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Roman RC, Faur CI, Gordan E, Văleanu M, Moldovan MA. Impact of the COVID-19 Pandemic on the Surgical Management of Head and Neck Non-Melanoma Skin Cancers in a Maxillofacial Center of Cluj-Napoca. J Clin Med 2024; 13:3934. [PMID: 38999499 PMCID: PMC11242733 DOI: 10.3390/jcm13133934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 06/14/2024] [Accepted: 07/03/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The COVID-19 era has been a bleak period for both cancer and non-cancer patients, with delayed non-emergency treatments, such as for non-melanoma skin cancer (NMSC). This study aimed to evaluate how the treatment of NMSC patients was influenced by the management of the COVID-19 pandemic in an Eastern European Maxillofacial Surgery center. Materials and Methods: A total of 176 patients with a histopathological diagnosis of head and neck NMSC who were surgically treated in Cluj-Napoca Emergency County Hospital between 2016 and 2022 were included in this study, and divided into two samples, pre-pandemic (2016-2019) and COVID-19 (2020-2022) periods. Results: The pandemic presented with a decrease of 46.15% in patients' hospitalization, with wealthy and educated patients being prevalent. Even if the waiting time for surgery was increased, the stage of cancer and preference method for reconstruction did not differ. Despite the lower addressability of NMSC patients during the pandemic, there were no changes in surgical treatment. Conclusions: During COVID-19, the number of patients was reduced, with a longer waiting time for surgery, but without any changes in tumor stage and treatment preferences. However, the benefit of removing a cancer tumor is higher compared to the risk of developing COVID-19 infection during hospitalization.
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Affiliation(s)
- Rareș Călin Roman
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Cosmin Ioan Faur
- Department of Oral Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Edina Gordan
- Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Mădălina Văleanu
- Department of Statistics, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Mădălina Anca Moldovan
- Department of Oral and Maxillofacial Surgery and Implantology, Iuliu Hatieganu University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
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Al Balushi Y, Burad J. Comparison Between Early and Late Tracheostomy in ICU Patients Including COVID-19 and Non-COVID-19 Patients: A Retrospective Cohort Study at a Tertiary Care Hospital. Cureus 2024; 16:e64481. [PMID: 39139353 PMCID: PMC11319799 DOI: 10.7759/cureus.64481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2024] [Indexed: 08/15/2024] Open
Abstract
Background Tracheostomy is a common intervention for intensive care unit (ICU) patients for various reasons. The superiority of early versus late tracheostomy is still unfounded for non-COVID-19 cases. The COVID-19 pandemic complicated the matter, as little literature was available on the ideal timing of tracheostomy for patients with COVID-19. Research question This study aimed to establish the superiority of early or late tracheostomy for COVID-19 and non-COVID-19 cases by comparing outcomes, including ICU mortality, ventilation days after tracheostomy, and ICU length of stay (LOS). Study design and methods A single-center retrospective cohort study was conducted on ventilated ICU patients both with and without COVID-19 at a university hospital between January 2020 and December 2021. During the study period, 1,393 ventilated patients were scanned, and 156 were found to be tracheostomized. Tracheostomy was considered to be early when performed within 10 days of intubation, after which it was considered to be late. Results Tracheostomy was performed early for 84/156 (53.8%) of tracheostomized patients and late for 72/156 (46.2%) of patients. The overall mortality was 42.9% (36/84) versus 69.4% (50/72) (P=0.001, OR=3.03, 95% CI=1.563-5.874), 31.4% versus 65.5% in the non-COVID-19 group and 60.6% versus 72.1% (P=0.005, OR=2.640, 95% CI=1.345-5.181) in the COVID-19 group for the early and late tracheostomy groups, respectively. Ventilation days were higher for the late tracheostomy group than for the early tracheostomy group in the non-COVID-19 group (17.10 versus 9.18 days, P<0.001). However, it was almost the same for the early and late tracheostomy groups in the COVID-19 group (14.15 versus 13.86 days, P=0.821). The ICU LOS was greater for the late tracheostomy group for both the COVID-19 and non-COVID-19 groups. Multivariate analysis revealed that ICU mortality is significantly associated with age, ventilation days, and ICU LOS. Interpretation The results of this study indicate that early tracheostomy was associated with lower mortality, fewer ventilation days, and shorter LOS in both the COVID-19 and non-COVID-19 groups.
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Affiliation(s)
- Yasir Al Balushi
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
| | - Jyoti Burad
- Anesthesia and Intensive Care, Sultan Qaboos University Hospital, Muscat, OMN
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Fancello V, Migliorelli A, Campomagnani I, Morolli F, Stomeo F, Ricci-Maccarini A, Magnani M, Stacchini M. Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO 2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience. J Clin Med 2024; 13:3670. [PMID: 38999236 PMCID: PMC11242032 DOI: 10.3390/jcm13133670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.
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Affiliation(s)
- Virginia Fancello
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Isotta Campomagnani
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | | | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
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Lein A, Brkic F, Liu DT, Haas M, Salkic A, Ibrisevic A, Uscuplic S, Harcinovic A, Thurner T, Brkic FF. Changes in management of head and neck malignancies during the COVID-19 pandemic. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2024; 44:169-175. [PMID: 38712519 PMCID: PMC11166219 DOI: 10.14639/0392-100x-n2779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 12/04/2023] [Indexed: 05/08/2024]
Abstract
Objective Despite multiple studies from high-income countries, reports from low- and middle-income countries on the impact of COVID-19 on head and neck cancer care remain sparse. This study aimed to assess the effects of the COVID-19 pandemic on head and neck cancer patients at a tertiary reference centre in Bosnia and Herzegovina. Methods We included 228 patients with malignant head and neck tumours evaluated and treated between January 1, 2019, and December 31, 2021. Patient demographics, histological characteristics, and treatment modalities were retrospectively obtained and compared between the pre-pandemic period (pre-COVID-19 group) and the period after the implementation of COVID-19 restrictive measures (COVID-19 group). Results Patients were significantly older during the COVID-19 pandemic. In particular, 63 patients (44.7%) were under 65 and 78 (55.3%) were 65 or older, while in the pre-COVID-19 period, 53 patients (60.9%) were under 65 and 34 (39.1%) were 65 or older (p = 0.017). The pre-COVID-19 and COVID-19 groups did not significantly differ regarding other patient- and tumour characteristics, or primary treatment modalities. Conclusions During the COVID-19 pandemic, significantly fewer patients were under 65 at the time of initial work-up, potentially reflecting the more enhanced disease-related anxiety of the younger population. Future studies are warranted to address this population's specific educational and psychological needs to ensure appropriate cancer care.
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Affiliation(s)
- Alexander Lein
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Fuad Brkic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - David T. Liu
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Markus Haas
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Almir Salkic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Azra Ibrisevic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sabrina Uscuplic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Alen Harcinovic
- Department of Otorhinolaryngology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Thomas Thurner
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
| | - Faris F. Brkic
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria
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Colin E, Paasche A, Destrez A, Devauchelle B, Bettoni J, Bouquet J, Dakpé S, Testelin S. Impact of the COVID-19 Pandemic on Head and Neck Cancer Management: The Experience of the Maxillo-Facial Surgery Department of a French Regional Referral Center in a High-Incidence Area. J Clin Med 2024; 13:2439. [PMID: 38673711 PMCID: PMC11050808 DOI: 10.3390/jcm13082439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/15/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Cancer patients are at a high risk of complications in cases of infection, and head and neck cancers (HNC) are no exception. Since late 2019, SARS-CoV-2 has caused a global health crisis, with high rates and severe forms of the disease in cancer patients. Hospitalization, surgery and radiotherapy were rapidly described as increasing the risk of infection. Since March 2020, the Amiens University Hospital (France) has been taking care of COVID-19 patients while its maxillofacial surgery department managed HNC patients without interruption, even during lockdown periods. However, many questions concerning the impact on patient care were still pending. The aim of this study is to describe HNC management in our center during the first epidemic peak and to evaluate the impact of containment measures on patient treatment. Methods: We retrospectively included 44 HNC patients treated in our department between 1 March and 31 August 2020. Two groups were defined according to the period of care: lockdown (March to May) and lighter restrictions (June to August). Results: The results show typical epidemiological characteristics, maintained management times and non-downgraded procedures. Conclusions: Thus, during the first epidemic peak, continuity of care and patients' safety could be ensured thanks to adequate means, adapted procedures and an experienced surgical team.
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Affiliation(s)
- Emilien Colin
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Agnès Paasche
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Alban Destrez
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Bernard Devauchelle
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Jérémie Bettoni
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Julien Bouquet
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Stéphanie Dakpé
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
| | - Sylvie Testelin
- Maxillofacial Surgery Department, Amiens University Hospital, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France; (A.P.); (A.D.); (B.D.); (J.B.); (J.B.); (S.D.); (S.T.)
- UR 7516 CHIMERE, University of Picardie Jules Verne, Chemin du Thil, CS 52501, 80025 Amiens, France
- Institut Faire Faces, Rond-Point du Pr Christian Cabrol, 80054 Amiens, France
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Nishiike S, Michiba T, Ito R, Ashida N, Kato H, Kuki A, Ogawa K, Tamura K, Uetsuka S. Quantitative measurement of airborne particles during endoscopic and microscopic ear surgery in the operating room. J Laryngol Otol 2024; 138:405-409. [PMID: 37646247 DOI: 10.1017/s0022215123001433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVE This study aimed to quantitatively investigate airborne particle load in the operating room during endoscopic or microscopic epitympanectomy or mastoidectomy. METHOD In the transcanal endoscopic ear surgery group, drilling was performed underwater. A particle counter was used to measure the particle load before, during and after drilling during transcanal endoscopic ear surgery or microscopic ear surgery. The device counted the numbers of airborne particles of 0.3, 0.5 or 1.0 μm in diameter. RESULTS The particle load during drilling was significantly higher in the microscopic ear surgery group (n = 5) than in the transcanal endoscopic ear surgery group (n = 11) for all particle sizes (p < 0.01). In the transcanal endoscopic ear surgery group, no significant differences among the particle load observed before, during and after drilling were seen for any of the particle sizes. CONCLUSION Bone dissection carries a lower risk of airborne infection if it is performed using the endoscopic underwater drilling technique.
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Affiliation(s)
- S Nishiike
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - T Michiba
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - R Ito
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - N Ashida
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - H Kato
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - A Kuki
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Ogawa
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - K Tamura
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - S Uetsuka
- Department of Otorhinolaryngology - Head and Neck Surgery, Osaka Rosai Hospital, Osaka, Japan
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Lee JJ, Rooney AS, Krzyzaniak A, Badiee J, Parra KT, Calvo RY, Lichter J, Sise CB, Sise MJ, Bansal V, Martin MJ. Lessons for the next pandemic: analysis of the timing and outcomes including post-discharge decannulation rates for tracheostomy in severe COVID-19 respiratory failure. Eur J Trauma Emerg Surg 2024; 50:581-590. [PMID: 38349397 DOI: 10.1007/s00068-024-02444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 12/31/2023] [Indexed: 04/23/2024]
Abstract
PURPOSE COVID-19 patients with respiratory failure frequently require prolonged ventilatory support that would typically warrant early tracheostomy. There has been significant debate on timing, outcomes, and safety of these procedures. The purpose of this study was to determine the epidemiological, hospital, and post-discharge outcomes of this cohort, based on early (ET) versus late (LT) tracheostomy. METHODS Retrospective review (March 2020-January 2021) in a 5-hospital system of ventilated patients who underwent tracheostomy. Demographics, hospital/ICU length of stay (LOS), procedural characteristics, APACHE II scores at ICU admission, stabilization markers, and discharge outcomes were analyzed. Long-term decannulation rates were obtained from long-term acute care facility (LTAC) data. RESULTS A total of 97 patients underwent tracheostomy (mean 61 years, 62% male, 64% Hispanic). Despite ET being frequently performed during active COVID infection (85% vs. 64%), there were no differences in complication types or rates versus LT. APACHE II scores at ICU admission were comparable for both groups; however, > 50% of LT patients met PEEP stability at tracheostomy. ET was associated with significantly shorter ICU and hospital LOS, ventilator days, and higher decannulation rates. Of the cohort discharged to an LTAC, 59% were ultimately decannulated, 36% were discharged home, and 41% were discharged to a skilled nursing facility. CONCLUSIONS We report the first comprehensive analysis of ET and LT that includes LTAC outcomes and stabilization markers in relation to the tracheostomy. ET was associated with improved clinical outcomes and a short LOS, specifically on days of pre-tracheostomy ventilation and in-hospital decannulation rates.
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Affiliation(s)
- Joseph J Lee
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Alexandra S Rooney
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Andrea Krzyzaniak
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA.
| | - Jayraan Badiee
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Kristine T Parra
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Richard Y Calvo
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Julian Lichter
- Department of Pulmonary Medicine, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, San Diego, CA, 92103, USA
| | - C Beth Sise
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Michael J Sise
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Vishal Bansal
- Department of Trauma & Acute Care Surgery, Scripps Mercy Hospital San Diego, 4077 Fifth Ave, MER-62, San Diego, CA, 92103, USA
| | - Matthew J Martin
- Department of Trauma & Acute Care Surgery, LA+USC Medical Center, University of Southern California, 2051 Marengo St, Los Angeles, CA, 90033, USA
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8
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Frank MH, van Dijk BAC, Schoonbeek RC, Zindler J, Devriese LA, van Es RJJ, Merkx MAW, de Bree R. Differences in the association of time to treatment initiation and survival according to various head and neck cancer sites in a nationwide cohort. Radiother Oncol 2024; 192:110107. [PMID: 38262531 DOI: 10.1016/j.radonc.2024.110107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES To assess whether there are differences in the effects of time to treatment interval (TTI) on patient survival for head and neck cancer (HNC) sites in order to provide evidence that can support decision-making regarding prioritizing treatment. MATERIALS AND METHODS Patients in the Netherlands with a first primary HNC without distant metastasis between 2010 and 2014 were included for analysis (N = 10,486). TTI was defined as the time from pathologic diagnosis to the start of initial treatment. Overall survival (OS), cox regression analyses and cubic spline hazard models were calculated and visualized. RESULTS Overall, the hazard of dying was higher (HR = 1.003; 95 % CI 1.001-1.005) with each additional day until treatment initiation. The pattern, as visualized in cubic spline graphs, differed by site the hazard increased more steeply with increasing TTI for oral cavity cancer. For oropharyngeal and laryngeal cancer, a slight increase commenced after a longer TTI than for oral cavity cancer, while there was hardly an increase in hazard with increasing TTI for hypopharyngeal cancer. CONCLUSION The relationship between longer TTI and decreased survival was confirmed, but slight variations in the pattern of the hazard of dying by TTI by tumour site were observed. These findings could support decisions on prioritizing treatment. However, other aspects such as extent of treatment and quality of life should be investigated further so this can also be included.
