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Regas I, Pichonnat M, Pluvy I, Obert L, Bellemère P, Chaves C, Loisel F. The impact of COVID-19 on hand surgery: A French retrospective comparative study in COVID-19 and non-COVID-19 hand trauma centers. Orthop Traumatol Surg Res 2023; 109:103118. [PMID: 34656810 PMCID: PMC8516143 DOI: 10.1016/j.otsr.2021.103118] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION In 2020, the pandemic divided France into two zones: COVID-19 and non-COVID-19. The main objective of our study was to compare the variability of surgical and emergency consultation activity amongst two hand trauma centers, between the pandemic period and outside the pandemic period. The secondary objective was to identify at-risk patients in order to develop preventative strategies in hand trauma. METHODS This bi-centric retrospective study considered the epidemiology of admissions to trauma centers during the first French lockdown. The data were compared to the same period in 2019 (control group). Two thousand and fifty-five patients underwent consultations for hand or wrist trauma. RESULTS The first French lockdown was associated with a 35% decrease in hand and wrist injuries in the COVID-19 zone versus 24% in the non-COVID-19 zone, compared to the same period in 2019 (p<0.0001, 95% CI: 6.5-15.6). Comparing 2019 and 2020, the incidence of wounds significantly increased in the COVID-19 zone (58% vs. 78%, p<0.0001) and significantly decreased in the non-COVID-19 zone (55% vs. 50%, p<0.0001). Complex wounds (16% vs. 35%, p<0.0001 and 15% vs. 17%, p<0.0001) and open fractures (8% vs. 14%, p=0.019 and 4.5% vs. 5.3%, p<0.0001) significantly increased in both zones during the pandemic. The rate of male, non-manual workers injured in domestic accidents (76% vs. 36%, p<0.0001) was significantly increased in all areas. CONCLUSION Hand and wrist trauma was less frequent but more severe during the pandemic compared to the same period in 2019. By encouraging the public to be aware of the risks and the means to avoid trauma, such as better information and compliance with safety instructions, we could minimize these risks. This data can be useful in planning preventative strategies for future lockdowns. LEVEL OF EVIDENCE III; case-control study.
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Affiliation(s)
- Inès Regas
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France; Nanomédecine, imagerie, thérapeutique - EA 4662, université de Bourgogne Franche-Comté, sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France.
| | - Marine Pichonnat
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France; Nanomédecine, imagerie, thérapeutique - EA 4662, université de Bourgogne Franche-Comté, sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France
| | - Isabelle Pluvy
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France; Nanomédecine, imagerie, thérapeutique - EA 4662, université de Bourgogne Franche-Comté, sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France
| | - Laurent Obert
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France; Nanomédecine, imagerie, thérapeutique - EA 4662, université de Bourgogne Franche-Comté, sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France
| | - Philippe Bellemère
- Institut de la main Nantes Atlantique, boulevard Charles-Gautier, 44800 Saint-Herblain, France
| | - Camilo Chaves
- Institut de la main Nantes Atlantique, boulevard Charles-Gautier, 44800 Saint-Herblain, France
| | - François Loisel
- Service d'orthopédie, de traumatologie, de chirurgie plastique, reconstructrice et assistance main, CHU de Besançon, 3, boulevard Alexandre-Fleming, 25030 Besançon, France; Université de Bourgogne Franche-Comté, Sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France; Nanomédecine, imagerie, thérapeutique - EA 4662, université de Bourgogne Franche-Comté, sciences médicales et pharmaceutiques, 19, rue Ambroise-Paré, 25030 Besançon, France
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Ferorelli D, Moretti L, Benevento M, Mastrapasqua M, Telegrafo M, Solarino B, Dell’Erba A, Bizzoca D, Moretti B. Digital Health Care, Telemedicine, and Medicolegal Issues in Orthopedics: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15653. [PMID: 36497728 PMCID: PMC9735483 DOI: 10.3390/ijerph192315653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/17/2022] [Accepted: 11/22/2022] [Indexed: 06/17/2023]
Abstract
The use of technologies in medicine has great potential to reduce the costs of health care services by making appropriate decisions that provide timely patient care. The evolution of telemedicine poses a series of clinical and medicolegal considerations. However, only a few articles have dealt with telemedicine and orthopedics. This review assesses the ethical and medicolegal issues related to tele-orthopedics. A systematic review was performed including papers published between 2017 and 2021 focusing on the main medicolegal and clinical-governance aspects of tele-orthopedics. Most of the articles were published during the COVID-19 pandemic, confirming the impetus that the pandemic has also given to the spread of telemedicine in the orthopedic field. The areas of interest dealt with in the scientific evidence, almost exclusively produced in the USA, Europe, the UK, and Canada, are quality, patient satisfaction, and safety. The impact of telemedicine in orthopedics has not yet been fully evaluated and studied in terms of the potential medicolegal concerns. Most of the authors performed qualitative studies with poor consistency. Authorizations and accreditations, protection of patient confidentiality, and professional responsibility are issues that will certainly soon emerge.
