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3.
Cir Cir ; 89(2): 183-188, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33784282

RESUMEN

ANTECEDENTES: La pandemia de COVID-19 ha ocasionado que los servicios de cirugía y de salud en todo el mundo tengan que reorganizarse y planear para poder brindar la mejor atención a los pacientes, con la protección necesaria para el personal de salud. Algunos de estos pacientes requerirán tratamiento quirúrgico, ya sea electivo o de urgencia. OBJETIVO: Reportar la experiencia inicial en el manejo de pacientes con COVID-19 que ameritaron tratamiento quirúrgico por los servicios de cirugía de un hospital de referencia. MÉTODO: Revisión de los protocolos quirúrgicos, equipo de protección personal usado por los equipos quirúrgicos y resultados del tratamiento de 42 pacientes sometidos a cirugía en un periodo de 4 meses. RESULTADOS: Fueron intervenidos 42 pacientes con COVID-19. Treinta pacientes tenían diagnóstico de infección por SARS-CoV-2 y en 12 casos el diagnóstico fue clínico y por imagen. Las cirugías más frecuentes fueron traqueostomía en 16 pacientes (38%) y laparotomías exploradoras en 8 pacientes (19%). La mediana de estancia posoperatoria fue de 17 días y la mortalidad durante los primeros 30 días fue del 26%. CONCLUSIONES: Es necesaria la reorganización de los departamentos quirúrgicos y del hospital para poder atender adecuadamente a los pacientes con COVID-19 y proteger al personal de salud. Los pacientes pueden presentan patologías que requieran tratamiento quirúrgico. Relacionado con la infección y la mayor frecuencia de comorbilidad, la mortalidad de estos pacientes es elevada. INTRODUCTION: the COVID-19 pandemic has caused a reorganization of hospital and general surgery departments worldwide to assure the best medical and surgical treatment of patients with this disease and protection of the health-related personnel. Some of them will require surgical treatment either elective or urgent. OBJECTIVE: report the initial experience in the management of patients with COVID-19 in a third level hospital. MATERIAL AND METHODS: a review of the surgical protocols, personal protection equipment used by the surgical teams, and results of the treatment of forty-two patients submitted to surgery. RESULTS: During four months (April-July 2020) forty-two patients with suspicion or confirmed infection of SARS-CoV2 underwent surgical treatment. The most common surgery was tracheostomy in 16 patients (38%) followed by exploratory laparotomy in 8 patients (19%). The median postoperative stay was 17 days and the thirty-day postoperative mortality rate was 26%. CONCLUSIONS: reorganization of the general surgery department and the hospital, favors adequate management and treatment of patients with COVID-19 and protection to the health-related personnel. Due to the usual co-existence of comorbidities and pulmonary complications the postoperative mortality of these patients is high.


Asunto(s)
/epidemiología , Laparotomía/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Traqueostomía/estadística & datos numéricos , /diagnóstico , /cirugía , Comorbilidad , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Urgencias Médicas/epidemiología , Femenino , Humanos , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Equipo de Protección Personal , Procedimientos Quirúrgicos Operativos/métodos , Factores de Tiempo
5.
J Perioper Pract ; 31(3): 108-113, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33557712

RESUMEN

INTRODUCTION: The Surgical Care Practitioner is a medical associate profession role, working to an advanced level, undertaken by registered nurses, operating department practitioners or physiotherapists, on completion of a Royal College of Surgeons accredited course. The COVID-19 pandemic has led to all heath care professionals needing to adapt to help support the health care system as it tackles its effect. AIM: Audit of roles undertaken by Surgical Care Practitioners during the COVID-19 pandemic in the context of Royal College of Surgeons (2014) Curriculum to review the utilisation of this medical associate profession role. METHOD: The online questionnaire service, SurveyMonkey®, was used to collect data on the activities being undertaken by the Surgical Care Practitioner during the COVID-19 pandemic. RESULTS: Eighty Surgical Care Practitioners from across seven different surgical specialties within the United Kingdom completed the online survey. Nearly half stated that they remained mostly working in their substantive role, just less than a third helped in critical care units, with the remaining redeployed in equal shares to emergency departments or assisting on wards with nurses and as part of medical teams. A brief description of their activities was also recorded. CONCLUSION: This audit has demonstrated the versatility of the Surgical Care Practitioner and ability to adapt during the pandemic.


