Working through the COVID-19 outbreak: Rapid review and recommendations for MSK and allied heath personnel

Impact of the COVID-19 pandemic on orthopaedic and traumatological care in Prague, the capital of the Czech Republic

The coronavirus disease (COVID-19) has significantly affected society, especially healthcare systems worldwide. The aim of this retrospective study is to evaluate the impact of the COVID-19 pandemic on orthopaedic and trauma healthcare at the largest university hospital in the Czech Republic. The evaluated periods were in accordance with three waves of the disease and three respective lockdowns. To correlate the results, we evaluated the number of patients (inpatients and outpatients) treated in the same period in the last 3 years before the pandemic. The number of orthopaedic outpatients during the lockdown period decreased by 54.12% (p = 0.002), 42.88% (p <0.001), and 34.53% (p = 0.03) in the first, second, and third lockdowns, respectively. The number of elective surgeries decreased by 69.01% (p <0.001), 87.57% (p <0.001), and 74.89% (p = 0.007) and the number of acute surgeries decreased by 33.15% (p = 0.002), 37.46% (p <0.001), and 27.24% (p = 0.034) in the first, second, and third lockdowns, respectively. This study showed a significant reduction in the healthcare of orthopaedic and trauma patients owing to the COVID-19 pandemic and emphasised the shortcomings of the healthcare system. In our study, there was a reduction in both outpatient (reduction of care by 24–54%) and inpatient care. The elective surgeries were reduced by 69–87% during different lockdown periods compared with the reference period. Based on the results of this study, we can formulate organisational measures to mitigate the impact of the pandemic on orthopaedic healthcare. Organisational procedures created based on acquired data and experience should maximise the bed capacity of the workplace and work efficiency with regard to the safety of medical staff.

A comprehensive review on facemask manufacturing, testing, and its environmental impacts

The coronavirus pandemic (COVID-19) is currently the biggest threat to human lives due to its rapid transmission rate causing severe damage to human health and economy. The transmission of viral diseases can be minimized at its early stages with proper planning and preventive practices. The use of facemask has proved to be most effective measure to curb the spread of virus along with social distancing and good hygiene practices. This necessitates more research on facemask technology to increase its filtration efficiencies and proper disposal, which can be accelerated with knowledge of the current manufacturing process and recent research in this field. This review article provides an overview of the importance of facemask, fundamentals of nonwoven fabrics, and its manufacturing process. It also covers topics related to recent research reported for improved facemask efficiencies and testing methods to evaluate the performance of facemask. The plastic waste associated with the facemask and measures to minimize its effect are also briefly described. A systematic understanding is given in order to trigger future research in this field to ensure that we are well equipped for any future pandemic.

The Role of Clinical Social Worker in Addressing the Social Consequences of Coronavirus (Covid-19): A Field Study

The present research aims to identify the social consequences of Coronavirus (Covid-19), the role of clinical social worker in addressing this issue, the obstacles that impede him/her and the mechanisms as well as suggestions that improve this role. The author adopted the descriptive analytical approach and designed a questionnaire to collect data. The results showed that the consequence of "concern about losing relatives and friends because of Coronavirus" was ranked the first. However, the consequence of "self-harm that may induce suicide due to the social restrictions imposed by home quarantine" was ranked the last. In addition, the most prominent role of the clinical social worker in addressing this crisis was educating community members about its risks and the relevant social behaviors. Moreover, the most prominent obstacle was lack of training social workers to address this issue. To improve his/her roles, the research recommends presenting courses and workshops to raise the competence of clinical social workers dealing with crises, in general, and Coronavirus, in particular.

COVID-19 Preventive Behavior Practices and Determinants: A Scoping Review

BACKGROUND: Coronary Heart Diseases (CHD) is one of the leading causes of death worldwide. Proper management for CHD patients is needed to reduce mortality. Nurses have a very important role in making CHD patients can carry out optimal health behaviors. AIM: This review study aims to identify the effect of the nurse-led program on CHD patients. METHODS: This systematic review was based on four electronic databases (Scopus, Science Direct, ProQuest, SAGE Journals) and published between 2011 and 2020. This review used the Joanna Briggs Institute and Prisma guidelines. The study’s eligibility was assessed from the title, abstract, research methodology, and full text. The review results were presented in tabulated data and narrative form. RESULTS: Nine articles showed that the nurse-led program significantly improved health behavior, health-related quality of life, clinical outcome, and illness perception in CHD patients. CONCLUSIONS: It is expected that the improvement of management in CHD patients will improve patients’ quality of life. Hence, it could reduce the number of morbidities and mortality.

Acute spine care services during covid-19 pandemic and 'lockdown': case series and our perspective from a level 1 trauma centre

Study design

Case Series.

Objective

Sudden ‘lockdown’ to contain spread of SarsCoV-2 infection had far-reaching consequences on the Spine Unit of our tertiary care hospital, situated in a hilly-region of Northern India. We intend to share our experience of providing care for acute spinal disorders from 23rd March, 2020, when nationwide lockdown and closure of elective services started in our country, to till 12th May, 2020, and to formulate few recommendations at the end.

Setting

Northern India.

Methods

Between 23rd March, 2020 and 12th May, 2020, data of all patients with spinal conditions presenting to Emergency Department for acute care services were collected prospectively. Existing protocols were modified in line with changing national and institute policies for functionality of the spine unit, challenges faced and steps taken were noted.

