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Vakili-Ojarood M, Naseri A, Shirinzadeh-Dastgiri A, Saberi A, HaghighiKian SM, Rahmani A, Farnoush N, Nafissi N, Heiranizadeh N, Antikchi MH, Narimani N, Atarod MM, Yeganegi M, Neamatzadeh H. Ethical Considerations and Equipoise in Cancer Surgery. Indian J Surg Oncol 2024; 15:363-373. [PMID: 39328740 PMCID: PMC11422545 DOI: 10.1007/s13193-024-02023-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 07/02/2024] [Indexed: 09/28/2024] Open
Abstract
The changing landscape of cancer surgery requires ongoing consideration of ethical issues to ensure patient-centered care and fair access to treatments. With technological advancements and the global expansion of surgical interventions, healthcare professionals must navigate complex ethical dilemmas related to patient autonomy, informed consent, and the impact of new technologies on the physician-patient relationship. Additionally, ethical principles and decision-making in oncology, especially in the context of genetic predisposition to breast cancer, highlight the importance of integrating patient knowledge, preferences, and alignment between goals and treatments. As global surgery continues to grow, addressing ethical considerations becomes crucial to reduce disparities in access to surgical interventions and uphold ethical duties in patient care. Furthermore, the rise of digital applications in healthcare, such as digital surgery, requires heightened awareness of the unique ethical issues in this domain. The ethical implications of using artificial intelligence (AI) in robotic surgical training have drawn attention to the challenges of protecting patient and surgeon data, as well as the ethical boundaries that innovation may encounter. These discussions collectively emphasize the complex ethical issues associated with surgical innovation and underscore the importance of upholding ethical standards in the pursuit of progress in the field. In this study, we thoroughly analyzed previous scholarly works on ethical considerations and equipoise in the field of oncological surgery. Our main focus was on the use of AI in this specific context.
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Affiliation(s)
- Mohammad Vakili-Ojarood
- Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Amirhosein Naseri
- Department of Colorectal Surgery, Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Ahmad Shirinzadeh-Dastgiri
- Department of Surgery, School of Medicine, Shohadaye Haft-E Tir Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ali Saberi
- Department of General Surgery, School of Medicine Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Masoud HaghighiKian
- Department of General Surgery, School of Medicine Hazrat-E Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Rahmani
- Department of Plastic Surgery, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Nazila Farnoush
- Department of General Surgery, Babol University of Medical Sciences, Babol, Iran
| | - Nahid Nafissi
- Breast Surgery Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Naeimeh Heiranizadeh
- Breast Surgery Department, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
- Department of Surgery, School of Medicine, Shahid Sadoughi General Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | | | - Nima Narimani
- Department of Urology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mehdi Atarod
- Department of Urology, Hasheminejad Kidney Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Yeganegi
- Department of Obstetrics and Gynecology, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Hossein Neamatzadeh
- Mother and Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Minzenmay L, Antoniadis G, Paľa A, Bäzner UM, Knoll A, Petkov M, Wirtz CR, Pedro MT. The impact of SARS-Covid-19 pandemic on peripheral nerve surgery - A single centre report. Clin Neurol Neurosurg 2024; 237:108124. [PMID: 38266330 DOI: 10.1016/j.clineuro.2024.108124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE SARS-Cov-19 pandemic totally changed daily routine work in German hospitals. As hospital capacity was reduced, many surgeries were postponed or even cancelled. On March 25th 2020 the German Society of Neurosurgery (DGNC) published a statement in which urgent non-elective surgeries were defined for each neurosurgical domain, whereas elective interventions were deferred. The present work examines the impact of these Covid strategies focusing on patients with peripheral lesions who were conducted to our department during this period of time. METHODS All patients who underwent any peripheral nerve surgery at our department from January 2018 until December 2022, were included. The complete range of surgeries including peripheral nerve lesions