Challenges to delivering pediatric surgery services in the midst of COVID 19 crisis: experience from a tertiary care hospital of Pakistan

Geospatial modelling of ambient air pollutants and chronic obstructive pulmonary diseases at regional scale in Pakistan

Pakistan is among the South Asian countries mostly vulnerable to the negative health impacts of air pollution. In this context, the study aimed to analyze the spatiotemporal patterns of chronic obstructive pulmonary disease (COPD) incidence and its relationship with air pollutants including aerosol absorbing index (AAI), carbon monoxide, sulfur dioxide (SO2), and nitrogen dioxide. Spatial scan statistics were employed to identify temporal, spatial, and spatiotemporal clusters of COPD. Generalized linear regression (GLR) and random forest (RF) models were utilized to evaluate the linear and non-linear relationships between COPD and air pollutants for the years 2019 and 2020. The findings revealed three spatial clusters of COPD in the eastern and central regions, with a high-risk spatiotemporal cluster in the east. The GLR identified a weak linear relationship between the COPD and air pollutants with R2 = 0.1 and weak autocorrelation with Moran's index = -0.09. The spatial outcome of RF model provided more accurate COPD predictions with improved R2 of 0.8 and 0.9 in the respective years and a very low Moran's I = -0.02 showing a random residual distribution. The RF findings also suggested AAI and SO2 to be the most contributing predictors for the year 2019 and 2020. Hence, the strong association of COPD clusters with some air pollutants highlight the urgency of comprehensive measures to combat air pollution in the region to avoid future health risks.

The Use of Tele-Education in Medicine, During and Beyond the COVID-19 Pandemic: A Commentary

Coronavirus disease 2019 (COVID-19), a disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged initially as an isolated illness in December 2019 and later progressed to a global pandemic. Hard-hit areas were lockdown, massively disrupting medical education activities. Tele-education, previously used as a means of long-distance education emerged as a solution in the field of medical education. Tele-rotations for medical students, journal clubs and lectures via Microsoft teams, medical conferences via zoom, residency, and fellowship interviews online, all emerged during this pandemic. Some medical students and trainees found it enjoyable, cost-effective, time saving, feasible, unbiased, and preferred mode of education. Challenges related to supervision, availability, affordability, diminished communication, disturbance of streaming, or distractions due to environment. Tele-education has had a boom in the era of COVID-19. Research is needed further on effective mentoring and supervision of trainees via tele educational teaching models.

Unveiling Maternal Health Insights During the COVID-19 Pandemic in Pakistan: Using Causal Loop Diagrams to Illuminate and Prevent Unintended Policy Effects

The authors explain that using causal loop diagrams can visualize retrospectively the unintended negative consequences of COVID-19 related policies on maternal health and has potential to be used prospectively to foster decision-making to prevent those consequences.

Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19-Related Surgical Backlog: Cross-sectional Study

BACKGROUND

During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19-related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19-related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra).

OBJECTIVE

In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation.

METHODS

Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists.

RESULTS

A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01).

CONCLUSIONS

Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff.

Perioperative Management for Emergency Surgery in Pediatric Patients with COVID-19: Retrospective Observational Study

Background

The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning.

Aim

To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country.

Methods

The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines.

Results

About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%.

Discussions

Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment  during these early pandemic times are often not efficient.

Conclusion

The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.

Challenges of the COVID-19 Pandemic for the Work–Family Balance of Pediatric Surgeons

The COVID-19 pandemic has been a great challenge, especially for families. We aimed to analyze the impact of the pandemic on childcare for and the work–family balance of pediatric surgeons in Germany. An anonymized questionnaire on the working and familial situation before and during the COVID-19 pandemic was sent to the members of the German Society of Pediatric Surgery and trainees in pediatric surgery (April–July 2021). One-hundred-fifty-three participants (59% female) completed the questionnaire. A total of 16% of the males and 62% of the females worked part-time. Most (68%) had underage children. During the COVID-19 pandemic, 36% reported a decrease in patients and interventions, and 55% reported an increase in the organizational work-related burden. Childcare for underage children during lockdown was organized mainly with the help of institutional emergency childcare (45%), staying home (34%), one parent working from a home office (33%), or staying home by themselves (34%). Before the lockdown, 54% reported a good work–family balance. During the lockdown, this worsened by 42%. Most of the families had to organize themselves. Different means such as a home office, flexible working hours, and different models for childcare can help to improve the situation.