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Affiliation(s)
- Davide Ferorelli
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Lorenzo Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marcello Benevento
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Maurizio Mastrapasqua
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Michele Telegrafo
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Biagio Solarino
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Alessandro Dell’Erba
- Section of Legal Medicine, Department of Interdisciplinary Medicine, University of Bari, 70121 Bari, Italy
| | - Davide Bizzoca
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Biagio Moretti
- Orthopedics and Trauma Unit, AOUC Policlinico di Bari, Department DiBraiN, University of Bari “Aldo Moro”, 70121 Bari, Italy
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3
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Glinkowski WM. Telemedicine Orthopedic Consultations Duration and Timing in Outpatient Clinical Practice During the COVID-19 Pandemic. Telemed J E Health 2022; 29:778-787. [PMID: 36251954 DOI: 10.1089/tmj.2022.0217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Introduction: Orthopedic associations advocated telemedicine during the COVID-19 pandemic to prevent disease transmission without hindering providing services to orthopedic patients. The study aimed to evaluate outpatient orthopedic teleconsultations' timing, length, and organizational issues in the circumstances of the COVID-19 pandemic based on consecutive orthopedic teleconsultations during the period of the first lockdown. Methods: Orthopedic telemedical consultations (OTCs) were provided from March 23, 2020, to June 1, 2020, and analyzed retrospectively based on mobile smartphone billing and electronic health record. Teleconsultations were based on the legal regulations of telemedicine services in Poland. Results: One thousand seventy-one patients (514 women and 557 men) with a mean age of 41.7 were teleconsulted. The length of the OTC averagely lasted 13.36 min (standard deviation 8.63). Consulted patients suffered from orthopedic disorders 65.3%, musculoskeletal injuries 26.3%, and other diseases 8.4%. Most OTCs were delayed (74.22%) concerning the planned schedule, with a median delay time of 12 min. Only 7.3% of teleconsultations were held precisely on time. Conclusions: Televisit length may not be dependent on gender, older age, or more diagnoses. The services like e-prescriptions, e-Referrals, e-Orders for orthotics, and e-Sick-leaves influence OTC length. Any extension of the patient's OTC may create a "snowball effect" of further delay for each subsequent OTC. Orthopedic teleconsultation requires new understanding and skills by both the patient and specialist physicians. Future research directions should concern the practical aspects of orthopedic teleconsultations, like legal, organizational, and technological issues and their implementation.
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Affiliation(s)
- Wojciech, M. Glinkowski
- Center of Excellence “TeleOrto” for Telediagnostics and Treatment of Disorders and Injuries of the Locomotor System, Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Warsaw, Poland
- Polish Telemedicine and eHealth Society, Warsaw, Poland
- Gabinet Lekarski, Warsaw, Poland
- Centrum Medyczne PZU Zdrowie, Warsaw, Poland
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4
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Orthopaedic, trauma surgery, and Covid-2019 pandemic: clinical panorama and future prospective in Europe. Eur J Trauma Emerg Surg 2022; 48:4385-4402. [PMID: 35523966 PMCID: PMC9075714 DOI: 10.1007/s00068-022-01978-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 04/16/2022] [Indexed: 12/13/2022]
Abstract
Purpose This study investigated the impact of the Covid-19 pandemic in Europe on consultations, surgeries, and traumas in the field of orthopaedic and trauma surgery. Strategies to resume the clinical activities were also discussed. Methods This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the 2020 PRISMA statement. All the comparative studies reporting data on the impact of Covid-19 in the field of orthopaedic and trauma surgery in Europe were accessed. Only comparative clinical studies which investigated the year 2020 versus 2019 were eligible. Results 57 clinical investigations were included in the present study. Eight studies reported a reduction of the orthopaedic consultations, which decreased between 20.9 and 90.1%. Seven studies reported the number of emergency and trauma consultations, which were decreased between 37.7 and 74.2%. Fifteen studies reported information with regard to the reasons for orthopaedic and trauma admissions. The number of polytraumas decreased between 5.6 and 77.1%, fractures between 3.9 and 63.1%. Traffic accidents admissions dropped by up to 88.9%, and sports-related injuries dropped in a range of 59.3% to 100%. The overall reduction of the surgical interventions ranged from 5.4 to 88.8%. Conclusion The overall trend of consultations, surgeries, and rate of traumas and fragility fractures appear to decrease during the 2020 European COVID pandemic compared to the pre-pandemic era. Given the heterogeneities in the clinical evidence, results from the present study should be considered carefully. Level of evidence Level IV, systematic review.
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5
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Occupational Hazards for the Practicing Orthopaedic Surgeon: A Standard Review. J Am Acad Orthop Surg 2022; 30:e607-e616. [PMID: 35171850 DOI: 10.5435/jaaos-d-21-00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/06/2021] [Indexed: 02/01/2023] Open
Abstract
Level V.