Results

All elective cases were postponed for an indefinite period at the starting of ‘Lockdown’. A total of 24 patients were received in ED during study period and 14 (58%) were managed operatively. The majority (79%) were with traumatic spine injury, and fall from height was most common mechanism of injury in traumatic spine patients (84%). There was higher incidence of surgical site infections (14%) among operated patients, compared to our previous average. We had modified routine policies to tackle challenges faced and till date of writing this article, none of the members of spine team or patients treated by us tested positive for SARSCoV-2.

Conclusion

To continue providing care for acute spinal conditions and maintaining academic activities of spine unit during ‘lockdown’ needs innovative policies in line with national protocols.

Rehabilitation Care at the Time of Coronavirus Disease-19 (COVID-19) Pandemic: A Scoping Review of Health System Recommendations

Purpose: The coronavirus disease-19 (COVID-19) was declared a pandemic by the World Health Organization in March 2020. COVID-19, caused by SARS-CoV-2 has imposed a significant burden on health care systems, economies, and social systems in many countries around the world. The provision of rehabilitation services for persons with active COVID-19 infection poses challenges to maintaining a safe environment for patients and treating providers. Materials and Methods: Established frameworks were used to guide the scoping review methodology. Medline, Embase, Pubmed, CINAHL databases from inception to August 1, 2020, and prominent rehabilitation organizations' websites were searched. Study Selection: We included articles and reports if they were focused on rehabilitation related recommendations for COVID-19 patients, treating providers, or the general population. Data Extraction: Pairs of team members used a pre-tested data abstraction form to extract data from included full-text articles. The strength and the quality of the extracted recommendations were evaluated by two reviewers using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Results: We retrieved 6,468 citations, of which 2,086 were eligible for review, after duplicates were removed. We excluded 1,980 citations based on title and abstract screening. Of the screened full-text articles, we included all 106 studies. A summary of recommendations is presented. We assessed the overall evidence to be strong and of fair quality. Conclusion: The rehabilitation setting, and processes, logistics, and patient and healthcare provider precaution recommendations identified aim to reduce the spread of SARS-CoV-2 infection and ensure adequate and safe rehabilitation services, whether face-to-face or through teleservices. The COVID-19 pandemic is rapidly changing. Further updates will be needed over time in order to incorporate emerging best evidence into rehabilitation guidelines.

The future of health care service in orthopedic practice: telemedicine or in-person visits?

BACKGROUND

The objective of this study was to assess patient satisfaction and preference for telemedicine vs. in-person visits for outpatient shoulder and elbow musculoskeletal consultation during the coronavirus disease 2019 (COVID-19) pandemic and in the future.

METHODS

Patients who had telemedicine visits for shoulder and elbow musculoskeletal complaints at a single institution from March through June 2020 were invited to respond to a post-visit survey. The survey included a standardized questionnaire that focused on the patient's satisfaction with the telemedicine visits during the pandemic and preference for using the telemedicine platform in the future, following the pandemic. Additional details regarding their virtual visits (severity of medical condition, as well as previous virtual or emergency department visits) were also obtained. Data regarding patient demographic characteristics and visit details (primary diagnosis, type of visit, length of visit, and treating physician) were extracted from the electronic medical records.

RESULTS

In total, 153 patients participated in the study. Overall, high satisfaction scores regarding the telemedicine visits were noted: 91% of patients reported that their concerns were adequately addressed, 89% would recommend telemedicine to a friend, and 94% stated that they would use the telemedicine platform again in the presence of a situation similar to the COVID-19 pandemic. However, the majority of patients (76%) reported a preference for in-person visits for the same musculoskeletal complaint if it were not for COVID-19. A telemedicine visit duration > 10 minutes and a first-time telemedicine visit correlated with higher satisfaction rates (P = .037 and P = .001, respectively).

CONCLUSIONS

COVID-19 has provided a boost to the use of our telemedicine platform, with a high satisfaction rate among patients with shoulder and elbow musculoskeletal complaints, largely owing to safety reasons and limited access to in-person doctor visits. However, a considerable number of patients would have preferred in-person visits for similar health complaints if there were no pandemic. Further research on optimizing the selection of patients for telemedicine visits and addressing their expectations and concerns regarding their visits will improve patients' preference for future telemedicine visits.

Age and socioeconomic status affect access to telemedicine at an urban level 1 trauma center

Objectives:

Despite clinical and economic advantages, routine utilization of telemedicine remains uncommon. The purpose of this study was to examine potential disparities in access and utilization of telehealth services during the rapid transition to virtual clinic during the coronavirus pandemic.

Design:

Retrospective chart review.

Setting:

Outpatient visits (in-person, telephone, virtual—Doxy.me) over a 7-week period at a Level I Trauma Center orthopaedic clinic.

Intervention:

Virtual visits utilizing the Doxy.me platform.

Main Outcome Measures:

Accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Methods:

All outpatient visits (in-person, telephone, virtual) during a 7-week period were tracked. At the end of the 7-week period, the electronic medical record was queried for each of the 641 patients who had a visit during this period for the following variables: gender, ethnicity, race, age, payer source, home zip code. Data were analyzed for both the total number of visits (n = 785) and the total number of unique patients (n = 641). Patients were identified as accessing at least 1 virtual visit (“Virtual”) or having telephone or in-person visits only (“No virtual”).

Results:

Weekly totals demonstrated a rapid increase from 0 to greater than 50% virtual visits by the third week of quarantine with sustained high rates of virtual visits throughout the study period. Hispanic and Black/African American patients were able to access virtual care at similar rates to White/Caucasian patients. Patients of ages 65 to 74 and 75+ accessed virtual care at lower rates than patients ≤64 (P = .003). No difference was found in rates of virtual care between payer sources. A statistically significant difference was found between patients from different zip codes (P = .028).