Impact of a same day admission project in reducing the preoperative bed occupancy demand in a pediatric inpatient hospital

Background

A same day admission approach was established for pediatric patients undergoing elective surgery owing to an increase in demand for bed availability and the need for medical, logistical, psychological, and fiscal improvements. This study aimed to assess the effectiveness of the same day admission approach for reducing demand for preoperative bed occupancy in pediatric inpatient units.

Method

Data on elective surgery patients considered for same day admission were prospectively collected in an Excel spreadsheet.

Results

Same day admission patients numbered 269 (25.87%; n = 1040), 461 (41.7%; n = 1104), 382 (38.67%; n = 998), and 560 (44.20%; n = 1267) in 2018, 2019, 2020, and 2021, respectively. Over the 4-year period between 2018 and 2021, pediatric orthopedic surgeries accounted for the majority of same day admissions (29.72%; n = 497), followed by ear, nose, and throat (21.30%; n = 356), general (16.99%; n = 284), plastic (14.53%; n = 243); urology (9.87%; n = 165); optometry and ophthalmology (3.77%; n = 63); neuro (2.51%; n = 42), and dental (1.31%; n = 22) surgeries. The total number of days of saved preoperative beds over the 4-year period was 1672 days (an average of 418 hospital days per year).

Conclusions

This study showed that same day admission approach should be implemented in pediatrics institutions to reduce hospital bed demand. The implementation of this initiative is widely variable between specialties due to interlinked medical, operational, and logistical factors.

Level of Evidence

III.

•

Same day admission is a model to reduce the average length of hospital stay for surgical patients and to reduce costs.

•

The study is confirming the feasibility of applying the same day admissions' project in the pediatric population.

•

This study compares the applicability of the same day admission’s project across pediatrics’ surgical subspecialties.

•

This study proves the possibility of applying same day admission's project in the local region.

Estratégias organizacionais no centro cirúrgico diante da pandemia de COVID 19: uma revisão integrativa

Introdução: os sistemas de saúde foram desafiados a desenvolver estratégias organizacionais para a prestação de cuidados cirúrgicos. Objetivo: apresentar as estratégias dos serviços de saúde no que se refere às práticas de cuidados cirúrgicos em tempos de pandemia de COVID-19. Materiais e métodos: revisão integrativa, desenvolvida em seis etapas, cuja busca dos artigos ocorreu na Biblioteca Virtual de Saúde, SciELO, PubMed e ScienceDirect. Os descritores controlados em saúde adotados foram “Centros Cirúrgicos” e “Infecções por Coronavírus”, de acordo com os sistemas DeCS e MeSH Terms. Foram selecionados 60 artigos de 405 estudos encontrados. Resultados: as principais estratégias utilizadas pelos serviços de saúde foram: a suspensão e adiamento de cirurgias eletivas durante as ondas de contágio da doença; e a triagem cuidadosa dos pacientes para COVID-19 antes e após intervenções cirúrgicas. Discussão: a suspensão e o adiamento de cirurgias eletivas devem ser avaliados com cautela pela equipe de saúde, de forma individualizada, para cada paciente, visto que situações clínicas não urgentes podem agravar ao longo do tempo, aumentando as chances de morbimortalidade desses pacientes. Conclusão: a triagem dos pacientes e dos profissionais da saúde para COVID-19 são estratégias importantes para evitar a contaminação desses sujeitos. A suspensão e o adiamento de cirurgias eletivas, durante as ondas de contágio por COVID-19, são recomendados para aumentar a capacidade de leitos disponíveis para pacientes graves hospitalizados por essa doença. Essa recomendação também auxilia no remanejamento de profissionais desse setor para as unidades com a demanda de cuidados de saúde mais elevada.

Challenges for maintaining surgical care practices in the COVID-19 pandemic: an integrative review

OBJECTIVES

To present the knowledge produced on challenges of health services for maintaining surgical care practices in times of the COVID-19 pandemic.

METHODS

This is an integrative literature review, performed with descriptors 'Operating rooms' and 'Coronavirus Infections' in the MEDLINE/PubMed Central, IBECS, LILACS, BDENF, Coleta SUS, BIGG, BINACIS, SciELO, PubMed, Science Direct, and Cochrane Library databases.

RESULTS

Of the 405 studies analyzed, 27 met the inclusion criteria. The main challenges for surgical services during the pandemic were: (i) rearrangement of general practice in surgical units; (ii) administration and management of resources and elective surgeries; (iii) follow-up and control of preoperative patients to medium term; (iv) maintenance of patients' and health professionals' autonomy and mental health in this context; and (v) teaching health residents in the operating room.

