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1.
Plast Reconstr Surg Glob Open ; 8(6): e2967, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1795025

ABSTRACT

BACKGROUND: Breast reconstruction has a well-documented positive impact on the psychosocial well-being of women recovering from breast cancer. Rates of breast cancer diagnoses are rising, and more women are seeking mastectomy as treatment and as prophylaxis. METHODS: Postmastectomy breast reconstruction often begins at the time of mastectomy in coordination with the oncologic breast surgeons. Immediate breast reconstruction increases complication rate (11% vs 4%) and unplanned reoperation rate (7% vs 4%), requiring more personnel and resources used during the preoperative, intraoperative, and postoperative phases of patient care. DISCUSSION: In the setting of global pandemics such as coronavirus disease 2019 (COVID-19), breast reconstruction demands a unique and nuanced approach, as most forms of breast reconstruction can occur successfully in a delayed fashion. While this may prolong the overall time until completion of reconstruction, other factors come into play in the setting of a communicable (potentially deadly) illness. Factors that must be considered include allocation of essential resources and protection of patients and families from disease transmission. CONCLUSIONS: Plastic surgeons performing breast reconstruction must take these factors into account when counseling their patients, colleagues, and institutions and be proactive in determining which procedures are time-critical and which should be postponed until the disaster situation has relieved.

2.
Clin Orthop Relat Res ; 479(1): 47-56, 2021 01 01.
Article in English | MEDLINE | ID: covidwho-1483562

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic has resulted in a rapid pivot toward telemedicine owing to closure of in-person elective clinics and sustained efforts at physical distancing worldwide. Throughout this period, there has been revived enthusiasm for delivering and receiving orthopaedic care remotely. Unfortunately, rapidly published editorials and commentaries during the pandemic have not adequately conveyed findings of published randomized trials on this topic. QUESTIONS/PURPOSES: In this systematic review and meta-analysis of randomized trials, we asked: (1) What are the levels of patient and surgeon satisfaction with the use of telemedicine as a tool for orthopaedic care delivery? (2) Are there differences in patient-reported outcomes between telemedicine visits and in-person visits? (3) What is the difference in time commitment between telemedicine and in-person visits? METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic review with the primary objective to determine patient and surgeon satisfaction with telemedicine, and secondary objectives to determine differences in patient-reported outcomes and time commitment. We used combinations of search keywords and medical subject headings around the terms "telemedicine", "telehealth", and "virtual care" combined with "orthopaedic", "orthopaedic surgery" and "randomized." We searched three medical databases (MEDLINE, Embase, and the Cochrane Library) in duplicate and performed manual searches to identify randomized controlled trials evaluating the outcomes of telemedicine and in-person orthopaedic assessments. Trials that studied an intervention that was considered to be telemedicine (that is, any form of remote or virtual care including, but not limited to, video, telephone, or internet-based care), had a control group that comprised in-person assessments performed by orthopaedic surgeons, and were reports of Level I original evidence were included in this study. Studies evaluating physiotherapy or rehabilitation interventions were excluded. Data was extracted by two reviewers and quantitative and qualitive summaries of results were generated. Methodological quality of included trials was assessed using the Cochrane Risk of Bias tool, which uniformly rated the trials at high risk of bias within the blinding categories (blinding of providers, patients, and outcome assessors). We screened 133 published articles; 12 articles (representing eight randomized controlled trials) met the inclusion criteria. There were 1008 patients randomized (511 to telemedicine groups and 497 to control groups). Subspecialties represented were hip and knee arthroplasty (two trials), upper extremity (two trials), pediatric trauma (one trial), adult trauma (one trial), and general orthopaedics (two trials). RESULTS: There was no difference in the odds of satisfaction between patients receiving telemedicine care and those receiving in-person care (pooled odds ratio 0.89 [95% CI 0.40 to 1.99]; p = 0.79). There were also no differences in surgeon satisfaction (pooled OR 0.38 [95% CI 0.07 to 2.19]; p = 0.28) or among multiple patient-reported outcome measures that evaluated pain and function. Patients reported time savings, both when travel time was excluded (17 minutes shorter [95% CI 2 to 32]; p = 0.03) and when it was included (180 minutes shorter [95% CI 78 to 281]; p < 0.001). CONCLUSION: Evidence from heterogeneous randomized studies demonstrates that the use of telemedicine for orthopaedic assessments does not result in identifiable differences in patient or surgeon satisfaction compared with in-person assessments. Importantly, the source studies in this review did not adequately capture or report safety endpoints, such as complications or missed diagnoses. Future studies must be adequately powered to detect these differences to ensure patient safety is not compromised with the use of telemedicine. Although telemedicine may lead to a similar patient experience, surgeons should maintain a low threshold for follow-up with in-person assessments whenever possible in the absence of further safety data. LEVEL OF EVIDENCE: Level I, therapeutic study.