Asunto(s)
/epidemiología , Competencia Clínica , Enfermeras Practicantes/organización & administración , Grupo de Atención al Paciente/organización & administración , Actitud del Personal de Salud , Conducta Cooperativa , Necesidades y Demandas de Servicios de Salud , Humanos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Encuestas y Cuestionarios , Reino Unido
6.
J Surg Res ; 259: 465-472, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33616077

RESUMEN

BACKGROUND: Within the operating rooms (ORs), distractions occur on a regular basis, which affect the surgical workflow and results in the interruption of urgent tasks. This study aimed to observe the occurrence of intraoperative distractions in Tunisian ORs and evaluate associations among distractions, teamwork, workload, and stress. METHODS: This observational cross-sectional study was conducted in four different ORs (orthopedic, urology, emergency, and digestive surgery) of Sahloul University Hospital for a period of 3 mo in 2018. Distractions and teamwork were recorded and rated in real time during the intraoperative phase of each case using validated observation sheets. Besides, at the end of each operation, stress and workload of team members were measured. RESULTS: Altogether, 50 cases were observed and 160 participants were included. Distractions happened in 100% of the included operations. Overall, we recorded 933 distractions that occurred once every 3 min, with a mean frequency of M = 18.66 (standard deviation [SD] = 8.24) per case. It is particularly noticeable that procedural distractions occurred significantly higher during teaching cases compared with nonteaching cases (M = 3.85, M = 0.60, respectively, P < 0.001). The mean global teamwork score was M = 3.85 (SD = 0.67), the mean workload score was M = 58.60 (SD = 24.27), and the mean stress score was M = 15.29 (SD = 4.00). Furthermore, a higher stress level among surgeons was associated with distractions related to equipment failures and people entering or exiting the OR (r = 0.206, P < 0.01 and r = 0.137, P < 0.01, respectively). Similarly, nurses reported a higher workload in the presence of distractions related to the work environment in the OR (r = 0.313, P < 0.05). CONCLUSIONS: This study highlighted a serious problem, which often team members seem to ignore or underestimate. Taking our findings into consideration, we recommend the implementation of the Surgical Checklist and preoperative briefings to reduce the number of surgical distractions. Also, a continuous teamwork training should be adopted to ensure that OR staff can avoid or handle distractions when they happen.


Asunto(s)
Estrés Laboral/epidemiología , Quirófanos/organización & administración , Grupo de Atención al Paciente/organización & administración , Cirujanos/organización & administración , Análisis y Desempeño de Tareas , Comunicación , Estudios Transversales , Femenino , Humanos , Masculino , Estrés Laboral/etiología , Estrés Laboral/prevención & control , Estrés Laboral/psicología , Quirófanos/estadística & datos numéricos , Tempo Operativo , Grupo de Atención al Paciente/estadística & datos numéricos , Cirujanos/psicología , Cirujanos/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/educación , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Flujo de Trabajo , Carga de Trabajo/psicología , Carga de Trabajo/estadística & datos numéricos
7.
Braz J Anesthesiol ; 71(2): 123-128, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33623174