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Affiliation(s)
- Michaël H Frank
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands; Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Department of Oral and Maxillofacial Surgery, Haaglanden Medical Center, The Hague, the Netherlands.
| | - Boukje A C van Dijk
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Epidemiology, Groningen, the Netherlands
| | - Rosanne C Schoonbeek
- University of Groningen, Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Jaap Zindler
- Department of Radiation Oncology, Haaglanden Medical Center, The Hague, the Netherlands
| | - Lot A Devriese
- University of Utrecht, Department of Medical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robert J J van Es
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Matthias A W Merkx
- Netherlands Comprehensive Cancer Organisation (IKNL), Department of Research and Development, Utrecht, the Netherlands; Radboud University Nijmegen, IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Remco de Bree
- University of Utrecht, Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, the Netherlands
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Zweerink ML, Sang HI, Durrani AK, Zreik K. Optimal Timing of Tracheostomy in the Setting of COVID-19 and Associated Pneumothorax. Cureus 2024; 16:e55479. [PMID: 38444928 PMCID: PMC10913698 DOI: 10.7759/cureus.55479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction At the beginning of the 2020 pandemic, no criteria were in place regarding the timing of tracheostomy placement in intubated COVID-19 patients, nor were there any data pertaining to pneumothorax incidence in this population. This study examines the timing of tracheostomy placement and its correlation with patient outcomes, along with pneumothorax incidence in COVID-19 patients who underwent a tracheostomy. Methods We performed a multi-institutional retrospective study of intubated COVID-19 patients admitted to intensive care units (ICUs) in North and South Dakota between April 2020 and December 2020. The timing of the tracheostomy was assessed, with primary outcomes being mortality, successful ventilator weaning, discharge to a long-term care facility, and overall length of stay. Patients were grouped by age, gender, ethnicity, and comorbidities. Pre- and post-tracheostomy pneumothorax was extracted from this dataset. Results We identified 85 patients who were intubated with COVID-19 and underwent a tracheostomy. The timing of tracheostomy varied widely, ranging from five to 53 days with an average time to tracheostomy being 17.3 days. Thirty-four of the patients expired, 32 patients were discharged to a long-term care hospital (LTCH), and 11 patients were discharged to an inpatient rehabilitation facility. Only three patients were discharged home. Regression analysis did not reveal statistically significant differences between patients who survived (N = 51) and patients who expired (N = 34) for almost all variables analyzed. Sixteen of the 85 patients were diagnosed with pneumothorax during their hospital stay. Half of these patients were diagnosed after a tracheostomy was placed. Conclusion This study did not demonstrate statistically significant differences in overall mortality or incidence of pneumothorax when it pertains to the timing of placement of tracheostomy. Variation in mortality was identified, in which younger patients were more likely to survive than older patients, a finding that was echoed in other studies. Considering this evidence, we cannot conclude that an association between the timing of tracheostomy and mortality from COVID-19; therefore, tracheostomy in the setting of COVID-19 can be performed at the provider's discretion.
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Affiliation(s)
- Matthew L Zweerink
- General Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
| | - Hilla I Sang
- Research Design and Biostatistics Core, Sanford Health, Fargo, USA
| | - Adam K Durrani
- School of Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Khaled Zreik
- Surgical Critical Care, Sanford Medical Center, Fargo, USA
- Surgical Critical Care, University of North Dakota School of Medicine and Health Sciences, Grand Forks, USA
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10
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Kraus F, Wech T, Köstler H, Hagen R, Scherzad A. Do Disinfectant Solutions during Gargling Reach the Pharynx? Folia Phoniatr Logop 2023; 76:102-108. [PMID: 37544306 DOI: 10.1159/000533135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
INTRODUCTION In times of COVID-19, gargling disinfectant is commonly used. Disinfectant solutions seem to decrease the infection's symptoms. For disinfection, several techniques are reported. So far, there are no data about the regions in the upper airways achieved by gargled fluid. METHODS Ten healthy volunteers without any dysphagia were investigated with a high-sensitivity flexible endoscopic evaluation of swallowing (hsFEES®) during and after gargling colored water. One volunteer repeated the gargling process in fast and real-time MRI. RESULTS In all cases, no color accumulation was detected on the posterior pharyngeal wall, epi- or hypopharynx during gargling. The MRI scans confirmed the results. CONCLUSIONS hsFEES® and fast MRI provide an insight into the gargling pattern. Data show that during gargling, the fluid covers the soft tissue in the oral cavity and the anterior part of the soft palate, but not the posterior pharyngeal wall nor the epi- and hypopharynx.
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Affiliation(s)
- Fabian Kraus
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Tobias Wech
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Herbert Köstler
- Department of Diagnostic and Interventional Radiology, University of Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Agmal Scherzad
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery, University of Würzburg, Würzburg, Germany
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11
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Meziane S, Taous M, Bourkhiss B. Mitigating the risk of COVID-19 infection in the operating room: Using healthcare failure mode and effect analysis. PERIOPERATIVE CARE AND OPERATING ROOM MANAGEMENT 2023; 31:100319. [PMID: 37131868 PMCID: PMC10140677 DOI: 10.1016/j.pcorm.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/19/2023] [Accepted: 04/26/2023] [Indexed: 05/04/2023]
Abstract
Context The process of caring for patients requiring surgery exposes them to a high risk of COVID-19 infection during the pre-operative, operative, and post-operative phases, as these procedures are known to be modes of transmission for the virus. Objective We conducted this study to prevent the risk of COVID-19 infection by identifying potential failure modes during the patient care process, determining critical activities, and defining mitigation measures to reduce transmission. Materials and methods Through a quality and a priori risk management method, which is Healthcare Failure Mode and Effect Analysis (HFMEA), applied in the patient care process in the Central Operating Room of Mohammed VI University Hospital in Morocco. Results We identified 38 potential failure modes in the patient care process during the three phases (preoperative, operative, and postoperative) that could increase the risk of COVID-19 infection. Of these, 61% are classified as critical, and we have identified all their possible causes. To reduce the risk of transmission, we have proposed 16 mitigation actions. Conclusion The use of HFMEA has been effective in the new pandemic context, improving patient safety during the care process in the operating room and reducing the risk of COVID-19 infection.
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Affiliation(s)
- Sara Meziane
- Department of Biology, Faculty of Science, IBN TOFAIL University. B.P: 133 Kenitra, 14000, Morocco
| | - Mohammed Taous
- The ophthalmology department, CHU Mohammed VI Oujda, Morocco
| | - Brahim Bourkhiss
- Department of Biology, Faculty of Science, University IBN TOFAIL, Kenitra, Morocco
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12
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Tolvi M, Oksanen LM, Lehtonen L, Geneid A, Männikkö P, Ruokonen H, Majander A, Arminen S, Aaltonen LM. Virtual visits at the Helsinki Head and Neck Center during the COVID-19 pandemic: patient safety incidents and the experiences of patients and staff. BMC Health Serv Res 2023; 23:483. [PMID: 37173703 PMCID: PMC10181879 DOI: 10.1186/s12913-023-09521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/09/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, health care had to find new ways to care for patients while reducing infection transmission. The role of telemedicine role has grown exponentially. METHODS A questionnaire on experiences and satisfaction was sent to the staff of the Head and Neck Center of Helsinki University Hospital and to otorhinolaryngology patients treated remotely between March and June 2020. Additionally, patient safety incident reports were examined for incidents involving virtual visits. RESULTS Staff (response rate 30.6%, (n = 116)) opinions seemed to be quite polarized. In general, staff felt virtual visits were useful for select groups of patients and certain situations, and beneficial in addition to face-to-face visits, not instead of them. Patients (response rate 11.7%, (n = 77)) gave positive feedback on virtual visits, with savings in time (average 89 min), distance travelled (average 31.4 km) and travel expenses (average 13.84€). CONCLUSIONS While telemedicine was implemented during the COVID-19 pandemic to ensure patient treatment, its usefulness after the pandemic must be examined. Evaluation of treatment pathways is critical to ensure that quality of care is upheld while new treatment protocols are introduced. Telemedicine offers the opportunity to save environmental, temporal, and monetary resources. Nonetheless, the appropriate use of telemedicine is essential, and clinicians must be offered the option to examine and treat patients face-to-face.
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Affiliation(s)
- Morag Tolvi
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Kasarmikatu 11-13Helsinki, FIN, Finland.
- Quality of Care and Patient Safety Department, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland.
| | - Lotta-Maria Oksanen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Kasarmikatu 11-13Helsinki, FIN, Finland
- Department of Phoniatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lasse Lehtonen
- Diagnostic Center, HUSLAB, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ahmed Geneid
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Kasarmikatu 11-13Helsinki, FIN, Finland
- Department of Phoniatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Pia Männikkö
- Customer Service Department, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Hellevi Ruokonen
- Department of Oral and Maxillofacial Diseases, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Majander
- Department of Ophthalmology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Susan Arminen
- Quality of Care and Patient Safety Department, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, Helsinki University Hospital and University of Helsinki, P.O. Box 263, 00029 HUS, Kasarmikatu 11-13Helsinki, FIN, Finland
- Quality of Care and Patient Safety Department, Head and Neck Center, Helsinki University Hospital, Helsinki, Finland
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Maeba T, Watanabe H, Wakuta N. SARS-CoV-2 Testing of the Maxillary Sinus Immediately after COVID-19 Recovery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4959. [PMID: 37113308 PMCID: PMC10132303 DOI: 10.1097/gox.0000000000004959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/06/2023] [Indexed: 04/29/2023]
Abstract
We report the case of a 19-year-old woman with left orbital floor fracture after a motorcycle accident. She presented with headache and diplopia; computed tomography showed herniation of the inferior rectus muscle into the maxillary sinus with orbital floor fracture. She was admitted for observation of her concussion and tested positive for coronavirus disease 2019 (COVID-19) half a day after admission. Her COVID-19 symptoms were mild; the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) antigen quantification test was below the standard value on the 10th day of hospitalization, and her isolation was lifted. She had diplopia with vertical eye motion disorder and underwent reconstruction of her orbital floor fracture on the 11th day. Although the orbital floor was connected to the maxillary sinus due to the orbital floor fracture, the presence and the viral load of SARS-CoV-2 in the maxillary sinus were unknown. The surgeons performed the operation while wearing N95 masks. A SARS-CoV-2 antigen quantification test and PCR test were performed on a sample from the maxillary sinus mucosa obtained through the orbital floor fracture before reconstruction of orbital floor with a titanium mesh implant; both were negative. To our knowledge, this is the first report of SARS-CoV-2 testing from the maxillary sinus immediately after COVID-19 recovery. We believe that the risk of SARS-CoV-2 infection from the maxillary sinus is small if the antigen test from the nasopharynx is negative.
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Affiliation(s)
- Takahiro Maeba
- From the Department of Plastic Surgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Haruka Watanabe
- Department of Infectious Disease, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
| | - Naoki Wakuta
- Department of Neurosurgery, Japanese Red Cross Fukuoka Hospital, Fukuoka, Japan
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14
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Yamazaki H, Yamamoto N, Sonoyama T, Maruoka H, Nasu S, Makino A, Tomonaga K, Shigemoto N, Ohge H, Fujiwara K, Shinohara S, Takeno S, Omori K, Naito Y. A multicenter study to investigate the positive rate of SARS-CoV-2 in middle ear and mastoid specimens from otologic surgery patients. Auris Nasus Larynx 2023; 50:285-291. [PMID: 35945108 PMCID: PMC9334977 DOI: 10.1016/j.anl.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/21/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab. METHODS We conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery. RESULTS The median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutions CONCLUSIONS: Our results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.