was examined encompassing compression syndromes, traumatic lesions of brachial plexus, traumatic lesions and tumors of single peripheral nerves. The numbers of surgical procedures were compared before, during and after pandemic. Pearson correlation coefficient was analysed. RESULTS From 2018 to 2022 the total number of surgical procedures involving peripheral nerves included 2422 procedures. Compression syndromes made up the largest proportion (1433 operations, 59%), followed by peripheral nerve lesions (445 operations, 18%), peripheral nerve tumors (344 operations, 14%) and lesions of the brachial plexus (142 operations, 6%). The average was 40,5 interventions per month, the range was 7-63. Two declines in the number of peripheral nerve surgeries were noted during this period. The first was in April and May 2020 with an average drop of 65% and 41% respectively. In these months the average number of operations was 37. The second decrease was from October 2021 until January 2022, where number of surgeries was reduced by 16%, 36%, 83% and 18% with an average number of 50 operations. Both declines showed a significant and strong correlation with the lower number of compression syndrome treatments (r = 0.952, p < 0.001 and r = 0.968, p < 0.001), while no drop and no significant correlation was found in the treatment of traumatic peripheral nerve injuries (p = 0.769, r = 0.095 and p = 0.243, r = 0.366) and traumatic brachial plexus injuries (p = 0.787, r = 0.088 and p = 0.780, r = 0.09). A weak significant correlation was seen in the treatment numbers of peripheral nerve tumors (p = 0.017, r = 0.672 and p = 0.015, r = 0.67). CONCLUSION Covid-19 pandemic lead to a significant decrease in the number of nerve decompressions, since, according to the German Society of Neurosurgery, those were considered as elective surgeries.
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Affiliation(s)
- Lena Minzenmay
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany.
| | - Gregor Antoniadis
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
| | - Andrej Paľa
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
| | - Ute Marlies Bäzner
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
| | - Andreas Knoll
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
| | - Martin Petkov
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
| | | | - Maria Teresa Pedro
- University of Ulm, Department of Neurosurgery, Lindenallee 2, 89312 Günzburg, Germany
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Park H, Kang H, Yoon S, Jeong S, Lee S. The Effect of the COVID-19 Pandemic on Early Adolescent Fractures in the Republic of Korea. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1671. [PMID: 37763789 PMCID: PMC10537179 DOI: 10.3390/medicina59091671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Restrictions on daily activities to slow down the propagation of COVID-19 have changed the epidemiological pattern of pediatric fractures in many countries. However, the effect of the pandemic on pediatric fractures has not been fully studied. In this study, we investigated the impact of COVID-19 on early adolescent fractures in Korea. Materials and methods: We conducted a retrospective follow-up on a nationwide cohort of Korean early adolescents born between 2006 and 2009. The prevalence and incidence of pediatric fractures and the frequency of surgical treatment were compared between two different eras. Results: The prevalence and incidence of fractures during the pandemic have both shown a significant decrease: prevalence reduced from 34,626 to 24,789 (p < 0.001), while incidence decreased from 29,804 to 18,898 (p < 0.001). Considering sex, the shift in fracture prevalence was statistically significant (p = 0.020), whereas the incidence was not (p = 0.862). The decline in both fracture prevalence and incidence exhibited significant variation across birth year groups (prevalence, p < 0.001; incidence, p < 0.001), with a more pronounced reduction observed in the older age groups. While the proportion of patients who required surgeries has increased, the mean frequency of surgical treatment per patient remained at a similar level (by prevalence, p = 0.181; by incidence, p = 0.735). The decline in both fracture prevalence and incidence has shown significant variation in relation to fracture sites (prevalence, p < 0.001; incidence, p < 0.001), with a decrease in distal limb fractures and an increase in forearm and axial body fractures. Conclusions: The pediatric fracture pattern in Korea has been notably influenced by the COVID-19 pandemic, warranting further investigation into causal factors. Our findings should help predict epidemiology in the post-pandemic period and thus aid policymaking and patient management.