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6
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Management of resources for orthopedic oncology and trauma patients during COVID-19 pandemic: A retrospective cohort study. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh210318027o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction/Objective. This study aims to evaluate changes in surgical
strategy and orthopedic epidemiology, and to compare the frequency of
surgeries before and during the COVID-19 pandemic. Methods. For periods
from April 1 to May 31 in years 2019 and 2020, retrospective data on patient
demographics and types of orthopedic surgical procedures were obtained from
hospital databases in a tertiary referral hospital. Results. During the
COVID-19 pandemic, the most common orthopedic surgical procedures performed
were trauma surgery (n = 81), while other procedures were referred to
oncology (n = 19), biopsy (n = 11), debridement (n = 10), amputation (n =
6), surgery of dysplastic hip (n = 5) and knee ligament repair (n = 1). The
majority of trauma cases were hip fracture surgeries (n = 23). The mean age
of patients was 70.5 years. Sixty-three patients were female and seventy
were male. Only one patient had a history of COVID-19 infection. In the same
period during the year before the pandemic, 86 patients had trauma surgery,
while 49 had oncological surgery and the mean patient?s age was 54.5.
Sixty-two patients were female, and seventy-three were male in this group.
The number of tumor surgeries before the pandemic was higher compared to the
same period during the pandemic (p < 0.05). Conclusion. During the
pandemic, although all orthopedic surgeries decreased, the rate of
osteoporotic hip fractures surgery was similar as in pre-pandemic state.
This finding emphasizes the increased need to implement preventive measures
regarding hip fractures during lockdown periods. The relation of hip and
spine osteoporotic fractures surgery was not different before and during the
pandemic.
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7
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Jungwirth-Weinberger A, Boettner F, Kapadia M, Diane A, Chiu YF, Lyman S, Fontana MA, Miller AO. History of COVID-19 Was Not Associated with Length of Stay or In-Hospital Complications After Elective Lower Extremity Joint Replacement. Arthroplast Today 2021; 13:109-115. [PMID: 34909457 PMCID: PMC8660178 DOI: 10.1016/j.artd.2021.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/11/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Background The impact of previous SARS-CoV-2 infection on the morbidity of elective total joint arthroplasty (TJA) is not fully understood. This study reports on the association between previous COVID-19 disease, hospital length of stay (LOS), and in-hospital complications after elective primary TJA. Methods Demographics, comorbidities, LOS, and in-hospital complications of consecutive 340 patients with a history of COVID-19 were compared with those of 5014 patients without a history of COVID-19 undergoing TJA. History of COVID-19 was defined as a positive IgG antibody test for SARS-CoV-2 before surgery. All patients were given both antibody and polymerase chain reaction tests before surgery. Results Patients with a history of COVID-19 were more likely to be obese (43.8% vs 32.4%, P < .001), Black (15.6% vs 6.8%, P < .001), or Hispanic (8.5% vs 5.4%, P = .028) than patients without a history of COVID-19. COVID-19 treatment was reported by 6.8% of patients with a history of COVID-19. Patients with a history of COVID-19 did not have a significantly longer median LOS after controlling for other factors (for hip replacements, median 2.9 h longer, 95% confidence interval = −2.0 to 7.8, P = .240; for knee replacements, median 4.1 h longer, 95% confidence interval = −2.4 to 10.5, P = .214), but a higher percentage were discharged to a post–acute care facility (4.7% vs 1.9%, P = .001). There was no significant difference in in-hospital complication rates between the 2 groups (0/340 = 0.0% vs 22/5014 = 0.44%, P = .221). Conclusions We do not find differences in LOS or in-hospital complications between the 2 groups. However, more work is needed to confirm these findings, particularly for patients with a history of more severe COVID-19. Level of evidence II.