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Affiliation(s)
- Hiroshi Yamazaki
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan; Hearing Research Division, Center for Clinical Research and Innovation, Kobe City Medical Center General Hospital, Kobe, Japan; Foundation for Biomedical Research and Innovation at Kobe, Kobe, Japan.
| | - Norio Yamamoto
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toru Sonoyama
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hayato Maruoka
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Seiko Nasu
- Department of Clinical Laboratory, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Akiko Makino
- Laboratory of RNA Viruses, Department of Virus Research, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Keizo Tomonaga
- Laboratory of RNA Viruses, Department of Virus Research, Institute for Life and Medical Sciences, Kyoto University, Kyoto, Japan
| | - Norifumi Shigemoto
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Hiroshima, Japan
| | - Keizo Fujiwara
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shogo Shinohara
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Sachio Takeno
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasushi Naito
- Department of Otolaryngology, Kobe City Medical Center General Hospital, Kobe, Japan
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15
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Levy DA, Boey HP, Leff PD. Modified Negative Pressure Enclosure During Tracheostomy in Patients With COVID-19. EAR, NOSE & THROAT JOURNAL 2023; 102:NP84-NP88. [PMID: 33530740 DOI: 10.1177/0145561321991319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
COVID-19 also known as severe acute respiratory syndrome coronavirus 2 is the result of a highly transmissible coronavirus which can result in severe infection of the respiratory tract. The global pandemic which began in early 2020 has created a number of challenges for the medical community to contain the rate of transmission, especially to health care workers. A minority of the infected population will progress toward severe respiratory distress ultimately requiring mechanical ventilator assistance. Although preliminary data suggest a poor prognosis for those requiring ventilation support, there is a subgroup who will eventually be weaned off. As the pandemic evolves, this cohort of infected, chronically intubated and ventilated individuals will become more prevalent and may require tracheostomy to aid in recovery. Unfortunately, tracheostomy is an aerosol-generating procedure which poses high risks to all members within the operating room, as described by previous authors. There is an urgent need to explore and develop methods to maximize the safety of tracheostomy and other aerosol-generating procedures in order to reduce intraoperative transmission. In the present article, we present a modified technique for negative pressure enclosure in patients with COVID-19 who underwent tracheostomy.
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Affiliation(s)
- Dylan A Levy
- 5783Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA
| | - Howard P Boey
- 5783Frank H. Netter MD School of Medicine at Quinnipiac University, North Haven, CT, USA.,23891Midstate Medical Center, Hartford HealthCare, Meriden, CT, USA.,Middlesex Hospital, Middletown, CT, USA.,Southern New England Ear, Nose Throat and Facial Plastic Group LLP, New Haven, CT, USA
| | - Peter D Leff
- 23891Midstate Medical Center, Hartford HealthCare, Meriden, CT, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
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16
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Peng Z, Yang S, Wang C, Bian X, Zhang X. Community pandemic prevention and control measures and their influence on citizen satisfaction during the COVID-19 pandemic in China. INTERNATIONAL JOURNAL OF DISASTER RISK REDUCTION : IJDRR 2023; 85:103494. [PMID: 36567742 PMCID: PMC9767881 DOI: 10.1016/j.ijdrr.2022.103494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 12/11/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
At the forefront of the fight against the pandemic, the community' s measures and services would have a greater impact than ever before on citizen satisfaction. However, the influence of citizen satisfaction on community pandemic prevention and control measures (CPPCM) during the pandemic is poorly understood. This study aims to investigate the allocation of CPPCM and its impact on CS. The Chinese national data was analyzed for the outcome. (1) Pandemic prevention propaganda (PPP), disinfection (DT), and body temperature tests (BTTs) were the primary measures taken by the Chinese community. (2) The CS for pandemic prevention and control is high, and urban and central Chinese communities express greater satisfaction. (3) The impact of disinfection, body temperature tests, free supplies, and assistance purchasing supplies on CS was greater in rural areas than in urban areas. (4) Regional variations exist in the impact of CS on CPPCM. (5) The number of measures has an inverted U-shaped relationship with citizen satisfaction. This study also suggests that the government should disseminate information about pandemic prevention in a timely manner, provide basic health and medical services, and evaluate the measures taken to avoid the discount effect.
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Affiliation(s)
- Zhengbo Peng
- School of Public Administration and Communication, Guilin University of Technology, Guilin, 541004, China
| | - Su Yang
- School of Public Administration and Communication, Guilin University of Technology, Guilin, 541004, China
| | - Cong Wang
- School of Economics and Management, Fuzhou University, Fuzhou, 350108, China
| | - Xiaojie Bian
- School of Marxism, Guilin University of Technology, Guilin, 541004, China
| | - Xiaojun Zhang
- School of Economics and Management, Fuzhou University, Fuzhou, 350108, China
- School of Government, Nanjing University, Nanjing, 210023, China
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17
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Alvarenga GFD, Nogueira Leite AK, Lehn CN, Dedivitis RA, Yumi Nakai M, Cavalheiro BG, Vaz Teixeira G, De Cicco R, Kowalski LP, Matos LLD. Impact of the COVID-19 Pandemic on Brazilian Head and Neck Surgery Centers. Braz J Otorhinolaryngol 2023; 89:456-461. [PMID: 36803803 PMCID: PMC9884113 DOI: 10.1016/j.bjorl.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/13/2022] [Accepted: 01/19/2023] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE The outbreak of the COVID-19 pandemic had a considerable impact on the healthcare access, treatment, and follow-up of oncologic patients. The aim of this study was to evaluate how the COVID-19 pandemic has affected consultation and follow-up demand as well as treatment volume at Brazilian Head and Neck Surgery centers. METHODS An anonymous online questionnaire was used for collection of data across all Brazilian Head and Neck Surgery Centers across a 3-month period (April‒June 2021). This information included the characteristics of each center, and the perceived self-reported impact of the COVID-19 pandemic on academic activities, residency training, and the diagnosis, treatment, and follow-up of patients with Head and Neck diseases between 2019 and 2020. RESULTS The response rate across the 40 registered Brazilian Head and Neck Surgery Centers was 47.5% (n=19). The data showed a significant reduction in the total number of consultations (24.8%) and number of attending patients (20.2%) between 2019 and 2020. The total number of diagnostic exams (31.6%) and surgical procedures (13.0%) conducted over this period also decreased significantly. CONCLUSIONS The COVID-19 pandemic had a significant national impact on Brazilian Head and Neck Surgery Centers. Future studies should examine the long-term effects of the pandemic on cancer treatment. LEVEL OF EVIDENCE Evidence from a single descriptive study.
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Affiliation(s)
| | - Ana Kober Nogueira Leite
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Carlos Neutzling Lehn
- Hospital do Servidor Público Estadual, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | | | - Marianne Yumi Nakai
- Irmandade da Santa Casa de Misericórdia de São Paulo, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Beatriz Godoi Cavalheiro
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil,Instituto Brasileiro de Controle do Câncer, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Gilberto Vaz Teixeira
- Centro de Pesquisas Oncológicas, Departamento de Cirurgia de Cabeça e Pescoço, Florianópolis, RS, Brazil,Universidade Federal de Santa Catarina, Faculdade de Medicina, Departamento de Cirurgia, Florianópolis, RS, Brazil
| | - Rafael De Cicco
- Instituto do Câncer Doutor Arnaldo Vieira de Carvalho, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Luiz Paulo Kowalski
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil
| | - Leandro Luongo de Matos
- Universidade de São Paulo, Faculdade de Medicina, Instituto do Câncer do Estado de São Paulo (ICESP), Departamento de Cirurgia de Cabeça e Pescoço, São Paulo, SP, Brazil,Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, SP, Brazil
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18
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Jankovic D, Krenzlin H, Keric N, Ottenhausen M. The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery - A single center analysis. Front Surg 2023; 9:1086960. [PMID: 36733680 PMCID: PMC9886891 DOI: 10.3389/fsurg.2022.1086960] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/06/2022] [Indexed: 01/19/2023] Open
Abstract
Objective Over the past two years during the pandemic, the German health system has taken drastic measures, like the continuous use of face masks for all staff, restrictions of hospital visits as well as cancellation of elective surgical procedures. As a potential side effect of these measures, a significant reduction of surgical site infections was reported for neurosurgical patients. The purpose of our study was to analyze the impact of these measures on spinal surgery. Methods We performed a retrospective analysis to compare patient samples, procedures and infection rates before (January 2019 - March 2020) and during (April 2020 - June 2021) the pandemic to evaluate the impact of the measures mentioned above. Demographic and clinical data were collected and correlated with the occurrence of postoperative complications, especially infection. Results Our analysis showed no relevant decrease of spine surgeries (838 surgeries in non-pandemic group vs. 831 surgeries pandemic group). The most common postoperative complication was wound infection in both groups, followed by urinary tract infection and pneumonia. In both patient groups, infections were more prevalent in surgeries of multilevel posterior instrumentation. Comparing the two groups of patients, a slight, non-significant (0.5%) reduction of overall postoperative complications in the pandemic group was observed. However, the number of spinal surgeries classified as emergencies in our institution increased by 10.2% during the last 15 months of the COVID-19 pandemic. In line with this finding the urgent transfer of patients from smaller hospitals increased by 14.2%, compared to previous years. Conclusion The volume of spinal surgeries remained high and complication rates stable during the pandemic. A reason why complication rates did not drop as reported previously might be a significant change in patient sample due to the increase of emergency surgeries. A decrease of complication rates, especially infections by the measures of infection prevention for the pandemic was not observed.
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Shreckengost CSH, Wan L, Reitz AW, Lin A, Dhamsania RK, Spychalski J, Douglas JM, Lane A, Amin D, Roser S, Berkowitz D, Foianini JE, Moore R, Sreedharan JK, Niroula A, Smith R, Khullar OV. Tracheostomies of Patients With COVID-19: A Survey of Infection Reported by Health Care Professionals. Am J Crit Care 2023; 32:9-20. [PMID: 36065019 DOI: 10.4037/ajcc2022337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Health care professionals (HCPs) performing tracheostomies in patients with COVID-19 may be at increased risk of infection. OBJECTIVE To evaluate factors underlying HCPs' COVID-19 infection and determine whether tracheostomy providers report increased rates of infection. METHODS An anonymous international survey examining factors associated with COVID-19 infection was made available November 2020 through July 2021 to HCPs at a convenience sample of hospitals, universities, and professional organizations. Infections reported were compared between HCPs involved in tracheostomy on patients with COVID-19 and HCPs who were not involved. RESULTS Of the 361 respondents (from 33 countries), 50% (n = 179) had performed tracheostomies on patients with COVID-19. Performing tracheostomies on patients with COVID-19 was not associated with increased infection in either univariable (P = .06) or multivariable analysis (odds ratio, 1.48; 95% CI, 0.90-2.46; P = .13). Working in a low- or middle-income country (LMIC) was associated with increased infection in both univariable (P < .001) and multivariable analysis (odds ratio, 2.88; CI, 1.50-5.53; P = .001). CONCLUSIONS Performing tracheostomy was not associated with COVID-19 infection, suggesting that tracheostomies can be safely performed in infected patients with appropriate precautions. However, HCPs in LMICs may face increased infection risk.
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Affiliation(s)
| | - Limeng Wan
- Limeng Wan is a student, Rollins School of Public Health, Emory University
| | - Alexandra W Reitz
- Alexandra W. Reitz is a resident physician, Department of Surgery, Emory University
| | - Alice Lin
- Alice Lin is a student, Rollins School of Public Health, Emory University
| | - Rohan K Dhamsania
- Rohan K. Dhamsania is a student, Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Julia Spychalski
- Julia Spychalski is a student, Rollins School of Public Health, Emory University
| | - J Miller Douglas
- J. Miller Douglas is a student, Department of Surgery and Rollins School of Public Health, Emory University
| | - Andrea Lane
- Andrea Lane is a student, Rollins School of Public Health, Emory University
| | - Dina Amin
- Dina Amin is an assistant professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - Steven Roser
- Steven Roser is a professor, Department of Surgery, Emory University and a surgeon, Oral and Maxillofacial Surgery, Grady Memorial Hospital, Atlanta, Georgia
| | - David Berkowitz
- David Berkowitz is a physician and professor, Department of Medicine, School of Medicine, Emory University
| | | | - Renée Moore
- Renée Moore is a professor, Rollins School of Public Health, Emory University
| | - Jithin K Sreedharan
- Jithin K. Sreedharan is general secretary, Indian Association of Respiratory Care, Kochi, India
| | - Abesh Niroula
- Abesh Niroula is a physician, Department of Medicine, School of Medicine, Emory University
| | - Randi Smith
- Randi Smith is a surgeon, Department of Surgery, Emory University, a professor, Rollins School of Public Health, Emory University, and a surgeon, Trauma and Surgical Critical Care, Grady Memorial Hospital
| | - Onkar V Khullar
- Onkar V. Khullar is a surgeon, Department of Surgery, Emory University
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20
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Alexandru M, Favier V, Coste A, Carsuzaa F, Fieux M, Fath L, Bartier S. Deterioration experienced by French otolaryngology residents in their training during the COVID-19 pandemic: A STROBE analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:13-18. [PMID: 35803874 PMCID: PMC9061179 DOI: 10.1016/j.anorl.2022.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the impact of the first three waves of COVID-19 on the academic and surgical training of ENT and Head and Neck Surgery residents in France. MATERIAL AND METHODS Observational, retrospective study. A 55-item survey of academic education and surgical training was sent to ENT residents in five major French regions (Île-de-France, Rhône-Alpes Auvergne, Occitanie, Grand Est, Grand Ouest) from August to October 2021. RESULTS Eighty-nine out of 135 residents (66%) responded. Two-thirds considered that surgical training was more affected than academic education, with reductions evaluated of 50-75%, 25-50% and 0-25% for the first three waves, respectively. Residents in Île-de-France, Rhône-Alpes Auvergne and Grand Est were the most affected by the first wave (75-100% reduction in surgical activity, in parallel to increased admissions). Otology, rhinology and functional exploration were the most affected, whereas pediatrics and oncology were spared. Seventy-one of the 89 residents (79.7%) felt that the first wave impacted their career, while this proportion decreased to 39.3% and 44.9% for the second and third waves, respectively. CONCLUSION The first wave of COVID-19, compared to the following two waves, severely impacted the surgical training of French ENT residents, especially in regions severely impacted by the pandemic, while academic education was relatively safeguarded by the implementation of e-learning alternatives.