RESUMEN

Background: SARS-CoV-2 virus changed society's behaviour. Population was advised to reduce unnecessary heath care use to accommodate urgent cases and daily increase of COVID-19 patients. Health care facilities faced huge challenges, having to readjust their response to preserve good quality of care. In Portugal, a significant reduction in the number of admissions to the Emergency Department (ED) was reported all over the country, however the impact on the dynamics of undeferrable surgery remains to be reported. This study compares the volume and characteristics of urgent/emergency surgery during the 2020 COVID-19 pandemic with the homologous period in 2019, chronologically illustrating the national evolution of new COVID-19 cases and the social and hospital containment response. Methods: A retrospective observational study was conducted in a tertiary hospital center located in the most affected region by COVID-19 in Portugal. Medical records of patients who underwent urgent/emergency surgery between March 1st and May 2nd of both 2020 and 2019 were examined and the volume of surgeries were compared. Also, daily national updates from Portuguese Directorate-General for Health were analysed. Results: During the COVID-19 pandemic approximately 30% less patients underwent urgent/emergency surgery (99%CI = 0.18-0.61, p < 0.001). Waiting time for surgery showed no difference between both years (p = 0.068), but patients who did surgery during the 2020 pandemic had higher mortality rates than the ones who did it in 2019 (11.4% in 2020 and 5.9% in 2019, p = 0.001). Reduction in surgery volume was correlated with the increasing number of infected cases nationally. Conclusion: This study demonstrates decreasing numbers of urgent/emergency procedures during the COVID-19 pandemic that may be justified by the national growth number of infected cases. Preoperative mass screening strategy was implemented without compromising the efficiency of surgical service, but patients' mortality was higher. The importance of visiting the ED during COVID-19 pandemic for serious cases that cannot be managed in other settings should be highlighted.


Asunto(s)
Urgencias Médicas , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal , Estudios Retrospectivos , Centros de Atención Terciaria , Listas de Espera
9.
Cir. Esp. (Ed. impr.) ; 99(1): 34-40, ene. 2021. tab
Artículo en Español | IBECS | ID: ibc-200219

RESUMEN

INTRODUCCIÓN: El Complejo Hospitalario de Navarra, centro sanitario de tercer nivel, implementó a partir de 2016 un nuevo sistema de vigilancia y control de infecciones relacionadas con la asistencia sanitaria según metodología de la Red Nacional de Vigilancia Epidemiológica. Las infecciones del lugar quirúrgico constituyen uno de los efectos adversos más relevantes, siendo la cirugía de colon un procedimiento de vigilancia obligatoria. Este sistema permitirá al hospital conocer sus tasas de infección quirúrgica, contrastarlas periódicamente para vigilar su tendencia y compararlas con las de otras instituciones sanitarias nacionales y europeas. MÉTODOS: Cuatrocientos dieciséis pacientes intervenidos de colon durante 2017-2019 fueron estudiados prospectivamente durante su hospitalización y hasta los 30días post-cirugía y estratificados según el riesgo de infección quirúrgica mediante el «índice NHSN» (National Health Safety Network). Se realizó un análisis estadístico descriptivo univariante y se calculó la incidencia acumulada de infección de lugar quirúrgico, global y por subgrupos según factores de riesgo. RESULTADOS: La incidencia acumulada global de infección del lugar quirúrgico fue del 10,6% (n = 44), con mayor incidencia en subgrupos de alto riesgo quirúrgico: un 25,0% en la categoría 2 del índice NHSN y un 42,9% en la categoría 3. CONCLUSIONES: La incidencia acumulada de infección del lugar quirúrgico obtenida es similar a la calculada en otros estudios realizados en condiciones semejantes, pero existe una diversidad metodológica que hace compleja la interpretación


BACKGROUND: Navarra Hospital Complex has renovated its healthcare-associated infections surveillance and control methods meeting the requirements of the Spanish National Epidemiologic Surveillance Network. Surgical site infections are one of the most relevant adverse outcomes, being the colon surgery one of the mandatory monitored procedures. This system will ease, not only the yearly estimation of the hospital surgical infection rates, but also its comparison at national and European levels. METHODS: 416 patients underwent surgery between 2017 and 2019. Clinical variables were gathered during the patient hospitalization and up to 30days from surgery, stratifying the cases by their NHSN (National Health Safety Network) surgical infection risk index. A univariant descriptive analysis was performed and outcome indicators were estimated. RESULTS: The cumulative incidence was 10.6%, with 44 cases. The rates were higher among the high-risk subgroups: 25.0% and 42.9%, respectively, for NSHN index categories 2 and 3. CONCLUSIONS: The incidence was similar to the ones found in other studies carried out in analogous conditions. However, the methodologic variability makes it difficult to compare results