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Affiliation(s)
- Anna Jungwirth-Weinberger
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Cantonal Hospital Baden, Im Ergel 1, CH-5404 Baden, Switzerland
| | - Friedrich Boettner
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Milan Kapadia
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Alioune Diane
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Yu-Fen Chiu
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Stephen Lyman
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Mark Alan Fontana
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.,Weill Cornell Medical College, Department of Population Health Sciences, 1300 York Ave, New York, NY, 10065, USA
| | - Andy O Miller
- Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Kumar A, Sinha S, Jameel J, Kumar S. Telemedicine trends in orthopaedics and trauma during the COVID-19 pandemic: A bibliometric analysis and review. J Taibah Univ Med Sci 2021; 17:203-213. [PMID: 34690642 PMCID: PMC8521392 DOI: 10.1016/j.jtumed.2021.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 08/13/2021] [Accepted: 09/03/2021] [Indexed: 12/23/2022] Open
Abstract
Objectives In the wake of recent widespread interest in telemedicine during the COVID-19 era, many orthopaedic surgeons may be unfamiliar with clinical examination skills, patients’ safety, data security, and implementation-related concerns in telemedicine. We present a bibliometric analysis and review of the telemedicine-related publications concerning orthopaedics care during the COVID-19 pandemic. Such analysis can help orthopaedic surgeons become acquainted with the recent developments in telemedicine and its usage in regular orthopaedics practice. Methods We systematically searched the database of Thomson Reuters Web of Science for telemedicine-related articles in orthopaedics published during the COVID-19 pandemic. The selected articles were analysed for their source journals, corresponding authors, investigating institutions, countries of the corresponding authors, number of citations, study types, levels of evidence, and a qualitative review. Results Fifty-nine articles meeting the inclusion criteria were published in 28 journals. Three hundred forty-two authors contributed to these research papers. The United States (US) contributed the most number of articles to the telemedicine-related orthopaedics research during the COVID-19 era. All articles combined had a total of 383 citations and 66.1% were related to the Economic and Decision-making Analyses of telemedicine implementation. By and large, level IV evidence was predominant in our review. Conclusion Telemedicine can satisfactorily cover a major proportion of patients' visits to outpatient departments, thus limiting hospitals’ physical workload. Telemedicine has a potential future role in emergency orthopaedics and inpatient care through virtual aids. The issues related to patient privacy, data security, medicolegal, and reimbursement-related aspects need to be addressed through precise national or regional guidelines. Lastly, the orthopaedic physical examination is a weak link in telemedicine and needs to be strengthened.
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Affiliation(s)
- Arvind Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Siddhartha Sinha
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Javed Jameel
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Sandeep Kumar
- Department of Orthopaedics, Hamdard Institute of Medical Sciences and Research, New Delhi, India
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Mills S, Ibarzábal-Gil A, Martínez-Diez JM, Pallarés-Sanmartín J, Kalbakdij-Sánchez C, Rubio-Suárez JC, Losantos-García I, Rodríguez-Merchán EC. SARS-CoV-2 outbreak impact on a trauma unit. World J Orthop 2021; 12:751-759. [PMID: 34754831 PMCID: PMC8554347 DOI: 10.5312/wjo.v12.i10.751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/17/2021] [Accepted: 08/18/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND From February 2020 onwards, our country has been hit by the coronavirus severe acute respiratory syndrome-2 (SARS-CoV-2) infection. At a glance, hospitals became overrun and had to reformulate all the assistance guidelines, focusing on the coronavirus disease 2019. One year after the start of the pandemic, we present the results of a morbimortality study.
AIM To analyze how our department was affected by the outbreak in terms of morbimortality, and to analyze demographic data, admission to hospital-related data, and subgroups analyses for patients with hip fractures and polytrauma.
METHODS We designed a study comparing data from patients who were admitted to our unit due to a lower limb fracture or a high energy trauma during the pandemic (from March to April 2020) to those admitted during the same period in 2019 before the pandemic. during the pandemic situation. Both cohorts completed a minimum of 6 mo of follow-up.
RESULTS The number of patients admitted to hospital in 2020 was nearly half of those in 2019. Hip fractures in the elderly represented 52 out of 73 of the admitted patients. Twenty patients had a positive test result for SARS-CoV-2 infection. Patients with SARS-CoV-2 infection were admitted to the hospital for a longer time than the non-infected (P < 0.001), and had a higher mortality rate during hospitalization and follow-up (P = 0.02). Patients with a hip fracture associated with a severe respiratory syndrome were mostly selected for conservative treatment (P = 0.03).
CONCLUSION Mortality and readmission rates were higher in the 2020 cohort and during follow-up, in comparison with the cohort in 2019.
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Affiliation(s)
- Sarah Mills
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
| | | | | | | | | | | | | | - E Carlos Rodríguez-Merchán
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
- Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research – IdiPAZ (La Paz University Hospital – Autonomous University of Madrid), Madrid, Spain
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10
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Kim SH, Ryu D, Kim H, Lee K, Jeon CH, Choi HJ, Jang JH, Kim JH, Yeom SR. Effects of the Coronavirus Disease 2019 (COVID-19) Pandemic on Outcomes among Patients with Polytrauma at a Single Regional Trauma Center in South Korea. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2020.0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose The coronavirus disease 2019 (COVID-19) pandemic has necessitated a redistribution of resources to meet hospitals’ service needs. This study investigated the impact of COVID-19 on a regional trauma center in South Korea. Methods We retrospectively reviewed cases of polytrauma at a single regional trauma center in South Korea between January 20 and September 30, 2020 (the COVID-19 period) and compared them to cases reported during the same time frame (January 20 to September 30) between 2016 and 2019 (the pre-COVID-19 period). The primary outcome was in-hospital mortality, and secondary outcomes included the number of daily admissions, hospital length of stay (LOS), and intensive care unit (ICU) LOS. Results The mean number of daily admissions decreased by 15% during the COVID-19 period (4.0±2.0 vs. 4.7±2.2, p=0.010). There was no difference in mechanisms of injury between the two periods. For patients admitted during the COVID-19 period, the hospital LOS was significantly shorter (10 days [interquartile range (IQR) 4–19 days] vs. 16 days [IQR 8–28 days], p<0.001); however, no significant differences in ICU LOS and mortality were found. Conclusions The observations at Regional Trauma Center, Pusan National University Hospital corroborate anecdotal reports that there has been a decline in the number of patients admitted to hospitals during the COVID-19 period. In addition, patients admitted during the COVID-19 pandemic had a significantly shorter hospital LOS than those admitted before the COVID-19 pandemic. These preliminary data warrant validation in larger, multi-center studies.