Subject(s)
COVID-19 , Job Satisfaction , Orthopedic Procedures , Orthopedics , Patient Satisfaction , Telemedicine , Humans
3.
Surg Today ; 51(3): 447-451, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1453756

ABSTRACT

Accumulation of experience and advances in techniques and instruments have enabled surgeons to perform video-assisted thoracic surgery (VATS) safely for sublobar resection, including segmentectomy and wedge resection. A key to successful VATS sublobar resection is to have adequate resection margins and the appropriate use of articulated surgical staplers is essential for this purpose. The SigniaTM stapling system (Covidien Japan, Tokyo) has been used extensively in the fields of thoracic surgery. Its features include high maneuverability with fully powered articulation, rotation, clamping, and firing, which the surgeon can control with one hand. We introduce the "sliding technique" using the SigniaTM system, which allows for adjustment of the resection lines of the pulmonary parenchyma to optimize safe surgical margins with minimal stapler movement, and without repetitively moving the stapler in and out of the pleural cavity, during VATS sublobar resection.


Subject(s)
Lung Neoplasms/surgery , Lung/surgery , Margins of Excision , Pneumonectomy/instrumentation , Pneumonectomy/methods , Surgical Staplers , Surgical Stapling/instrumentation , Surgical Stapling/methods , Thoracic Surgery, Video-Assisted/instrumentation , Thoracic Surgery, Video-Assisted/methods , Humans , Safety
4.
Head Neck ; 42(7): 1392-1396, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1384168

ABSTRACT

The severe acute respiratory syndrome (SARS)-CoV-2 pandemic continues to produce a large number of patients with chronic respiratory failure and ventilator dependence. As such, surgeons will be called upon to perform tracheotomy for a subset of these chronically intubated patients. As seen during the SARS and the SARS-CoV-2 outbreaks, aerosol-generating procedures (AGP) have been associated with higher rates of infection of medical personnel and potential acceleration of viral dissemination throughout the medical center. Therefore, a thoughtful approach to tracheotomy (and other AGPs) is imperative and maintaining traditional management norms may be unsuitable or even potentially harmful. We sought to review the existing evidence informing best practices and then develop straightforward guidelines for tracheotomy during the SARS-CoV-2 pandemic. This communication is the product of those efforts and is based on national and international experience with the current SARS-CoV-2 pandemic and the SARS epidemic of 2002/2003.


Subject(s)
Clinical Decision-Making , Coronavirus Infections/epidemiology , Hospital Mortality/trends , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/therapy , Tracheotomy/methods , COVID-19 , Coronavirus Infections/prevention & control , Critical Care/methods , Elective Surgical Procedures/methods , Elective Surgical Procedures/statistics & numerical data , Emergencies , Female , Follow-Up Studies , Humans , Intensive Care Units/statistics & numerical data , Internationality , Intubation, Intratracheal , Male , Occupational Health , Pandemics/prevention & control , Patient Safety , Pneumonia, Viral/prevention & control , Respiration, Artificial/methods , Risk Assessment , SARS Virus/pathogenicity , Survival Rate , Time Factors , Treatment Outcome , United States/epidemiology , Ventilator Weaning/methods
5.
J Card Surg ; 36(9): 3354-3363, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1276727

