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McCollister K, Berry JG, Melvin P, Tartarilla AB, Nuzzi LC, Lajoie D, Meara JG, Ward VL. Effects of Sociodemographic and Child Opportunity Index on Pediatric Plastic and Oral and Maxillofacial Surgical Volume Trends in the COVID-19 Pandemic. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5707. [PMID: 38596585 PMCID: PMC11000752 DOI: 10.1097/gox.0000000000005707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/12/2024] [Indexed: 04/11/2024]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic caused disruptions to pediatric surgical care. Although surgical capacity has returned to the prepandemic state, barriers to surgical access may still exist for children who are medically underserved. We assessed pediatric plastic and oral and maxillofacial surgical volumes by sociodemographic characteristics before and during the COVID-19 pandemic. Methods A 72-month retrospective cohort analysis of 10,681 pediatric plastic and oral and maxillofacial procedures between 2016 and 2021 was conducted. Multivariable logistic regression and interrupted time series analyses were used to analyze surgical volume trends by sociodemographic groups and Child Opportunity Index (COI). Results Compared with prepandemic, patients undergoing procedures were more likely to be older than 18 years (P < 0.001) and Hispanic/Latino (adjusted odds ratio 1.38; 95% confidence interval, 1.14-1.68; P < 0.01). Surgical volume trends among patients from the lowest COI levels were lower than where they were estimated to have been if the pandemic did not occur (P = 0.040). Patients who spoke a primary language other than English or Spanish (P = 0.02) and patients with the lowest COI levels (P = 0.04) continued to have unrecovered surgical volumes. Conclusions There were differences in the sociodemographic case-mix of patients undergoing plastic and oral and maxillofacial surgical procedures before and during the pandemic, and surgical volumes did not recover at the same rate for all patients. Further research can determine why certain sociodemographic groups and patients with low COI levels had decreased surgical access compared with prepandemic trends, and develop interventions focused on equitable pediatric surgical access.
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Affiliation(s)
- Kali McCollister
- From the Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
| | - Jay G. Berry
- Complex Care, Division of General Pediatrics, Boston Children’s Hospital, Boston, Mass
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
| | - Patrice Melvin
- From the Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
- Office of Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
| | - Ashley B. Tartarilla
- From the Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
| | - Laura C. Nuzzi
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
| | - Debra Lajoie
- Nursing Research Medical, Surgical, Behavioral Health & Emergency Programs, Boston Children’s Hospital, Boston, Mass
| | - John G. Meara
- Department of Plastic and Oral Surgery, Boston Children’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
| | - Valerie L. Ward
- From the Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
- Harvard Medical School, Boston, Mass
- Office of Health Equity and Inclusion, Boston Children’s Hospital, Boston, Mass
- Department of Radiology, Boston Children’s Hospital, Boston, Mass
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Berry JG, Ferrari L, Ward VL, Hall M, Desmarais A, Raval MV, Tian Y, Mathieu D, Incorvia J, Meara JG. Child Opportunity Index Disparities in Pediatric Surgical Encounters During the Coronavirus 2019 Pandemic. Acad Pediatr 2024; 24:43-50. [PMID: 37625667 DOI: 10.1016/j.acap.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/04/2023] [Accepted: 08/19/2023] [Indexed: 08/27/2023]
Abstract
OBJECTIVE Surgical encounters decreased during the coronavirus disease (COVID-19) pandemic and may have been deferred more in children with impeded health care access related to social/community risk factors. We compared surgery trends before and during the pandemic by Child Opportunity Index (COI). METHODS Retrospective analysis of 321,998 elective surgical encounters of children ages 0-to-18 years in 44 US children's hospitals from January 1, 2017 to December 31, 2021. We used auto-regression to compare observed versus predicted encounters by month in 2020-21, modeled from 2017 to 2019 trends. Encounters were compared by COI score (very low, low, moderate, high, very high) based on education, health/environment, and social/economic attributes of the zip code from the children's home residence. RESULTS Most surgeries were on the musculoskeletal (28.1%), ear/nose/pharynx (17.1%), cardiovascular (15.1%), and digestive (9.1%) systems; 20.6% of encounters were for children with very low COI, 20.8% low COI, 19.8% moderate COI, 18.6% high COI, and 20.1% very high COI. Reductions in observed volume of 2020-21 surgeries compared with predicted varied significantly by COI, ranging from -11.3% (95% confidence interval [CI] -14.1%, -8.7%) for very low COI to -2.6% (95%CI -3.9%, 0.7%) for high COI. Variation by COI emerged in June 2020, as the volume of elective surgery encounters neared baseline. For 12 of the next 18 months, the reduction in volume of elective surgery encounters was the greatest in children with very low COI. CONCLUSIONS Children from very low COI zip codes experienced the greatest reduction in elective surgery encounters during early COVID-19 without a subsequent increase in encounters over time to counterbalance the reduction.