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11
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Kovoor JG, Tivey DR, Ovenden CD, Babidge WJ, Maddern GJ. Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change. BJS Open 2021; 5:6342605. [PMID: 34355242 PMCID: PMC8342932 DOI: 10.1093/bjsopen/zrab048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.
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Affiliation(s)
- J G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - D R Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | - W J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - G J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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García de Cortázar Antolín U, Arrieta Salinas M, Escobar Sánchez D, Caba Doussoux P. [Survey about the impact of COVID-19 on the traumatology and orthopedic surgery departments in Spain]. J Healthc Qual Res 2021; 36:253-262. [PMID: 34305039 PMCID: PMC8221915 DOI: 10.1016/j.jhqr.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 12/23/2022]
Abstract
Introducción Se diseñó y se envió una encuesta para analizar el impacto de la pandemia por COVID-19 en el funcionamiento y desempeño de los servicios de Traumatología del Sistema Nacional de Salud y entidades privadas. Material y métodos Estudio descriptivo tipo encuesta difundida a los traumatólogos españoles a través de plataformas de Internet. Resultados Se obtuvieron 401 respuestas válidas. De estos traumatólogos, el 85,7% vio reducida su actividad quirúrgica entre el 50 y 100%. El 46% fue requerido para colaborar en asistencia de pacientes con COVID-19. Un 43% expresó que durante la primera ola de la pandemia su labor fue infrautilizada. El 52% modificó las indicaciones de tratamiento en diversas fracturas, con variabilidad entre centros y comunidades. Un 30% refiere estar satisfecho con la gestión del Estado y un 60% con la de su comunidad autónoma y centro. Un 70% no está satisfecho con la formación sobre el uso de mascarillas y equipos de protección individuales (EPI) y un 80% con la formación para tomar muestras. El 65% no ha dispuesto de equipos de protección para desempeñar su trabajo. Al 46% se le han denegado medidas de protección para tratar pacientes con sospecha o infección confirmada. Conclusión La pandemia por COVID-19 ha situado al Sistema Nacional de Salud en una situación de extrema gravedad. Analizando los resultados, se observa un uso ineficiente de los recursos humanos disponibles, un descontento generalizado y una ausencia de medios y medidas de protección y formación.
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Affiliation(s)
| | - M Arrieta Salinas
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basurto, Bilbao, España
| | - D Escobar Sánchez
- Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario de Basurto, Bilbao, España
| | - P Caba Doussoux
- Servicio de Cirugía Ortopédica y Traumatología, Hospital 12 de Octubre, Madrid, España
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Guindani N, De Pellegrin M. Developmental dysplasia of the hip screening during the lockdown for COVID-19: experience from Northern Italy. J Child Orthop 2021; 15:248-254. [PMID: 34211601 PMCID: PMC8223091 DOI: 10.1302/1863-2548.15.210007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Developmental dysplasia of the hip (DDH) ultrasound screening (USS), which is usually performed in Italy as an outpatient, was halted for an indefinite period in most centres during lockdown. The aim of this study was to analyze the effect of COVID-19 on DDH-USS, in two paediatric orthopaedic centres in one of the most critical areas of the western World. METHODS An academic teaching hospital and paediatric trauma centre (T) and a University hospital and DDH referral centre (H), classified as national COVID-19 hubs, were involved. Graf's method was applied in both centres. In T, paediatricians directly referred only patients with delayed DDH-USS or suspicious unstable hips; in H, paediatricians or parents could directly refer to the screening service. RESULTS The mean age of the 95 patients (190 hips) who were referred for DDH-USS in T, was 3.85 months (0.1 to 7.4); 175 were type I, nine were type IIa (+ and -), five type D and one type IV. In H, the screened patients in 2020 were only 78% of the same period in 2019. A total of 28 patients with 32 hips (8 IIb, 5 IIc, 8 D, 11 III) had late diagnosis at a mean age of 114 days (96 to 146). In the same period in 2019 only eight patients with 11 hips (8 IIb, 1 D, 1 III, 1 IV) at a mean age of 142 days (92 to 305) had late diagnosis. CONCLUSION DDH-USS was the only screening in newborns which halted during lockdown. Few centres, which still performed diagnosis and treatment, were overloaded causing a delay in DDH management. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nicola Guindani