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Affiliation(s)
- M. Alexandru
- Service d’ORL et chirurgie cervico-faciale, université Paris-Saclay, hôpital Bicêtre, AP–HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France,Corresponding author
| | - V. Favier
- Département d’ORL et chirurgie cervico-faciale, CHU de Montpellier, hôpital Gui-de-Chauliac, 34295 Montpellier, France
| | - A. Coste
- Service d’ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France,Service d’ORL et de chirurgie cervico-faciale, CHU d’Henri-Mondor, 8, rue Gustave-Eiffel, 94000 Créteil, France,Inserm, IMRB, université Paris Est Créteil, 94010 Créteil, France,CNRS ERL 7000, 94010 Créteil, France
| | - F. Carsuzaa
- Service d’ORL et chirurgie cervico-faciale, CHU de Poitiers, 86000 Poitiers, France
| | - M. Fieux
- Inserm, IMRB, université Paris Est Créteil, 94010 Créteil, France,CNRS ERL 7000, 94010 Créteil, France,Service d’ORL, d’otoneurochirurgie et de chirurgie cervico-faciale, centre hospitalier Lyon Sud, hospices civils de Lyon, 69495 Pierre-Bénite cedex, France,Université de Lyon, université Lyon 1, 69003 Lyon, France
| | - L. Fath
- Service d’ORL et de chirurgie cervico-faciale, hôpital de Hautepierre, avenue Molière, 67098 Strasbourg, France,Unité Inserm 1121, biomatériaux et bioingénierie, 1, rue Eugène-Boeckel, 67000 Strasbourg, France
| | - S. Bartier
- Service d’ORL et de chirurgie cervico-faciale, centre hospitalier intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France,Service d’ORL et de chirurgie cervico-faciale, CHU d’Henri-Mondor, 8, rue Gustave-Eiffel, 94000 Créteil, France,Inserm, IMRB, université Paris Est Créteil, 94010 Créteil, France,CNRS ERL 7000, 94010 Créteil, France
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21
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Collins RA, DiGennaro C, Beninato T, Gartland RM, Chaves N, Broekhuis JM, Reddy L, Lee J, Deimiller A, Alterio MM, Campbell MJ, Lee YJ, Khilnani TK, Stewart LA, O’Brien MA, Alvarado MVY, Zheng F, McAneny D, Liou R, McManus C, Dream SY, Wang TS, Yen TW, Alhefdhi A, Finnerty BM, Fahey TJ, Graves CE, Laird AM, Nehs MA, Drake FT, Lee JA, McHenry CR, James BC, Pasieka JL, Kuo JH, Lubitz CC. Limited disease progression in endocrine surgery patients with treatment delays due to COVID-19. Surgery 2023; 173:93-100. [PMID: 36210185 PMCID: PMC9420726 DOI: 10.1016/j.surg.2022.06.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/31/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic profoundly impacted the delivery of care and timing of elective surgical procedures. Most endocrine-related operations were considered elective and safe to postpone, providing a unique opportunity to assess clinical outcomes under protracted treatment plans. METHODS American Association of Endocrine Surgeon members were surveyed for participation. A Research Electronic Data Capture survey was developed and distributed to 27 institutions to assess the impact of COVID-19-related delays. The information collected included patient demographics, primary diagnosis, resumption of care, and assessment of disease progression by the surgeon. RESULTS Twelve out of 27 institutions completed the survey (44.4%). Of 850 patients, 74.8% (636) were female; median age was 56 (interquartile range, 44-66) years. Forty percent (34) of patients had not been seen since their original surgical appointment was delayed; 86.2% (733) of patients had a delay in care with women more likely to have a delay (87.6% vs 82.2% of men, χ2 = 3.84, P = .05). Median duration of delay was 70 (interquartile range, 42-118) days. Among patients with a delay in care, primary disease site included thyroid (54.2%), parathyroid (37.2%), adrenal (6.5%), and pancreatic/gastrointestinal neuroendocrine tumors (1.3%). In addition, 4.0% (26) of patients experienced disease progression and 4.1% (24) had a change from the initial operative plan. The duration of delay was not associated with disease progression (P = .96) or a change in operative plan (P = .66). CONCLUSION Although some patients experienced disease progression during COVID-19 delays to endocrine disease-related care, most patients with follow-up did not. Our analysis indicated that temporary delay may be an acceptable course of action in extreme circumstances for most endocrine-related surgical disease.
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Affiliation(s)
- Reagan A. Collins
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Catherine DiGennaro
- Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA
| | - Toni Beninato
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Natalia Chaves
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Jordan M. Broekhuis
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Lekha Reddy
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jenna Lee
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Maeve M. Alterio
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | | | - Yeon Joo Lee
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Latoya A. Stewart
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Mollie A. O’Brien
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | | | - Feibi Zheng
- Department of Surgery, Baylor College of Medicine, Houston, TX
| | - David McAneny
- Department of Surgery, Boston Medical Center and Boston University School of Medicine, MA
| | - Rachel Liou
- Section of Endocrine Surgery, Columbia University, New York, NY
| | | | - Sophie Y. Dream
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tracy S. Wang
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Tina W. Yen
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Amal Alhefdhi
- Department of General Surgery, Breast and Endocrine Section, King Faisal Specialist Hospital and Research Centre, Al Mathar Ash Shamali, Riyadh, Saudi Arabia
| | - Brendan M. Finnerty
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | - Thomas J. Fahey
- Department of Surgery, Weill Cornell Medicine/New York-Presbyterian Hospital, New York, NY
| | | | - Amanda M. Laird
- Department of Surgery, Rutgers Cancer Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Matthew A. Nehs
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA
| | | | - James A. Lee
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Christopher R. McHenry
- Department of Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Benjamin C. James
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA,Harvard Medical School, Boston, MA
| | - Janice L. Pasieka
- Department of Surgery, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Jennifer H. Kuo
- Section of Endocrine Surgery, Columbia University, New York, NY
| | - Carrie Cunningham Lubitz
- Department of Surgery, Massachusetts General Hospital, Boston, MA,Institute of Technology Assessment, Massachusetts General Hospital, Boston, MA,Harvard Medical School, Boston, MA,Reprint requests: Carrie Cunningham Lubitz, MD, MPH, 55 Fruit Street, Boston, MA 02114
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22
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Restini C, Faner M, Miglio M, Bazzi L, Singhal N. Impact of COVID-19 on Medical Education: A Narrative Review of Reports from Selected Countries. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2023; 10:23821205231218122. [PMID: 38130830 PMCID: PMC10734352 DOI: 10.1177/23821205231218122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023]
Abstract
The COVID-19 pandemic presented unprecedented challenges to medical training worldwide. Many studies examining barriers, such as student safety concerns and technological issues for adaptability to a virtual learning mode, were conducted during social distancing and described the pandemic's impact on medical education. This narrative sought to review how medical schools adapted to the pandemic and to provide a unique analysis of the challenges faced in delivering medical curricula worldwide. A search of the medical education literature yielded articles describing methods employed by medical colleges from locations worldwide. All articles that met search parameters were archived on PubMed. Of 109 manuscripts, 12 describe strategies adopted by 10 countries. They support the discussion of teaching and learning at the pre-clerkship and clerkship levels during the COVID-19 pandemic. Online learning became the method adopted by medical schools worldwide to address hurdles during the pandemic. Access to technology, the internet, and appropriate infrastructure, resulted in solid indicators of medical education success. From the student's perspective, the most significant advantage of this strategy was flexibility. The compiled reports are representative approaches used during the pandemic and may serve as guidelines for medical colleges when strategic change is needed during pre-clerkship and clerkship education. Strategies based on information technology proved successful; however, more equitable access is necessary. It is crucial to consider the complexities of syndemic conditions when adjusting the curriculum in challenging situations such as a pandemic.
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Affiliation(s)
- Carolina Restini
- Department of Pharmacology and Toxicology, College of Osteopathic Medicine, Michigan State University, Macomb University Center (MUC), Clinton Township, MI, USA
- Detroit Medical Center (DMC), College of Osteopathic Medicine, Michigan State University, Detroit, MI, USA
| | - Martha Faner
- Detroit Medical Center (DMC), College of Osteopathic Medicine, Michigan State University, Detroit, MI, USA
| | - Maria Miglio
- Detroit Medical Center (DMC), College of Osteopathic Medicine, Michigan State University, Detroit, MI, USA
| | - Lena Bazzi
- Detroit Medical Center (DMC), College of Osteopathic Medicine, Michigan State University, Detroit, MI, USA
| | - Neena Singhal
- Detroit Medical Center (DMC), College of Osteopathic Medicine, Michigan State University, Detroit, MI, USA
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23
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Yilmaz HE, Yilmaz M, Tangirala VA, Spring K. Awareness of surgical smoke risks and assessment of safety practices during the Covid-19 pandemic. THE NATIONAL MEDICAL JOURNAL OF INDIA 2022; 35:189-190. [DOI: 10.25259/nmji-35-3-189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Huriye Erbak Yilmaz
- Department of Biochemistry, University of Katip Celebi University Ataturk Education and Research Hospital, Turkey
- Izmir Biomedicine and Genome Centre, University of Dokuz Eylul, Turkey
| | - Murat Yilmaz
- Department of Neurosurgery, University of Dokuz Eylul, School of Medicine Izmir, Turkey
| | | | - Kevin Spring
- Department of Medical Oncology, Ingham Institute for Applied Medical Research, School of Medicine, Western Sydney University and SWS Clinical School, UNSW, Sydney, NSW, Australia
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24
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Yin F, Feng Z. The Effect of COVID-19 Safety Protocols on Hospital Workers' Mental Health: A Moderated-Mediation Model of COVID-19 Anxiety and Psychological Resilience. Behav Sci (Basel) 2022; 12:bs12120477. [PMID: 36546960 PMCID: PMC9774179 DOI: 10.3390/bs12120477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Social distancing measures can create psychological issues, especially among hospital staff who constantly deal with emergency patients. To explore the mediating role of COVID-19 anxiety on the association between COVID-19 safety protocols and mental health, and to test the moderating role of resilience between COVID-19 safety protocols and COVID-19 anxiety, this work collected data on hospital staff in terms of COVID-19 safety protocols, psychological resilience, COVID-19 anxiety, and improving staff mental health. The effects of the use of COVID-19 safety protocols on COVID-19 anxiety and the mental health of hospital workers in China were also analyzed. The experimental results showed that resilience remarkably moderated COVID-19 safety protocols and COVID-19 anxiety among Chinese hospital staff.
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25
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Singh Y, Soni KD, Singh A, Choudhary N, Perveen F, Aggarwal R, Patel N, Kumar S, Trikha A. Clinical characteristics of COVID-19 patients who underwent tracheostomy and its effect on outcome: A retrospective observational study. World J Virol 2022; 11:477-484. [PMID: 36483098 PMCID: PMC9724205 DOI: 10.5501/wjv.v11.i6.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/12/2022] [Accepted: 09/22/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The exponential rise in Coronavirus disease 2019 (COVID-19) cases has resulted in an increased number of patients requiring prolonged ventilatory support and subsequent tracheostomy. With the limited availability of literature regarding the outcomes of COVID-19 patients with tracheostomy, we attempted to study the clinical characteristics and multiple parameters affecting the outcomes in these patients.
AIM To determine all-cause mortality following tracheostomy and its association with various risk factors in COVID-19 patients.
METHODS This retrospective study included 73 adult COVID-19 patients admitted to the ICU between 1 April, 2020 and 30 September, 2021 who underwent tracheostomy as a result of acute respiratory failure due to COVID-19. The data collected included demographics (age, sex), comorbidities, type of oxygen support at admission, severity of COVID-19, complications, and other parameters such as admission to tracheostomy, intubation to tracheostomy, ICU stay, hospital stay, and outcome.
RESULTS This study included 73 adult patients with an average age of 52 ± 16.67 years, of which 52% were men. The average time for admission to tracheostomy was 18.12 ± 12.98 days while intubation to tracheostomy was 11.97 ± 9 days. The mortality rate was 71.2% and 28.8% of patients were discharged alive. The mean duration of ICU and hospital stay was 25 ± 11 days and 28.21 ± 11.60 days, respectively. Greater age, severe COVID-19, mechanical ventilation, shock and acute kidney injury were associated with poor prognosis; however, early tracheostomy in intubated patients resulted in better outcomes.
CONCLUSION Patients with severe COVID-19 requiring mechanical ventilation have a poor prognosis but patients with early tracheostomy may benefit with no added risk. We recommend that the timing of tracheostomy be decided on a case-by-case basis and a well-designed randomised controlled trial should be performed to elucidate the potential benefit of early tracheostomy in such patients.