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Affiliation(s)
- HyunSeo Park
- CHA University School of Medicine, 120 Hyeryong-ro, Pocheon-si 11160, Gyeonggi-do, Republic of Korea; (H.P.); (H.K.)
| | - Hogyeong Kang
- CHA University School of Medicine, 120 Hyeryong-ro, Pocheon-si 11160, Gyeonggi-do, Republic of Korea; (H.P.); (H.K.)
| | - Siyeong Yoon
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
| | - Simho Jeong
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
| | - Soonchul Lee
- Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University School of Medicine, 335 Pangyo-ro, Bundang-gu, Seongnam-si 13488, Gyeonggi-do, Republic of Korea; (S.Y.); (S.J.)
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Wang KC, Butler LR, White CA, Patel AV, Parsons BO, Cagle PJ. The Impact of COVID-19 on the Timing of Rotator Cuff Repair and Method of Postoperative Follow-up. Rev Bras Ortop 2023; 58:463-470. [PMID: 37396078 PMCID: PMC10310421 DOI: 10.1055/s-0042-1749206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/28/2022] [Indexed: 10/18/2022] Open
Abstract
Objective Rotator cuff repair (RCR) is one of the most common arthroscopic procedures. Our investigation aims to quantify the impact that the COVID-19 pandemic had on RCR, specifically on patients with acute, traumatic injuries. Methods Institutional records were queried to identify patients who underwent arthroscopic RCR between March 1 st to October 31 st of both 2019 and 2020. Patient demographic, preoperative, perioperative, and postoperative data were collected from electronic medical records. Inferential statistics were used to analyze data. Results Totals of 72 and of 60 patients were identified in 2019 and in 2020, respectively. Patients in 2019 experienced shorter lengths of time from MRI to surgery (62.7 ± 70.5 days versus 115.7 ± 151.0 days; p = 0.01). Magnetic resonance imaging (MRI) scans showed a smaller average degree of retraction in 2019 (2.1 ± 1.3 cm versus 2.6 ± 1.2 cm; p = 0.05) but no difference in anterior to posterior tear size between years (1.6 ± 1.0 cm versus 1.8 ± 1.0 cm; p = 0.17). Less patients in 2019 had a telehealth postoperative consultation with their operating surgeon compared with 2020 (0.0% versus 10.0%; p = 0.009). No significant changes in complications (0.0% versus 0.0%; p > 0.999), readmission (0.0% versus 0.0%; p > 0.999), or revision rates (5.6% versus 0.0%; p = 0.13) were observed. Conclusion From 2019 to 2020, there were no significant differences in patient demographics or major comorbidities. Our data suggests that even though the time from MRI to surgery was delayed in 2020 and telemedicine appointments were necessary, RCR was still performed in a timely manner and with no significant changes in early complications. Level of Evidence III.
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Affiliation(s)
- Kevin C. Wang
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Liam R. Butler
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Christopher A. White
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Akshar V. Patel
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Bradford O. Parsons
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
| | - Paul J. Cagle
- Departamento de Cirurgia Ortopédica, Icahn School of Medicine at Mount Sinai, Nova York, NY, Estados Unidos
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Padua L, Cuccagna C, Giovannini S, Coraci D, Pelosi L, Loreti C, Bernabei R, Hobson-Webb LD. Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol 2023; 22:255-267. [PMID: 36525982 DOI: 10.1016/s1474-4422(22)00432-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 09/12/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022]
Abstract
Carpal tunnel syndrome is the most common entrapment neuropathy, affecting quality of life for many people. Although it is a well recognised condition, new insights into epidemiology, diagnosis, and treatment have emerged in the past 6 years. The availability of disease-modifying treatments for rare systemic disorders associated with carpal tunnel syndrome (eg, amyloidosis) should alert clinicians to these diagnostic possibilities. Besides clinical evaluation and electrophysiology, the role of ultrasonography as a diagnostic tool has been confirmed and new ultrasound techniques have been applied, the clinical use and feasibility of which require further investigation. Surgical and non-surgical interventions are beneficial for the treatment of carpal tunnel syndrome and several treatment options are now available, giving clinicians the possibility to choose the best approach for every patient. New diagnostic and therapeutic techniques require further validation.
