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1.
Mayo Clin Proc ; 95(6): 1213-1221, 2020 06.
Article in English | MEDLINE | ID: covidwho-1450185

ABSTRACT

As the coronavirus disease 19 (COVID-19) global pandemic rages across the globe, the race to prevent and treat this deadly disease has led to the "off-label" repurposing of drugs such as hydroxychloroquine and lopinavir/ritonavir, which have the potential for unwanted QT-interval prolongation and a risk of drug-induced sudden cardiac death. With the possibility that a considerable proportion of the world's population soon could receive COVID-19 pharmacotherapies with torsadogenic potential for therapy or postexposure prophylaxis, this document serves to help health care professionals mitigate the risk of drug-induced ventricular arrhythmias while minimizing risk of COVID-19 exposure to personnel and conserving the limited supply of personal protective equipment.


Subject(s)
Death, Sudden, Cardiac , Hydroxychloroquine , Long QT Syndrome , Lopinavir , Risk Adjustment/methods , Ritonavir , Torsades de Pointes , Anti-Infective Agents/administration & dosage , Anti-Infective Agents/adverse effects , Betacoronavirus/drug effects , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/drug therapy , Coronavirus Infections/epidemiology , Death, Sudden, Cardiac/etiology , Death, Sudden, Cardiac/prevention & control , Drug Combinations , Drug Monitoring/methods , Drug Repositioning/ethics , Drug Repositioning/methods , Electrocardiography/methods , Humans , Hydroxychloroquine/administration & dosage , Hydroxychloroquine/adverse effects , Long QT Syndrome/chemically induced , Long QT Syndrome/mortality , Long QT Syndrome/therapy , Lopinavir/administration & dosage , Lopinavir/adverse effects , Pandemics , Pneumonia, Viral/drug therapy , Pneumonia, Viral/epidemiology , Ritonavir/administration & dosage , Ritonavir/adverse effects , SARS-CoV-2 , Torsades de Pointes/chemically induced , Torsades de Pointes/mortality , Torsades de Pointes/therapy
2.
Clin Orthop Relat Res ; 479(8): 1691-1699, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1132600

ABSTRACT

BACKGROUND: Many patients with coronavirus disease 2019 (COVID-19) are asymptomatic. The prevalence of COVID-19 in orthopaedic populations will vary depending on the time and place where the sampling is performed. The idea that asymptomatic carriers play a role is generalizable but has not been studied in large populations of patients undergoing elective orthopaedic surgery. We therefore evaluated this topic in one large, metropolitan city in a state that had the ninth-most infections in the United States at the time this study was completed (June 2020). This work was based on a screening and testing protocol that required all patients to be tested for COVID-19 preoperatively. QUESTIONS/PURPOSES: (1) What is the prevalence of asymptomatic COVID-19 infection in patients planning to undergo orthopaedic surgery in one major city, in order to provide other surgeons with a framework for assessing COVID-19 rates in their healthcare system? (2) How did patients with positive test results for COVID-19 differ in terms of age, sex, and orthopaedic conditions? (3) What proportion of patients had complications treated, and how many patients had a symptomatic COVID-19 infection within 30 days of surgery (recognizing that some may have been missed and so our estimates of event rates will necessarily underestimate the frequency of this event)? METHODS: All adult patients scheduled for surgery at four facilities (two tertiary care hospitals, one orthopaedic specialty hospital, and one ambulatory surgery center) at a single institution in the Philadelphia metropolitan area from April 27, 2020 to June 12, 2020 were included in this study. A total of 1295 patients were screened for symptoms, exposure, temperature, and oxygen saturation via a standardized protocol before surgical scheduling; 1.5% (19 of 1295) were excluded because they had COVID-19 symptoms, exposure, or recent travel based on the initial screening questionnaire, leaving 98.5% (1276 of 1295) who underwent testing for COVID-19 preoperatively. All 1276 patients who passed the initial screening test underwent nasopharyngeal swabbing for COVID-19 via reverse transcription polymerase chain reaction before surgery. The mean age at the time of testing was 56 ± 16 years, and 53% (672 of 1276) were men. Eighty-seven percent (1106), 8% (103), and 5% (67) were tested via the Roche, Abbott, and Cepheid assays, respectively. All patients undergoing elective surgery were tested via the Roche assay, while those undergoing nonelective surgery received either the Abbott or Cepheid assay, based on availability. Patients with positive test results undergoing elective surgery had their procedures rescheduled, while patients scheduled for nonelective surgery underwent surgery regardless of their test results. Additionally, we reviewed the records of all patients at 30 days postoperatively for emergency room visits, readmissions, and COVID-19-related complications via electronic medical records and surgeon-reported complications. However, we had no method for definitively determining how many patients had complications, emergency department visits, or readmissions outside our system, so our event rate estimates for these endpoints are necessarily best-case estimates. RESULTS: A total of 0.5% (7 of 1276) of the patients tested positive for COVID-19: five via the Roche assay and two via the Abbott assay. Patients with positive test results were younger than those with negative results (39 ± 12 years versus 56 ± 16 years; p = 0.01). With the numbers available, we found no difference in the proportion of patients with positive test results for COVID-19 based on subspecialty area (examining the lowest and highest point estimates, respectively, we observed: trauma surgery [3%; 2 of 68 patients] versus hip and knee [0.3%; 1 of 401 patients], OR 12 [95% CI 1-135]; p = 0.06). No patients with negative preoperative test results for COVID-19 developed a symptomatic COVID-19 infection within 30 days postoperatively. Within 30 days of surgery, 0.9% (11 of 1276) of the patients presented to the emergency room, and 1.3% (16 of 1276) were readmitted for non-COVID-19-related complications. None of the patients with positive test results for COVID-19 preoperatively experienced complications. However, because some were likely treated outside our healthcare system, the actual percentages may be higher. CONCLUSION: Because younger patients are more likely to be asymptomatic carriers of disease, surgeons should emphasize the importance of taking proper precautions to prevent virus exposure preoperatively. Because the rates of COVID-19 infection differ based on city and time, surgeons should monitor the local prevalence of disease to properly advise patients on the risk of COVID-19 exposure. Further investigation is required to assess the prevalence in the orthopaedic population in cities with larger COVID-19 burdens. LEVEL OF EVIDENCE: Level III, therapeutic study.