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Affiliation(s)
- Yudhyavir Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Abhishek Singh
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nikita Choudhary
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Fahina Perveen
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Richa Aggarwal
- Department of Critical and Intensive Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nishant Patel
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Shailendra Kumar
- Department of Anesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Anjan Trikha
- Department of Anesthesia, All India Institute of Medical Sciences, New Delhi 110029, India
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26
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Demissie WR, Mulatu B, Siraj A, Hajikassim A, Kejela E, Muluken Z, Mekonin GT, Biratu M, Birhanu M, Dadi N, Kelbesa M, Belay A, Dukessa A. Pattern of Perioperative Surgical Patient Care, Equipment Handling and Operating Room Management During COVID-19 Pandemic at Jimma Medical Center. J Multidiscip Healthc 2022; 15:2527-2537. [PMID: 36352855 PMCID: PMC9639398 DOI: 10.2147/jmdh.s372428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background The nature of COVID-19 transmission creates significant risks in surgical departments owing to the close contact of medical staff with patients, the limited physical environment of the operating room and recovery room, the possibility of shared surgical equipment and challenges in the delivery of surgical care in all surgical departments. Globally, studies have reported that the effects of the pandemic on surgical departments are profound, potentially long-lasting and extensive. To manage these effects, different local guidelines and recommendations have been developed, with potential differences in their effectiveness and implementation. Therefore, harmonized and effective national/international guidelines for specific surgical departments during perioperative periods are pertinent to curtail the infection, and will inevitably need to be adapted for consistent and sustainable implementation by all medical staff. The pattern of surgical patient care during the COVID-19 pandemic at Jimma Medical Center (JMC), Ethiopia, has not been explored yet. The present study aimed to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC. Methods A cross-sectional study was conducted to describe the pattern of perioperative surgical patient care, equipment handling and operating room management during the COVID-19 pandemic at JMC, using five-point Likert scales (0, not at all; 1, rarely; 2, sometimes; 3, most of the time; 4, frequently). A total of 90 respondents [35 patients (five patients from each of seven surgical departments) and 55 healthcare providers (six professionals from each of nine units, including the center of sterility room and anesthesia)] who were available during the study period, selected by a convenience sampling technique with multistage clustering, participated in the study. Data were collected using a structured questionnaire via direct observation and face-to-face interviews with patients undergoing surgery, healthcare providers and hospital administrators, against the standard surgical patient care guidelines. The collected data were manually checked for missing values and outliers, cleared, entered into EpiData (v4.3.1) and exported to SPSS (v22) for analysis. The mean score of practice was compared among different disciplines by applying the unpaired t-test. The findings of the study were reported using tables and narration. A p-value of less than 0.05 was declared as statistically significant. Results Despite the surgical care practice having changed during the COVID-19 pandemic in all service domains, it is not implemented consistently among different surgical departments owing to different barriers (lack of training on the updated guidelines and financial constraints). The majority of surgical staff were implementing the use of preventive measures against COVID-19, while they were practiced less among patients. The guidelines for surgical practice during the preoperative phase were well applied, especially screening patients by different methods and the application of telemedicine to reduce physical contacts. But, against guidelines, elective patients were planned and underwent surgery, especially in the general surgery department. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. The extent of practice for anesthesia care, operating room management and postoperative care in the recovery room also changed, and the guidelines were sometimes applied. Conclusion and Recommendations Although perioperative surgical care practice differed before and during the pandemic, the standard guidelines were inconsistently implemented among surgical departments. The implementation of recommended guidelines in the center of sterility room in handling surgical equipment was not very different before and during the pandemic. Thus, the authors developed safe surgical care guidelines throughout the different domains (infection prevention and PPE use; preoperative care, intraoperative care, operating room management, anesthesia care, equipment handling process and postoperative care) for all disciplines and shared them with all staff. We recommend that all surgical staff should access these guidelines and strictly adhere to them for surgical service during the pandemic.
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Affiliation(s)
- Wondu Reta Demissie
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia
| | - Bilisuma Mulatu
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | - Ahmed Siraj
- School of Medicine, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Edosa Kejela
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Zemenu Muluken
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | | | - Melka Biratu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Mitiku Birhanu
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Negashu Dadi
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Megersa Kelbesa
- Department of Anesthesia, Jimma University, Jimma, Oromia, Ethiopia
| | - Admasu Belay
- School of Nursing, Jimma University, Jimma, Oromia, Ethiopia
| | - Abebe Dukessa
- Department of Biomedical Sciences, Jimma University, Jimma, Oromia, Ethiopia
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27
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Standiford TC, Farlow JL, Brenner MJ, Blank R, Rajajee V, Baldwin NR, Chinn SB, Cusac JA, De Cardenas J, Malloy KM, McDonough KL, Napolitano LM, Sjoding MW, Stoneman EK, Washer LL, Park PK. COVID-19 Transmission to Health Care Personnel During Tracheostomy Under a Multidisciplinary Safety Protocol. Am J Crit Care 2022; 31:452-460. [PMID: 35953441 DOI: 10.4037/ajcc2022538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Tracheostomies are highly aerosolizing procedures yet are often indicated in patients with COVID-19 who require prolonged intubation. Robust investigations of the safety of tracheostomy protocols and provider adherence and evaluations are limited. OBJECTIVES To determine the rate of COVID-19 infection of health care personnel involved in COVID-19 tracheostomies under a multidisciplinary safety protocol and to investigate health care personnel's attitudes and suggested areas for improvement concerning the protocol. METHODS All health care personnel involved in tracheostomies in COVID-19-positive patients from April 9 through July 11, 2020, were sent a 22-item electronic survey. RESULTS Among 107 health care personnel (80.5%) who responded to the survey, 5 reported a positive COVID-19 test result (n = 2) or symptoms of COVID-19 (n = 3) within 21 days of the tracheostomy. Respondents reported 100% adherence to use of adequate personal protective equipment. Most (91%) were familiar with the tracheostomy protocol and felt safe (92%) while performing tracheostomy. Suggested improvements included creating dedicated tracheostomy teams and increasing provider choices surrounding personal protective equipment. CONCLUSIONS Multidisciplinary engagement in the development and implementation of a COVID-19 tracheostomy protocol is associated with acceptable safety for all members of the care team.
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Affiliation(s)
- Taylor C Standiford
- Taylor C. Standiford is a second-year resident, Department of Otolaryngology-Head & Neck Surgery, University of California, San Francisco
| | - Janice L Farlow
- Janice L. Farlow is a head and neck surgical oncology fellow, Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus
| | - Michael J Brenner
- Michael J. Brenner is an associate professor, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor
| | - Ross Blank
- Ross Blank is an assistant professor, Department of Anesthesiology, University of Michigan, Ann Arbor
| | - Venkatakrishna Rajajee
- Venkata-krishna Rajajee is a professor, Department of Neurosurgery, University of Michigan, Ann Arbor
| | - Noel R Baldwin
- Noel R. Baldwin is a registered nurse, Critical Care Medicine Unit, University of Michigan, Ann Arbor
| | - Steven B Chinn
- Steven B. Chinn is an assistant professor, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor
| | - Jessica A Cusac
- Jessica A. Cusac is a respiratory therapist, clinical specialist, University Hospital/Cardiovascular Center, University of Michigan, Ann Arbor
| | - Jose De Cardenas
- Jose De Cardenas is an associate professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Kelly M Malloy
- Kelly M. Malloy is an associate professor, Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor
| | - Kelli L McDonough
- Kelli L. McDonough is a clinical research project manager, Department of Surgery, University of Michigan, Ann Arbor
| | - Lena M Napolitano
- Lena M. Napolitano is a professor, Department of Surgery, University of Michigan, Ann Arbor
| | - Michael W Sjoding
- Michael W. Sjoding is an assistant professor, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Michigan, Ann Arbor
| | - Emily K Stoneman
- Emily K. Stoneman is an associate professor, Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor
| | - Laraine L Washer
- Laraine L. Washer is a professor, Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor
| | - Pauline K Park
- Pauline K. Park is a professor, Department of Surgery, University of Michigan, Ann Arbor
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Peñaranda A, Moreno-López S, Peñaranda D, Pérez-Herrera LC. Effect of the COVID-19 pandemic on the mental health, daily and occupational activities of pediatric otolaryngologists in Latin America. Front Public Health 2022; 10:735073. [PMID: 36339173 PMCID: PMC9630938 DOI: 10.3389/fpubh.2022.735073] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 10/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Otolaryngologists have a higher risk of physical/psychological problems due to their frequent exposure to SARS-CoV-2. There is no information about the impact of COVID-19 on the mental health of these specialists in low/middle-income countries from Latin America. This study aimed to assess the frequency of anxiety, depression, and stress, as well as the changes in occupational and daily activities due to the COVID-19 pandemic in a group of pediatric otolaryngologists in Latin America. Methods Observational, cross-sectional study conducted between October and December 2020. Mental health tools such as the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Perceived Stress Scale-10 were applied. Fear to COVID-19 scale and questionnaires about occupational and daily activities were also applied. Results Among 55 pediatric otolaryngologists, the frequency of anxiety, depression, and stress were 67.3%, 45.5, and 40%, respectively. Up to 27.3% of the specialists reported moderate to severe symptoms of anxiety, while 7.3 and 40% presented moderate depression and stress symptoms. The specialists reported a reduction of 58.3% of their consultations, as well as a 51.7% reduction in their monthly income compared to the same period before the pandemic. Up to 14.6% of the specialists expect to incorporate long-term (>1 year) drastic changes in their daily activities due to the pandemic. Conclusions The frequency of anxiety, depression, and stress was high among pediatric otolaryngologists in Latin America compared to previous studies performed in high-income countries. Further research on these psychological outcomes is needed to achieve early mental health strategies.
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Affiliation(s)
- Augusto Peñaranda
- Otolaryngology and Allergy Research Groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
- Department of Otolaringology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Sergio Moreno-López
- Otolaryngology and Allergy Research Groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
| | - Daniel Peñaranda
- Department of Otolaryngology, Fundación Universitaria de Ciencias de la Salud-Hospital de San José, Bogotá, Colombia
| | - Lucía C. Pérez-Herrera
- Otolaryngology and Allergy Research Groups, Unidad Médico Quirúrgica de Otorrinolaringología (UNIMEQ-ORL), Bogotá, Colombia
- School of Medicine, Universidad de Los Andes, Bogotá, Colombia
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Khan MM, Manduchi B, Rodriguez V, Fitch MI, Barbon CEA, McMillan H, Hutcheson KA, Martino R. Exploring patient experiences with a telehealth approach for the PRO-ACTIVE trial intervention in head and neck cancer patients. BMC Health Serv Res 2022; 22:1218. [PMID: 36180905 PMCID: PMC9523628 DOI: 10.1186/s12913-022-08554-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/11/2022] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Following the COVID-19 directive to cease non-essential services, a rapid shift was made in the delivery of Speech Language Pathology (SLP) dysphagia management in the 3-arm, randomized PRO-ACTIVE trial. To inform future programs, this study explored patients' experiences with telehealth when the planned in-person SLP intervention was moved to a telehealth modality. METHODS A theory-guided qualitative descriptive approach was used. Willing participants who had received at least one telehealth swallowing therapy session participated in a one-time semi-structured interview. Interview transcripts were subjected to a standard qualitative content/theme analysis. Researchers reviewed all transcripts and used a multi-step analysis process to build a coding framework through consensus discussion. Summaries and key messages were generated for each code. RESULTS Eleven participants recounted their telehealth experiences and reported feeling satisfied, comfortable and confident with the session(s). They identified that previous experience with teleconferencing, access to optimal technical equipment, clinician skill, and caregiver assistance facilitated their telehealth participation. Participants highlighted that telehealth was beneficial as it reduced commuting time, COVID-19 exposure and fatigue from travel; and also allowed caregiver participation particularly during COVID. In comparing their in-person SLP sessions to telehealth sessions, limitations were also identified, including: lack of previous experience with and/or poor access to technology, and less opportunity for personalization. Participants indicated that use of phone alone was less preferred than an audio/video platform. DISCUSSION Patients reported that overall, telehealth sessions did not compromise their learning experience when compared to in-person sessions. Patients benefited from use of telehealth in several ways despite some limitations of the use of technology. Patient feedback about telehealth provides an important perspective that may be critical to inform best practices for care delivery.
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Affiliation(s)
- M M Khan
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - B Manduchi
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - V Rodriguez
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - M I Fitch
- Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - C E A Barbon
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA
| | - H McMillan
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA
| | - K A Hutcheson
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, 7007 Bertner Ave., Houston, TX, 77030, USA.
- Department of Radiation Oncology, The University of Texas, M.D. Anderson Cancer Center, Houston, TX, USA.
| | - R Martino
- Department of Speech-Language Pathology, University of Toronto, 160-500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- Krembil Research Institute, University Health Network, Toronto, ON, Canada.
- Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
- Department of Otolaryngology- Head and Neck Surgery, University of Toronto, Toronto, ON, Canada.
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Martins MS, Lourenção DCDA, Pimentel RRDS, de Oliveira JM, Manganoti LTDCN, Modesto RC, Silva MSDS, Dos Santos MJ. Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review. BMJ Open 2022; 12:e060182. [PMID: 36123068 PMCID: PMC9485646 DOI: 10.1136/bmjopen-2021-060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To map the recommendations for hospitalised patient safety in the context of the COVID-19 pandemic. DESIGN Scoping review using the method recommended by the Joanna Briggs Institute. DATA SOURCES Databases: Medline, SCOPUS, EMBASE, ScienceDirect, LILACS, CINAHL and IBECS; grey literature platform: Google Scholar; and 11 official websites of leading healthcare institutions were searched on 27 April 2021 and updated on 11 April 2022. ELIGIBILITY CRITERIA We included documents that present recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic, published in any language, from 2020 onwards. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in pairs with consensus rounds. A descriptive analysis was carried out to present the main characteristics of the articles. Qualitative data from the extraction of recommendations were analysed through content analysis. RESULTS One hundred and twenty-five documents were included. Most papers were identified as expert consensus (n=56, 44.8%). Forty-six recommendations were identified for the safety of hospitalised patients: 17 relating to the reorganisation of health services related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment; 11 on the approach to the airways and the prevention of the spread of aerosols; 11 related to sanitary and hygiene issues; 4 about proper use of personal protective equipment and 3 for effective communication. CONCLUSIONS The recommendations mapped in this scoping review present the best practices produced so far and serve as a basis for planning and implementing good practices to ensure safe hospital care, during and after COVID-19. The engagement of everyone involved in the care of hospitalised patients is essential to consolidate the mapped recommendations and provide dignified, safe and quality care.