ABSTRACT

Cardiac surgery was severely affected by the COVID-19 pandemic. Reallocation of resources, conversion of surgical intensive care units and wards to COVID-19 facilities, increased risk of nosocomial transmission to cardiac surgery patients, lead to reduced accessibility, quality, and affordability of health care facilities to cardiac surgery patients. Increasing the mortality and morbidity rate among such patients. Cardiac patients are at an increased risk to develop a severe illness if infected by COVID-19 and are associated with a high mortality rate. Therefore, measures had to be taken to reduce the spread of the virus. Various approaches such as the hubs and the spokes centers, or parallel system were enforced. Elective surgeries were postponed while urgent surgeries were prioritized. Use of personal protective equipments and surgeries performed by only senior surgeons became necessary. Surgical trainees were also affected as limited training opportunities deprived them of the experience required to complete their fellowship. Some of the trainees were reallocated to COVID-19 wards, while others invested their time in research opportunities. Online platforms were used for teaching, meetings, and workshops across the globe. Although some efforts have been made to reduce the impact of the pandemic, more research and innovation is required.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Humans , Pandemics , Personal Protective Equipment , SARS-CoV-2
6.
Global Spine J ; : 21925682211022311, 2021 Jun 14.
Article in English | MEDLINE | ID: covidwho-1268187

ABSTRACT

STUDY DESIGN: Cross-sectional, anonymous, international survey. OBJECTIVES: The COVID-19 pandemic has resulted in the rapid adoption of telemedicine in spine surgery. This study sought to determine the extent of adoption and global perspectives on telemedicine in spine surgery. METHODS: All members of AO Spine International were emailed an anonymous survey covering the participant's experiences with and perceptions of telemedicine. Descriptive statistics were used to depict responses. Responses were compared among regions. RESULTS: 485 spine surgeons participated in the survey. Telemedicine usage rose from <10.0% to >39.0% of all visits. A majority of providers (60.5%) performed at least one telemedicine visit. The format of "telemedicine" varied widely by region: European (50.0%) and African (45.2%) surgeons were more likely to use phone calls, whereas North (66.7%) and South American (77.0%) surgeons more commonly used video (P < 0.001). North American providers used telemedicine the most during COVID-19 (>60.0% of all visits). 81.9% of all providers "agreed/strongly agreed" telemedicine was easy to use. Respondents tended to "agree" that imaging review, the initial appointment, and postoperative care could be performed using telemedicine. Almost all (95.4%) surgeons preferred at least one in-person visit prior to the day of surgery. CONCLUSION: Our study noted significant geographical differences in the rate of telemedicine adoption and the platform of telemedicine utilized. The results suggest a significant increase in telemedicine utilization, particularly in North America. Spine surgeons found telemedicine feasible for imaging review, initial visits, and follow-up visits although the vast majority still preferred at least one in-person preoperative visit.

7.
Int J Environ Res Public Health ; 18(10)2021 May 17.
Article in English | MEDLINE | ID: covidwho-1234726

ABSTRACT

Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.


Subject(s)
COVID-19 , Orthopedic Procedures , Surgeons , Humans , Italy/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
8.
Obes Res Clin Pract ; 15(4): 395-401, 2021.
Article in English | MEDLINE | ID: covidwho-1201459