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Affiliation(s)
- Jay G Berry
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass; Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass; Department of Pediatrics (JG Berry), Harvard Medical School, Boston, Mass.
| | - Lynne Ferrari
- Perioperative Anesthesia (L Ferrari), Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, Mass
| | - Valerie L Ward
- Department of Radiology (VL Ward), Boston Children's Hospital and Harvard Medical School, Mass; Office of Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass; Sandra L. Fenwick Institute for Pediatric Health Equity and Inclusion (VL Ward), Boston Children's Hospital, Mass
| | - Matt Hall
- Children's Hospital Association (M Hall), Lenexa, Kans
| | - Anna Desmarais
- Complex Care (JG Berry and A Desmarais), Division of General Pediatrics, Boston Children's Hospital, Mass
| | - Mehul V Raval
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill; Division of Pediatric Surgery (MV Raval), Department of Surgery, Feinberg School of Medicine, Northwestern University, Ann & Robert H. Lurie Children's Hospital, Chicago, Ill
| | - Yao Tian
- Surgical Outcomes Quality Improvement Center (MV Raval and Y Tian), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Ill
| | - Derek Mathieu
- Department of Finance (D Mathieu), Boston Children's Hospital, Mass; Department of Surgery (D Mathieu), Harvard Medical School, Boston, Mass
| | - Joseph Incorvia
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
| | - John G Meara
- Department of Plastic and Oral Surgery (JG Berry, J Incorvia, and JG Meara), Boston Children's Hospital, Mass
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Nuzzi A, Latorre V, Semisa D, Scozzi B. Improving the mental health care process in response to Covid-19 pandemic: The case of a penitentiary mental health division. PLoS One 2023; 18:e0293492. [PMID: 37903102 PMCID: PMC10615294 DOI: 10.1371/journal.pone.0293492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Covid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach-which innovatively combines Soft System Methodology and Business Process Management-constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings.
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Affiliation(s)
- Angela Nuzzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| | - Valeria Latorre
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
- Penitentiary Mental Health Service, Department of Mental Health, ASL Bari, Bari, Italy
| | - Domenico Semisa
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
| | - Barbara Scozzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
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Pace D, Lopez ME, Berman L. Quality improvement dissemination in pediatric surgery: The APSA quality and safety toolkit. Semin Pediatr Surg 2023; 32:151279. [PMID: 37075657 DOI: 10.1016/j.sempedsurg.2023.151279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Shared experiential learning is critical in the field of pediatric surgery to support the translation of evidence into practice. Surgeons who develop QI interventions in their own institutions based on the best available evidence create work products that can accelerate similar projects in other institutions, rather than continuously reinventing the wheel. The American Pediatric Surgical Association (APSA) Quality and Safety Committee (QSC) toolkit was created to facilitate knowledge-sharing and thereby hasten the development and implementation of QI. The toolkit is an expanding open-access web-based repository of curated QI projects that includes evidence-based pathways and protocols, stakeholder presentations, parent/patient educational materials, clinical decision support (CDS) tools, and other components of successful QI interventions in addition to contact information for the surgeons who developed and implemented them. This resource catalyzes local QI endeavors by showcasing a range of projects that can be adapted to fit the needs of a given institution, and it also serves as a network to connect interested surgeons with successful implementers. As healthcare shifts towards value-based care models, quality improvement becomes increasingly important, and the APSA QSC toolkit will continue to adapt to the evolving needs of the pediatric surgery community.
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Affiliation(s)
- Devon Pace
- Department of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States
| | - Monica E Lopez
- Department of Pediatric Surgery, Section of Surgical Sciences, Vanderbilt University Medical Center, Monroe Carrell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States
| | - Loren Berman
- Department of Pediatric Surgery, Nemours Children's Health, Wilmington, DE, United States; Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, United States.