CONCLUSIONS

For surgical care services, the challenges caused by managing the high demand of patients in need of care resulted in the transfer of own resources to other units and the consequent hiring of professionals to meet the demand for these services due to the damming of postponed elective surgeries. This knowledge will allow us to propose strategies in decision making in this scenario, considering the new waves that may arise from this disease.

Surgeon, patient, and caregiver perspective of pediatric surgical telemedicine in the COVID-19 pandemic era

PURPOSE

Adoption of telemedicine (TME) in surgical specialties, prior to the COVID-19 pandemic, has previously been slow. The purpose of this prospective, observational, single institution study is to evaluate surgeon and caregiver perspectives of TMEs during the pandemic.

METHODS

Surveys were distributed to surgical faculty regarding perceptions of TME early during the pandemic and 2 months later. Caregivers (or patients > 18 years old) were asked after each TME to complete a survey regarding perceptions of TMEs.

RESULTS

Surveys were distributed to 73 surgeons. Response rates were 71% initially and 63% at follow-up. Sixty-eight percent reported no prior TME experience. No significant differences were noted in the overall satisfaction. An inverse relationship between surgeon age and satisfaction at the follow-up survey was identified (p = 0.007). Additional surveys were distributed to 616 caregivers or patients (response rate 13%). Seventy-two percent reported no prior experience with TME and 79% described TME as similar to an in-person visit. Audiovisual satisfaction of the TME was higher in greater income households (p = 0.02).

CONCLUSIONS

Pre-pandemic experience with TME was low in both groups; however, experiences were perceived as satisfactory. Positive experiences with TME may encourage increased utilization in the future, although demographic variations may impact satisfaction with TME.

TRIAL REGISTRATION

Unique identifier NCT04376710 at Clinicaltrials.gov (5/6/2020).

Unequal impact of the COVID-19 pandemic on paediatric cancer care: a population-based cohort study in China

Background

The COVID-19 pandemic has had widespread adverse collateral effects on health care delivery for non-COVID-19 disease conditions. Paediatric oncology care is reliant on prompt testing and diagnosis and on timely and coordinated multimodal treatment, all of which have been impacted by the pandemic. This study aimed to quantify the initial and enduring effects of the COVID-19 pandemic on the utilization of paediatric cancer care and to examine whether the pandemic differentially impacted specific demographic groups.

Method

We performed an interrupted time series analysis using negative binomial regression to estimate the change in the monthly admissions for paediatric cancer patients (Age 0-17) associated with the COVID-19 pandemic and subsequent lockdown policies. We obtained data from deidentified individual electronic medical records of paediatric cancer inpatients admitted between January 1, 2015 and May 31, 2021 to a tertiary hospital that provides general and specialized healthcare services to an estimated population of 8.4 million in Jining China. Relative risk (RR) estimates representing monthly admissions compared with expected admissions had the pandemic not occurred were derived. The number of inpatient admissions lost due to the pandemic were estimated.

Findings

The overall denominator for the paediatric population was 1 858 209 individuals in January 2015, which increased to 2 043 803 by May 2021. In total, there were 4 901 admissions for paediatric cancer during the study period, including 1 479 (30%) since February 2020 when the lockdown was implemented. A 33% reduction (95% CI: -43% to -22%) in admissions was observed in February 2020, with the largest relative reduction (-48%, 95% CI: -64% to -24%) among first-time admissions and admissions for patients from rural districts (-46%, 95% CI: -55% to -36%). Admissions quickly rebounded in March 2020 when many government-imposed mobility restrictions were lifted, and continued to resume gradually over time since April 2020, leading to a full recovery as of November 2020. However, the recovery for first-time admissions, and among female patients, younger patients (<5 years) and patients from rural districts was slower over time and incomplete (first-time admissions and rural patients) as of January 2021.

Interpretation

The COVID-19 pandemic has had substantial impact on the timely utilization of paediatric oncology services in China, particularly in the early stage of the first wave. Importantly, some population groups were disproportionately affected and the recovery of admissions among those subgroups has been slow and incomplete, warranting targeted approaches to address potentially exacerbated gender and socio-economic inequalities in access to healthcare resources.