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Affiliation(s)
- Luca Padua
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy.
| | - Cristina Cuccagna
- UOC Neuroriabilitazione Alta Intensità, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Silvia Giovannini
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; UOS Riabilitazione Post-Acuzie, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Padua, Italy
| | - Luciana Pelosi
- Departments of Neurology and Neurophysiology, Bay of Plenty District Health Board, Tauranga Hospital, Tauranga, New Zealand
| | - Claudia Loreti
- Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Roberto Bernabei
- Department of Geriatrics and Orthopaedics, Università Cattolica del Sacro Cuore, Rome, Italy; Department of Aging, Neurological, Orthopaedic and Head-Neck Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Lisa D Hobson-Webb
- Department of Neurology, Neuromuscular Division, Duke University, Durham, NC, USA
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Das S, Mehregan C, Richards C, Schneider M, Le K, Lin X. Intraoperative Complication Rates in Cataract Surgery After Resuming Surgery Following the COVID-19 Shutdown. Clin Ophthalmol 2023; 17:641-647. [PMID: 36861034 PMCID: PMC9969798 DOI: 10.2147/opth.s348710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 11/15/2022] [Indexed: 02/25/2023] Open
Abstract
Purpose To evaluate surgeon performance and intraoperative complication rates of cataract surgery after resumption of elective surgeries following the operating room (OR) shutdown from the coronavirus disease 2019 (COVID-19) pandemic. Subjective surgical experience is also evaluated. Methods This is a retrospective comparative study which analyzes cataract surgeries performed at an inner city, tertiary academic center. Cataract surgeries were categorized into Pre-Shutdown (January 1-March 18, 2020), and Post-Shutdown, for all cases which occurred after surgeries resumed (May 11-July 31, 2020). No cases were performed between March 19 and May 10, 2020. Patients undergoing combined cataract and minimally invasive glaucoma surgery (MIGS) were included, but MIGS complications were not counted as cataract complications. No other combined cataract-other ophthalmic surgeries were included. A survey was used to gather subjective surgeon experience. Results A total of 480 cases (n=306 Pre-Shutdown and n=174 Post-Shutdown) were analyzed. Although there was a higher frequency of complex cataract surgeries performed Post-Shutdown (5.2% vs 21.3%; p<0.00001), complication rates before versus after the shutdown were not statistically significant (9.2% vs 10.3%; p=0.75). Phacoemulsification was the step of cataract surgery in which residents were most concerned about when returning to the OR. Conclusion After the surgical hiatus due to COVID-19, significantly more complex cataract surgeries were reported and surgeons reported higher general anxiety level when first returning to the OR. Increased anxiety did not lead to higher surgical complications. This study provides a framework to understand surgical expectations and outcomes for patients whose surgeons faced a prolonged two-month hiatus from cataract surgery.