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Shirriff A, Gragas A, Tabak B, Abella M, Ahn HJ, Woo R. Efficacy of Telehealth in Preoperative Pediatric Surgery Consultations. J Surg Res 2023; 288:240-245. [PMID: 37030181 PMCID: PMC10076909 DOI: 10.1016/j.jss.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 04/10/2023]
Abstract
INTRODUCTION The Coronavirus disease 2019 pandemic created a sudden need to transition outpatient pediatric surgical care to a telehealth platform, allotting little time to study the efficacy of these changes. In particular, the accuracy of telehealth preoperative assessment remains unclear. Therefore, we sought to study the prevalence of errors in diagnosis and procedure cancellations between preoperative in-person evaluations and telehealth evaluations. METHODS We conducted a single institution, retrospective chart review of perioperative medical records at a tertiary children's hospital over a 2-year period. Data included patient demographics (age, sex, county, primary language, and insurance), preoperative diagnosis, postoperative diagnosis, and surgical cancellation rates. Data were analyzed using Fisher's exact and chi-square tests. Alpha was set at 0.05. RESULTS A total of 523 patients were analyzed, with 445 in-person visits and 78 telehealth visits. There were no demographic differences between the in-person and telehealth cohorts. The frequency of changes from the preoperative to the postoperative diagnosis was not significantly different between in-person preoperative visits and telehealth preoperative visits (0.99% versus 1.41%, P = 0.557). The frequency of case cancellations between the two consultation modalities was not significantly different (9.44% versus 8.97%, P = 0.899). CONCLUSIONS Our results demonstrate that preoperative pediatric surgical consultations held via telehealth were neither associated with a decrease in the accuracy of preoperative diagnosis, nor an increased rate of surgery cancellations, compared to those held in-person. Further study is needed to better determine the advantages, disadvantages, and limitations of telehealth in the delivery of pediatric surgical care.
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Affiliation(s)
- Ashley Shirriff
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii.
| | - Anna Gragas
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Benjamin Tabak
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Maveric Abella
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
| | - Russell Woo
- Department of Surgery, John A. Burns School of Medicine, University of Hawai'i, Honolulu, Hawaii
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Matava C, So JP, Hossain A, Kelley S. Experiences of Health Care Professionals Working Extra Weekends to Reduce COVID-19-Related Surgical Backlog: Cross-sectional Study. JMIR Perioper Med 2022; 5:e40209. [PMID: 36423322 DOI: 10.2196/40209] [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: 06/10/2022] [Revised: 11/15/2022] [Accepted: 11/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND During the quiescent periods of the COVID-19 pandemic in 2020, we implemented a weekend-scheduled pediatric surgery program to reduce COVID-19-related backlogs. Over 100 staff members from anesthesiologists to nurses, surgeons, and administrative and supporting personnel signed up to work extra weekends as part of a novel weekend elective pediatric surgery program to reduce COVID-19-related backlog: Operating Room Ramp-Up After COVID-19 Lockdown Ends-Extra Lists (ORRACLE-Xtra). OBJECTIVE In this study, we sought to evaluate staff perceptions and their level of satisfaction and experiences with working extra scheduled weekend elective surgical cases at the end of the 3-month pilot phase of ORRACLE-Xtra and identify key factors for participation. METHODS Following the pilot of ORRACLE-Xtra, all perioperative staff who worked at least 1 weekend list were invited to complete an online survey that was developed and tested prior to distribution. The survey collected information on the impact of working weekends on well-being, overall satisfaction, and likelihood of and preferences for working future weekend lists. Logistic regression was used to estimate the association of well-being with satisfaction and willingness to work future weekend lists. RESULTS A total of 82 out of 118 eligible staff responded to the survey for a response rate of 69%. Staff worked a median of 2 weekend lists (IQR 1-9). Of 82 staff members, 65 (79%) were satisfied or very satisfied with working the extra weekend elective lists, with surgeons and surgical trainees reporting the highest levels of satisfaction. Most respondents (72/82, 88%) would continue working weekend lists. A sense of accomplishment was associated with satisfaction with working on the weekend (odds ratio [OR] 19.97, 95% CI 1.79-222.63; P=.02) and willingness to participate in future weekend lists (OR 17.74, 95% CI 1.50-200.70; P=.02). Many (56/82, 68%) were willing to work weekend lists that included longer, more complex cases, which was associated with a sense of community (OR 0.12, 95% CI 0.02-0.63; P=.01). CONCLUSIONS Staff participating in the first 3 months of the ORRACLE-Xtra program reported satisfaction with working weekends and a willingness to continue with the program, including doing longer, more complex cases. Institutions planning on implementing COVID-19 surgical backlog work may benefit from gathering key information from their staff.