Challenges and Changes in Pediatric Surgical Practice during the COVID-19 Pandemic Era

Aim

Working practices in pediatric surgery underwent enormous changes during the era of the COVID-19 pandemic. While certain surgical conditions in children can be managed temporarily with nonsurgical options, most neonates with congenital surgical malformations require emergent operations. We discuss the challenges faced; measures adopted in dealing with surgical emergencies and analyze the diagnoses and outcomes of patients with COVID-19 infection in our institute during the pandemic era.

Materials and Methods

When the lockdown was imposed, it was mandated that all elective procedures should be put on hold. We formulated criteria for triaging procedures as emergent, urgent, and elective. A standard operating protocol was devised regarding admission, pre and postoperative management. Protocols for surgical procedures were established in a separate Covid-designated operation room including a specified sequence of donning and doffing personal protective equipment.

Results

In the COVID era, from March 23, 2020 to mid-July 2021, 1282 surgeries have been done in our department, 344 emergencies and 461 planned procedures, which include 31 COVID-19 positive cases, with overall good outcomes. 103 emergency surgeries were done during the first wave (March-end to June 2020), and 103during the second wave (April to mid-June 2021). Moreover, not a single healthcare worker in the department has been infected.

Conclusion

Pediatric Surgeons are adapting to the new guidelines to continue to provide emergency services with safe and effective care to their patients during the COVID-19 pandemic. Simultaneously, focus on personal and staff protection is ensured to keep the healthcare workers healthy and able to discharge their duties adequately.

Global Financial Crisis, Smart Lockdown Strategies, and the COVID-19 Spillover Impacts: A Global Perspective Implications From Southeast Asia

This present study primarily emphasizes to seek the COVID-19 adverse impacts posing health challenges and global economic crisis. The pandemic (COVID-19) continues to hit the global economies adversely. Pakistan is the 5th-most-populous nation, and recorded positive cases with the third-highest positivity ratio in South Asia, and 26th-highest deaths toll of 21,450 and 29th number of most COVID-19 positive cases with 933,750 worldwide, as of June 6, 2021. The first wave appeared at the end of May 2020, and mid of June reported its peak, which ended by mid-July 2020. Early November 2020 witnessed the second wave with low intensity reached the climax by mid-December. The COVID-19's third wave severely affected the country during mid-March 2021. It exhibited the highest positivity rate, around 20%. New positive patients and deaths toll commenced to skyrocket and reported peak by April 15, 2021. Then situation gradually improved with effective measures and restrictions. The pandemic coronavirus (COVID-19) has affected 220 territories, regions, and countries and resulted in more than 174.116 million infections, deaths, 3.75 million, and 157.157 million positive cases fully recovered from this infectious disease, as of June 7, 2021. The pandemic has caused a severe crisis of healthcare facilities and economic challenges worldwide. Pakistani economy reported GPD's negative growth (-0.05) for the first time over the last 60 years in 2020, which caused a massive financial crisis. The Government's relief package intervened to reduce public mental stress and improve the quality of their lives. IMF reported that Pakistan's GPD bounced back at 4% growth by June 2021. This article determines that economic instability and health burden happened in Pakistan for a longer time than financial disequilibrium that occurred globally. Pakistan encountered this crisis due to its feeble healthcare systems and fragile economy. This study explores adverse health issues and spillover consequences on the economic crisis in Pakistan with global implications. It recommends smart lockdown restrictions in most affected areas to reopen the economic cycle with strict preventive measures to minimize the COVD-19 adverse consequences.

Online action planning forums to develop a roadmap to mitigate the impact of COVID-19 on the delivery of global children’s surgical care

PURPOSE

We aimed to understand the challenges facing children's surgical care providers globally and realistic interventions to mitigate the catastrophic impact of COVID-19 on children's surgery.

METHODS

Two online Action Planning Forums (APFs) were organized by the Global Initiative for Children's Surgery (GICS) with a geographically diverse panel representing four children's surgical, anesthesia, and nursing subspecialties. Qualitative analysis was performed to identify codes, themes, and subthemes.

RESULTS

The most frequently reported challenges were delayed access to care for children; fear among the public and patients; unavailability of appropriate personal protective equipment (PPE); diversion of resources toward COVID-19 care; and interruption in student and trainee hands-on education. To address these challenges, panelists recommended human resource and funding support to minimize backlog; setting up international, multi-center studies for systematic data collection specifically for children; providing online educational opportunities for trainees and students in the form of large and small group discussions; developing best practice guidelines; and, most importantly, adapting solutions to local needs.