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Colon/cirugía , Factores de Riesgo , Monitoreo Epidemiológico , Infección Hospitalaria/epidemiología , Estudios Prospectivos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Endoscopía , Profilaxis Antibiótica , Intervalos de Confianza
10.
World J Surg ; 45(4): 946-954, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33511422

RESUMEN

BACKGROUND: The COVID-19 pandemic has resulted in large-scale healthcare restrictions to control viral spread, reducing operating room censuses to include only medically necessary surgeries. The impact of restrictions on which patients undergo surgical procedures and their perioperative outcomes is less understood. METHODS: Adult patients who underwent medically necessary surgical procedures at our institution during a restricted operative period due to the COVID-19 pandemic (March 23-April 24, 2020) were compared to patients undergoing procedures during a similar time period in the pre-COVID-19 era (March 25-April 26, 2019). Cardinal matching and differences in means were utilized to analyze perioperative outcomes. RESULTS: 857 patients had surgery in 2019 (pre-COVID-19) and 212 patients had surgery in 2020 (COVID-19). The COVID-19 era cohort had a higher proportion of patients who were male (61.3% vs. 44.5%, P < 0.0001), were White (83.5% vs. 68.7%, P < 0.001), had private insurance (62.7% vs. 54.3%, p 0.05), were ASA classification 4 (10.9% vs. 3%, P < 0.0001), and underwent oncologic procedures (69.3% vs. 42.7%, P < 0.0001). Following 1:1 cardinal matching, COVID-19 era patients (N = 157) had a decreased likelihood of discharge to a nursing facility (risk difference-8.3, P < 0.0001) and shorter median length of stay (risk difference-0.6, p 0.04) compared to pre-COVID-19 era patients. There was no difference between the two patient cohorts in overall morbidity and 30-day readmission. CONCLUSIONS: COVID-19 restrictions on surgical operations were associated with a change in the racial and insurance demographics in patients undergoing medically necessary surgical procedures but were not associated with worse postoperative morbidity. Further study is necessary to better identify the causes for patient demographic differences.


Asunto(s)
Demografía , Pandemias , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Medicare , Persona de Mediana Edad , Estados Unidos/epidemiología , Adulto Joven
11.
Isr Med Assoc J ; 23(1): 12-16, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33443336

RESUMEN

BACKGROUND: Dietary modifications and patient-tailored medical management are significant in controlling renal stone disease. Nevertheless, the literature regarding effectiveness is sparse. OBJECTIVES: To explore the impact of dietary modifications and medical management on 24-hour urinary metabolic profiles (UMP) and renal stone status in recurrent kidney stone formers. METHODS: We reviewed our prospective registry database of patients treated for nephrolithiasis. Data included age, sex, 24-hour UMP, and stone burden before treatment. Under individual treatment, patients were followed at 6-8 month intervals with repeat 24-hour UMP and radiographic images. Nephrolithiasis-related events (e.g., surgery, renal colic) were also recorded. We included patients with established long-term follow-up prior to the initiation of designated treatment, comparing individual nephrolithiasis status before and after treatment initiation. RESULTS: Inclusion criteria were met by 44 patients. Median age at treatment start was 60.5 (50.2-70.2) years. Male:Female ratio was 3.9:1. Median follow-up was 10 (6-25) years and 5 (3-6) years before and after initiation of medical and dietary treatment, respectively. Metabolic abnormalities detected included: hypocitraturia (95.5%), low urine volume (56.8%), hypercalciuria (45.5%), hyperoxaluria (40.9%), and hyperuricosuria (13.6%). Repeat 24-hour UMP under appropriate diet and medical treatment revealed a progressive increase in citrate levels compared to baseline and significantly decreased calcium levels (P = 0.001 and 0.03, respectively). A significant decrease was observed in stone burden (P = 0.001) and overall nephrolithiasis-related events. CONCLUSIONS: Dietary modifications and medical management significantly aid in correcting urinary metabolic abnormalities. Consequently, reduced nehprolithiasis-related events and better stone burden control is expected.