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Affiliation(s)
- Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jeannette P So
- Perioperative Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alomgir Hossain
- Clinical Research Services, The Hospital for Sick Children, Toronto, ON, Canada
| | - Simon Kelley
- Division of Orthopaedics, The Hospital for Sick Children, Toronto, ON, Canada
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Reiter AJ, Ingram MCE, Raval MV, Garcia E, Hill M, Aranda A, Chandler NM, Gonzalez R, Born K, Mack S, Lamoshi A, Lipskar AM, Han XY, Fialkowski E, Spencer B, Kulaylat AN, Barde A, Shah AN, Adoumie M, Gross E, Mehl SC, Lopez ME, Polcz V, Mustafa MM, Gander JW, Sullivan TM, Sulkowski JP, Ghani O, Huang EY, Rothstein D, Muenks EP, St. Peter SD, Fisher JC, Levy-Lambert D, Reichl A, Ignacio RC, Slater BJ, Tsao K, Berman L. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: A Cohort Study. J Pediatr Surg 2022:S0022-3468(22)00716-3. [PMID: 36428183 PMCID: PMC9632239 DOI: 10.1016/j.jpedsurg.2022.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children. METHODS This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications. RESULTS Of 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications. CONCLUSIONS Postoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients. LEVEL OF EVIDENCE Iii, Respiratory complications.
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Affiliation(s)
- Audra J. Reiter
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States,Corresponding author
| | - Martha-Conley E. Ingram
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Elisa Garcia
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Madelyn Hill
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Nicole M Chandler
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Kristen Born
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Shale Mack
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Abdulraouf Lamoshi
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Aaron M. Lipskar
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Xiao-Yue Han
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Elizabeth Fialkowski
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Brianna Spencer
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Afif N. Kulaylat
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Amrene Barde
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Ami N. Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Maeva Adoumie
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Erica Gross
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Steven C. Mehl
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston TX, United States
| | - Monica E. Lopez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Valerie Polcz
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Moiz M. Mustafa
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Jeffrey W. Gander
- Division of Pediatric Surgery, Department of Surgery, UVA Children's Hospital, Charlottesville, VA, United States
| | - Travis M. Sullivan
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Jason P. Sulkowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Owais Ghani
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Eunice Y. Huang
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - David Rothstein
- Division of Pediatric Surgery, Department of Surgery, Seattle Children's Hospital, Seattle WA, United States
| | - E. Peter Muenks
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Shawn D. St. Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Jason C. Fisher
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Dina Levy-Lambert
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Allison Reichl
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Romeo C. Ignacio
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Bethany J. Slater
- Division of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago, Chicago, IL, United States
| | - KuoJen Tsao
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
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Challenges of the COVID-19 Pandemic for the Work–Family Balance of Pediatric Surgeons. SURGERIES 2022. [DOI: 10.3390/surgeries3030027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The COVID-19 pandemic has been a great challenge, especially for families. We aimed to analyze the impact of the pandemic on childcare for and the work–family balance of pediatric surgeons in Germany. An anonymized questionnaire on the working and familial situation before and during the COVID-19 pandemic was sent to the members of the German Society of Pediatric Surgery and trainees in pediatric surgery (April–July 2021). One-hundred-fifty-three participants (59% female) completed the questionnaire. A total of 16% of the males and 62% of the females worked part-time. Most (68%) had underage children. During the COVID-19 pandemic, 36% reported a decrease in patients and interventions, and 55% reported an increase in the organizational work-related burden. Childcare for underage children during lockdown was organized mainly with the help of institutional emergency childcare (45%), staying home (34%), one parent working from a home office (33%), or staying home by themselves (34%). Before the lockdown, 54% reported a good work–family balance. During the lockdown, this worsened by 42%. Most of the families had to organize themselves. Different means such as a home office, flexible working hours, and different models for childcare can help to improve the situation.