Conclusion:

A rapid transition to virtual clinic can be performed at a level 1 trauma center, and high rates of virtual visits can be maintained. However, disparities in access exist and need to be addressed.

Bibliometric analysis of COVID-19 related publications in Indian orthopaedic journals

BACKGROUND

The COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics.

METHODS

A cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied.

RESULTS

A total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2^nd April 2020 to 31^st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word.

CONCLUSION

The Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

Bibliometric analysis of the top 50 most cited publications of the Journal of Clinical Orthopaedics and Trauma

BACKGROUND

The Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus.

METHODS

We looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords.

RESULTS

Total citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT.

CONCLUSIONS

There is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.

Occupational risk factors of contracting COVID-19 among health workers: A systematic review

BACKGROUND

With the spread of COVID-19 and the worsening global prevention and control situation, the risk of infection faced by health workers has been unprecedented. It is necessary to fully understand the occupational risks of health workers to protect them and reduce their risk of infection.

OBJECTIVE

This study aimed to obtain comprehensive and detailed information on occupational risk factors of infectious diseases for HWs in different dimensions and to propose control strategies for three risk dimensions to protect HWs who are at high risk of infection during the pandemic.

METHODS

A total number of 619 articles published from 2010 to 2021 were searched to conduct bibliometric analysis, which were retrieved in the Web of Science database with defined search terms. There were 26 articles met the criteria, and they were screened to identify occupational risk factors.

RESULTS

We conducted an analysis of cited institutions, co-citation network analysis of journals, and references from bibliometric analysis. Nine risk factors were extracted, and they were classified and sorted into three dimensions. Infection control strategies for each dimension were proposed.

CONCLUSIONS

The risk of infection faced by HWs is unprecedented. Medical institutions should pay more attention to the nine risk factors that we identified and use the three risk dimensions to carry out risk identification and infection control to reduce the infection risk of HWs and protect them better.

Coating with Hypertonic Saline Improves Virus Protection of Filtering Facepiece Manyfold-Benefit of Salt Impregnation in Times of Pandemic

Recently, as is evident with the COVID-19 pandemic, virus-containing aerosols can rapidly spread worldwide. As a consequence, filtering facepieces (FFP) are essential tools to protect against airborne viral particles. Incorrect donning and doffing of masks and a lack of hand-hygiene cause contagion by the wearers' own hands. This study aimed to prove that hypertonic saline effectively reduces the infectious viral load on treated masks. Therefore, a hypertonic salt solution´s protective effect on surgical masks was investigated, specifically analyzing the infectivity of aerosolized Alphacoronavirus 1 in pigs (Transmissible Gastroenteritis Virus (TGEV)). Uncoated and hypertonic salt pre-coated FFPs were sprayed with TGEV. After drying, a defined part of the mask was rinsed with the medium, and the eluent was used for the infection of a porcine testicular cell line. Additionally, airborne microorganisms´ long-term infectivity of sodium-chloride in phosphate-buffered saline comprising 5% saccharose was investigated. In the results from an initial Median Tissue Culture Infectious Dose, infection rate of TGEV was minimally reduced by untreated FFP. In contrast, this could be reduced by a factor of 10⁴ if FFPs were treated with hypertonic salt solutions. Airborne pathogens did not contaminate the growth medium if salt concentrations exceeded 5%. We conclude that hypertonic saline is a vital tool for anti-virus protection, exponentially improving the impact of FFPs.

COVID-19 lockdown disrupts support networks integral to maintaining foot health: a mixed-methods study

BACKGROUND

In response to the COVID-19 pandemic, populations were advised to remain at home to control viral spread. Government-mandated restrictions on free movement affected individuals' engagement with physical activity, with reported increases leading to biopsychosocial health benefits and conversely increased sedentary behaviour leading to poorer health. Good foot health is key to enabling physical activity and maximal participation in activities of occupation and daily living.

METHODS

A population-based cross-sectional study was performed, using a web-based platform. Quantitative and qualitative data were captured through responses to closed and open survey questions. Anybody with a foot health condition was eligible to participate in the online survey. Links were sent through professional networks, support groups and charities, using a snowball strategy to maximise participation.

RESULTS

Two hundred fifty-five respondents completed the survey. Most (n = 193, 75.69%) reported an ongoing foot pain or problem that had been present for 4 weeks or longer, whilst 49 respondents (19.22%) noted a new pain or problem. Pain was the most frequently reported symptom (n = 139, 54.51%), whilst change in appearance of the foot was also commonly reported (n = 122, 47.84%), often alongside the observable presence of swelling. Musculoskeletal foot symptoms were frequently reported (n = 123, 48%), and were significantly associated with reported reduced physical activity (X2 = 6.61, p = 0.010). Following qualitative analysis five themes and 11 subthemes emerged, informed by 49 independent codes. A central theme of lockdown disrupting support networks, both formal (healthcare providers) and informal (friends or family members) emerged. The 5 sub-themes were: 1. foot pain is a constant companion, 2. self-care, 3. 'cope or crumble' scenarios, 4. future intent to access healthcare and 5. reduced ability to undertake physical activity.