Asunto(s)
Dietoterapia/métodos , Cálculos Renales , Nefrolitiasis , Cuidados Posteriores/métodos , Cuidados Posteriores/estadística & datos numéricos , Calcio/orina , Ácido Cítrico/orina , Femenino , Humanos , Israel/epidemiología , Cálculos Renales/complicaciones , Cálculos Renales/epidemiología , Cálculos Renales/fisiopatología , Masculino , Administración del Tratamiento Farmacológico/estadística & datos numéricos , Metaboloma/efectos de los fármacos , Metaboloma/fisiología , Persona de Mediana Edad , Monitoreo Fisiológico/métodos , Nefrolitiasis/diagnóstico , Nefrolitiasis/dietoterapia , Nefrolitiasis/tratamiento farmacológico , Nefrolitiasis/metabolismo , Evaluación de Procesos y Resultados en Atención de Salud , Cólico Renal/epidemiología , Cólico Renal/etiología , Prevención Secundaria/métodos , Prevención Secundaria/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Ácido Úrico/orina
12.
ANZ J Surg ; 91(3): 329-334, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33475217

RESUMEN

BACKGROUND: The New Zealand government instituted escalating public health interventions to prevent the spread of COVID-19. There was concern this would affect health seeking behaviour leading to delayed presentation and worse outcomes. The aim of this study was to examine the effects of these interventions on rate and severity of acute general surgical admissions in Northland, New Zealand. METHODS: A retrospective comparative cohort study was performed. Two cohorts were identified: 28 February to 8 June 2020 and same period in 2019. Data for surgical admissions and operations and emergency department (ED) presentation were obtained from the hospital data warehouse. Three index diagnoses were assessed for severity. RESULTS: There were 650 acute general surgical admissions in 2019 and 627 in 2020 (P 0.353). Operations were performed in 226 and 224 patients respectively (P 0.829). ED presentations decreased from 11 398 to 8743 (P < 0.001). No difference in severity of acute appendicitis (P 0.970), acute diverticulitis (P 0.333) or acute pancreatitis (P 0.803) was detected. Median length-of-stay, 30-day mortality and admission diagnosis were comparable. CONCLUSION: Despite a significant reduction in ED presentations, interventions for COVID-19 did not result in a difference in the rate or severity of acute general surgical admissions.


Asunto(s)
/epidemiología , Urgencias Médicas , Salud Pública , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
13.
Cir Pediatr ; 34(1): 28-33, 2021 Jan 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33507641

RESUMEN

OBJECTIVES: The primary objective was to describe the characteristics and demographics of the surgical procedures carried out at a tertiary hospital during the SARS-CoV-2 pandemic. The secondary objective was to study the impact of the pandemic on the acute appendicitis cases treated at our healthcare facility and to compare them with a pre- SARS-CoV-2 period. MATERIAL AND METHODS: A retrospective study of all patients undergoing surgery at the pediatric surgery department in the pandemic period, from the beginning of the state of emergency in Spain until the first restrictions were removed, was conducted. RESULTS: A total of 61 patients underwent surgery in 58 days vs. 406 patients in the same 2019 period (p < 0.00001). 59.01% of surgeries were urgent. 5.1% of patients had a positive SARS-CoV-2 diagnostic test. 30 different procedures were carried out, with appendectomy being the most frequent one (n = 13, 19.6% of patients). 61.5% of appendicitis cases were complicated vs. 42.4% in the non-COVID period (p = 0.17). Surgical approach was open in 46.1% of patients vs. 6.1% in the non-COVID period (p = 0.004). No statistically significant differences were found in terms of complication rate or hospital stay. CONCLUSIONS: During the SARS-CoV-2 pandemic, a significant decrease in the number of daily procedures was noted, with more than half being urgent. Appendicular pathologies were in a more advanced stage than usual, with a clear trend towards open surgery vs. laparoscopy.


Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Laparoscopía/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Pediatría , Estudios Retrospectivos , España , Centros de Atención Terciaria
14.
Cir Pediatr ; 34(1): 34-38, 2021 Jan 01.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33507642

RESUMEN

INTRODUCTION: The pandemic caused by the SARS-CoV-2 virus has led to an unprecedented situation, with population lockdowns, congestion of healthcare resources, cancellation of scheduled surgical activity, fear of contagion, and delays in patient care. The objective of this study was to analyze its impact on pediatric surgical activity at a reference healthcare facility. MATERIAL AND METHODS: A comparative study of activity in the pediatric surgery environment at a Spanish reference healthcare facility was carried out. It included outpatient consultations, scheduled surgeries, and activity at the emergency department during the lockdown period in Spain (March-May 2020) vs. the same 2019 period. Number of consultations and surgeries, type of surgery performed and/or cancelled, and stage of the pathologies treated were collected. RESULTS: A 98% decrease in scheduled surgeries, an 84% decrease in healthcare burden from the pediatric emergency department, a 55.24% decrease in urgent surgeries, an 82% decrease in outpatient activity at external consultations, and a 94% decrease in inter-hospital referrals, along with a 66% increase in urgent pathology severity, were found. CONCLUSIONS: The COVID-19 pandemic cancelled virtually all pediatric surgery activity, which caused treatment delays in severe pathologies and increased morbidity in regular urgent procedures.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Atención Ambulatoria/estadística & datos numéricos , Niño , Humanos , Pediatría , España , Atención Terciaria de Salud , Factores de Tiempo
15.
JCO Oncol Pract ; 17(3): e377-e385, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33332170

RESUMEN

PURPOSE: The response to the COVID-19 pandemic has affected the management of patients with cancer. In this pooled retrospective analysis, we describe changes in management patterns for patients with cancer diagnosed with COVID-19 in two academic institutions in the San Francisco Bay Area. MATERIALS AND METHODS: Adult and pediatric patients diagnosed with COVID-19 with a current or historical diagnosis of malignancy were identified from the electronic medical record at the University of California, San Francisco, and Stanford University. The proportion of patients undergoing active cancer management whose care was affected was quantified and analyzed for significant differences with regard to management type, treatment intent, and the time of COVID-19 diagnosis. The duration and characteristics of such changes were compared across subgroups. RESULTS: A total of 131 patients were included, of whom 55 were undergoing active cancer management. Of these, 35 of 55 (64%) had significant changes in management that consisted primarily of delays. An additional three patients not undergoing active cancer management experienced a delay in management after being diagnosed with COVID-19. The decision to change management was correlated with the time of COVID-19 diagnosis, with more delays identified in patients treated with palliative intent earlier in the course of the pandemic (March/April 2020) compared with later (May/June 2020) (OR, 4.2; 95% CI, 1.03 to 17.3; P = .0497). This difference was not seen among patients treated with curative intent during the same timeframe. CONCLUSION: We found significant changes in the management of cancer patients with COVID-19 treated with curative and palliative intent that evolved over time. Future studies are needed to determine the impact of changes in management and treatment on cancer outcomes for patients with cancer and COVID-19.


Asunto(s)
Antineoplásicos/administración & dosificación , Neoplasias/terapia , Radioterapia/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Administración Oral , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/uso terapéutico , California , Niño , Preescolar , Femenino , Humanos , Infusiones Intravenosas , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Neoplasias/diagnóstico , Cuidados Paliativos , Estudios Retrospectivos , Factores de Tiempo , Adulto Joven
16.
Pan Afr Med J ; 37(Suppl 1): 15, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33343794