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Affiliation(s)
| | | | | | - Janine Melo de Oliveira
- Escola de Enfermagem, Universidade Federal de Alagoas, Maceio, Brazil
- Curso de Enfermagem, Universidade Estadual de Ciências da Saúde de Alagoas, Maceio, Brazil
| | | | | | | | - Marcelo José Dos Santos
- Career Guidance Department, Universidade de São Paulo Escola de Enfermagem, Sao Paulo, Brazil
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Tolvi M, Lahti T, Aaltonen LM. Otorhinolaryngology Virtual Visits During the COVID-19 Pandemic: A 2-Year Follow-Up Study. Telemed J E Health 2022; 29:665-673. [PMID: 36112177 DOI: 10.1089/tmj.2022.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective: To clarify how successful virtual visits were in different age groups and subspecialties of otorhinolaryngology during the COVID-19 pandemic, with a 2-year follow-up. Methods: We examined the progress of treatment and need for face-to-face follow-ups in a retrospective setting. Case records of all the visits marked as virtual between March and June 2020 in Helsinki University Hospital Department of Otorhinolaryngology-Head and Neck Surgery (ORL-HNS) were reviewed. Results: Among 865 virtual visits, 71.2% (n = 616) clearly advanced treatment, 53.8% (n = 465) needed no face-to-face follow-up, and only 9.0% (n = 78) were followed by an unplanned visit within 6 months. Statistically significant differences were detected among different subspecialties and age groups. Virtual visits achieved clear progress of treatment most frequently in laryngology (119/149 visits, 79.9%) and in head and neck surgery (69/83 visits, 83.1%). Laryngology patients required the least face-to-face follow-ups (n = 38 scheduled, 25.5% of laryngology visits). Most visits with clear progress involved 18-29-year-olds (n = 100, 80.0%) and they also required least face-to-face follow-ups (n = 39, 31.2%). During the 6-month to 2-year follow-up, 82 patients (9.6%) contacted our clinic directly for outpatient treatment, 28 patients (3.3%) called or visited the emergency department, and 37 patients (4.3%) were referred to the ORL-HNS clinic again for the same issue. Conclusion: Virtual visits were beneficial for treatment of otorhinolaryngology patients, and unplanned visits afterward were rare. Differences in effectiveness among subspecialties suggest that the utility of telemedicine applications can be enhanced by examining more closely which patient and ailment characteristics favor virtual visits.
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Affiliation(s)
- Morag Tolvi
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - Tiitu Lahti
- Department of Otorhinolaryngology—Head and Neck Surgery, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology—Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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Alam I, Garg K, Raheja A, Tandon V, Sharma R, Singh M, Singh GP, Mishra S, Singh PK, Agrawal D, Soni KD, Suri A, Chandra PS, Kale SS. Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes. World Neurosurg 2022; 165:e59-e73. [PMID: 35643408 PMCID: PMC9131442 DOI: 10.1016/j.wneu.2022.05.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase. METHODS This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B). RESULTS The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups. CONCLUSIONS The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.
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Affiliation(s)
- Intekhab Alam
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India,To whom correspondence should be addressed: Vivek Tandon, M.B.B.S., M.S., M.Ch
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder Pal Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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B. Cardin G, Rivest D, Ayad T, Robert É, Rahal A, Christopoulos A. Quantification and visualization of aerosols in ear, nose, and throat exam and flexible laryngoscopy. Laryngoscope Investig Otolaryngol 2022; 7:963-969. [PMID: 36000064 PMCID: PMC9392400 DOI: 10.1002/lio2.826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/26/2022] [Indexed: 11/11/2022] Open
Abstract
Objective To measure and visualize aerosol generation during ear, nose, and throat (ENT) exam and flexible laryngoscopy, as safety recommendations are currently to defer routine and low-priority examinations. Methods Aerosols generated during ENT examination and flexible laryngoscopy were quantified by laser aerosol spectrometry and visualized live by high-speed imaging during those procedures for three participants who were tested three times for each test. Results Routine ENT examination and flexible laryngoscopy produce aerosols at levels comparable to normal breathing and speech. Conclusion During ENT examination and flexible laryngoscopy, the practitioner should wear a surgical mask and potentially contaminated surfaces should be cleaned after the procedure. For flexible laryngoscopy, it is recommended in addition that the patient wear a mask over the mouth in case the procedure induces a sneeze. The time during which the patient is unmasked should be minimized. In these settings, the risk to the practitioner is minimal unless the patient is sneezing or symptomatic. Level of Evidence 1.
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Affiliation(s)
- Guillaume B. Cardin
- Centre de recherche du Centre hospitalier de l'Université de MontréalMontrealQuébecCanada
- Institut du Cancer de MontréalMontrealQuébecCanada
| | - Dominic Rivest
- Mechanical Engineering DepartmentÉcole Polytechnique de MontréalMontrealQuébecCanada
| | - Tareck Ayad
- Centre de recherche du Centre hospitalier de l'Université de MontréalMontrealQuébecCanada
- Otolaryngology‐Head and Neck Surgery ServiceCentre hospitalier de l'Université de MontréalMontrealQuébecCanada
| | - Étienne Robert
- Mechanical Engineering DepartmentÉcole Polytechnique de MontréalMontrealQuébecCanada
| | - Akram Rahal
- Maxillofacial Surgery ServiceCentre Hospitalier de l'Université de MontréalMontrealQuébecCanada
| | - Apostolos Christopoulos
- Centre de recherche du Centre hospitalier de l'Université de MontréalMontrealQuébecCanada
- Otolaryngology‐Head and Neck Surgery ServiceCentre hospitalier de l'Université de MontréalMontrealQuébecCanada
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Kourtidis S, Münst J, Hofmann VM. Effects of the COVID-19 Pandemic on Head and Neck Cancer Stage and Treatment Duration. Cureus 2022; 14:e26744. [PMID: 35967177 PMCID: PMC9364957 DOI: 10.7759/cureus.26744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective To assess the efficacy of oncologic healthcare during the COVID-19 pandemic on patients with head and neck squamous cell carcinoma (SCC) in a tertiary university hospital in Germany. Methods This retrospective, cross-sectional, observational study included 94 patients with newly diagnosed head and neck squamous cell carcinoma during a two-year period. Patients were assigned to two date-dependent groups; referrals before (group A) and during (group B) the COVID-19 pandemic. Time intervals from the symptom(s) onset to diagnosis, diagnosis to treatment, and treatment initiation to completion were recorded. Furthermore, TNM stages and the application of reconstructive surgery with free tissue transfer were determined. Patients’ outcomes and characteristics were compared between the two groups. Finally, a comprehensive literature review was carried out to identify similar epidemiological studies. Results The symptom-to-diagnosis interval was longer during the COVID-19 pandemic [median 9.5 (A) versus 15 (B) weeks, p = 0.054]. The intervals from diagnosis to treatment and treatment initiation to end of treatment were approximately the same in both groups [median 3 (A) versus 3.2 (B) weeks, p = 0.264; and 6.9 (A) versus 6.3 (B) weeks, p = 0.136]. The T-and N-stages were not higher during the pandemic [early T-stage (T1+T2) versus advanced T-stage (T3+T4), p = 0.668; and N-negative (N0) versus N-positive status (N1,2,3), p = 0.301]. Patients who presented with distant metastatic disease and those who underwent reconstructive surgery with free tissue transfer were observed more frequently in the lockdown phase [M1 versus M0, p= 0.022; and flap versus no flap, p=0.007]. Conclusion This study suggests the consistent diagnostic and therapeutical performance of the tertiary oncologic healthcare in Berlin, Germany, despite the challenges that patient care units faced during the COVID-19 pandemic.
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Elzayat S, Elfarargy HH, Mandour M, Mahrous A, El-Deeb ME, Barbara M, Elsherief H. The Impact of COVID-19 on the Daily Life and Medical Practice of Otolaryngology Physicians. Int Arch Otorhinolaryngol 2022; 26:e478-e486. [PMID: 35846808 PMCID: PMC9282957 DOI: 10.1055/s-0042-1745854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction
The coronavirus disease 2019 (COVID-19) has made otolaryngologists more susceptible than their counterparts to its effect.
Objective
This study aimed to find if COVID-19 had a different impact on ear, nose, and throat (ENT) physicians' of various categories (residents, registrars, and consultants ) regarding many aspects of the quality of life (protection, training, financial, and psychological aspects).
Methods
We included 375 ENT physicians, of different categories (residents, registrars, and consultants), from 33 general hospitals and 26 university hospitals in Egypt. The study was conducted using a 20-item questionnaire with a response scale consisting of three categories: yes, no, and not sure. It covered infection control and personal protective equipment (PPE) usage; medical practice and safety; online consultation and telemedicine,; webinars and online lectures; COVID-19 psychological, financial, and quarantine period effects; and future expectations.
Results
The results of the questionnaire showed that COVID-19 had a statistically significant impact on the daily life of the responders. There were statistically significant differences among the three involved categories, based on their answers.
Conclusion
This study showed a statistically significant difference regarding the impact of COVID-19 on many aspects of the quality of life (protection, training, financial, and psychological aspects) of ENT physicians of various categories (residents, registrars, and consultants), and these effects may persist for a long time.
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Affiliation(s)
- Saad Elzayat
- Faculty of Medicine, Department of Otorhinolaryngology, Kafrelsheikh University, Egypt
| | - Haitham H Elfarargy
- Faculty of Medicine, Department of Otorhinolaryngology, Kafrelsheikh University, Egypt
| | - Mahmoud Mandour
- Faculty of Medicine, Department of Otolaryngology, Tanta University, Egypt
| | - Ali Mahrous
- Faculty of Medicine, Department of Otorhinolaryngology, Al-Azhar University, Egypt
| | - Mohamed E El-Deeb
- Faculty of Medicine, Department of Otorhinolaryngology, Kafrelsheikh University, Egypt
| | - Maurizio Barbara
- Faculty of Medicine, Department of Otolaryngology, Sapienza Roma University, Italy
| | - Hossam Elsherief
- Faculty of Medicine, Department of Otolaryngology, Tanta University, Egypt
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Monroy‐Iglesias MJ, Rai S, Mistretta FA, Roberts G, Dickinson H, Russell B, Moss C, De Berardinis R, Ferro M, Musi G, Brown C, Nair R, Thurairaja R, Fernando A, Cathcart P, Khan A, Dasgupta P, Malde S, Hadijpavlou M, Dolly S, Haire K, Tagliabue M, de Cobelli O, Challacombe B, Van Hemelrijck M. Impact of the COVID-19 pandemic on urological cancers: The surgical experience of two cancer hubs in London and Milan. BJUI COMPASS 2022; 3:277-286. [PMID: 35783588 PMCID: PMC9231679 DOI: 10.1002/bco2.135] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/01/2021] [Accepted: 11/28/2021] [Indexed: 01/13/2023] Open
Abstract
Objective To report on the outcomes of urological cancer patients undergoing radical surgery between March-September 2020 (compared with 2019) in the European Institute of Oncology (IEO) in Milan and the South East London Cancer Alliance (SELCA). Materials and Methods Since March 2020, both institutions implemented a COVID-19 minimal 'green' pathway, whereby patients were required to isolate for 14 days prior to admission and report a negative COVID-19 polymerase chain reaction (PCR) test within 3 days of surgery. COVID-19 positive patients had surgery deferred until a negative swab. Surgical outcomes assessed were: American Society of Anaesthesiologists (ASA) grade; surgery time; theatre time; intensive care unit (ICU) stay >24 h; pneumonia; length of stay (LOS); re-admission. Postoperative COVID-19 infection rates and associated mortality were also recorded. Results At IEO, uro-oncological surgery increased by 4%, as compared with the same period in 2019 (n = 515 vs. 534). The main increase was observed for renal (16%, n = 98 vs. 114), bladder (24%, n = 45 vs. 56) and testicular (27%, n = 26 vs. 33). Patient demographics were all comparable between 2019 and 2020. Only one bladder cancer patient developed COVID-19, reporting mild/moderate disease. There was no COVID-19 associated mortality. In the SELCA cohort, uro-oncological surgery declined by 23% (n = 403 vs. 312) compared with the previous year. The biggest decrease was seen for prostate (-42%, n = 156 vs. 91), penile (-100%, n = 4 vs. 0) and testicular cancers (-46%, n = 35 vs. 24). Various patient demographic characteristics were notably different when comparing 2020 versus 2019. This likely reflects the clinical decision of deferring COVID-19 vulnerable patients. One patient developed COVID-19, with no COVID-19 related mortality. Conclusion The COVID-19 minimal 'green' pathways that were put in place have shown to be safe for uro-oncological patients requiring radical surgery. There were limited complications, almost no peri-operative COVID-19 infection and no COVID-19-related mortality in either cohort.