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Affiliation(s)
- Shibandri Das
- Kresge Eye Institute Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Christian Mehregan
- Kresge Eye Institute Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Michael Schneider
- Kresge Eye Institute Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA
| | - Kim Le
- Department of Ophthalmology, Henry Ford Hospital, Detroit, MI, USA
| | - Xihui Lin
- Kresge Eye Institute Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA,Correspondence: Xihui Lin, Kresge Eye Institute, Department of Ophthalmology, Visual and Anatomic Sciences, Wayne State University School of Medicine, Detroit, MI, USA, Tel +1 314-359-2691, Fax +1 313 577-9675, Email
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Mawhorter ME, Nguyen P, Goldsmith M, Owens RG, Baer B, Raman JD. Diagnostic yield and costs associated with a routine pre-operative COVID-19 testing algorithm for asymptomatic patients prior to elective surgery. AMERICAN JOURNAL OF CLINICAL AND EXPERIMENTAL UROLOGY 2022; 10:341-344. [PMID: 36313209 PMCID: PMC9605940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVES Infection with COVID-19 presents known and unknown perioperative risks to the patient and operative staff. Pre-operative testing protocols have become widespread, yet little is known about the utility of this practice in asymptomatic patients undergoing elective surgery. We describe the impact and cost of a routine testing protocol on elective surgical procedures in a retrospective series at a single institution. METHODS Standardized pre-operative COVID-19 testing in all surgical patients was implemented in May 2020. Health system protocol required testing 3 to 5 days before all elective surgery. Data stratified by surgical specialty were collected over the initial 90-day period and disposition over a period of 6-months was assessed for all positive and indeterminate results. RESULTS Thirty-one (0.41%) positive results amongst 7579 pre-procedural tests, including 3 of 792 (0.38%) for urologic procedures, were noted in asymptomatic patients. Following a positive test, 20 procedures (62.5%) were delayed an average of 49 days, 8 were not performed and 3 proceeded without delay. All 3 urologic procedures were delayed a mean of 59 days. Institutional cost per test ranged from $34-$54. The number needed to test for one positive result was 244 with a cost of $11,573 for each positive result. CONCLUSIONS Institution of a universal pre-operative COVID-19 screening protocol for asymptomatic, unvaccinated patients undergoing elective surgery identified clinically silent infection in 0.4% of cases with a significant associated cost. Risk and symptom-based testing is likely a better strategy for triaging resources.
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Affiliation(s)
- Michael E Mawhorter
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
| | - Paul Nguyen
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
| | - Mackenzie Goldsmith
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
| | - Russell Grant Owens
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
- Department of Urology, University of IowaIowa, IA, USA
| | - Blake Baer
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
| | - Jay D Raman
- Department of Urology, Penn State Health Milton S. Hershey Medical CenterHershey, PA, USA
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Oocyte Retrieval in Asymptomatic Patients Positive for SARS-CoV-2. Case Rep Obstet Gynecol 2022; 2022:3107747. [PMID: 35990707 PMCID: PMC9391171 DOI: 10.1155/2022/3107747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 07/20/2022] [Indexed: 11/17/2022] Open
Abstract
Objective. To report two cases of oocyte retrieval performed in asymptomatic SARS-CoV-2-positive patients. Design. Case report. Setting. Outpatient private practice infertility center. Patients. A 28-year-old woman at risk for OHSS who took her trigger injection prior to testing positive for SARS-CoV-2 and a 19-year-old oncofertility patient who tested positive prior to retrieval due to a family exposure. Both patients were asymptomatic. Main Outcome Measures. Cycle outcomes, patient safety, and staff safety. Results. Both patients underwent successful oocyte retrieval procedures without developing symptoms or complications from COVID-19. No staff members that cared for these patients developed symptoms of COVID-19. Conclusion. Worsening fertility outcomes and potential for psychological and financial burdens to the patient must be balanced with risk of perioperative complications in patients testing positive for SARS-CoV-2. As we continue to provide fertility care in a world with COVID-19, appropriate risk mitigation strategies should be implemented to minimize exposure to SARS-CoV-2.