CONCLUSIONS

Pain was the most frequently reported foot problem during COVID-19 lockdown restriction. Lockdown restrictions disrupted support networks integral to maintaining foot health. Poor foot health impacted people's ability to remain physically active. Complaints previously considered relatively 'minor' such as support for skin and nail care, were found to be exacerbated by restricted support networks, leading to greater negative impact.

A comprehensive review on global contributions and recognition of pharmacy professionals amidst COVID-19 pandemic: moving from present to future

BACKGROUND

COVID-19, a respiratory tract infection caused by SARS-CoV-2, is a burning question worldwide as it gives rise to a pandemic situation. No specific medications are still recommended for COVID-19; however, healthcare support is crucial for ameliorating the disease condition. Pharmacists are the frontline fighters who are responsible for providing healthcare support to the COVID-19 infected patients around the world. This review endeavored to briefly rationalize the contributions of several pharmacy professionals in diverse fields along with their collaborative efforts and dedication regarding their limitations during the COVID-19 situation and view the prospects of pharmaceutical care services in the post-pandemic period.

MAIN BODY OF THE ABSTRACT

Online databases were utilized to search for scholarly articles and organizational websites, to sum up the information about the contemporary and expanded role of pharmacists. Key articles were retrieved from Google Scholar, PubMed, and Science Direct databases using terms: "COVID-19," "novel coronavirus," "community," "industrial," "hospital," "clinical," "recognition," "obstacles," "collaboration," "SARS-CoV-2," "healthcare," and "outbreak" in combination with "pharmacist." The articles were included from the inception of the pandemic to January 25, 2021. The current review found pharmacist's global contributions and involvements with other professionals to provide healthcare services amidst COVID-19. This included testing of suspects, providing medical information, psycho-social support, debunking myths, mitigating drug shortage events, telemedicine, e-prescription, infection control, and controlling the drug supply chain. In many countries, pharmacists' activities were much appreciated but in some countries, they were not properly acknowledged for their contributions amidst COVID-19 outbreak. They played additional roles such as participating in the antimicrobial stewardship team, improving value-added services, conducting clinical data analysis to suppress the outspread of the SARS-CoV-2.

SHORT CONCLUSION

During the COVID-19 pandemic while the whole world is fighting against an invisible virus, the pharmacists are the earnest hero to serve their responsibilities along with additional activities. They need to be prepared and collaborate with other healthcare professionals further to meet the challenges of post-pandemic circumstances.

Risk of COVID-19 Infection and Associated Factors Among Healthcare Workers: A Cross-Sectional Study at Eka Kotebe Treatment Center in Ethiopia

BACKGROUND

Healthcare worker-associated COVID-19 infection is a worldwide problem. The magnitude of exposure risk to COVID-19 infections in Ethiopia is rapidly increasing following its spread in the country. However, studies about the risk of COVID-19 infection among healthcare workers and factors associated with risk of COVID-19 infection are lacking in Ethiopia.

OBJECTIVE

The study investigated level of risk of COVID-19 infection and associated factors among healthcare workers at Eka Kotebe COVID-19 treatment center.

METHODS

A facility-based cross-sectional study was conducted from September to October 2020 to determine risk of COVID-19 infection and associated factors at Eka Kotebe COVID-19 treatment center. In total, 318 healthcare workers participated in the study. Data was analyzed using SPSS version 25. A binary logistic regression model was used to evaluate the risk of COVID-19 infection among healthcare workers.

RESULTS

A total of 243 (76%) healthcare workers had a high exposure risk of COVID-19 infection. Department of healthcare workers, ICU department workers [AOR: 6.545, 95% CI; (1.79-23.97)], long working hours [AOR: 9.224, 95% CI; (2.00-42.61)], inadequate supply of PPE [AOR: 0.318, 95% CI; (0.14-0.75)], lack of access to alcohol-based hand rub [AOR: 0.093, 95% CI; (0.01-0.98)], providing care within one meter of COVID-19 patients [AOR: 20.633, 95% CI; (3.88-109.76)], and direct contact with an environment in which a COVID-19 patient received care [AOR: 9.600, 95% CI; (1.05-84.50)] were found to be risk factors for COVID-19 infection.

CONCLUSION

Healthcare workers face a high risk of COVID-19 infection while providing care for COVID-19 patients. Proper use and adequate supply of PPE and the implementation of basic infection prevention and control with frequent protocol revision and strict supervision are crucial to limit exposure risk to COVID-19 among healthcare workers.

Adapting Management of Sarcomas in COVID-19: An Evidence-Based Review

With the novel coronavirus disease (COVID-19) being declared a global pandemic by the World Health Organization, the Indian healthcare sector is at the forefront to deliver optimal care. Patients with cancer especially are at serious risk for increased chances of morbidity and mortality due to their immunocompromised state. Currently there is a paucity of definitive guidelines for the management of sarcomas during the pandemic in a resource-constrained and diverse population setting like India. Health care professionals from various specialties involved in the management of sarcomas have collaborated to discuss various aspects of evidence-based sarcoma management during the COVID-19 pandemic. This article provides structured recommendations for HCP to adapt to the situation, optimize treatment protocols with judicious use of all resources while providing evidence-based treatment for sarcoma patients.

Aerosol-generating behaviours in speech pathology clinical practice: A systematic literature review

OBJECTIVE

To evaluate the evidence of aerosol generation across tasks involved in voice and speech assessment and intervention, to inform better management and to reduce transmission risk of such diseases as COVID-19 in healthcare settings and the wider community.

DESIGN

Systematic literature review.