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Affiliation(s)
- Maria J. Monroy‐Iglesias
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR)King's College LondonLondonUK
| | - Sonpreet Rai
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | | | | | - Beth Russell
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR)King's College LondonLondonUK
| | - Charlotte Moss
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR)King's College LondonLondonUK
| | - Rita De Berardinis
- Division of Otolaryngology and Head and Neck SurgeryEuropean Institute of Oncology IRCCSMilanItaly
| | - Matteo Ferro
- Division of UrologyEuropean Institute of Oncology IRCCSMilanItaly
| | - Gennaro Musi
- Division of UrologyEuropean Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Haemato‐oncologyUniversity of MilanMilanItaly
| | - Christian Brown
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Rajesh Nair
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Ramesh Thurairaja
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Archana Fernando
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Paul Cathcart
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Azhar Khan
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Prokar Dasgupta
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Sachin Malde
- Department of UrologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | | | - Saoirse Dolly
- Department of Medical OncologyGuy's and St Thomas' NHS Foundation TrustLondonUK
| | - Kate Haire
- South East London Cancer AllianceLondonUK
| | - Marta Tagliabue
- Division of Otolaryngology and Head and Neck SurgeryEuropean Institute of Oncology IRCCSMilanItaly
- Department of Biomedical SciencesUniversity of SassariSassariItaly
| | - Ottavio de Cobelli
- Division of UrologyEuropean Institute of Oncology IRCCSMilanItaly
- Department of Oncology and Haemato‐oncologyUniversity of MilanMilanItaly
| | - Ben Challacombe
- Division of UrologyEuropean Institute of Oncology IRCCSMilanItaly
| | - Mieke Van Hemelrijck
- Faculty of Life Sciences and Medicine, Translational Oncology & Urology Research (TOUR)King's College LondonLondonUK
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Reflecting on Plastic Surgery Training During Early COVID-19 Pandemic: Resident Exposure and Telemedicine. J Craniofac Surg 2022; 33:1820-1824. [PMID: 35762598 PMCID: PMC9432419 DOI: 10.1097/scs.0000000000008471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 12/29/2021] [Indexed: 11/26/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) pandemic has been an unprecedented public health crisis. As hospitals took measures to increase their capacity to manage COVID-19 patients, plastic surgeons have also had to modify their routine to continue serving their vital role within the hospital environment. In an effort to reduce exposure to COVID-19 and conserve hospital resources, many plastic surgery programs drastically modified call schedules, restructured inpatient teams, triaged operative cases, and expanded telemedicine encounters. Plastic surgery programs focused on craniofacial procedures were impacted by precautionary preventative protocol and shifts in case load made to protect both the healthcare teams and the patients. At academic centers, plastic surgery trainees of all domains felt the impact of these changes. Recognizing the implications on future craniofacial surgical practice, the pandemic has made, the goal of the authors’ study is to measure initial impacts of COVID-19 on plastic surgery trainees using a nationwide survey. The authors’ results present the first quantitative analysis of plastic surgery trainees’ exposure to COVID-19, deployment to other medical specialties, usage of personal protective equipment, and implementation of telemedicine during the pandemic. While healthcare systems have greatly adapted to pandemic complications and can anticipate vaccination, resurgence of COVID-19 cases linked to the delta variant heightens the authors' urgency in understanding the early pandemic, and its lasting impacts on healthcare. In the months following pandemic onset, telemedicine has become a mainstay in healthcare, trainees have adapted and become integrated in patient care in novel ways, and visits unable to transition to telemedical settings received substantial attention to ensure patient and provider safety.
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Kant R, Totaganti M, Mohan B, Bairwa M, Panda PK, Tyagi A, Prasad A, Bahurupi Y. Clinical Characteristics of 100 Patients With COVID-19-Associated Mucormycosis From a Tertiary Care Center in North India. Cureus 2022; 14:e25652. [PMID: 35800201 PMCID: PMC9252165 DOI: 10.7759/cureus.25652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2022] [Indexed: 12/11/2022] Open
Abstract
Background Fungal infection in patients with coronavirus disease 2019 (COVID-19) has emerged as a new challenge in healthcare facilities. This study aimed to describe the demographic and clinical characteristics of COVID-19-associated mucormycosis (CAM). Methodology This retrospective, single-center case series included patients who were hospitalized and diagnosed with COVID-19 and mucormycosis at the All India Institute of Medical Sciences, Rishikesh (North India) from April 15, 2021, onwards and last followed up on June 30, 2021. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed. Results Of the 100 consecutive inpatients with CAM, 95 (95%) had diabetes mellitus. At the onset of illness, the most common manifestations were facial swelling (85%), eye swelling (83%), headache (68%), pain around the eyeball (67%), malaise (57%), and fever (50%). The most common organ involved on examination was the nose and paranasal sinus (96%), followed by the orbit (83%), palate (19%), and cranial nerves (7%). Pulmonary involvement was seldom observed (1%). Predominant pathological findings were the presence of aseptate hyphae (75%), necrosis (75%), angioinvasion (36%), and perineural invasion (2.6%). During the last follow-up, 13 patients died, with 11 (84.6%) having severe COVID-19 and two (15.3%) having moderate COVID-19. Conclusions Steroid use and diabetes mellitus are the significant risk factors of CAM. Patients with CAM usually present with face/eye swelling with radiological involvement of the nose and sinus and may die because of severe COVID-19.
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Ramanathan M, Ravichandran SK, Parameswaran A. COVID-19 and Cleft and Craniofacial Surgery in Indian Scenario. J Maxillofac Oral Surg 2022; 21:460-465. [PMID: 33897127 PMCID: PMC8054694 DOI: 10.1007/s12663-020-01487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 11/27/2020] [Indexed: 12/05/2022] Open
Abstract
The coronavirus disease (COVID-19) had created the new normal approach towards the management of all maxillofacial problems as it is highly contagious and causing a threat to the health care professionals. The surgical management of patients with cleft and craniofacial deformities has caused lots of anxiety among patients and doctors in the recent COVID era as some essential treatment will be required for cleft babies from day one. Safety and protection for cleft children and parents must be the priority while dealing with this non-emergency disease. This article will highlight the important steps of management of the cleft and craniofacial cases during this pandemic by adhering to the protocols. It also throws light towards the strategies in revoking the cleft surgical management at least till this infection subsides.
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Affiliation(s)
- Manikandhan Ramanathan
- Meenakshi Cleft and Craniofacial Centre, Meenakshi General Hospital, Alapakkam Main Road, Maduravoyal, Chennai, Tamil Nadu 600 095 India
| | - Sailesh Kumar Ravichandran
- Meenakshi Cleft and Craniofacial Centre, Meenakshi General Hospital, Alapakkam Main Road, Maduravoyal, Chennai, Tamil Nadu 600 095 India
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Azmy MC, Pathak S, Schiff BA. The surgical airway in the COVID-19 era. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:134-140. [PMID: 35505952 PMCID: PMC9047482 DOI: 10.1016/j.otot.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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COVID-19 and head and neck oncology. OPERATIVE TECHNIQUES IN OTOLARYNGOLOGY-HEAD AND NECK SURGERY 2022; 33:119-127. [PMID: 35505950 PMCID: PMC9047541 DOI: 10.1016/j.otot.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The COVID-19 pandemic has generated a plethora of unique challenges which have forced Otolaryngologists/Head and Neck Surgeons to adapt the ways in which patients with head and neck cancer are diagnosed and managed. This article aims to describe the impact of COVID-19 on the practice of head and neck oncology, as well as provide evidence-based management recommendations for head and neck cancer during a public health emergency such as the current pandemic.
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Abstract
OBJECTIVE Endoscopic hydro-mastoidectomy, in which mastoidectomy is performed underwater, can be employed during transcanal endoscopic ear surgery for cholesteatoma removal. It was hypothesised that endoscopic hydro-mastoidectomy might take less time than endoscopic non-underwater mastoidectomy because the endoscope does not need to be removed for cleaning. METHODS This study compared the mastoidectomy and total operative durations between the endoscopic hydro-mastoidectomy (n = 25) and endoscopic non-underwater drilling (control, n = 8) groups. Moreover, it compared the size of resected areas of the external auditory canal between the two groups. RESULTS The mastoidectomy time of the endoscopic hydro-mastoidectomy group was significantly shorter than that of the control group (p < 0.01). The total operative time did not differ significantly between the endoscopic hydro-mastoidectomy and control groups (p = 0.17). The resected area was significantly larger in the endoscopic hydro-mastoidectomy group than in the control group (p < 0.05). CONCLUSION Endoscopic hydro-mastoidectomy enables more extensive bone resection within a shorter period.
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Bunch CM, Moore EE, Moore HB, Neal MD, Thomas AV, Zackariya N, Zhao J, Zackariya S, Brenner TJ, Berquist M, Buckner H, Wiarda G, Fulkerson D, Huff W, Kwaan HC, Lankowicz G, Laubscher GJ, Lourens PJ, Pretorius E, Kotze MJ, Moolla MS, Sithole S, Maponga TG, Kell DB, Fox MD, Gillespie L, Khan RZ, Mamczak CN, March R, Macias R, Bull BS, Walsh MM. Immuno-Thrombotic Complications of COVID-19: Implications for Timing of Surgery and Anticoagulation. Front Surg 2022; 9:889999. [PMID: 35599794 PMCID: PMC9119324 DOI: 10.3389/fsurg.2022.889999] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/05/2022] [Indexed: 12/12/2022] Open
Abstract
Early in the coronavirus disease 2019 (COVID-19) pandemic, global governing bodies prioritized transmissibility-based precautions and hospital capacity as the foundation for delay of elective procedures. As elective surgical volumes increased, convalescent COVID-19 patients faced increased postoperative morbidity and mortality and clinicians had limited evidence for stratifying individual risk in this population. Clear evidence now demonstrates that those recovering from COVID-19 have increased postoperative morbidity and mortality. These data-in conjunction with the recent American Society of Anesthesiologists guidelines-offer the evidence necessary to expand the early pandemic guidelines and guide the surgeon's preoperative risk assessment. Here, we argue elective surgeries should still be delayed on a personalized basis to maximize postoperative outcomes. We outline a framework for stratifying the individual COVID-19 patient's fitness for surgery based on the symptoms and severity of acute or convalescent COVID-19 illness, coagulopathy assessment, and acuity of the surgical procedure. Although the most common manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is COVID-19 pneumonitis, every system in the body is potentially afflicted by an endotheliitis. This endothelial derangement most often manifests as a hypercoagulable state on admission with associated occult and symptomatic venous and arterial thromboembolisms. The delicate balance between hyper and hypocoagulable states is defined by the local immune-thrombotic crosstalk that results commonly in a hemostatic derangement known as fibrinolytic shutdown. In tandem, the hemostatic derangements that occur during acute COVID-19 infection affect not only the timing of surgical procedures, but also the incidence of postoperative hemostatic complications related to COVID-19-associated coagulopathy (CAC). Traditional methods of thromboprophylaxis and treatment of thromboses after surgery require a tailored approach guided by an understanding of the pathophysiologic underpinnings of the COVID-19 patient. Likewise, a prolonged period of risk for developing hemostatic complications following hospitalization due to COVID-19 has resulted in guidelines from differing societies that recommend varying periods of delay following SARS-CoV-2 infection. In conclusion, we propose the perioperative, personalized assessment of COVID-19 patients' CAC using viscoelastic hemostatic assays and fluorescent microclot analysis.
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Affiliation(s)
- Connor M. Bunch
- Department of Emergency Medicine, Henry Ford Hospital, Detroit, MI, United States
| | - Ernest E. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Hunter B. Moore
- Department of Surgery, Ernest E. Moore Shock Trauma Center at Denver Health, Denver, CO, United States
| | - Matthew D. Neal
- Pittsburgh Trauma Research Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Anthony V. Thomas
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Nuha Zackariya
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Jonathan Zhao
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Sufyan Zackariya
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Toby J. Brenner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Margaret Berquist
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hallie Buckner
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Grant Wiarda
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Daniel Fulkerson
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Wei Huff
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Neurosurgery, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Hau C. Kwaan
- Division of Hematology and Oncology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Genevieve Lankowicz
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | | | | | - Etheresia Pretorius
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Maritha J. Kotze
- Division of Chemical Pathology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Muhammad S. Moolla
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Sithembiso Sithole
- Division of General Medicine, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - Tongai G. Maponga
- Division of Medical Virology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Douglas B. Kell
- Department of Physiological Sciences, Stellenbosch University, Stellenbosch, South Africa
- Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- The Novo Nordisk Foundation Centre for Biosustainability, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Mark D. Fox
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
| | - Laura Gillespie
- Department of Quality Assurance and Performance Improvement, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rashid Z. Khan
- Department of Hematology, Michiana Hematology Oncology, Mishawaka, IN, United States
| | - Christiaan N. Mamczak
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Orthopaedic Trauma, Memorial Hospital South Bend, South Bend, IN, United States
| | - Robert March
- Department of Cardiothoracic Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Rachel Macias
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Plastic and Reconstructive Surgery, St. Joseph Regional Medical Center, Mishawaka, IN, United States
| | - Brian S. Bull
- Department of Pathology and Human Anatomy, Loma Linda University School of Medicine, Loma Linda, CA, United States
| | - Mark M. Walsh
- Indiana University School of Medicine South Bend Campus, Notre Dame, IN, United States
- Department of Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, United States
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Zhang H, Li A, Zhu B, Niu Y, Ruan Z, Liu L, Gao X, Wang K, Yin L, Peng M, Xue Q, Leng H, Min B, Tian Q, Wang C, Yang Y, Zhu Z, Si T, Li W, Shangguan F, Hong X, Chang H, Song H, Li D, Jia L, Dong H, Wang Y, Cosci F, Wang H. COVID-19 pandemic: study on simple, easy, and practical relaxation techniques while wearing medical protective equipment. Psychol Med 2022; 52:1386-1392. [PMID: 32829730 PMCID: PMC7484302 DOI: 10.1017/s0033291720003220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND No studies have reported on how to relieve distress or relax in medical health workers while wearing medical protective equipment in coronavirus disease 2019 (COVID-19) pandemic. The study aimed to establish which relaxation technique, among six, is the most feasible in first-line medical health workers wearing medical protective equipment. METHODS This was a two-step study collecting data with online surveys. Step 1: 15 first-line medical health workers were trained to use six different relaxation techniques and reported the two most feasible techniques while wearing medical protective equipment. Step 2: the most two feasible relaxation techniques revealed by step 1 were quantitatively tested in a sample of 65 medical health workers in terms of efficacy, no space limitation, no time limitation, no body position requirement, no environment limitation to be done, easiness to learn, simplicity, convenience, practicality, and acceptance. RESULTS Kegel exercise and autogenic relaxation were the most feasible techniques according to step 1. In step 2, Kegel exercise outperformed autogenic relaxation on all the 10 dimensions among the 65 participants while wearing medical protective equipment (efficacy: 24 v. 15, no space limitation: 30 v. 4, no time limitation: 31 v. 4, no body position requirement: 26 v. 4, no environment limitation: 30 v. 11, easiness to learn: 28 v. 5, simplicity: 29 v. 7, convenience: 29 v. 4, practicality: 30 v. 14, acceptance: 32 v. 6). CONCLUSION Kegel exercise seems a promising self-relaxation technique for first-line medical health workers while wearing medical protective equipment among COVID-19 pandemic.