ABSTRACT

INTRODUCTION: There is a paucity of data in scientific literature on the impact of Coronavirus Disease 2019 (COVID-19) pandemic on bariatric surgery. The aim of this study was to evaluate the impact of COVID-19 pandemic on Bariatric Surgery globally. METHODS: We conducted a global online survey of bariatric surgeons between 16/04/20 - 15/05/20. The survey was endorsed by five national bariatric surgery societies and circulated amongst their memberships. Authors also shared the link through their personal networks, email groups, and social media. RESULTS: 703 respondents from 77 countries completed the survey. Respondents reported a drop in elective bariatric activity from a median (IQR) of 130 (60-250) procedures in 2019 to a median of 0 (0-2) between16/03/2020 and 15/04/2020 during the pandemic. The corresponding figures for emergency activity were 5 (2-10) and 0 (0-1) respectively. 441 (63%) respondents did not perform any bariatric procedures during this time period. Surgeons reported outcomes of 61 elective bariatric surgical procedures during the pandemic with 13 (21%) needing ventilation and 2 (3.3%) deaths. Of the 13 emergency bariatric procedures reported, 5 (38%) needed ventilation and 4 (31%) died. 90 (13%) surgeons reported having had to perform a bariatric surgical or endoscopic procedure without adequate Personal Protective Equipment. CONCLUSIONS: COVID-19 pandemic led to a remarkable decline in global elective and emergency bariatric surgery activity at its beginning. Both elective and emergency procedures performed at this stage of the pandemic had considerable morbidity and mortality.


Subject(s)
Bariatric Surgery , COVID-19 , Bariatric Surgery/trends , Humans , Pandemics/prevention & control , Surveys and Questionnaires
9.
Cureus ; 13(3): e14124, 2021 Mar 26.
Article in English | MEDLINE | ID: covidwho-1200340

ABSTRACT

Telesurgery, or remote surgery, is widely known as a master-slave technology. It has achieved a milestone in surgical technology and intervention, providing widespread prospects of operating on a patient in a remote area with increased accuracy and precision. It consists of one or more arms controlled by a surgeon and a master controller in a remote area accessing all the information being transferred via a telecommunication system. This paper reviews the present advancements and their benefits and limitations in the field of telesurgery. A handful of operations have been done so far. However, due to time-lag (latency), global networking problems, legal issues and skepticism, and on top of the cost of robotic systems and their affordability have led to the concept of telerobotics and surgery to lag. However, with more information and high speed, 5G networking, which has been in a trial to reduce latency to its minimum, is beneficial. Haptic feedback technology in telesurgery and robotics is another achievement that can be improved; further, this allows the robotic arms to mimic the natural hand movements of the surgeon in the control center so that the master controller can perform surgeries with more dexterity and acuity. Due to coronavirus (COVID-19), this type of surgery approach can reduce the probability of contracting the virus, saving more lives and the future.

10.
Eur Arch Otorhinolaryngol ; 278(10): 4091-4099, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1184666

ABSTRACT

PURPOSE: SARS-CoV-2 vaccines are a key step in fighting the pandemic. Nevertheless, their rapid development did not allow for testing among specific population subgroups such as pregnant and breastfeeding women, or elaborating specific guidelines for healthcare personnel working in high infection risk specialties, such as otolaryngology (ORL). This clinical consensus statement (CCS) aims to offer guidance for SARS-CoV-2 vaccination to this high-risk population based on the best evidence available. METHODS: A multidisciplinary international panel of 33 specialists judged statements through a two-round modified Delphi method survey. Statements were designed to encompass the following topics: risk of SARS-Cov-2 infection and use of protective equipment in ORL; SARS-Cov-2 infection and vaccines and respective risks for the mother/child dyad; and counseling for SARS-CoV-2 vaccination in pregnant, breastfeeding, or fertile healthcare workers (PBFHW). All ORL PBFHW were considered as the target audience. RESULTS: Of the 13 statements, 7 reached consensus or strong consensus, 2 reached no consensus, and 2 reached near-consensus. According to the statements with strong consensus otorhinolaryngologists-head and neck surgeons who are pregnant, breastfeeding, or with childbearing potential should have the opportunity to receive SARS-Cov-2 vaccination. Moreover, personal protective equipment (PPE) should still be used even after the vaccination. CONCLUSION: Until prospective evaluations on these topics are available, ORL-HNS must be considered a high infection risk specialty. While the use of PPE remains pivotal, ORL PBFHW should be allowed access to SARS-CoV-2 vaccination provided they receive up-to-date information.