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Tse CY, Lee LHH, Akbari AR, Niazi NS, Pillai A. The Impact of COVID-19 Restrictions and Changes in Guidelines on Adult Wrist Fracture Management. J Wrist Surg 2022; 11:322-329. [PMID: 35971468 PMCID: PMC9375687 DOI: 10.1055/s-0041-1736608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic had an unprecedented impact on the healthcare service of the United Kingdom. This study aims to evaluate the effect on wrist fracture care as a result of the COVID-19 pandemic, changes in British Orthopaedic Association Standards of Trauma and Orthopaedics wrist fracture management guidelines, and introduction of lockdown restrictions. Methods This is a retrospective observational study with data collected using the Pathpoint eTrauma platform (Open Medical, United Kingdom). All adults (18 years + ) admitted with wrist fractures within the study phases to Manchester University National Health Service Foundation Trust were included. Each phase of the study period represents a change in lockdown restrictions, including lockdown 1, period of eased restrictions after lockdown 1, lockdown 2, and lockdown 3. These phases were then compared with a prepandemic period. A total of 608 referrals were included for analysis. Results The number of referrals per week decreased from 9.94 prepandemic to as low as 8.12 during lockdown 2. Falls remained the most common mechanism of injury, followed by cycling that saw an increase by more than threefold from 2.42% prepandemic to 8.17% ( p = 0.500) during lockdown 1 and 8.77% ( p = 0.0164) during the easing of lockdown 1. Sports-related injuries and occupational injuries decreased throughout. Assaults and altercations, road traffic accidents, roller-skate, and skateboard-related injuries increased throughout. Surgical procedures per week decreased from 5.06 prepandemic to as low as 4.55 during lockdown 1. Procedure cancellations remained steady apart from an increase during lockdown 2. Referrals managed operatively increased from 50.9% prepandemic to 58.9% in lockdown 2, before dropping to 49.2% in lockdown 3. Mean time from presentation to surgery increased from 9.08 days prepandemic to 16.27 days in lockdown 1 but decreased to just below the prepandemic baseline thereafter. Conclusion Overall, there was a decrease in the number of wrist fracture referrals and surgical procedures compared with before the pandemic. There was also an increased wait-time to surgery and an increased rate of cancellations. Statistical analyses fail to find significance in changes other than mechanisms of injury, which resulted from lockdown restrictions. Therefore, service provision, delivery, and efficiency not affected significantly by changes in guidelines and lockdown restrictions.
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Affiliation(s)
- Cheuk Yin Tse
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Lawrence Hin Hai Lee
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Amir Reza Akbari
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Noman Shakeel Niazi
- Department of Trauma and Orthopaedics, Manchester University NHS Foundation Trust, M23 9LT Wythenshawe Hospital, Manchester, United Kingdom
| | - Anand Pillai
- Department of Trauma and Orthopaedics, Manchester University NHS Foundation Trust, M23 9LT Wythenshawe Hospital, Manchester, United Kingdom
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Spooner J, Lawen T, Ory J. Triaging urological surgeries to cope with the coronavirus-19 pandemic. Curr Opin Urol 2022; 32:131-140. [PMID: 34939597 PMCID: PMC8815629 DOI: 10.1097/mou.0000000000000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The coronavirus-19 (COVID-19) pandemic has led to strains on hospital resources and difficulties in safely and effectively triaging surgical procedures. In this article, we discuss the important considerations for triaging urologic surgeries during a global pandemic, mitigating factors on how to perform surgeries safely, and general guidelines for specific surgeries. RECENT FINDINGS Many urological procedures have been cut back due to the pandemic, with benign disease states being most affected whereas oncology cases affected least. Current recommendations in urology triage life-threatening conditions, or conditions that may lead to life-threatening ailments as a priority for treatment during the pandemic. Additionally, published recommendations have been put forth recommending all surgical patients be screened for COVID-19 to protect staff, prevent disease dissemination, and to educate patients on worse outcomes that can occur if infected with COVID-19 in the postoperative period. SUMMARY COVID-19 has caused worldwide shortages of healthcare resources and increased the need to ethically triage resources to adequately treat the urologic community. These resource limitations have led to increased wait times and cancellations of many urology surgeries that are considered 'elective'.