- Orthopedic and Traumatology, Regional Health Care and Social Agency Papa Giovanni XXIII, Bergamo, Italy,Correspondence should be sent to: Nicola Guindani, Orthopedic and Traumatology, Regional Health Care and Social Agency Papa Giovanni XXIII, Bergamo, Italy. E-mail:
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14
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Aprato A, Guindani N, Massè A, Castelli CC, Cipolla A, Antognazza D, Benazzo F, Bove F, Casiraghi A, Catani F, Dallari D, D’Apolito R, Franceschini M, Momoli A, Ravasi F, Rivera F, Zagra L, Zatti G, D’Angelo F. Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5340. [PMID: 34067826 PMCID: PMC8156362 DOI: 10.3390/ijerph18105340] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Background: From 10 March up until 3 May 2020 in Northern Italy, the SARS-CoV-2 spread was not contained; disaster triage was adopted. The aim of the present study is to assess the impact of the COVID-19-pandemic on the Orthopedic and Trauma departments, focusing on: hospital reorganization (flexibility, workload, prevalence of COVID-19/SARS-CoV-2, standards of care); effects on staff; subjective orthopedic perception of the pandemic. Material and Methods: Data regarding 1390 patients and 323 surgeons were retrieved from a retrospective multicentric database, involving 14 major hospitals. The subjective directors' viewpoints regarding the economic consequences, communication with the government, hospital administration and other departments were collected. Results: Surgical procedures dropped by 73%, compared to 2019, elective surgery was interrupted. Forty percent of patients were screened for SARS-CoV-2: 7% with positive results. Seven percent of the patients received medical therapy for COVID-19, and only 48% of these treated patients had positive swab tests. Eleven percent of surgeons developed COVID-19 and 6% were contaminated. Fourteen percent of the staff were redirected daily to COVID units. Communication with the Government was perceived as adequate, whilst communication with medical Authorities was considered barely sufficient. Conclusions: Activity reduction was mandatory; the screening of carriers did not seem to be reliable and urgent activities were performed with a shortage of workers and a slower workflow. A trauma network and dedicated in-hospital paths for COVID-19-patients were created. This experience provided evidence for coordinated responses in order to avoid the propagation of errors.
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Affiliation(s)
- Alessandro Aprato
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Nicola Guindani
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandro Massè
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Claudio C. Castelli
- Regional Health Care and Social Agency Papa Giovanni XXIII, 25127 Bergamo, Italy;
| | - Alessandra Cipolla
- Azienda Ospedaliera CTO-CRF Maria Adelaide, Università degli Studi di Torino, 10126 Turin, Italy; (A.A.); (A.M.); (A.C.)
| | - Delia Antognazza
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
| | - Francesco Benazzo
- Fondazione Poliambulanza Istituto Ospedaliero, 25124 Brescia, Italy;
| | - Federico Bove
- Azienda Ospedaliera Niguarda Ca’ Granda, 20162 Milano, Italy;
| | | | - Fabio Catani
- Orthopaedics and Traumatology, Modena University Hospital, Università degli Studi di Modena e Reggio Emilia, 41121 Modena, Italy;
| | - Dante Dallari
- IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy;
| | - Rocco D’Apolito
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | | | - Alberto Momoli
- Orthopaedics and Traumatology, San Bortolo Hospital, 36100 Vicenza, Italy;
| | - Flavio Ravasi
- ASST-Melegnano-Martesana, Ortopedia di Cernusco sul Naviglio, 20070 Vizzolo Predabissi, Italy;
| | | | - Luigi Zagra
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milano, Italy; (R.D.); (L.Z.)
| | - Giovanni Zatti
- Orthopaedics and Traumatology, University of Milano–Bicocca, 20900 Monza, Italy;
| | - Fabio D’Angelo
- Department of Biotechnology and Life Sciences (DBSV), Università degli Studi dell’Insubria, 21100 Varese, Italy; (D.A.); (F.D.)
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Saad-Ilyas M, Zehra U, Khan UU, Mohammad I, Muhammad R, Aziz A. Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study. Malays Orthop J 2021; 15:72-78. [PMID: 33880151 PMCID: PMC8043628 DOI: 10.5704/moj.2103.011] [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: 11/18/2022] Open
Abstract
Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID-19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.
