RESUMO
BACKGROUND: Coronavirus disease 2019 has demanded enormous adjustments to National Health Service provisions. Non-urgent out-patient work was initially postponed or performed virtually, but is now being re-established. In ENT surgery, aerosol-generating procedures pose a particular challenge in out-patient settings. OBJECTIVE: A rapid restructuring of ENT out-patient services is required, to safely accommodate aerosol-generating procedures and increase in-person attendances, whilst coronavirus disease 2019 persists. METHODS: Data were collected prospectively over four consecutive cycles. Two surveys were conducted. Results were analysed and disseminated, with recommendations for service restructuring implemented at cycle end-points. RESULTS: Out-patient activity increased four-fold, associated with a significant rise in aerosol-generating procedures during the study period. Mean aerosol-generating procedure duration dropped weekly, implying a learning curve. Service restructuring occurred at cycle end-points. CONCLUSION: Iterative data gathering, results analysis and outcome dissemination enabled a swift, data-driven approach to the restructuring of ENT out-patient services. Patient and staff safety was ensured, whilst out-patient capacity was optimised.
Assuntos
Infecções por Coronavirus/transmissão , Otolaringologia/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Pneumonia Viral/transmissão , Aerossóis , Betacoronavirus/isolamento & purificação , Líquidos Corporais/virologia , COVID-19 , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Reestruturação Hospitalar/organização & administração , Humanos , Incidência , Programas Nacionais de Saúde/organização & administração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estudos Prospectivos , Melhoria de Qualidade , SARS-CoV-2 , Inquéritos e Questionários , Reino Unido/epidemiologiaRESUMO
During airway surgery, the anaesthetist may be required to manipulate or withdraw the endotracheal tube. Traditional surgical head drapes often make access to the tube difficult, therefore limiting control of the airway and risking de-sterilisation of the surgical field. We report a new method of draping for major neck operations that permits easy access to the endotracheal tube while maintaining sterility of the operative field.
Assuntos
Cuidados Intraoperatórios/métodos , Intubação Intratraqueal/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Campos Cirúrgicos , Humanos , Pescoço/cirurgiaRESUMO
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative and other groups support maintaining transferrin saturation (TSAT) levels above 20% and serum ferritin levels above 100 ng/ml to ensure adequate erythropoiesis in hemodialysis patients receiving erythropoietin. However, researchers have found that even patients with TSATs above 20% may still have functional iron deficiency. This article presents information that supports the fact that maintenance of TSATs between 30% and 50%, through the use of continuous intravenous iron therapy, results in improvement of anemia, reduction in erythropoietin dose requirements, and an increase in the reticulocyte hemoglobin content. The implications of these findings for clinical practice are also discussed.