RESUMEN

The public health impact of the COVID-19 pandemic cannot be overstated. Its impact on the cost of surgical and obstetric care is significant. More so, in a country like Nigeria, where even before the pandemic, out-of-pocket spending (OOPS) has been the major payment method for healthcare. The increased cost of surgical and obstetric care occasioned by the pandemic has principally been due to the additional burden of ensuring the use of adequate/appropriate personal protective equipment (PPE) during patient care as a disease containment measure. These PPE are not readily available in public hospitals across Nigeria. Patients are therefore compelled to bear the financial burden of procuring scarce PPE for use by health care personnel, further increasing the already high cost of healthcare. In this study, we sought to appraise the impact of the COVID-19 pandemic on the cost of surgical and obstetric care in Nigeria, drawing from the experience from one of the major Nigerian teaching hospitals- the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State. The cost of surgical and obstetric care was reviewed and compared pre- and during the COVID-19 pandemic, deriving relevant examples from some commonly performed surgical operations in our centre (OAUTHC). We reviewed patients' hospital bills and receipts of consumables procured for surgery. Our findings revealed that the cost of surgical and obstetric care during the COVID-19 pandemic had significantly increased. We identified gaps and made relevant recommendations on measures to reduce the additional costs of surgical and obstetric care during and beyond pandemic.


Asunto(s)
Costos de Hospital/estadística & datos numéricos , Obstetricia/economía , Procedimientos Quirúrgicos Operativos/economía , Prestación de Atención de Salud/economía , Femenino , Hospitales de Enseñanza , Humanos , Nigeria , Obstetricia/estadística & datos numéricos , Equipo de Protección Personal/provisión & distribución , Embarazo , Salud Pública/economía , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
17.
Minerva Chir ; 75(5): 320-327, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33210528

RESUMEN

BACKGROUND: During Coronavirus disease (COVID-19) pandemic entire countries rapidly ran out of intensive care beds, occupied by critically ill infected patients. Elective surgery was initially halted and acute non-deferrable surgical care drastically limited. The presence of COVID-19 patients into intensive care units (ICU) is currently decreasing but their congestion have restricted our therapeutic strategies during the last months. METHODS: In the COVID-19 era eighteen patients (8 men, 10 women) with a mean age of 80 years, needing undelayable abdominal surgery underwent awake open surgery at our Department. Prior to surgery, all patients underwent COVID-19 investigation. In all cases locoregional anesthesia (LA) was performed. Intraoperative and postoperative pain has been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. RESULTS: Mean operative time was 104 minutes. In only one case conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. Only one perioperative complication occurred. Early readmissions after surgery were never observed. CONCLUSIONS: On the basis of our experience awake laparotomy under LA resulted feasible, safe, painless and, in specific cases, the only viable option. For patients presenting fragile cardiovascular and respiratory, reserves and in whom general anesthesia (GA) would presumably increase morbidity and mortality we encourage LA as an alternative to GA. In the COVID-19 era, it has become part of our ICU-preserving strategy allowing us to carry out undeferrable surgeries.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Anciano Frágil , Laparotomía/estadística & datos numéricos , Neumonía Viral/epidemiología , Anciano , Anciano de 80 o más Años , Anestesia General , Anestesia Local/métodos , Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Urgencias Médicas/epidemiología , Femenino , Humanos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Tempo Operativo , Dolor Postoperatorio/prevención & control , Pandemias , Neumonía Viral/diagnóstico , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos
18.
Bull World Health Organ ; 98(10): 671-682, 2020 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-33177757

RESUMEN

Objective: To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We collected data provided by users of the mobile app "Anesthesiologist" during 1 October 2018-30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings: A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion: App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need.