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Affiliation(s)
- Huiqin Zhang
- Department of Ultrasound, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Aimin Li
- Department of Respiratory and Critical Care Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Boheng Zhu
- Department of Psychology, University of Bologna, Bologna, Italy
| | - Yanyan Niu
- Department of Orthopedics, Jincheng People's Hospital, Shanxi Medical University, Jincheng, China
| | - Zheng Ruan
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lihong Liu
- Department of Neurology, Ningcheng Center Hospital, Ningcheng, Inner Mongolia, China
| | - Xiaoling Gao
- Department of Respiratory and Critical Care Medicine, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Kun Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Department of Neurology, Beijing Puren Hospital, Beijing, China
| | - Lu Yin
- Medical Research & Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
| | - Mao Peng
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qing Xue
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haixia Leng
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Baoquan Min
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Qing Tian
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
| | - Chunxue Wang
- Department of Neuropsychiatry and Behavioral Neurology and Clinical Psychology Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yuan Yang
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Zhu
- Department of Psychiatry, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tianmei Si
- Peking University Sixth Hospital, Institute of Mental Health, National Clinical Research Center for Mental Health Disorders & Key Laboratory of Mental Health, Ministry of Health, Peking University, Beijing, China
| | - Wei Li
- Department of Neurology, The Third People's Hospital of Chengdu, Chengdu, China
| | | | - Xia Hong
- Department of Neurology, Xiyuan Hospital, China Academy of Chinese Medical Science, Beijing, China
| | - Hong Chang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Haiqing Song
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongning Li
- Department of Neurology, Ningcheng Center Hospital, Ningcheng, Inner Mongolia, China
| | - Longbin Jia
- Department of Neurology, Jincheng People's Hospital, Shanxi Medical University, Jincheng, China
| | - Huiqing Dong
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yuping Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fiammetta Cosci
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Hongxing Wang
- Division of Neuropsychiatry and Psychosomatics, Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- Beijing Psychosomatic Disease Consultation Center, Xuanwu Hospital, Capital Medical University, Beijing, China
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A comparative study on the clinical profile of COVID-related and non-COVID-related acute invasive fungal rhino sinusitis. Eur Arch Otorhinolaryngol 2022; 279:5239-5246. [PMID: 35476130 PMCID: PMC9042656 DOI: 10.1007/s00405-022-07402-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
Purpose To compare the clinical profile of COVID-related and non-COVID-related rhino-orbito-cerebral invasive fungal disease. Methods We have compared the comorbidities, clinical features, course of the disease and outcome between COVID-related and non-COVID-related acute invasive fungal rhinosinusitis (AIFRS) of the rhino-orbito-cerebral form. Results HbA1c and blood sugar at the time of admission were significantly higher in the non-COVID group (P < 0.05). Duration of stay, and use of steroids were significantly higher among the COVID group (P < 0.05). The period of hospital stay was significantly higher in the COVID group. The overall survival in the COVID group was 67.57%. In the non-COVID group the overall survival was 61.90%.This study found that odds of surgical treatment was significantly lower among non-survivors (P < 0.05). Similarly patients who developed stages 3 & 4 of the disease had a lower survival rate (P < 0.05). Conclusion Diabetes mellitus is a key risk factor for the development of AIFRS. Pre-existing, grossly uncontrolled DM was the predisposing factor in the non-COVID group. Deranged glucose profile associated with COVID illness and its treatment and immunological disturbances in a vulnerable population, contributed to the surge in cases of AIFRS in the COVID-19-related group. Patients who underwent combined medical and surgical treatment had a significantly better outcome following AIFRS.
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Hansson A, Sunnergren O, Hammarskjöld A, Alkemark C, Taxbro K. Characteristics, complications, and a comparison between early and late tracheostomy: A retrospective observational study on tracheostomy in patients with COVID‐19‐related acute respiratory distress syndrome. Health Sci Rep 2022; 5:e595. [PMID: 35509382 PMCID: PMC9059198 DOI: 10.1002/hsr2.595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
Background and Aims As the coronavirus disease 2019 (COVID-19) pandemic spread worldwide in 2020, the number of patients requiring intensive care and invasive mechanical ventilation (IMV) has increased rapidly. During the pandemic, early recommendations suggested that tracheostomy should be postponed, as the potential benefits were not certain to exceed the risk of viral transmission to healthcare workers. The aim of this study was to assess the utility of tracheostomy in patients with COVID-19-related acute respiratory distress syndrome, in terms of patient and clinical characteristics, outcomes, and complications, by comparing between early and late tracheostomy. Methods A multicenter, retrospective observational study was conducted in Jönköping County, Sweden. Between 14 March 2020 and 13 March 2021, 117 patients were included. All patients ≥18 years of age with confirmed COVID-19, who underwent tracheostomy were divided into two groups based on the timing of the procedure (≤/>7 days). Outcomes including the time on IMV, intensive care unit (ICU) length of stay, and mortality 30 days after ICU admission, as well as complications due to tracheostomy were compared between the groups. Results Early tracheostomy (<7 days, n = 56) was associated with a shorter median duration of mechanical ventilation (7 [12], p = 0.001) as well as a shorter median ICU stay (8 [14], p = 0.001). The most frequent complication of tracheostomy was minor bleeding. With the exception of a higher rate of obesity in the group receiving late tracheostomy, the patient characteristics were similar between the groups. Conclusion This study showed that early tracheostomy was safe and associated with a shorter time on IMV as well as a shorter ICU length of stay, implicating possible clinical benefits in critically ill COVID-19 patients. However, it is necessary to verify these findings in a randomized controlled trial.
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Affiliation(s)
- Anna Hansson
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Faculty of Medicine and Health Sciences, School of Medicine Linköping University Linköping Sweden
| | - Ola Sunnergren
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
- Department of Otorhinolaryngology Region Jönköping County Jönköping Sweden
| | - Anneli Hammarskjöld
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Catarina Alkemark
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
| | - Knut Taxbro
- Department of Anaesthesiology and Intensive Care Medicine Ryhov County Hospital Jönköping Sweden
- Department of Biomedical and Clinical Sciences Linköping University Linköping Sweden
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Dhanani R, Wasif M, Pasha HA, Ghaloo SK, Hussain M, Shah Vardag AB. Ethical Dilemmas in the Management of Head and Neck Cancers in the Era of the COVID-19 Pandemic. Turk Arch Otorhinolaryngol 2022; 60:42-46. [PMID: 35634234 PMCID: PMC9103564 DOI: 10.4274/tao.2022.2021-11-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 12/01/2022] Open
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Quaranta N, Pantaleo A, Mincione A, Berrettini S, Cuda D, Paludetti G, Miani C, Petrone P, Vicini C, Cavallaro G. Recommendations from the Italian Society of Otolaryngology for clinical management during the SARS-CoV-2 pandemic. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:S94-S106. [PMID: 35763280 PMCID: PMC9988253 DOI: 10.14639/0392-100x-suppl.1-42-2022-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/02/2022] [Indexed: 11/23/2022]
Abstract
The coronavirus disease (COVID-19) pandemic has deeply impacted health, and
affects many different medical specialties. Head and neck surgeons, in
particular, have been recognised as one of the professionals at the highest risk
of infection through aerosol-generating procedures as part of their usual job.
The aim of this document is to review the current literature on the topic, to
provide useful recommendations to avoid both healthcare staff exposure to
contagion and the delay in the diagnosis and treatment of Head and Neck
diseases, in this new phase of COVID-19 pandemic.
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Affiliation(s)
- Nicola Quaranta
- Otolaryngology Unit, Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Alessandra Pantaleo
- Otolaryngology Unit, Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Antonio Mincione
- Department of Otorhinolaryngology, ASST-OVEST Milanese, Magenta, Italy
| | - Stefano Berrettini
- Otolaryngology, Audiology and Phoniatrics Unit, University of Pisa, Pisa, Italy
| | - Domenico Cuda
- Department of Otorhinolaryngology, "Guglielmo da Saliceto" Hospital, Piacenza, Italy
| | - Gaetano Paludetti
- Head & Neck Department, Università Cattolica del Sacro Cuore, Rome, Italy; Otorhinolaryngology and Head & Neck Surgery Unit, Fondazione Policlinico Universitario "A. Gemelli"- IRCCS, Rome, Italy
| | - Cesare Miani
- Department of Otorhinolaryngology, Hospital of Tolmezzo, ASUFC Udine, Udine, Italy
| | | | - Claudio Vicini
- Department of Head-Neck Surgery, Head-Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giada Cavallaro
- Otolaryngology Unit, Department of Basic Medical Sciences, Neuroscience, and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
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Ralli M, Colizza A, D’Aguanno V, Scarpa A, Russo G, Petrone P, Grassia R, Guarino P, Capasso P. Risk of SARS-CoV-2 contagion in otolaryngology specialists. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2022; 42:S58-S67. [PMID: 35763275 PMCID: PMC9137374 DOI: 10.14639/0392-100x-suppl.1-42-2022-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 has rapidly spread in the past two years with a profound impact on otolaryngological activities, which has undergone radical transformation to guarantee diagnostic and therapeutic procedures mainly in oncology and urgent patients, while ensuring protection for healthcare personnel and patients. During the initial phases of the pandemic, scheduled visits and elective surgeries were postponed leading to a delay in the diagnosis and treatment of several diseases, including head and neck cancer, with a shift toward more advanced cancer stages and more aggressive treatments. Aerosol and droplets are the main routes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), thus leading to a high risk of contagion during otolaryngology visits and surgery. Therefore, the correct use of personal protective equipment (PPE) and attention to procedure-specific risks and measures to avoid contagion are of utmost importance for healthcare professionals, and especially for those dealing with otolaryngology diseases. This narrative review highlights that otolaryngological activity implies a high risk of contagion during outpatient visit, surgery, or urgent conditions. The correct use of PPE, evaluation of procedure-specific risks and reduction of non-urgent procedures are considered the main strategies to limit contagion.
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Affiliation(s)
- Massimo Ralli
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | - Andrea Colizza
- Department of Sense Organs. Sapienza University of Rome, Rome, Italy
| | | | - Alfonso Scarpa
- Department of Medicine, Surgery and Dentistry. University of Salerno, Salerno, Italy
| | - Gennaro Russo
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | | | - Rosa Grassia
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
| | - Pierre Guarino
- Otolaryngology Unit, Santo Spirito Hospital, Pescara, Italy
| | - Pasquale Capasso
- Otolaryngology Unit, AORN dei Colli, V. Monaldi Hospital, Napoli, Italy
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Moser CH, Freeman-Sanderson A, Keeven E, Higley KA, Ward E, Brenner MJ, Pandian V. Tracheostomy care and communication during COVID-19: Global interprofessional perspectives. Am J Otolaryngol 2022; 43:103354. [PMID: 34968814 PMCID: PMC8695522 DOI: 10.1016/j.amjoto.2021.103354] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/13/2021] [Indexed: 12/26/2022]
Abstract
Objective Investigate healthcare providers, caregivers, and patient perspectives on tracheostomy care barriers during COVID-19. Study design Cross-sectional anonymous survey Setting Global Tracheostomy Collaborative Learning Community Methods A 17-item questionnaire was electronically distributed, assessing demographic and occupational data; challenges in ten domains of tracheostomy care; and perceptions regarding knowledge and preparedness for navigating the COVID-19 pandemic. Results Respondents (n = 115) were from 20 countries, consisting of patients/caregivers (10.4%) and healthcare professionals (87.0%), including primarily otolaryngologists (20.9%), nurses (24.3%), speech-language pathologists (18.3%), respiratory therapists (11.3%), and other physicians (12.2%). The most common tracheostomy care problem was inability to communicate (33.9%), followed by mucus plugging and wound care. Need for information on how to manage cuffs and initiate speech trials was rated highly by most respondents, along with other technical and knowledge areas. Access to care and disposable supplies were also prominent concerns, reflecting competition between community needs for routine tracheostomy supplies and shortages in intensive care units. Integrated teamwork was reported in 40 to 67% of respondents, depending on geography. Forty percent of respondents reported concern regarding personal protective equipment (PPE), and 70% emphasized proper PPE use. Conclusion While safety concerns, centering on personal protective equipment and pandemic resources are prominent concerns in COVID-19 tracheostomy care, patient-centered concerns must also be prioritized. Communication and speech, adequate supplies, and care standards are critical considerations in tracheostomy. Stakeholders in tracheostomy care can partner to identify creative solutions for delays in restoring communication, supply disruptions, and reduced access to tracheostomy care in both inpatient and community settings.
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Affiliation(s)
- Chandler H Moser
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States.
| | - Amy Freeman-Sanderson
- Graduate School of Health, University of Technology, Sydney, NSW, Australia; Royal Prince Alfred Hospital, Sydney, NSW, Australia; Critical Care Division, The George Institute for Global Health, Sydney, NSW, Australia.
| | - Emily Keeven
- Patient Care Services, Children's Mercy Hospitals and Clinics, University of Kansas Health System, Kansas City, MO, United States.
| | - Kylie A Higley
- Children's Mercy Hospitals and Clinics, University of Kansas Health System, Kansas City, MO, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States.
| | - Erin Ward
- Global Tracheostomy Collaborative, Raleigh, NC, United States; Family Liaison, Boston Children's Hospital Tracheostomy Team, Boston Children's Hospital, Boston, MA, United States; MTM-CNM Family Connection, Inc., Methuen, MA, United States
| | - Michael J Brenner
- Global Tracheostomy Collaborative, Raleigh, NC, United States; Department of Otolaryngology - Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States.
| | - Vinciya Pandian
- Department of Nursing Faculty, Johns Hopkins University School of Nursing; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States.
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