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Bottle A, Neale FK, Foley KA, Viner RM, Kenny S, Aylin P, Saxena S, Hargreaves DS. Impact of COVID-19 on outpatient appointments in children and young people in England: an observational study. BMJ Open 2022; 12:e060961. [PMID: 35940830 PMCID: PMC9364042 DOI: 10.1136/bmjopen-2022-060961] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES To describe the impact of the COVID-19 pandemic on outpatient appointments for children and young people. SETTING All National Health Service (public) hospitals in England. PARTICIPANTS All people in England aged <25 years. OUTCOME MEASURES Outpatient department attendance numbers, rates and modes (face to face vs telephone) by age group, sex and socioeconomic deprivation. RESULTS Compared with the average for January 2017 to December 2019, there was a 3.8 million appointment shortfall (23.5%) for the under-25 population in England between March 2020 and February 2021, despite a total rise in phone appointments of 2.6 million during that time. This was true for each age group, sex and deprivation fifth, but there were smaller decreases in face to face and total appointments for babies under 1 year. For all ages combined, around one in six first and one in four follow-up appointments were by phone in the most recent period. The proportion of appointments attended was high, at over 95% for telephone and over 90% for face-to-face appointments for all ages. CONCLUSIONS COVID-19 led to a dramatic fall in total outpatient appointments and a large rise in the proportion of those appointments conducted by telephone. The impact that this has had on patient outcomes is still unknown. The differential impact of COVID-19 on outpatient activity in different sociodemographic groups may also inform design of paediatric outpatient services in the post-COVID period.
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Affiliation(s)
- Alex Bottle
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Francesca K Neale
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Kimberley A Foley
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Russell M Viner
- Population, Policy and Practice Research Programme, UCL Great Ormond Street Institute of Child Health Population Policy and Practice, London, UK
| | - Simon Kenny
- National Clinical Director, NHS England and NHS Improvement, London, UK
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
| | - Paul Aylin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Dougal S Hargreaves
- Department of Primary Care and Public Health, Imperial College London, London, UK
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Efendi D, Hasan F, Natalia R, Utami AR, Sonko I, Asmarini TA, Yuningsih R, Wanda D, Sari D. Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review. PLoS One 2022; 17:e0263267. [PMID: 35113925 PMCID: PMC8812980 DOI: 10.1371/journal.pone.0263267] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting. METHODS AND FINDINGS The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning). CONCLUSION Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.
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Affiliation(s)
- Defi Efendi
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Depok, Indonesia
| | - Faizul Hasan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Regina Natalia
- School of Nursing, Mitra Bunda Health Institute, Batam, Indonesia
| | - Ayuni Rizka Utami
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Ismaila Sonko
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia, West Africa
| | - Titik Ambar Asmarini
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal and Pediatric Intensive Care Unit, Gatot Soebroto Indonesian Central of Army Hospital, Jakarta, Indonesia
| | - Risna Yuningsih
- Neonatal Intensive Care Unit, Dr. Dradjat Prawiranegara General Hospital, Banten, Indonesia
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dian Sari
- School of Nursing, Prima Nusantara Health Institute, Bukittinggi, Indonesia
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11
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Caffarelli C, Santamaria F, Procaccianti M, Piro E, delle Cave V, Borrelli M, Santoro A, Grassi F, Bernasconi S, Corsello G. Developments in pediatrics in 2020: choices in allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, ortopedics, respiratory tract illnesses and rheumatology. Ital J Pediatr 2021; 47:232. [PMID: 34876198 PMCID: PMC8650733 DOI: 10.1186/s13052-021-01184-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/22/2021] [Indexed: 11/25/2022] Open
Abstract
In this article, we describe the advances in the field of pediatrics that have been published in the Italian Journal of Pediatrics in 2020. We report progresses in understanding allergy, autoinflammatory disorders, critical care, endocrinology, genetics, infectious diseases, microbiota, neonatology, neurology, nutrition, orthopedics, respiratory tract illnesses, rheumatology in childhood.