Subject(s)
Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Mass Screening/statistics & numerical data , Orthopedic Procedures/statistics & numerical data , Preoperative Care/statistics & numerical data , Adult , COVID-19/virology , COVID-19 Testing/statistics & numerical data , Female , Humans , Longitudinal Studies , Male , Middle Aged , Philadelphia/epidemiology , Prevalence , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
3.
J Am Acad Orthop Surg ; 28(24): 1003-1008, 2020 Dec 15.
Article in English | MEDLINE | ID: covidwho-961787

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a ubiquitous health concern and a global pandemic. In an effort to slow the disease spread and protect valuable healthcare resources, cessation of nonessential surgery, including many orthopaedic procedures, has become commonplace. This crisis has created a unique situation in the care of spine patients as we must balance the urgency of patient evaluation, surgical intervention, and continued training against the risk of disease exposure and resource management. The spine division of an orthopaedic surgery department has taken an active role in enacting protocol changes in anticipation of COVID-19. In the initial 4 weeks of the COVID-19 pandemic the spine division went from an average of 60.4 cases to 10 cases during the same timeframe. Clinic visits decreased from 417.4 to 322 with new patient visits decreasing from 28% to 20%. Three hundred eighteen of the 322 (98.7%) clinic visits were performed via telehealth. Although these changes have been forced upon us by necessity, we feel that our division and department will emerge in a more responsive, agile, and stronger state. As we look to the coming months and beyond, it will be important to continue to adapt to the changing landscape during unprecedented times.


Subject(s)
COVID-19/prevention & control , Occupational Exposure/prevention & control , Orthopedics/organization & administration , Patient Selection , Spinal Diseases/surgery , Academic Medical Centers/organization & administration , Elective Surgical Procedures , Humans , Occupational Health , Operating Rooms , Orthopedic Procedures , Orthopedics/education , Personnel Staffing and Scheduling , Professional Staff Committees , SARS-CoV-2 , Spinal Diseases/classification , Telemedicine , Triage
4.
Cancer ; 126(19): 4414-4422, 2020 10 01.
Article in English | MEDLINE | ID: covidwho-664278