DATA SOURCES AND ELIGIBILITY

Medline, Embase, Scopus, Web of Science, CINAHL, PubMed Central and grey literature through ProQuest, The Centre for Evidence-Based Medicine, COVID-Evidence and speech pathology national bodies were searched up until August 13th, 2020 for articles examining the aerosol-generating activities in clinical voice and speech assessment and intervention within speech pathology.

RESULTS

Of the 8288 results found, 39 studies were included for data extraction and analysis. Included articles were classified into one of three categories: research studies, review articles or clinical guidelines. Data extraction followed appropriate protocols depending on the classification of each article (e.g. PRISMA for review articles). Articles were assessed for risk of bias and certainty of evidence using the GRADE system. Six behaviours were identified as aerosol generating. These were classified into three categories: vegetative acts (coughing, breathing), verbal communication activities of daily living (speaking, loud voicing), and performance-based tasks (singing, sustained phonation). Certainty of evidence ranged from very low to moderate with variation in research design and variables.

CONCLUSIONS

This body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation. As many aerosol-generating behaviours are common human behaviours, these findings can be applied across healthcare and community settings.

SYSTEMATIC REVIEW REGISTRATION

Registration number CRD42020186902 with PROSPERO International Prospective Register for Systematic Reviews.

Covid-19 Pandemic: Resumption of Orthopedic Care and Medical Education

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

The prevalence of preventive behaviors and associated factors during the early phase of the COVID-19 pandemic among Iranian People: Application of a Health Belief Model

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has developed into a severe public health concern. The present study was aimed to evaluate the related preventive behaviors to COVID-19, and associated factors among Iranians based on the constructs of the Health Belief Model (HBM).

METHODS

This cross-sectional study was conducted between March and April 2020 among Iranians. Data of 1,020 people were collected by a self-administered questionnaire based on the constructs of HBM and also a demographics questionnaire. Simple and multivariable linear regression models were used to determine the predictors of preventive behaviors concerning COVID-19. A P-value of less than 0.05 was considered significant.

RESULTS

The mean score of preventive behaviors concerning COVID-19 was 4.27 (standard deviation = 0.60). 40.6% (95% CI: 38.6-43.7%), and 56.5% (95% CI: 53.4-59.5%) of the participants exhibited a high, and moderate level of preventive behaviors, respectively. 75.1% of the participants would always/often wear face masks out home or in crowded places. The most common preventive behaviors were using of personal belongings in the workplace or at home (96.1%) and staying at home except for very necessary or for work (92.9%). Results showed that all six HBM constructs, i.e., perceived susceptibility (B = 0.07, P < 0.001), perceived severity (B = 0.08, P < 0.001), perceived benefits (B = 0.25, P < 0.001), perceived barriers (B = -0.12, P = 0.001), cues to action (B = 0.07, P < 0.001), and self-efficacy (B = 0.26, P < 0.001) were significant predictors of related preventive behaviors to COVID-19. Female gender was another predictor of preventive behaviors (B = 0.18, P < 0.001).

CONCLUSIONS

This study demonstrated the effectiveness of HBM constructs in predicting COVID-19 preventive behaviors. Therefore, the model as a framework for designing training programs for improving health behaviors among Iranians during the COVID-19 pandemic seems to be helpful.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

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.

Distance Management of Spinal Disorders During the COVID-19 Pandemic and Beyond: Evidence-Based Patient and Clinician Guides From the Global Spine Care Initiative

BACKGROUND

The COVID-19 pandemic has greatly limited patients' access to care for spine-related symptoms and disorders. However, physical distancing between clinicians and patients with spine-related symptoms is not solely limited to restrictions imposed by pandemic-related lockdowns. In most low- and middle-income countries, as well as many underserved marginalized communities in high-income countries, there is little to no access to clinicians trained in evidence-based care for people experiencing spinal pain.

OBJECTIVE

The aim of this study is to describe the development and present the components of evidence-based patient and clinician guides for the management of spinal disorders where in-person care is not available.

METHODS

Ultimately, two sets of guides were developed (one for patients and one for clinicians) by extracting information from the published Global Spine Care Initiative (GSCI) papers. An international, interprofessional team of 29 participants from 10 countries on 4 continents participated. The team included practitioners in family medicine, neurology, physiatry, rheumatology, psychology, chiropractic, physical therapy, and yoga, as well as epidemiologists, research methodologists, and laypeople. The participants were invited to review, edit, and comment on the guides in an open iterative consensus process.

RESULTS

The Patient Guide is a simple 2-step process. The first step describes the nature of the symptoms or concerns. The second step provides information that a patient can use when considering self-care, determining whether to contact a clinician, or considering seeking emergency care. The Clinician Guide is a 5-step process: (1) Obtain and document patient demographics, location of primary clinical symptoms, and psychosocial information. (2) Review the symptoms noted in the patient guide. (3) Determine the GSCI classification of the patient's spine-related complaints. (4) Ask additional questions to determine the GSCI subclassification of the symptom pattern. (5) Consider appropriate treatment interventions.

CONCLUSIONS

The Patient and Clinician Guides are designed to be sufficiently clear to be useful to all patients and clinicians, irrespective of their location, education, professional qualifications, and experience. However, they are comprehensive enough to provide guidance on the management of all spine-related symptoms or disorders, including triage for serious and specific diseases. They are consistent with widely accepted evidence-based clinical practice guidelines. They also allow for adequate documentation and medical record keeping. These guides should be of value during periods of government-mandated physical or social distancing due to infectious diseases, such as during the COVID-19 pandemic. They should also be of value in underserved communities in high-, middle-, and low-income countries where there is a dearth of accessible trained spine care clinicians. These guides have the potential to reduce the overutilization of unnecessary and expensive interventions while empowering patients to self-manage uncomplicated spinal pain with the assistance of their clinician, either through direct in-person consultation or via telehealth communication.