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Affiliation(s)
- Carlo Caffarelli
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Francesca Santamaria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Michela Procaccianti
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Ettore Piro
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
| | - Valeria delle Cave
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Melissa Borrelli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Angelica Santoro
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | - Federica Grassi
- Clinica Pediatrica, Department of Medicine and Surgery, Azienda Ospedaliera-Universitaria, University of Parma, Via Gramsci, 14 Parma, Italy
| | | | - Giovanni Corsello
- Department of Sciences for Health Promotion and Mother and Child Care ‘’G. D’Alessandro”, University of Palermo, Palermo, Italy
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12
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Mehl SC, Loera JM, Shah SR, Vogel AM, Fallon SC, Glover CD, Monson LA, Enochs JA, Hollier LH, Lopez ME. Favorable postoperative outcomes for children with COVID-19 infection undergoing surgical intervention: Experience at a free-standing children's hospital. J Pediatr Surg 2021; 56:2078-2085. [PMID: 33581882 PMCID: PMC7838581 DOI: 10.1016/j.jpedsurg.2021.01.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 01/13/2021] [Accepted: 01/23/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Current literature has shown that adult patients with perioperative Coronavirus Disease-2019 (COVID-19) have increased rates of postoperative morbidity and mortality. We hypothesized that children with COVID-19 have favorable postoperative outcomes compared to the reported adult experience. METHODS We performed a retrospective cohort study for children with a confirmed preoperative COVID-19 diagnosis from April 1st, 2020 to August 15th, 2020 at a free-standing children's hospital. Primary outcomes evaluated were postoperative complications, readmissions, reoperations, and mortality within 30 days of operation. Secondary outcomes included hospital resource utilization, hospital length of stay, and postoperative oxygen support. RESULTS A total of 66 children with preoperative confirmed COVID-19 were evaluated with median age of 9.5 years (interquartile range (IQR) 5-14) with 65% male and 70% Hispanic White. Sixty-five percent of patients had no comorbidities, with abdominal pain identified as the most common preoperative symptom (65%). Twenty-three percent of patients presented with no COVID-19 related symptoms. Eighty-two percent of patients had no preoperative chest imaging and 98% of patients did not receive preoperative oxygen support. General pediatric surgeons performed the majority of procedures (68%) with the most common diagnosis appendicitis (47%). Forty-one percent of patients were discharged the same day as surgery with 9% of patients utilizing postoperative intensive care unit resources and only 5% receiving postoperative invasive mechanical ventilation. Postoperative complications (7%), readmission (6%), and reoperation (6%) were infrequent, with no mortality. CONCLUSION COVID-19+ children requiring surgery have a favorable postoperative course and short-term outcomes compared to the reported adult experience. TYPE OF STUDY Prognosis Study. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Steven C. Mehl
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Jackquelin M. Loera
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
| | - Sohail R. Shah
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Adam M. Vogel
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Sara C. Fallon
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States,Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States
| | - Chris D. Glover
- Department of Pediatric Anesthesiology, Texas Children's Hospital, Houston, TX, United States
| | - Laura A. Monson
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Joyce A. Enochs
- Department of Surgery, Perioperative Services, Texas Children's Hospital, Houston, TX, United States
| | - Larry H. Hollier
- Department of Surgery, Division of Plastic Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Monica E. Lopez
- Michael E. DeBakey Department of Surgery, Division of Pediatric Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin Street, Suite 1210, Houston, TX 77030, United States,Corresponding author
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13
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Dibbs RP, Ferry AM, Mehl SC, Ferguson SM, Versalovic J, Dunn JJ, Enochs J, Monson LA, Hollier LH. Screening pediatric surgical patients during the COVID-19 pandemic. JAAPA 2021; 34:43-48. [PMID: 34582385 DOI: 10.1097/01.jaa.0000791484.37318.d3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT SARS-CoV-2 has profoundly affected the way healthcare is delivered and has created significant strain on medical facilities globally. As a result, hospitals have had to continuously adapt in order to provide optimal patient care while minimizing the risk of SARS-CoV-2 transmission, particularly in the surgical setting. Texas Children's Hospital developed a set of protocols for surgical screening and clearance of patients in the context of the COVID-19 pandemic. These screening protocols were designed to mitigate the risk of exposing patients and healthcare providers to SARS-CoV-2 and have evolved significantly as a result of the emerging changes in medicine, technology, and governmental regulations. In this article, we share the reasoning behind the development, implementation, and successive modification of our institutional screening protocols.