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Affiliation(s)
- Jesse Spooner
- Dalhousie University, Department of Urology, Halifax, Nova Scotia, Canada
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Zapata Contreras L, Páez Jiménez JA, Castro González JS, Villada Duque A. Elective surgery after Covid-19: A narrative review of the literature. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2022. [DOI: 10.5554/22562087.e1022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
By November 2021, at the time of preparing this article, the disease caused by the new coronavirus (Coronavirus Disease 2019 - COVID-19), declared as a pandemic by the World Health Organization (WHO) on March 11, 2020, had affected more than 128 million people and claimed upwards of 5 million lives. Many of the patients who suffered from this disease will need elective procedures, and this will require knowledge on how to perform the surgery, what tests to order and the extent of preoperative optimization. The objective of this work was to conduct a narrative review of the current evidence regarding time to the performance of an elective procedure in a patient who suffered from COVID-19, the preoperative tests that need to be ordered, and the degree of clinical optimization required according to the complexity of the surgery and individual patient clinical condition. A search was conducted in the Pubmed/Medline, Science Direct, OVID and SciELO databases, as well as in the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) web-based platforms. Although the evidence is still limited, different scientific societies have issued relevant guidelines pertaining to the timing of an elective procedure after COVID-19 infection. For patients who were asymptomatic, the time is 4 weeks after the initial diagnosis of SARS-CoV-2, whereas for symptomatic patients with a mild to moderate course, the time is at least 7 weeks, and 12 weeks if ICU admission was required. There are no guidelines pertaining to preoperative tests or the degree of clinical optimization, although institutional protocols have been developed based on expert consensus on the topic.
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Anesi GL, Kerlin MP. The impact of resource limitations on care delivery and outcomes: routine variation, the coronavirus disease 2019 pandemic, and persistent shortage. Curr Opin Crit Care 2021; 27:513-519. [PMID: 34267075 PMCID: PMC8416747 DOI: 10.1097/mcc.0000000000000859] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Resource limitation, or capacity strain, has been associated with changes in care delivery, and in some cases, poorer outcomes among critically ill patients. This may result from normal variation in strain on available resources, chronic strain in persistently under-resourced settings, and less commonly because of acute surges in demand, as seen during the coronavirus disease 2019 (COVID-19) pandemic. RECENT FINDINGS Recent studies confirmed existing evidence that high ICU strain is associated with ICU triage decisions, and that ICU strain may be associated with ICU patient mortality. Studies also demonstrated earlier discharge of ICU patients during high strain, suggesting that strain may promote patient flow efficiency. Several studies of strain resulting from the COVID-19 pandemic provided support for the concept of adaptability - that the surge not only caused detrimental strain but also provided experience with a novel disease entity such that outcomes improved over time. Chronically resource-limited settings faced even more challenging circumstances because of acute-on-chronic strain during the pandemic. SUMMARY The interaction between resource limitation and care delivery and outcomes is complex and incompletely understood. The COVID-19 pandemic provides a learning opportunity for strain response during both pandemic and nonpandemic times.
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Affiliation(s)
- George L. Anesi
- Division of Pulmonary, Allergy, and Critical Care
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Meeta Prasad Kerlin
- Division of Pulmonary, Allergy, and Critical Care
- Palliative and Advanced Illness Research (PAIR) Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Tawfik AM, Silver JM, Katt BM, Patankar A, Rivlin M, Beredjiklian PK. Patient Perceptions of COVID-19 Precautions and Their Effects on Experiences With Hand Surgery. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2021; 3:167-171. [PMID: 33997725 PMCID: PMC8113162 DOI: 10.1016/j.jhsg.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/07/2021] [Indexed: 02/06/2023] Open
Abstract
Purpose The purpose of this study is to evaluate patient perceptions of COVID-19 precautions and how these precautions have affected their hand and upper extremity surgery experience. Methods We sent an 18-item survey to 1,213 patients who underwent elective hand and upper extremity surgery at 1 academic institution from October 2020 to January 2021. The survey consisted of questions related to patient demographics, treatment delays due to COVID-19, and patient perceptions of COVID-19 precautions. Descriptive statistics were performed to analyze the survey responses. Responses for patients aged 18–50 and 51+ were compared using a chi-square analysis for categorical variables and a Student t-test for continuous variables. Results Out of 1,213 invitations, 384 survey respondents completed the survey (31.6%). Of the respondents, 16.8% reported delaying medical treatment for an average of 123.2 days because of COVID-19. The preventative measures were found to be adequate by 95% of patients. Only 2.6% of patients reported experiencing surgical delays due to preoperative COVID-19 testing or other COVID-19-related precautions. COVID-19 testing was seen as necessary by 88% of patients, and 74% did not find COVID-19 testing to be a barrier to their surgery. Patients aged 51+ were more likely to delay seeking medical treatment than younger patients (19.3% vs 9.1%, respectively). Furthermore, those that did delay seeking treatment waited longer on average than their younger counterparts (136.1 vs 72.9 days, respectively). Conclusions In conclusion, patients undergoing hand and upper extremity surgery typically do not find COVID-19 precautions to be a significant barrier to care and understand their importance. Despite this, many patients, particularly older ones, are delaying medical care for extended periods of time. It is important for hand surgeons to acknowledge their patients’ perspectives and work to educate patients on evolving surgical safety guidelines. Clinical relevance Patient perspectives of current COVID-19 precautions can help inform hand surgeons on areas for continued patient education.