CONCLUSION

Identification of key challenges and interventions to mitigate the impact of the COVID-19 pandemic on global children's surgery via an objective, targeted needs assessment serves as an essential first step. Key interventions in these areas are underway.

Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave

The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.

Multisystem Inflammatory Syndrome in Children and Adolescents (MIS-C) under the Setting of COVID-19: A Review of Clinical Presentation, Workup and Management

Earlier in its course, SARS-CoV-2 was primarily identified to cause an acute respiratory illness in adults, the elderly and immunocompromised, while children were known to be afflicted with milder symptoms. However, since mid-April of 2020, latent effects of the virus have begun emerging in children and adolescents, which is characterised by a multisystem hyperinflammatory state; thus, the term Multisystem Inflammatory Syndrome in Children (MIS-C) was introduced by the WHO and CDC. The syndrome manifests itself approximately 4 weeks after COVID-19 infection, with symptoms mimicking Kawasaki Disease and Kawasaki Disease Shock Syndrome. Demographically, MIS-C peaks in children aged 5 to 14 years, with clusters in Europe, North and Latin America seen, later followed by Asia. Although the exact pathophysiology behind the syndrome is unknown, recent studies have proposed a post-infectious immune aetiology, which explains the increased levels of immunoglobulins seen in affected patients. Patient presentation includes, but is not limited to, persistent fever, rash, gastrointestinal symptoms and cardiac complications including myocarditis. These patients also have raised inflammatory markers including C reactive protein, ferritin and interleukin-6. In poorly controlled patients, the syndrome can lead to multiorgan failure and death. The mainstay of treatment includes the use of intravenous immunoglobulins, steroids, immune modulators and aspirin. Adjunct therapy includes the use of low molecular weight heparin or warfarin for long term anticoagulation. Currently very little is known about the syndrome, highlighting the need for awareness amongst healthcare workers and parents. Moreover, with increased cases of COVID-19 as a result of the second wave, it is essential to keep MIS-C in mind when attending patients with a past history of COVID-19 exposure or infection. Additionally, once these patients have been identified and treated, strict follow-up must be done in order carry out long term studies, and to identify possible sequelae and complications.

Proactive Teleconsultation for Coronavirus Disease 2019 Cases Identified Through the Community-Testing Initiative in Karachi, Pakistan: A Low-Cost Value-Added Service to Support a Pandemic Response in a Resource-Limited Setting

Background: Coronavirus disease 2019 (COVID-19) struck Pakistan with a magnitude that required micro- and macro-level adjustments at national and provincial levels. Access to medical consultation became a challenge; hospitals were flooded with cases beyond their capacity and transport was halted due to lockdown. Global Health Directorate of The Indus Health Network supported the provincial government by rolling out several walk-in community-based testing initiatives across Karachi. Results were conveyed to the patients through each district government. With a disproportionate rise in cases, an increasing delay in reporting results was observed. Methods: To help the district government bridge this gap, two physicians were engaged to convey timely results to patients who tested positive, through a helpline. Subsequently, proactive teleconsultation was initiated. We present a retrospective review of data collected during teleconsultation for COVID-19 cases identified through community-based testing between April 5 and June 10, 2020. Results: A total of 4,279 tests were conducted, revealing a 28% positivity rate (1,196 cases). Out of these, 752 (62.9%) baseline positive patients were contactable. Most patients identified either a close contact (46.8%) or a household contact (30.1%) as the source of infection. 41.8% patients were asymptomatic, 52.9% had mild to moderate illness, and 1.1% needed referral to the emergency department. 82.7% patients reported no comorbidities. Conclusion: The rapid surge of cases could not be handled by a small team and an institutional strategy of integration into an existing call center service was adopted. We share our insights to help develop evidence-based policies to effectively tackle current or future threats in similar settings.

Exploring the impact of the COVID-19 pandemic on pediatric surgical services: a scoping review

Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. The majority of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and outpatient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery, and restore all kinds of surgeries to improve the quality of life of the patient.

A Comprehensive Overview of the COVID-19 Literature: Machine Learning-Based Bibliometric Analysis

BACKGROUND

Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19-related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging.

OBJECTIVE

We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature.

METHODS

We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning-based method to analyze the most relevant COVID-19-related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub.

RESULTS

Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19-related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread.

CONCLUSIONS

We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors.

A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis (Preprint).. [DOI: 10.2196/preprints.23703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

BACKGROUND

Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging.

OBJECTIVE

We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature.

METHODS

We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub.

RESULTS

Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread.

CONCLUSIONS

We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors.