurosurgeons , Pandemics , Physical Examination/methods , Spinal Diseases/diagnosis , Telemedicine/methods , Adult , Age Factors , Aged , Aged, 80 and over , Attitude of Health Personnel , Female , Health Personnel , Humans , Male , Middle Aged , Patient Satisfaction/statistics & numerical data , Postoperative Care , Preoperative Care
19.
J Card Surg ; 36(10): 3731-3737, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1334486

ABSTRACT

BACKGROUND: The Coronavirus 19 (COVID-19) pandemic forced an unprecedented shift of postoperative care for cardiac surgery patients to telemedicine. How patients and surgeons perceive telemedicine is unknown. We examined patient and provider satisfaction with postoperative telehealth visits following cardiac surgery. METHODS: Between April 2020 and September 2020, patients who underwent open cardiac surgery and had a postoperative appointment via telemedicine were administered a patient satisfaction survey over the phone. Time of survey administration ranged from 1 to 4 weeks following their appointment. Surgeons also completed a satisfaction survey following each telemedicine appointment they conducted. RESULTS: Fifty patients were surveyed. Of these, 36 (72%) had a postoperative appointment over the telephone, and 14 (28%) had a postoperative appointment via video-chat. Overall, patients expressed satisfaction with the care that they received via our two telemedicine modalities (mean Likert scale agreement 4.8, SD 0.5). Despite this, 46% of patients said they would prefer their next postoperative appointment to be via telemedicine even if there was not a stay-at-home order in place. All surgeons surveyed reported (agree/strongly agree) that they would prefer to see their postoperative patients using telemedicine. CONCLUSIONS: These findings highlight acceptability of continuing telemedicine use in the postoperative care of cardiac surgery patients.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Telemedicine , Humans , Patient Satisfaction , Postoperative Care , SARS-CoV-2
20.
J Card Surg ; 36(10): 3738-3739, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1332870

ABSTRACT

Telemedicine, telehealth and artificial intelligence in healthcare are becoming commonly utilized in various medical specialties. The article authored by Dr. Aminah Sallam and colleagues in the Journal provides data in support of the cardiac surgical patients, and the caring cardiac surgeons willingness to adopt telemedicine as a method of connectivity between patient and surgeon.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Telemedicine , Artificial Intelligence , Humans , Postoperative Care , SARS-CoV-2
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