Subject(s)
COVID-19 Vaccines , COVID-19 , Otolaryngologists , Surgeons , Breast Feeding , Consensus , Female , Humans , Male , Pregnancy , SARS-CoV-2 , Vaccination
11.
J Cardiothorac Surg ; 16(1): 73, 2021 Apr 09.
Article in English | MEDLINE | ID: covidwho-1175332

ABSTRACT

BACKGROUND: The ongoing coronavirus disease 2019 (Covid-19) pandemic presents challenges for surgeons of all disciplines, including cardiologists. The volume of cardiac surgery cases has to comply with the mandatory constraints of healthcare capacities. The treatment of Covid-19-positive patients must also be considered. Unfortunately, no scientific evidence is available on this issue. Therefore, this study aimed to offer some consensus-based considerations, derived from available scientific papers, regarding the organization and performance of cardiac surgery against the backdrop of the Covid-19 pandemic. METHODS: Key recommendations were extracted from recent literature concerning cardiac surgery. RESULTSː Reducing elective cardiac procedures should be based on frequent clinical assessment of patients on the waiting list (every one or two weeks) and the current local status of the Covid-19 pandemic. Screening tests at admission for every patient are broadly recommended. Where appropriate, alternative treatment methods can be considered, including percutaneous techniques and minimally invasive surgery, if performed by experienced cardiac surgery teams. CONCLUSIONS: There is little evidence on the strategies to organize cardiac surgery in the Covid-19 pandemic. Most authors agree on reducing elective operations based on patients' clinical condition and the status of the Covid-19 pandemic. Admission screenings and the use of percutaneous or minimally invasive approaches should be preferred to reduce in-hospital stays.


Subject(s)
COVID-19 , Cardiac Surgical Procedures , Decision Making , Evidence-Based Medicine , SARS-CoV-2 , Humans
12.
Ann Vasc Surg ; 76: 1-9, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1174100

ABSTRACT

INTRODUCTION: The novel coronavirus SARS-CoV-2 (COVID-19) has spread rapidly since it was identified. We sought to understand its effects on vascular surgery practices stratified by VASCON surgical readiness level and determine how these effects have changed during the course of the pandemic. METHODS: All members of the Vascular and Endovascular Surgery Society were sent electronic surveys questioning the effects of COVID-19 on their practices in the early pandemic in April (EP) and four months later in the pandemic in August (LP) 2020. RESULTS: Response rates were 206/731 (28%) in the EP group and 108/731 (15%) in the LP group (P < 0.0001). Most EP respondents reported VASCON levels less than 3 (168/206,82%), indicating increased hospital limitations while 6/108 (6%) in the LP group reported this level (P < 0.0001). The EP group was more likely to report a lower VASCON level (increased resource limitations), and decreased clinic, hospital and emergency room consults. Despite an increase of average cases/week to pre-COVID-19 levels, 46/108 (43%) of LP report continued decreased compensation, with 57% reporting more than 10% decrease. Respondents in the decreased compensation group were more likely to have reported a VASCON level 3 or lower earlier in the pandemic (P = 0.018). 91/108(84%) of LP group have treated COVID-19 patients for thromboembolic events, most commonly acute limb ischemia (76/108) and acute DVT (76/108). While the majority of respondents are no longer delaying the vascular surgery cases, 76/108 (70%) feel that vascular patient care has suffered due to earlier delays, and 36/108 (33%) report a backlog of cases caused by the pandemic. CONCLUSIONS: COVID-19 had a profound effect on vascular surgery practices earlier in the pandemic, resulting in continued detrimental effects on the provision of vascular care as well as compensation received by vascular surgeons.