ABSTRACT

BACKGROUND: Because of the global spread of coronavirus disease 2019 (COVID-19), oncology departments across the world have rapidly adapted their cancer care protocols to balance the risk of delaying cancer treatments and the risk of COVID-19 exposure. COVID-19 and associated changes may have an impact on the psychosocial functioning of patients with cancer and survivors. This study was designed to determine the impact of the COVID-19 pandemic on young people living with and beyond cancer. METHODS: In this cross-sectional study, 177 individuals, aged 18 to 39 years, were surveyed about the impact of COVID-19 on their cancer care and psychological well-being. Participants also reported their information needs with respect to COVID-19. Responses were summarized with a content analysis approach. RESULTS: This was the first study to examine the psychological functioning of young patients and survivors during the first weeks of the COVID-19 pandemic. A third of the respondents reported increased levels of psychological distress, and as many as 60% reported feeling more anxious than they did before COVID-19. More than half also wanted more information tailored to them as young patients with cancer. CONCLUSIONS: The COVID-19 pandemic is rapidly evolving and changing the landscape of cancer care. Young people living with cancer are a unique population and might be more vulnerable during this time in comparison with their healthy peers. There is a need to screen for psychological distress and attend to young people whose cancer care has been delayed. As the lockdown begins to ease, the guidelines about cancer care should be updated according to this population's needs.


Subject(s)
COVID-19 , Cancer Survivors/psychology , Neoplasms/psychology , Neoplasms/therapy , Access to Information/psychology , Adolescent , Adult , Anxiety/psychology , COVID-19/psychology , Cross-Sectional Studies , Female , Humans , Internet , Male , Patient Satisfaction , Stress, Psychological , United Kingdom , Young Adult
5.
Muscle Nerve ; 62(1): 46-49, 2020 07.
Article in English | MEDLINE | ID: covidwho-116283

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic has resulted in reorganization of healthcare settings affecting the delivery of clinical care to patients with spinal muscular atrophy (SMA). There is a concern that patients with SMA may be at increased risk of manifesting severe symptoms of COVID-19. Currently approved therapies for SMA improve survival and motor function; however, their delivery requires an increased exposure to the health system and a dedicated healthcare team. In this study, we discuss consensus recommendations pertaining to care of SMA patients during the pandemic. We highlight that SMA treatments should not be perceived as elective. Decisions regarding the delay of treatments should be made with consideration of the potential risks of COVID-19 exposure and the risk of that delay. We emphasize the importance of collaborative treatment decisions between the patient, family, and healthcare provider, considering any geographic- or institution-specific policies and precautions for COVID-19.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/complications , Delivery of Health Care/methods , Disease Management , Muscular Atrophy, Spinal/therapy , Pandemics , Pneumonia, Viral/complications , COVID-19 , Coronavirus Infections/epidemiology , Humans , Muscular Atrophy, Spinal/complications , Pneumonia, Viral/epidemiology , SARS-CoV-2
6.
Biomed Pharmacother ; 127: 110176, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-108841

ABSTRACT

Epidemic prevention and control measures for the new coronavirus disease 2019 (COVID-19) has achieved significant results. As of 8 April 2020, 22,073 infection cases of COVID-19 among healthcare workers from 52 countries had been reported to WHO. COVID-19 has strong infectivity, high transmission speeds, and causes serious infection among healthcare worker. Burns are an acute-care condition, and burn treatment needs to be initiated before COVID-19 infection status can be excluded. The key step to infection prevention is to identify risk points of infection exposure, strengthen the protection against those risk points, and formulate an appropriate diagnosis and treatment protocol. Following an in-depth study of the latest literature on COVID-19 diagnosis and treatment, we reviewed the protocols surrounding hospitalization of patients with extensive burns (area≥50 %) in our hospital from February 2009 to February 2019 and, in accordance with the epidemiological characteristics of COVID-19, developed an algorithm for protection during diagnosis and treatment of burns. Therefore, the aspects of medical protection and the diagnosis and treatment of burns appear to be particularly important during the prevention and control of the COVID-19. This algorithm was followed for 4 patients who received emergency treatment in February 2020 and were hospitalized. All healthcare worker were protected according to the three-tiered protective measures, and there was no nosocomial infection. During the COVID-19 epidemic, the early stages of emergency treatment for patients with extensive burns requiring the establishment of venous access for rehydration, endotracheal intubation or tracheostomy, wound treatment, and surgery are the risk points for exposure to infection. The implementation of effective, appropriate-grade protection and formulation of practical treatment protocols can increase protection of healthcare worke and reduce the risk of COVID-19 infection exposure.


Subject(s)
Betacoronavirus/isolation & purification , Burns , Coronavirus Infections , Epidemics , Infection Control , Occupational Exposure/prevention & control , Pandemics , Pneumonia, Viral , Burns/diagnosis , Burns/epidemiology , Burns/therapy , COVID-19 , Clinical Decision Rules , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Humans , Infection Control/methods , Infection Control/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Risk Assessment , SARS-CoV-2 , Trauma Severity Indices
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