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World J Pediatr Congenit Heart Surg ; 11(5): 675-679, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-638726


The world as we once knew it has been drastically altered secondary to coronavirus disease 2019 (COVID-19). The impact of these changes, particularly for those practicing in the medical profession, extends beyond the physical to the psychological, emotional, and spiritual. We discuss the factors that contribute to these stresses, way to manage them, and how we as leaders of our teams can inspire resilience and help our colleagues endure these most difficult times.

Betacoronavirus , Coronavirus Infections/complications , Courage , Leadership , Pneumonia, Viral/complications , Surgical Procedures, Operative/standards , Coronavirus Infections/epidemiology , Humans , Pandemics , Pneumonia, Viral/epidemiology
J Pediatr Surg ; 55(8): 1431-1435, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-591535


INTRODUCTION: The impact of COVID-19 pandemic on pediatric surgical care systems is unknown. We present an initial evaluation of self-reported pediatric surgical policy changes from hospitals across North America. METHODS: On March 30, 2020, an online open access, data gathering spreadsheet was made available to pediatric surgeons through the American Pediatric Surgical Association (APSA) website, which captured information surrounding COVID-19 related policy changes. Responses from the first month of the pandemic were collected. Open-ended responses were evaluated and categorized into themes and descriptive statistics were performed to identify areas of consensus. RESULTS: Responses from 38 hospitals were evaluated. Policy changes relating to three domains of program structure and care processes were identified: internal structure, clinical workflow, and COVID-19 safety/prevention. Interhospital consensus was high for reducing in-hospital staffing, limiting clinical fellow exposure, implementing telehealth for conducting outpatient clinical visits, and using universal precautions for trauma. Heterogeneity in practices existed for scheduling procedures, implementing testing protocols, and regulating use of personal protective equipment. CONCLUSIONS: The COVID-19 pandemic has induced significant upheaval in the usual processes of pediatric surgical care. While policies evolve, additional research is needed to determine the effect of these changes on patient and healthcare delivery outcomes. LEVEL OF EVIDENCE: III.

Betacoronavirus , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Hospitals, Pediatric , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/standards , Telemedicine/methods , Child , Disease Transmission, Infectious/statistics & numerical data , Humans , North America/epidemiology , Pandemics
J Pediatr Surg ; 55(8): 1427-1430, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-548366


OBJECTIVE: During the COVID-19 pandemic, experience-based guidelines are needed in the pediatric population in order to deliver high quality care in a new way that keeps patients and healthcare workers safe and maximizes hospital resource utilization. BACKGROUND: The COVID-19 pandemic has created an unprecedented strain on national health care resources, particularly in New York City, the epicenter of the outbreak in the United States. Prudent allocation of surgical resources during the pandemic quickly became essential, and there is an unprecedented need to weigh the risks of operating versus delaying intervention in our pediatric patients. METHODS: Here we describe our experience in surgical decision-making in the pediatric surgical population at Morgan Stanley Children's Hospital of New York-Presbyterian (MSCHONY), which has served as a major urban catchment area for COVID-19 positive pediatric patients. We describe how we have adjusted our current treatment of multiple facets of pediatric surgery including oncology, trauma, minimally invasive procedures, and extracorporeal membrane oxygenation (ECMO). CONCLUSIONS: Our pediatric surgery department had to creatively and expeditiously adjust our protocols, guidelines, and workforce to not only serve our pediatric population but merge ourselves with our adult hospital system during the COVID pandemic. TYPE OF STUDY: Clinical research paper LEVEL OF EVIDENCE: Level V.

Betacoronavirus , Coronavirus Infections/epidemiology , Decision Making , Guidelines as Topic , Hospitals, Pediatric/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/standards , Child , Humans , New York City/epidemiology
Clinics (Sao Paulo) ; 75: e1923, 2020.
Article in English | MEDLINE | ID: covidwho-329921


The coronavirus disease (COVID-19) outbreak started in Wuhan, China, in December 2019, and evolved into a global problem in a short period. The pandemic has led to many social and health-care challenges. In this context, surgery is an area that is facing the need for many adaptations. In this systematic literature review, we analyzed different perspectives concerning this situation, aiming to provide recommendations that could guide surgeons and entities toward screening, elective and emergency surgeries, decision making, and operating room management. A computerized search in PubMed, Scopus, and Scientific Electronic Library Online (SciELO) for relevant literature up to April 4, 2020, was performed. Articles were included if they were related to surgery dynamics in the context of the COVID-19 pandemic. Of the 281 articles found in our initial search and 15 articles from alternative sources, 39 were included in our review after a systematic evaluation. Concerning preoperative testing for severe acute respiratory syndrome coronavirus 2 infection, 29 (74.4%) articles recommended some kind of screening. Another major suggestion was postponing all (or at least selected) elective operations (29 articles, 74.4%). Several additional recommendations with respect to surgical practice or surgical staff were also assessed and discussed, such as performing laparoscopic surgeries and avoiding the use of electrocauterization. On the basis of the current literature, we concluded that any surgery that can be delayed should be postponed. COVID-19 screening is strongly recommended for all surgical cases. Moreover, surgical staff should be reduced to the essential members and provided with institutional psychological support.

Betacoronavirus , Coronavirus Infections/prevention & control , Decision Making , Operating Rooms/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Surgical Procedures, Operative/standards , Coronavirus Infections/epidemiology , Humans , Pneumonia, Viral/epidemiology , Surgical Procedures, Operative/statistics & numerical data , Triage/methods
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Article in English | MEDLINE | ID: covidwho-268764


BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.

Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Infection Control/standards , Pandemics , Pneumonia, Viral , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Algorithms , Anesthesia/standards , China , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Emergencies , Hospital Units/standards , Humans , Pandemics/prevention & control , Perioperative Care/standards , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Surgical Procedures, Operative/standards , Tomography, X-Ray Computed/standards , Triage/standards
Langenbecks Arch Surg ; 405(3): 359-364, 2020 May.
Article in English | MEDLINE | ID: covidwho-209715


BACKGROUND: The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has escalated rapidly to a global pandemic stretching healthcare systems worldwide to their limits. Surgeons have had to immediately react to this unprecedented clinical challenge by systematically repurposing surgical wards. PURPOSE: To provide a detailed set of guidelines developed in a surgical ward at University Hospital Wuerzburg to safely accommodate the exponentially rising cases of SARS-CoV-2 infected patients without compromising the care of emergency surgery and oncological patients or jeopardizing the well-being of hospital staff. CONCLUSIONS: The dynamic prioritization of SARS-CoV-2 infected and surgical patient groups is key to preserving life while maintaining high surgical standards. Strictly segregating patient groups in emergency rooms, non-intensive care wards and operating areas prevents viral spread while adequately training and carefully selecting hospital staff allow them to confidently and successfully undertake their respective clinical duties.

Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Infection Control/methods , Outcome Assessment, Health Care , Pneumonia, Viral/epidemiology , Practice Guidelines as Topic , Surgical Procedures, Operative/standards , Betacoronavirus , Coronavirus Infections/prevention & control , Female , Germany , Hospitals, University , Humans , Male , Pandemics/prevention & control , Pandemics/statistics & numerical data , Patient Care/standards , Patient Isolation , Pneumonia, Viral/prevention & control