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Affiliation(s)
- Rami P Dibbs
- Rami P. Dibbs and Andrew M. Ferry are research fellows in the Division of Plastic Surgery at Texas Children's Hospital and Baylor College of Medicine in Houston, Tex. Steven C. Mehl is a general surgery resident physician at Baylor College of Medicine. Susannah M. Ferguson is clinical lead of advanced practice providers in the Department of Surgery at Texas Children's Hospital. James Versalovic is pathologist-in-chief at Texas Children's Hospital and director of Texas Children's Microbiome Center. James J. Dunn is the director of medical microbiology and virology at Texas Children's Hospital. Joyce Enochs is manager of nursing perioperative services at Texas Children's Hospital. Laura A. Monson is a pediatric plastic and reconstructive surgeon and chief surgical quality and safety officer at Texas Children's Hospital. Larry H. Hollier, Jr. , is a plastic and reconstructive surgeon and surgeon-in-chief at Texas Children's Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise
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14
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Bašković M. The impact of telemedicine on the quality and satisfaction with the health care provided during the COVID-19 pandemic in the field of pediatrics with special reference to the surgical professions. POLISH JOURNAL OF SURGERY 2021; 93:53-60. [DOI: 10.5604/01.3001.0015.2649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The COVID-19 pandemic has forced healthcare systems around the world to adopt telemedicine at an unprecedented rate.
Visits to telemedicine have increased to provide access and maintain continuity of care. Internet access has almost become
a necessity, and new technologies allow for the easy flow of data from patient to doctor and vice versa. Doctors of all specialties
were forced to adapt to the pandemic and emerging conditions. The provision of surgical services and the learning ability of
surgeons are particularly disrupted, and the pediatric surgical community is not exempt. During the pandemic, telemedicine
proved to be a viable and safe technique for providing health services. In an environment of a health system that is constantly
facing a shortage of resources, effective telemedicine placement can come with a high benefit-cost ratio and quality of care,
while ensuring patient satisfaction.
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Affiliation(s)
- Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Croatia
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15
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Saalabian K, Rolle U, Friedmacher F. Impact of the Global COVID-19 Pandemic on the Incidence, Presentation, and Management of Pediatric Appendicitis: Lessons Learned from the First Wave. Eur J Pediatr Surg 2021; 31:311-318. [PMID: 34161983 DOI: 10.1055/s-0041-1731295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The fast-evolving nature of the coronavirus disease 2019 (COVID-19) pandemic has led to unprecedented clinical, logistical, and socioeconomical challenges for health-care systems worldwide. While several studies have analyzed the impact on the presentation and management of acute appendicitis (AA) in the adult population, there is a relative paucity of similar research in pediatric patients with AA. To date, there is some evidence that the incidence of simple AA in children may have decreased during the first lockdown period in spring 2020, whereas the number of complicated AA cases remained unchanged or increased slightly. Despite a worrying trend toward delayed presentation, most pediatric patients with AA were treated expediently during this time with comparable outcomes to previous years. Hospitals must consider their individual capacity and medical resources when choosing between operative and non-operative management of children with AA. Testing for severe acute respiratory syndrome coronavirus type 2 is imperative in all pediatric patients presenting with fever and acute abdominal pain with diarrhea or vomiting, to differentiate between multisystem inflammatory syndrome and AA, thus avoiding unnecessary surgery. During the further extension of the COVID-19 crisis, parents should be encouraged to seek medical care with their children early in order that the appropriate treatment for AA can be undertaken in a timely fashion.