Asunto(s)
Anestesiología/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Aplicaciones Móviles/estadística & datos numéricos , Neumonía Viral/epidemiología , Vigilancia en Salud Pública/métodos , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Betacoronavirus , Humanos , Estudios Longitudinales , Pandemias
19.
Can J Surg ; 63(5): E431-E434, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33009897

RESUMEN

SUMMARY: Hepato-pancreato-biliary (HPB) injuries can be extremely challenging to manage. This scoping review (8438 citations) offers a number of recommendations. If diagnosis and therapy are rapid, patients with major hepatic injuries who present in physiologic extremis have high survival rates despite prolonged hospital stays. Nonoperative management of major liver injuries, as diagnosed using computed tomography, is typically successful. Adjuncts (e.g., angioembolization, laparoscopic washouts, biliary stents) are essential in managing high-grade injuries. Injury to the extrahepatic biliary tree is rare. Cholecystectomy is indicated for all gallbladder trauma. Full-thickness common bile duct injuries require a hepaticojejunostomy, although damage control remains closed suction drainage. Injuries to the pancreatic head often involve concurrent trauma to regional vasculature. Damage control necessitates drainage after stopping hemorrhage. Injury to the left pancreas commonly requires a distal pancreatectomy. Outcomes for high-grade pancreatic and liver injuries are improved by involving an HPB team. Complications are multidisciplinary and should be managed without delay.


Asunto(s)
Traumatismos Abdominales/terapia , Sistema Biliar/lesiones , Hígado/lesiones , Páncreas/lesiones , Traumatismos Abdominales/complicaciones , Traumatismos Abdominales/diagnóstico , Traumatismos Abdominales/mortalidad , Sistema Biliar/diagnóstico por imagen , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/métodos , Tratamiento Conservador/normas , Tratamiento Conservador/estadística & datos numéricos , Humanos , Hígado/diagnóstico por imagen , Páncreas/diagnóstico por imagen , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Guías de Práctica Clínica como Asunto , Índice de Severidad de la Enfermedad , Procedimientos Quirúrgicos Operativos/efectos adversos , Procedimientos Quirúrgicos Operativos/métodos , Procedimientos Quirúrgicos Operativos/normas , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Factores de Tiempo , Tiempo de Tratamiento/normas , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
20.
Can J Surg ; 63(5): E396-E408, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33009899

RESUMEN

BACKGROUND: The scope of practice of general surgeons in Canada is highly variable. The objective of this study was to examine the demographic characteristics of general surgeons in Canada and compare surgical procedures performed across community sizes and specialties. METHODS: Data from the Canadian Institute for Health Information's National Physician Database were used to analyze fee-for-service (FFS) care provided by general surgeons and other providers across Canada in 2015/16. RESULTS: Across 8 Canadian provinces, 1669 general surgeons provided FFS care. The majority of the surgeons worked in communities with more than 100 000 residents (71%), were male (78%), were aged 35-54 years (56%) and were Canadian medical graduates (76%). Only 7% of general surgeons practised in rural areas and 14% in communities with between 10 000 and 50 000 residents. Rural communities were significantly more likely to have surgeons who were international medical graduates or who were older than 65 years. The surgical procedures most commonly performed by general surgeons were hernia repairs, gallbladder and biliary tree surgery, excision of skin tumours, colon and intestine resections and breast surgery. Many general surgeons performed procedures not listed in their Royal College of Physicians and Surgeons of Canada training objectives. CONCLUSION: Canadian general surgeons provide a wide array of surgical services, and practice patterns vary by community size. Surgeons practising in rural and small communities require proficiency in skills not routinely taught in general surgery residency. Opportunities to acquire these skills should be available in training to prepare surgeons to meet the care needs of Canadians.


Asunto(s)
Cirugía General/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/tendencias , Pautas de la Práctica en Medicina/estadística & datos numéricos , Alcance de la Práctica/tendencias , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Adulto , Canadá , Competencia Clínica/estadística & datos numéricos , Planes de Aranceles por Servicios/estadística & datos numéricos , Femenino , Cirugía General/economía , Cirugía General/educación , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Internado y Residencia/tendencias , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina/economía , Pautas de la Práctica en Medicina/tendencias , Servicios de Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/tendencias , Cirujanos/economía , Cirujanos/educación , Cirujanos/estadística & datos numéricos , Procedimientos Quirúrgicos Operativos/economía , Procedimientos Quirúrgicos Operativos/educación
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