Subject(s)
COVID-19 , Delivery of Health Care/trends , Practice Patterns, Physicians'/trends , Surgeons/trends , Vascular Surgical Procedures/trends , Adult , Delivery of Health Care/economics , Fee-for-Service Plans/trends , Female , Health Care Surveys , Humans , Income/trends , Male , Middle Aged , Practice Patterns, Physicians'/economics , Quality Indicators, Health Care/trends , Surgeons/economics , Time Factors , Vascular Surgical Procedures/adverse effects , Vascular Surgical Procedures/economics
13.
Cureus ; 13(3): e13769, 2021 Mar 08.
Article in English | MEDLINE | ID: covidwho-1168102

ABSTRACT

Some patients may need mechanical ventilation support during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease-2019, COVID-19) infection and may eventually require tracheostomy in the following days. Tracheostomy is considered as a high-risk procedure for surgeons and operative personnel in terms of air contamination. We present a case of percutaneous dilational tracheostomy performed in a patient with COVID-19 pneumonia and the methods we used to reduce contamination risks for the healthcare staff.

14.
J Multidiscip Healthc ; 14: 665-672, 2021.
Article in English | MEDLINE | ID: covidwho-1154153

ABSTRACT

BACKGROUND: The COVID-19 pandemic is not only affecting public health, but it is also impairing the specialized surgical care services in the hospitals. The present study aimed to assess the barriers faced by the surgeons while performing surgical procedures during the COVID-19 pandemic. METHODS: A cross-sectional, web-based survey was conducted from September 10 to October 14, 2020. The study population consisted of surgeons practicing in Kpk, Pakistan. Descriptive statistics and binary logistic regression analysis were used to analyze the data. RESULTS: A total of 292, out of 543, surgeons participated in the study (response rate: 59.6%). The younger surgeons (25-30 years) considered the lack of policies and practices regarding exposure to COVID-19 patients as a significant barrier to their practice. The surgeons practicing in private hospitals considered themselves at a higher risk while providing surgical care to the COVID-19 patients. The non-cooperation of the patients was the main barrier in delivering surgical care services. CONCLUSION AND RECOMMENDATION: The current study highlighted the barriers to the surgeons while providing surgical care to patients in the current pandemic. The most pronounced barriers to the surgeons were the lack of policies regarding exposure to COVID-19 and practice and non-cooperation of the patient. To address these barriers, it is recommended that health regulatory agencies of Pakistan should implement strict infection control practices to ensure the safety of surgeons and allied healthcare staff during the COVID-19 pandemic.

15.
Orthop J Sports Med ; 9(3): 2325967121990929, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1117417

ABSTRACT

BACKGROUND: The COVID-19 pandemic has changed the practice of orthopaedic sports medicine. The threat of COVID-19 persists, and future restrictions to elective procedures are possible. It is important to understand how sports surgeons are prioritizing surgical cases during elective case restrictions and how telehealth is being incorporated into practice. PURPOSE: To understand how orthopaedic sports surgeons have triaged surgical sports cases and how telehealth is being utilized in response to COVID-19. STUDY DESIGN: Cross-sectional study. METHODS: A survey was presented to participants of the American Orthopaedic Society for Sports Medicine (AOSSM) webinar "Handling Sports and COVID-19" and distributed through email to all members of the AOSSM. The survey consisted of 25 questions with 3 sections: demographics, clinical practice, and telehealth. Descriptive statistics were performed. RESULTS: Overall, 104 respondents participated. Respondents varied with respect to their location, type of clinical practice, and years in practice. The cases with the highest priority during triage included infections, fractures, and traumatic tendon ruptures (eg, quadriceps tendon). Before COVID-19, <14.0% of surgeons used telehealth, and 76.7% had never used telehealth. Now, however, 81.4% of respondents plan to use telehealth at least once a week in their practice. Respondents indicated postoperative visits and return patients as the most appropriate for telehealth. The majority felt that telehealth was not appropriate for new shoulder (65.9%) or knee (55.6%) evaluation. The leading barriers to telehealth use that were identified included, in decreasing order, concerns about clinical appropriateness, accuracy of physical examination, billing/reimbursement, and medicolegal concerns. CONCLUSION: Telehealth has seen rapid adoption during the COVID-19 pandemic, and the majority of respondents plan to continue using it. It is being used more for established patients rather than new patient visits. For surgical cases, there was a clear triage priority of sports medicine cases, including infections, fractures, and traumatic tendon ruptures. Lower extremity cases had higher priority than upper extremity.