Evidence-based review of safe theatre practice during the COVID-19 pandemic beyond personal protective equipment

INTRODUCTION

COVID-19 remains a threat for a fear of a second pandemic. Emergency orthopaedic operations are still among the most commonly performed procedures with increased risk of transmission of SARS CoV-2 to the patients and the healthcare workers. The aim of this study was to present the evidence available into best practices limiting the spread of COVID-19 in healthcare setting during current and future pandemics.

METHODS

A review of the literature was performed in multiple databases (PubMed, the Cochrane Library, Google Scholar, World Health Organization and Centers for Disease Control), using 'COVID-19' with other relevant keywords in different combinations. Owing to the limited and heterogenous evidence available, data were presented in a narrative manner.

FINDINGS

From the evidence gathered it was noted that a multimodal approach to minimising pathogen transmission is required. This primarily comprises the wider engineering and administrative controls to reduce the concentration of the pathogen and to separate staff and patients from it. Theatre isolation and traffic control bundling, theatre flow and logistics, ventilation and waste management form a pivotal role in the environmental/engineering controls. Administrative measures include policies for both patients and staff. For patients, isolation and preoperative screening are of utmost value. For staff, testing for COVID-19, risk assessment, redeployment and provision of persona; protective equipment, together with the necessary training are important administrative controls.

CONCLUSION

We believe these measures are likely to improve the sustainability of resources and can be carried to elective settings in order to return to some form of normality and help to mitigate the effects of future pandemics.

The impact of COVID-19 on hand therapy practice

BACKGROUND

Hand therapists and health care providers across the spectrum have been profoundly impacted by COVID-19. Greater insight and information regarding how practitioners have been affected by this unparalleled pandemic is important.

PURPOSE

Survey research was performed to examine the impact of the COVID-19 pandemic on hand therapy practice.

STUDY DESIGN

Online survey research.

METHODS

Four constructs guided the development of the survey: psychosocial and financial impact; safety practice patterns; changes in current practice patterns; use of telehealth. The survey was distributed to members of the American Society of Hand Therapists from April 14, 2020 through May 4, 2020. Descriptive demographic data were obtained. Frequencies were examined using ChiSquare, correlations were examined using Spearman Correlation Coefficient, and means were compared via independent t-test.

RESULTS

A total of 719 members responded to the survey. Eighty-six percent of therapists reported feeling more stress than they did prior to the COVID-19 pandemic. This level of stress was similar across ages, practice settings, financial stability or instability, and geographical settings. Older therapists (r_s = 0.04) and those that practiced longer (r_s = 0.009) felt more comfortable with in-person treatment. Ninety-eight percent of therapists reported a decrease in caseload. Postoperative cases (P= .0001) and patients ages 19-49 were more likely to receive in-person treatment (P= .002). 46% of therapists reported providing telehealth services. Nontraumatic, nonoperative cases (P= .0001) and patients aged 65 or older were more likely to receive telehealth services (P= .0001). Younger therapists (r_s = 0.03) and therapists working in outpatient therapist owned, outpatient corporate owned, and outpatient academic medical centers (X² [4, N = 637] = 15.9463, P= .003) were more likely to utilize telehealth.

CONCLUSION

Stress was felt globally among hand therapy clinicians regardless of financial security or insecurity, age, practice area, or geographical setting. Therapists saw a drastic decrease in caseloads. In-person caseloads shifted primarily to postoperative cases.

STUDY DESIGN

Web based survey.

Orthopaedic surgeons' perceptions and attitudes on COVID-19 related changes in practice: an international cross-sectional survey

Introduction

the purpose of this study was to assess the orthopaedic surgeons' perceptions and attitudes on COVID-19 related changes in their practice.

Methods

an online survey was shared with orthopaedic surgeons practicing in different countries.

Results

this study showed that orthopaedic surgery plan management was adapted to respond more effectively to the COVID-19 pandemic while maintaining the continuity of health care and ensuring protection of medical staff and patients. Among the introduced measures, elective surgery was postponed to free-up beds for suspected or COVID-19 positive patients requiring hospitalization. Additionally, the number of outpatient visits was considerably decreased and non-urgent visits were postponed to reduce the flow of patients in and out of hospitals and therefore minimize the risk of contamination. Interestingly, data revealed the willingness of orthopaedic surgeons to take care of COVID-19 positive patients and support their colleagues in intensive care units, if needed.

Conclusion

orthopaedic surgery departments have adapted their programs to face the unprecedented challenges due to the COVID-19 pandemic. Quick measures were taken to reduce the risk of contamination in patients, medical staff and to allow hospitals to free up beds for treatment of patients with positive or suspected COVID-19.

Airflow Characteristics in Aeromedical Aircraft: Considerations During COVID-19

Objective

The aeromedical transport of coronavirus patients presents risks to clinicians and aircrew. Patient positioning and physical barriers may provide additional protection during flight. This paper describes airflow testing undertaken on fixed wing and rotary wing aeromedical aircraft.

Methods

Airflow testing was undertaken on a stationary Hawker Beechcraft B200C and Leonardo Augusta Westland 139. Airflow was simulated using a Trainer 101 (MSS Professional A/S, Odense Sø, Syddanmark, Denmark) Smoke machine. Different cabin configurations were used along with variations in heating, cooling, and ventilation systems.