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Affiliation(s)
- Kerstin Saalabian
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Udo Rolle
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
| | - Florian Friedmacher
- Department of Pediatric Surgery, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt (Main), Germany
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16
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Melander S, Almström J, Enlund G, Frykholm P. The COVID-19 pandemic first wave in Sweden: A national registry study of the effects on pediatric anesthesia and surgery. Paediatr Anaesth 2021; 31:846-853. [PMID: 33971054 PMCID: PMC8242453 DOI: 10.1111/pan.14203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The COVID-19 pandemic is pushing healthcare systems to their limits. Dramatic reductions in the adult elective surgery are ubiquitous, but corresponding changes in pediatric services are not well described. The Swedish Perioperative Registry contains data on all anesthetic procedures in Sweden, and therefore, provides a unique opportunity to analyze the effect of the pandemic on the pediatric anesthesia capacity on a national level. We hypothesized that there would be a significant reduction in pediatric elective procedures. The aim was to determine the effects on pediatric surgical and anesthetic services during the first wave of the COVID-19 pandemic in Sweden. METHODS For this retrospective registry cohort study, we extracted all procedures performed on patients <18 years of age in 2020 and 2019. Weeks 12 to 26 of 2020 were defined as the first wave, and data were analyzed according to level of care, type of surgery, procedure code, and emergency or elective surgery. RESULTS We found 7015 fewer procedures during the first wave epoch. Elective cases were reduced by 53.7% while emergency surgery was not significantly affected. During the peak of the first wave in April, there was a 72.8% reduction in elective cases; ENT/maxillofacial surgery showed the greatest reduction (86.7%). The surgical and anesthesia capacity recovered to near-normal levels by the end of June 2020. CONCLUSION We conclude that the impact of COVID-19 on pediatric surgical procedures in Sweden during the first wave of the pandemic was dramatic, but elective services were restored a few months after the peak.
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Affiliation(s)
- Sixten Melander
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Jimmy Almström
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Gunnar Enlund
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
| | - Peter Frykholm
- Department of Surgical SciencesSection of Anaesthesia and Intensive Care MedicineUppsala UniversityUppsalaSweden
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17
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Yasmin F, Bin Zafar MD, Salman A, Farooque U, Asghar MS, Khan AA, Mohiuddin O, Hassan SA. Exploring the impact of the COVID-19 pandemic on pediatric surgical services: a scoping review. Minerva Pediatr (Torino) 2021; 73:460-466. [PMID: 33845565 DOI: 10.23736/s2724-5276.21.06146-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Inevitably, along with other healthcare specializations, pediatric surgery was affected by the Coronavirus disease-19 (COVID-19) pandemic. Children were reported to manifest mild to moderate symptoms and mortality was primarily observed in patients aged <1 year and having underlying comorbidities. The majority of the cases were asymptomatic in children, hence, posing a challenge for pediatric surgery centers to take drastic measures to reduce the virus transmission. Telemedicine was introduced and outpatient consultations were conducted online as out-patient clinics were closed. Elective surgeries were postponed with delayed appointments while the healthcare sector was diverted towards tackling COVID-19. Case urgency was classified and triaged, leading to limited surgeries being performed only in COVID-19 negative patients following an extensive screening process. The screening process consisted of online history taking and RT-PCR tests. Newer practices such as mouth rinse, video laryngoscopy, and anesthesia were introduced to restrict patients from crying, coughing, and sneezing, as an attempt to avoid aerosolization of viral particles and safely conduct pediatric surgeries during the pandemic. Surgical trainees were also affected as the smaller number of surgeries conducted reduced the clinical experience available to medical enthusiasts. There is still room for advanced practices to be introduced in pediatric surgery, and restore all kinds of surgeries to improve the quality of life of the patient.
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Affiliation(s)
- Farah Yasmin
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan -
| | - Muhammad D Bin Zafar
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ariba Salman
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Umar Farooque
- Department of Neurology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad S Asghar
- Department of Internal Medicine, Dow University Hospital (Ohja Campus), Karachi, Pakistan
| | - Anosh A Khan
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Osama Mohiuddin
- MBBS, Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed A Hassan
- Department of Cardiovascular Medicine, University of Louisville, Louisville, KY, USA
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18
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Ingram MCE, Mehl S, Rentea RM, Lopez ME, Raval MV, Newton C, Berman L. Sharing strategies for safe delivery of surgical care for children in the COVID-19 Era. J Pediatr Surg 2021; 56:196-198. [PMID: 33248680 PMCID: PMC7661910 DOI: 10.1016/j.jpedsurg.2020.11.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Martha-Conley E. Ingram
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA,Corresponding author
| | - Steven Mehl
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston TX, USA
| | - Rebecca M. Rentea
- Division of Pediatric Surgery, Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
| | - Monica E. Lopez
- Division of Pediatric Surgery, Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, Houston TX, USA
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Christopher Newton
- Division of Pediatric Surgery, Department of Surgery, UCSF East Bay, Oakland, CA, USA
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery, Sidney Kimmel Medical College at Thomas Jefferson University Hospital, Nemours Al duPont Hospital for Children, Wilmington, DE, USA
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