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Affiliation(s)
- M Saad-Ilyas
- Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - U Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - U U Khan
- Department of Orthopaedic, Kabir Medical College, Peshawar, Pakistan
| | - I Mohammad
- Trauma Centre, Makhdoom Aali, Tehsil Dunyapur, Pakistan
| | - R Muhammad
- Department of Orthopaedics, Chandka Medical College, Larkana, Pakistan
| | - A Aziz
- Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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Tarun V, Anurag T, Yugal K, Raj K, Lalit M. Orthopaedic operating room considerations in covid-19 pandemic: A systematic review. ACTA ACUST UNITED AC 2021; 8:91-95. [PMID: 34307063 PMCID: PMC7900750 DOI: 10.1016/j.jajs.2021.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 02/19/2021] [Indexed: 01/15/2023]
Abstract
Purpose Worldwide COVID 19 has affected the medical practices and Orthopaedics is not any different. Despite risk, the surgeons cannot deny the surgical procedure on patients with suspected or confirmed COVID 19 infection. The purpose of this manuscript is to review various operating room measures which are recommended and being followed to carry out orthopaedic surgeries in the current scenario of COVID 19 pandemic. The information would be useful for orthopaedic surgeons to carry out safe surgical practice for reducing the transmission of COVID 19 infection. Method ology: A systematic literature search was performed using search engines- PubMed, Google Scholar and Scopus from January to August 2020 for relevant research articles. The keywords utilized for systematic literature search were "COVID 19", "Corona virus" and "Operating room", "Orthopaedic procedure" in 4 combinations. Duplicates were excluded. Further sorting was done according to the pre-set inclusion and exclusion criteria. Original articles pertaining to orthopaedic surgery and operating room in COVID 19 and available in English language were included. Editorials, case reports, other speciality articles were excluded. Results 16 articles were finally included in review after screening for titles, abstracts and full texts. The information obtained is presented as a narrative review. Conclusion Various important recommendations include use of negative pressure OR, HEPA filters, dedicated separate OR for COVID positive and suspected patients with well defined separate corridors for transport, avoid AGP wherever possible, minimize the number of assistants and staff and follow strict sanitation protocols after each surgery. A well planned systematic approach is warranted to mitigate the risk of transmission of COVID 19 while carrying out orthopaedic surgeries.
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Affiliation(s)
- Verma Tarun
- Department of Orthopaedics, Medical College Baroda and SSG Hospital, Vadodara, Gujarat, India
| | - Tiwari Anurag
- Department of Orthopaedics, Gandhi Medical College, Bhopal, India
| | - Karkhur Yugal
- Orthopaedics and Joint Replacement, Managing Head- Orthopaedic Services, Orthocure Clinics Pvt Ltd, Gurugram, India
| | - Kumar Raj
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Maini Lalit
- Department of Orthopaedics, Maulana Azad Medical College, New Delhi, India
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Holmes N, Virani S, Relwani J. Hospital transmission rates of the SARS-CoV 2 disease amongst orthopaedic in-patients in a secondary care centre: A quantitative review. J Clin Orthop Trauma 2021; 16:43-48. [PMID: 33519136 PMCID: PMC7834768 DOI: 10.1016/j.jcot.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Orthopaedic practice changed during COVID-19 with elective work ceasing, trauma reducing and work forces redistributed to medical areas. During the United Kingdom lockdown, hospitals were stretched thinly with admissions of SARS-CoV-2 positive patients. AIM Evaluate orthopaedic admissions to a district general hospital during lockdown and the volume of those who subsequently were found to be COVID-19 positive. METHOD Retrospective study of patients admitted under trauma and orthopaedics between March 23, 2020-June 18, 2020. Data includes; diagnosis, COVID-19 swab dates, results and mortality using orthopaedic admission sheets, patient and pathology electronic recording system. RESULTS 3/4 of admitted patients tested negative for SARS-CoV-2 initially. Of these 240 patients, 12.5% subsequently tested positive during their stay, often within one week of their admission. 17.8% of patients were never tested. 7.8% mortality rate of which 48% were neck of femur fracture (NOF#) patients. 28 NOF# were confirmed COVID-19 positive; mortality rate of 21.4%. 87 NOF# were COVID-19 negative; mortality rate 6.9%. Mortality relative risk (RR) for NOF# and COVID-19 positive was 2.6. COVID-19 positive mortality 27% as compared to 4% in COVID-19 negative patients. Patients who acquired COVID-19 whilst in hospital had a mortality relative risk 6.4. CONCLUSION 12.5% orthopaedic in-hospital viral transmission rate amongst orthopaedic patients despite the segregation measures taken, possibly due to asymptomatic health care workers or inpatients awaiting swab results. We emphasize the importance of testing all inpatients and regular testing of healthcare workers.
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Guo X, Feng Y, Sun T, Feng S, Tang J, Chen L, Cao X, Lin H, He X, Li M, Zhang Z, Yin G, Mei X, Huang H. Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version). JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Treatment of spinal cord injury (SCI) remains challenging. Considering the rapid developments in neurorestorative therapies for SCI, we have revised and updated the Clinical Therapeutic Guidelines for Neurorestoration in Spinal Cord Injury (2016 Chinese version) of the Chinese Association of Neurorestoratology (Preparatory) and China Committee of International Association of Neurorestoratology. Treatment of SCI is a systematic multimodal process that aims to improve survival and restore neurological function. These guidelines cover real-world comprehensive neurorestorative management of acute, subacute, and chronic SCI and include assessment and diagnosis, pre-hospital first aid, treatment, rehabilitation, and complication management.