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Affiliation(s)
- Amr M Tawfik
- Rothman Orthopaedic Institute, Philadelphia, PA.,Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy M Silver
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Brian M Katt
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Aneesh Patankar
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
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Olech J, Ciszewski M, Morasiewicz P. Epidemiology of distal radius fractures in children and adults during the COVID-19 pandemic - a two-center study. BMC Musculoskelet Disord 2021; 22:306. [PMID: 33771142 PMCID: PMC7995382 DOI: 10.1186/s12891-021-04128-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 02/17/2021] [Indexed: 01/13/2023] Open
Abstract
Background Distal radius fractures (DRFs) constitute 15–21% of all fractures. There are no detailed data on the possible changes in the epidemiology and treatment of DRFs in children and adults during the Covid pandemic. The purpose of our study was a comprehensive assessment of the impact of the COVID-19 pandemic on distal radius fractures (DRF) epidemiology, including both children and adults and various fracture fixation methods in two large trauma centers in Poland. Methods This study compared the medical data on the treatment of distal radius fractures in Poland in two periods: the period of the COVID-19 pandemic (from March 15 to October 15, 2020) and the corresponding period prior to the pandemic (from March 15 to October 15, 2019). We assessed detailed data from two trauma centers for pediatric and adult patients. Outpatients seeking medical attention at emergency departments and inpatients undergoing surgery at trauma-orthopedic wards were evaluated. We compared epidemiological data, demographic data, treatment type, and hospital stay duration. Results The total number of patients hospitalized due to DRF during the pandemic was 180, it was 15.1% lower than that from the pre-COVID-19 pandemic period (212). In the case of adult patients, the total number of those hospitalized during the pandemic decreased significantly (by 22%) from 132 to 103 patients. Analysis of the individual treatment methods revealed that the number of adults who underwent conservative treatment was considerably (by 30.3%) significantly lower in the period of the COVID-19 pandemic, from 119 to 83 patients. Compared to 13 patients from the pre-pandemic period, the number of surgically treated adults statistically increased to 20 patients (by 53.8%). Our analyses showed hospitalizations of surgically treated adults to be shorter by 12.7% during the pandemic, with the corresponding hospitalizations of surgically treated pediatric patients to be shorter by11.5%. Conclusions Our study showed a significant impact of the COVID-19 pandemic on the epidemiology and treatment of DRFs in children and adults. We found decreased numbers of pediatric and adult patients with DRFs during the COVID-19 pandemic. The pandemic caused an increase in the number of children and significantly increase adults undergoing surgical treatment for DRFs, a decrease in mean patient age, shorter significantly length of hospital stay, and an increased number of men with DRFs.
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Affiliation(s)
- Jarosław Olech
- Provincial Specialist Hospital in Legnica, Orthopedic Surgery Department, Iwaszkiewicza 5, 59-220, Legnica, Poland
| | - Mariusz Ciszewski
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401, Opole, Poland
| | - Piotr Morasiewicz
- Department of Orthopaedic and Trauma Surgery, University Hospital in Opole, Institute of Medical Sciences, University of Opole, al. Witosa 26, 45-401, Opole, Poland.
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