Implementation of Novel Protocols in an Ophthalmic Ambulatory Surgical Center to Resume Surgical Procedures During COVID-19.

BACKGROUND AND OBJECTIVES: With the resumption of elective ophthalmic surgery during COVID-19, revised protocols were mandated to protect both staff and patients from transmission while increasing case numbers. We discuss a widely generalizable and in-depth protocol intended to safely allow the restart of elective procedures in 2 dedicated ophthalmic ambulatory surgical centers (ASCs) using monitored anesthesia care. METHODS: A single-center review of protocols and practices designed to limit COVID-19 transmission. RESULTS: All patients were tested within 72 hours prior to the procedure with a COVID-19 nasal swab to assess for active disease. A distance of 6 ft between each stretcher and the staff within the ASC was maintained when possible. Preoperative anesthetizing and dilating eye drops were administered from multiuse bottles without contact with surfaces. Surgical cases were restarted at a reduced capacity of a maximum of 7 per day to distance patient arrivals. Removal of waiting room chairs and the creation of new break areas allowed for social distancing. CONCLUSION: As recommendations change on the basis of an increased understanding of the COVID-19 virus, ophthalmologists and ASC staff need to tailor protocols and workflows to limit transmission of virus with resumption of ocular surgery.

Development and preliminary evaluation of a telephone-based mindfulness training intervention for survivors of critical illness.

RATIONALE: Persistent symptoms of psychological distress represent an unmet need among intensive care unit (ICU) survivors. OBJECTIVES: We aimed to develop and pilot test a simple telephone-based mindfulness training intervention to address this population's unique needs. METHODS: Open trial involving survivors of medical and surgical critical illness and their informal caregivers, using a pretest-posttest design. MEASUREMENTS AND MAIN RESULTS: We developed a six-session, telephone-delivered, ICU survivor-specific mindfulness intervention based on past focus groups, the medical literature, and the precedent of the most effective components of existing mindfulness programs. A total of 11 survivors of mechanical ventilation were enrolled, together with 2 informal caregivers for exploratory purposes. Three patients dropped out before intervention initiation because of progressive illness or severe social stressors. Of the 10 remaining participants, 8 (80%) completed the program within 7 weeks. Among these eight patients and caregivers who completed all study procedures, six (75%) experienced improvement in symptoms of psychological distress (anxiety, depression, or post-traumatic stress disorder). Changes in distress symptoms were correlated with improvement in mindfulness qualities, adaptive coping, and emotion regulation. Participants reported high satisfaction with the program in postintervention interviews. CONCLUSIONS: A new ICU survivor-specific mindfulness training intervention delivered by telephone was acceptable and feasible. Changes in symptoms of distress were correlated with changes in skills that were targeted by the mindfulness program. Controlled trials are needed to further evaluate this promising intervention.

Pelvic lymphocysts occurring after Wertheim's operation: a review of 11 years' experience

In an analysis of 100 cases of radical hysterectomy with extraperitoneal lymphadenectomy performed for carcinoma of the cervix, postoperative pelvic lymphocysts were detected in 11 patients (11 per cent). Eight of these (73 per cent) were asymptomatic. Although potentially serious complications are known to occur with lymphocysts. Only minor ones were encountered. This paper outlines the clinical features and management in this group of patients. A system of management dependent on the size and symptoms of the cyst is proposed