Results

For the Hawker Beechcraft B200C, smoke generated within the forward section of the cabin was observed to fill the cabin to a fluid boundary located in-line with the forward edge of the cargo door. With the curtain closed, smoke was only observed to enter the cockpit in very small quantities. For the Leonardo AW139, smoke generated within the cabin was observed to expand to fill the cabin evenly before dissipating. With the curtain closed, smoke was observed to enter the cockpit only in small quantities

Conclusion

The use of physical barriers in fixed wing and rotary wing aeromedical aircraft provides some protection to aircrew. Optimal positioning of the patient is on the aft stretcher on the Beechcraft B200C and on a laterally orientated stretcher on the AW139. The results provide a baseline for further investigation into methods to protect aircrew during the coronavirus pandemic.

Pros and Cons of Plastic during the COVID-19 Pandemic

Since the beginning of the first cases of the new coronavirus, opinions and laws on the use of plastic materials have been questioned around the world. Their importance in the manufacture of hospital devices and personal protective equipment (PPE) is unquestionable, as they contribute largely to the reduction of the virus spread, helping health systems from all edges of the world and, most importantly, saving lives. However, the same material that is a protector, becomes a polluter when inadequately disposed of in the environment, generating or worsening socio-environmental problems, such as pollution of water bodies by plastic. A critical overview of the role of plastic during the COVID-19 pandemic is provided in this paper. A future panorama is attempted to be outlined. The real possibility of the virus spread from the use of plastic is discussed, as well as the recycling of plastic during the pandemic, correlating its use with problems that it may cause.

COVID-19 Risk Factors Among Health Workers: A Rapid Review

Coronavirus disease 2019 (Covid-19) poses an important occupational health risk to health workers (HWs) that has attracted global scrutiny. To date, several thousand HWs globally have been reported as infected with the severe acute respiratory syndrome coronavirus 2 virus that causes the disease. It is therefore a public health priority for policymakers to understand risk factors for this vulnerable group to avert occupational transmission. A rapid review was carried out on 20 April 2020 on Covid-19 risk factors among HWs in PubMed, Google Scholar, and EBSCOHost Web (Academic Search Complete, CINAHL Complete, MEDLINE with Full Text, CINAHL with Full Text, APA PsycInfo, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition) and WHO Global Database. We also searched for preprints on the medRxiv database. We searched for reports, reviews, and primary observational studies (case control, case cross-over, cross-sectional, and cohort). The review included studies conducted among HWs with Covid-19 that reported risk factors irrespective of their sample size. Eleven studies met the inclusion criteria. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions were identified as risk factors for Covid-19 among HWs. In the context of Covid-19, HWs face an unprecedented occupational risk of morbidity and mortality. There is need for rapid development of sustainable measures that protect HWs from the pandemic.

Effect of Shelter-in-Place Orders and the COVID-19 Pandemic on Orthopaedic Trauma at a Community Level II Trauma Center

OBJECTIVES

To evaluate the effect of the COVID-19 pandemic and the "shelter-in-place" order on orthopaedic trauma presenting to a community level II trauma center. It is hypothesized that the overall number of orthopaedic trauma encounters (OTEs), the number of OTEs related to both high and low severity injuries, and the proportion of OTEs related to high severity versus low severity injuries decreased compared with previous years.

METHODS

A retrospective analysis was conducted of OTEs between 2016 and 2020. High and low severity OTEs were classified according to an algorithm created by the researchers. Data were statistically analyzed and compared with external data for traffic counts, motor vehicle accidents, and Transportation Security Administration checkpoints.

RESULTS

A 45.1% decrease (P = 0.0005) was seen in OTEs from March and April 2016-2019 compared with 2020. The decrease began approximately 12 days before the shelter-in-place order. There was a 58.8% decrease in high severity injuries with a fracture (P = 0.013) and a 42.9% decrease in low severities injuries (P = 0.0003). The proportion of high to low severity OTEs was unchanged.

CONCLUSIONS

The quantity of OTEs was significantly affected by the COVID-19 pandemic and Michigan shelter-in-place order. A decrease in both high and low severity OTEs was found; however, there was no statistically significant change in the ratio of high to low severity OTEs compared with previous years. Although it is difficult to determine what portion of the decrease in OTE is attributable to the shelter-in-place order versus the COVID-19 pandemic in general, data suggest both play a role.

LEVEL OF EVIDENCE

Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.

Copper-Alloy Surfaces and Cleaning Regimens against the Spread of SARS-CoV-2 in Dentistry and Orthopedics. From Fomites to Anti-Infective Nanocoatings

The latest diffusion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the coronavirus disease (COVID-19), has involved the whole world population. Even if huge efforts to control the pandemic have been done, the viral spread is still continuing. COVID-19 is reported as a zoonosis jumped from bats and pangolins to humans. After infection in humans, SARS-CoV-2 is found in the nasopharyngeal and salivary secretions. The virus has also been detected in the blood plasma of infected patients. The viral spread occurs through droplets exhaled from the nose and mouth of the infected people when they breath or talk, or through droplets propelled as a dense cloud by chough or sneeze. The virus can also be delivered as an aerosol from blood plasma, through surgical procedures. Following these ways, the virus can disperse in the air, then reaching and settling on the exposed surfaces. How long the virus will survive on a surface depends on the material the surface is made from. Infection via high-touch surfaces should be prevented. Copper alloy coatings, combined with efficient hygienic/disinfectant procedures and careful surgical practice, could be helpful to health protection in dental practice and can also be adopted in orthopedic traumatology.