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Prioritising of hip and knee arthroplasty procedures during the COVID-19 pandemic: the European Hip Society and the European Knee Associates Survey of Members. Knee Surg Sports Traumatol Arthrosc 2021; 29:3159-3163. [PMID: 33433635 PMCID: PMC7802426 DOI: 10.1007/s00167-020-06379-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE During the COVID-19 pandemic there has been a massive reduction of arthroplasty services due to reallocation of hospital resources. The unique challenge for clinicians has been to define which arthroplasty patients most urgently require surgery. The present study aimed to investigate priority arthroplasty procedures during the pandemic and in the reinstatement period from the surgeon's perspective. MATERIAL AND METHODS An online survey was conducted among members of the European Hip Society (EHS), European Knee Associates (EKA) and other invited orthopaedic arthroplasty surgeons (experts) from across the world. The survey consisted of 17 different arthroplasty procedures/indications of which participants were asked to choose and rank the most important 10. RESULTS Four hundred and thirty-nine arthroplasty surgeons from 44 countries responded. The EHS and EKA had a 43% response rate of members. In weighted average points, the majority of respondents (67.5 points) ranked 'acute fractures requiring arthroplasty (Periprosthetic fractures, THA/hemi-arthroplasty for femoral neck fractures)' as priority indication number one, followed by 'first-stage explantations for acute PJI (periprosthetic joint infection)' in second place and priority indication (45.9 points) three as 'one-stage revision for acute PJI' (39.7 points). CONCLUSIONS There was agreement that femoral neck fractures, periprosthetic fractures, and acute infections should be prioritised and cannot be postponed in the setting of the COVID-19 pandemic. As arthroplasty procedures are being resumed in most countries now, there has also been a relaxation of lockdown rules in most countries, which might cause a so-called second wave of the pandemic. Therefore, the results of the current study present a proposal by experts as to which operations should be prioritised in the setting of a second wave of the pandemic.
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Tekalegn Y, Sahiledengle B, Bekele K, Tesemma A, Aseffa T, Teferu Engida Z, Girma A, Tasew A, Zenbaba D, Aman R, Seyoum K, Woldeyohannes D, Legese B. Correct Use of Facemask Among Health Professionals in the Context of Coronavirus Disease (COVID-19). Risk Manag Healthc Policy 2020; 13:3013-3019. [PMID: 33376425 PMCID: PMC7755342 DOI: 10.2147/rmhp.s286217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/17/2020] [Indexed: 01/16/2023] Open
Abstract
Purpose Coronavirus disease (COVID-19) mainly spreads through respiratory droplets and close contacts. Wearing a facemask and other personal protective equipment (PPE) is essential in preventing the spread of COVID-19. However, the use of PPE alone does not provide a sufficient level of protection, and correct use and disposal are required. Hence, this study aimed to assess health professionals’ practice regarding proper use of facemask in the perspectives of COVID-19 prevention. Methods A web-based online survey was conducted from June 3, 2020, to August 11, 2020, to assess health professionals’ practice regarding correct use of facemask. The survey tool was prepared in Google form and distributed to the health professionals through their emails and social media pages. Data were analyzed using STATA version 14. A descriptive result was reported using frequency tables and bar charts. Factors associated with correct use of facemask were assessed using binary logistic regression model. Results A total of 368 health professionals have participated in this study. All of the participants’ work involves direct contact with patients and 98 (26.6%) of them work in direct contact with COVID-19 patients daily. The level of overall correct use of facemask was 10.1% (95% CI: 7.4–13.6). Two hundred fifty-five (69.3%) do not perform hand hygiene before wearing a facemask and 238 (64.7%) do not perform hand hygiene after removing the facemask. Three hundred twenty-three (87.8%) of the study participants reuse disposable facemasks. The odds of practicing correct use of facemask were more than two times higher among health professionals who received training related to personal protective equipment utilization (AOR= 2.2, 95% CI: 1.1–4.5) compared to their counterparts. Conclusion This study revealed that health professionals’ practice regarding the correct use of facemask in the context of COVID-19 prevention is very low. Receiving training related to proper utilization of personal protective equipment was found to favor the correct use of facemask. In this regard, health authorities should provide training to enable the rational and correct use of facemask among healthcare workers.
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Affiliation(s)
- Yohannes Tekalegn
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Kebebe Bekele
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Abdi Tesemma
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Tesfaye Aseffa
- Department of Nursing, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Zinash Teferu Engida
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Alemu Girma
- Department of Surgery, Madda Walabu University, Goba Referral Hospital, School of Medicine, Bale-Goba, Ethiopia
| | - Alelign Tasew
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Demisu Zenbaba
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Rameto Aman
- Department of Public Health, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Kenbon Seyoum
- Department of Midwifery, Madda Walabu University, Goba Referral Hospital, School of Health Sciences, Bale-Goba, Ethiopia
| | - Demelash Woldeyohannes
- Department of Public Health, Wachemo University, School of Medicine and Health Sciences, Hossana, Ethiopia
| | - Birhan Legese
- Department of Public Health, Ambo University, School of Medicine and Health Sciences, Ambo, Ethiopia
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