16.
Clin Ophthalmol ; 15: 307-313, 2021.
Article in English | MEDLINE | ID: covidwho-1110159

ABSTRACT

BACKGROUND: Concerns had been raised for the potential hazard of SARS-CoV-2 transmissions via aerosols and fluid droplets during cataract surgeries amid the COVID-19 pandemic. This study aims to evaluate the rate of visible aerosol generation and fluid spillage from surgical wounds during phacoemulsification in human subjects. METHODS: This is a prospective consecutive interventional case series. High-resolution video captures of 30 consecutive uncomplicated phacoemulsification surgeries, performed by 3 board-certified specialists in ophthalmology, were assessed by 2 independent and masked investigators for intraoperative aerosolization and fluid spillage. Water-contact indicator tape was mounted on the base of the operating microscope, around the objective lens, to detect any fluid contact. RESULTS: No visible intraoperative aerosolization was detected in any of the cases, irrespective of different surgical practices among the surgeons with regard to wound size and position, lens fragmentation technique, power settings and means of ocular lubrication, or the different densities of cataract encountered. Large droplets spillage was noted from the paracentesis wounds in 70% of the cases. For all cases where fluid spill was detected on video, there was no fluid contact detected on the water-contact indicator tape. CONCLUSION: Visible aerosolization was not detected during phacoemulsification in our case series. Although the rate of fluid spillage was high, the lack of detectable contact with the indicator tape suggested that these large droplets posed no significant infectious risks to members of the surgical team.

17.
Indian J Ophthalmol ; 69(3): 706-708, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1089030

ABSTRACT

PURPOSE: The aim of this study was to analyze the impact of COVID-19 lockdown on keratoplasty and Eye Banking in India. METHODS: An e-mail survey was conducted among cornea surgeons and eye bankers of India. Participants were asked to report their practice patterns for the management of corneal perforation during lockdown, different preservative media used during and before lockdown, and waiting time and waiting time before COVID-19 lockdown. RESULTS: Eight of 20 eye banks did not collect corneal tissue during April-June 2020; in contrast, 9 eye banks used to collect around 100 corneas per month during pre-COVID-19 time. Two-third of the surgeons (66.1%, n = 41/62) did not perform any corneal tissue transplant between April and June 2020. Cyanoacrylate tissue adhesive application was the most commonly, performed procedure (79%, n = 49/62) for tectonic purpose during this period. Glycerol was the most preferred alternative preservation method considered by both the groups. More than half of the surgeons (64.5%, n = 40/62) had an average waiting time of <1 week for scheduling patients for keratoplasty in pre-COVID-19 period. CONCLUSION: There is was a significant drop in both corneal tissue retrieval and utilization during during COVID-19 lockdown. There was a felt need for an alternate long term storage media.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/methods , Corneal Diseases/surgery , Corneal Transplantation/methods , Eye Banks/statistics & numerical data , Quarantine , Tissue Donors/statistics & numerical data , Comorbidity , Corneal Diseases/epidemiology , Female , Humans , India/epidemiology , Male , Pandemics , SARS-CoV-2 , Surgeons/statistics & numerical data , Surveys and Questionnaires
18.
Ann Med Surg (Lond) ; 62: 261-264, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1064792

ABSTRACT

BACKGROUND: SARS-Cov-2 infects not only adults, but also children, including pediatric surgery patients with acute abdomen. Here, we report a pediatric surgery case with incarcerated inguinal hernia and suspected COVID-19. CASE PRESENTATION: A 11-month-old male was brought to our emergency department with the main complaint of recurrent yellowish-green vomiting that was experienced from one day before admission. High fever and shortness of breath were also reported. This patient was also suffering from moderate dehydration. Neither history of contact with a confirmed case of COVID-19 nor traveling from any local transmission area were found. However, a SARS-CoV-2 rapid antibody test revealed a positive result. A lump in the left scrotum that persisted during admission was found. Fluid resuscitation and nasogastric tube placement for decompression was performed. Manual reduction was attempted but failed to reduce the lump. Accordingly, we decided to perform an emergency high ligation using tertiary protection regulations, i.e., full personal protective equipment (PPE) for COVID-19. Intraoperatively, we found a small intestine loop trapped in the scrotum and stuck in the inguinal canal. Postoperatively, the baby was continued to be managed as a patient with COVID-19 while waiting for the real-time reverse transcription polymerase chain reaction (RT-PCR) results. DISCUSSION: Manual reduction is standard treatment for incarcerated inguinal hernia in children. The successful rate of manual reduction is about 70%, therefore, if the manual reduction fails, an emergency surgery is mandatory.During the COVID-19 pandemic, all medical procedures require clarity of the patient's status including whether infected with COVID-19. Along with proper precautions, great care must be taken during surgery to minimize the risk of cross infection to health workers. CONCLUSIONS: During the COVID-19 pandemic, surgeons should always be aware of the possibility of cross-transmission from the patient, since children are also susceptible to SARS-CoV-2 infection. When and wherever possible, surgeons should perform the procedure in the quickest and most effective manner to shorten exposure time with patient and anesthetic aerosols as well as using appropriate PPE.

19.
J Telemed Telecare ; : 1357633X21990997, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1060004

ABSTRACT

INTRODUCTION: The emergence of COVID-19 and its ensuing restrictions on in-person healthcare has resulted in a sudden shift towards the utilization of telemedicine. The purpose of this study is to assess patient satisfaction and patient-reported outcome measures (PROMs) for individuals who underwent follow-up for shoulder surgery using telemedicine compared to those who received traditional in-person clinic follow-up. METHODS: Patients who underwent either rotator cuff repair or total shoulder arthroplasty during a designated pre-COVID-19 (traditional clinic follow-up) or peri-COVID-19 (telemedicine follow-up) span of time were identified. PROMs including the American Shoulder and Elbow Surgeons standardized assessment form, the three-level version of the EQ-5D form, the 12-Item Short Form survey, and a modified version of a published telemedicine survey were administered to participants six months post-operatively via phone call. RESULTS: Sixty patients agreed to participate. There was no significant difference between the pre-COVID-19 and peri-COVID-19 groups in patient satisfaction with their follow-up visit (p = 0.289), nor was there a significant difference in PROMs between the two groups. In total, 83.33% of the telemedicine group and 70.37% of the in-person clinic group preferred traditional in-person follow-up over telemedicine. DISCUSSION: In a cohort of patients who underwent telemedicine follow-up for shoulder surgery during the COVID-19 pandemic, there was no difference in patient satisfaction and PROMs compared to traditional in-person clinic follow-up. This study indicates that while the majority of participants preferred face-to-face visits, patients were relatively satisfied with their care and had similar functional outcome scores in both groups, despite the large disruption in healthcare logistics caused by COVID-19.

20.
J Laryngol Otol ; : 1-4, 2020 Nov 23.
Article in English | MEDLINE | ID: covidwho-1023793

ABSTRACT

OBJECTIVE: This study sought to assess the impact of simulation training in influencing trainees' initial surgical participation as perceived by experienced surgeon trainers. METHODS: Twenty ENT surgeons assessed how much of a given procedure they would expect to allow a trainee to perform for their first time. Responses were provided for trainees who had undergone a relevant simulation course and those who had not, and scored according to the eLogbook levels of involvement in surgery. This was completed for simulated procedures with validated models, across four grades of junior doctors. RESULTS: A total of 1120 judgements on the trainees' intended level of involvement were made. The median involvement score was higher in the simulation group versus the non-simulation group (Mann-Whitney U, p = 0.0001), corresponding to a translation in surgical opportunity from a primarily assisting role to an active role. CONCLUSION: Trainer perception of a relevant ENT simulation course appears to positively impact on the initial surgical opportunities afforded to the trainee.

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