"A community system": A critical foundation for the epidemic prevention and control of SARS-CoV-2

In response to COVID‐19 that has constituted a global pandemic, countries around the world have successively adopted a myriad of prevention and control measures. As the first country with the COVID‐19 outbreak, the Chinese government has adopted a series of timely and strict prevention and control measures against the spread of the SARS‐CoV‐2, which has effectively slowed down the spread of the SARS‐CoV‐2 and created a valuable window for the international community to overcome the epidemic. China's experience in combating the COVID‐19 has shown that building a community prevention and control system is essential to control the spread of coronavirus. As the backbone of the epidemic prevention and control system, the community prevention and control system plays an important role in improving the pattern of disorderly medical treatment, screening suspected patients, preventing the input of pathogens, ensuring residents' medical needs, stabilizing public sentiment, reducing disease fear, and maintaining residents' national security. At the same time, it also exposed the problems of the community prevention and control epidemic system in terms of infrastructure, human resources, and internal systems. Based on this, this article suggests that we should improve the hardware facilities of community, improve the internal mechanism of the community, strengthen the stability of the community talent team, improve the level of linkage between the community and other departments to prevent and control the spread of SARS‐CoV‐2, effectively use information technology and actively mobilize social forces to help community prevention and control COVID‐19.

Trauma Care in COVID-19 Pandemic

The development of COVID-19 pandemic is the serious challenge for trauma care systems across the world. Recommendations on general principles of trauma care in the settings of pandemic, medical stuff protection and prevention of the spread of infection based on the data from international centers are presented in the article. Delay of all elective cases, restriction of surgical treatment of fractures with relative indications for surgery are recommended. The segregation of cases into COVID-19 confirmed or suspected and COVID-19 negative patients is important. When possible before the admission to in-patient department the patient shall be tested on COVID-19. When the COVID-19 status of the patient is unclear all possible protection measures shall be used: patient isolation and medical stuff protection. To prevent the spread of infection it is recommended to split the stuff of the traumacenter into 2 or 3 groups. Each of the groups is working during the week with subsequent period of the self-isolation (remote work) for the period of 1-2 weeks (according to the duration of incubation period of the COVID-19). During the surgical treatment the most dangerous stages of the surgery are endotracheal intubation / extubation and also aerosol-generative procedures: electrocoagulation, pulsed wound lavage, drilling, the use of oscillating saw and medullary reaming. The stuff in the OP-theatre has to be accordingly equipped (personal protection equipment). The risk factors for the medical stuff are fatigue from overwork, the absence of real-time training in infection-prevention measures and non-compliance with PPE.

COVID-19. An update for orthopedic surgeons

The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.

Orthopedic healthcare in the time of COVID-19: Experience of the orthopedic surgery department at Mustapha Bacha Hospital, Algeria

In response to the global health emergency, which has been raised to its highest level as a consequence of the coronavirus disease 2019 (COVID-19), urgent and aggressive actions were taken by health institutions across the world to stop the spread of the disease while ensuring continuity of vital care. This article outlines the urgent measures put in place by the orthopedic surgery department at Mustapha Bacha Hospital in response to the COVID-19 pandemic.

The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives

The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19⁺ patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice.

In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.

Impact of Covid-19 pandemic on surgical practice in Kurdistan, Iraq: An online cross-sectional survey

Introduction

The COVID-19 pandemic is a major challenge to healthcare services in the world. It has negatively impacted surgical practice, and health workers. We aimed to assess the impact of the COVID-19 pandemic on surgical practice in the Kurdistan Region, Iraq.

Methods

An online cross-sectional study using an online survey was performed between 13 April to 29 April, 2020 in the Kurdistan Region, Iraq. An online cross-sectional study using an online survey was performed between 13 April to 29 April, 2020 in the Kurdistan Region, Iraq. A total of 241 surgeons, aged 28–70 years (mean range 22.2 ± 7.9 SD), were recruited to this study. The questionnaire was designed to evaluate the impact of the COVID-19 pandemic on surgeons' practices. Participants completed a self-developed online questionnaire.

Results

The majority of participants (44.39%) were general surgeons, followed by urologists (17.01%). Approximately 82.57% of surgeons performed surgeries during the COVID-19 pandemic and 60.31% undertook emergency surgeries only. There was no significant difference between men and women (P = 0.41) and different age groups (P = 0.08). Only 28.22% of surgeons had access to full personal protective equipment (PPE), and 41.18% believed that wearing PPEs severely affected their skills. Results also found that surgeons aged between 28 and 34 years were more pledged to the use of PPEs, than other age groups (P = 0.001). The use of PPEs during surgeries was significantly higher in the Sulaymaniyah province (P = 0.001). The surgical services were also severely impacted in the Sulaymaniyah province than in the other provinces (p = 0.001).

Conclusion

The COVID-19 pandemic severely affected surgical practice in the Kurdistan Region, particularly in the Sulaymaniyah province. Males, and young surgeons showed a higher commitment level for using PPE. Additional training and precautions are needed to increase awareness about COVID-19 among surgeons, and the importance of using PPE during surgery.

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COVID19 pandemic has severely affected surgical in Kurdistan region, Iraq.

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The surgical services in Sulaymaniyah province were severely impacted by the COVID-19 pandemic.

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Young surgeons showed a higher commitment level for using PPE during surgery.