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1.
Am Surg ; 86(6): 715-720, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683956

RESUMO

BACKGROUND: Surgeons can help reduce health care spending by selecting affordable and efficient instruments. The laparoscopic appendectomy (LA) is commonly performed and can serve as a model for improving health care cost. METHODS: We retrospectively reviewed all adult patients who underwent LA for non-perforated appendicitis from March 2015 to November 2017. Our objective was to determine which combination of disposable instruments afforded the lowest total operative cost without compromising postoperative outcomes. RESULTS: In total, 1857 consecutive patients were reviewed from 2 hospitals. After determining the 8 most commonly utilized combinations of disposable instruments, 846 patients were ultimately analyzed. The combination of a LigaSure, Endoloop, and an EndoBag (LEB) had the shortest median operative time (25 minutes, P < .001) and lowest median total operative cost ($1893, P < .001). CONCLUSIONS: The LEB instrument combination rendered the shortest operative time, lowest total operative cost, and can be used to maximize surgical value during LA.


Assuntos
Apendicectomia/métodos , Apendicite/cirurgia , Equipamentos Descartáveis/economia , Laparoscopia , Instrumentos Cirúrgicos/economia , Adulto , Apendicectomia/economia , Apendicectomia/instrumentação , Apendicite/economia , Análise Custo-Benefício , Feminino , Humanos , Laparoscopia/economia , Laparoscopia/instrumentação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos
2.
Artigo em Inglês | MEDLINE | ID: mdl-32656101

RESUMO

CDC and WHO guidelines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis only recommend synthetic fiber swabs for nasopharyngeal (NP) sampling. We show that cotton-tipped plastic swabs do not inhibit PCR and have equivalent performance to rayon swabs. Cotton-tipped plastic swabs are massively produced worldwide and would prevent swab supply shortages under the current high SARS-CoV-2 testing demands, particularly in developing countries.


Assuntos
Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico/instrumentação , Infecções por Coronavirus/diagnóstico , Equipamentos para Diagnóstico/provisão & distribução , Equipamentos Descartáveis/provisão & distribução , Pneumonia Viral/diagnóstico , Reação em Cadeia da Polimerase em Tempo Real/instrumentação , Betacoronavirus/genética , Celulose/provisão & distribução , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/virologia , Fibra de Algodão/provisão & distribução , Humanos , Nasofaringe , Pandemias , Plásticos/provisão & distribução , Pneumonia Viral/virologia , RNA Viral/análise , Reação em Cadeia da Polimerase em Tempo Real/métodos , Manejo de Espécimes/instrumentação , Manejo de Espécimes/métodos
3.
Int J Surg ; 80: 21-25, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32590073

RESUMO

The current dreadful pandemic of coronavirus disease (COVID-19) is playing havoc with humanity, socio-communal systems and economic reserves worldwide. Certain countries have managed to curtail COVID-19 crisis to some extent, however, a great majority still remains helpless in containing this outbreak. Rapidly evolving disease patterns and complex epidemiology of the COVID-19 necessitate a tailored approach by medical experts in dealing with this devastating outbreak. Similar to other medical disciplines, surgical associations and societies have developed a tailored approach of patients' selection and management plans with improvised endolaparoscopic practice during the COVID-19 pandemic. Non-essential and non-urgent surgical procedures are deferred till this outbreak is abated. Benefits of delaying elective and non-urgent surgery outweighs the risk of performing surgical procedures on patients with asymptomatic or active COVID-19 disease. Laparoendoscopic procedures increase the risk of aerosol exposure, disease transmission and contamination. Limiting the number of operating room personnel, use of disposable instruments, small trocar incisions, negative pressure environment, and setting energy devices at low modes can help reduce disease transmission during laparoendocsopic procedures. This write up sheds lights on the impact of the COVID-19, big data analytics of response of medical personnel in understanding and curtailing the disease process and the consensus guidelines for carrying out laparoscoendoscopic procedures.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos Descartáveis , Endoscopia/métodos , Alocação de Recursos para a Atenção à Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Laparoscopia/métodos , Neoplasias/cirurgia , Pandemias/prevenção & controle , Seleção de Pacientes , Pneumonia Viral/prevenção & controle , Betacoronavirus , Big Data , Protocolos Clínicos , Coronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Ciência de Dados , Procedimentos Cirúrgicos Eletivos/métodos , Eletrocoagulação/métodos , Contaminação de Equipamentos/prevenção & controle , Pessoal de Saúde , Humanos , Salas Cirúrgicas , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Procedimentos Cirúrgicos Ultrassônicos/métodos
4.
Acad Radiol ; 27(8): 1119-1125, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32499157

RESUMO

RATIONALE AND OBJECTIVES: The use of chest computed tomography (CT) in the era of the COVID-19 pandemic raises concern regarding the transmission risks to patients and staff caused by CT room contamination. Meanwhile the Center for Disease Control guidance for air exchange in between patients may heavily impact workflows. To design a portable custom isolation device to reduce imaging equipment contamination during a pandemic. MATERIALS AND METHODS: Center for Disease Control air exchange guidelines and requirements were reviewed. Device functional requirements were outlined and designed. Engineering requirements were reviewed. Methods of practice and risk mitigation plans were outlined including donning and doffing procedures and failure modes. Cost impact was assessed in terms of CT patient throughput. RESULTS: CT air exchange solutions and alternatives were reviewed. Multiple isolation bag device designs were considered. Several designs were custom fabricated, prototyped and reduced to practice. A final design was tested on volunteers for comfort, test-fit, air seal, and breathability. Less than 14 times enhanced patient throughput was estimated, in an ideal setting, which could more than counterbalance the cost of the device itself. CONCLUSION: A novel isolation bag device is feasible for use in CT and might facilitate containment and reduce contamination in radiology departments during the COVID Pandemic.


Assuntos
Infecções por Coronavirus , Equipamentos Descartáveis/normas , Contaminação de Equipamentos/prevenção & controle , Controle de Infecções/métodos , Pandemias , Isolamento de Pacientes , Pneumonia Viral , Tomografia Computadorizada por Raios X/instrumentação , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Estudos de Viabilidade , Pessoal de Saúde , Humanos , Eliminação de Resíduos de Serviços de Saúde/métodos , Pandemias/prevenção & controle , Isolamento de Pacientes/instrumentação , Isolamento de Pacientes/métodos , Equipamento de Proteção Individual , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Radiografia Torácica/métodos , Tomografia Computadorizada por Raios X/efeitos adversos
7.
Prehosp Disaster Med ; 35(4): 434-437, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32398188

RESUMO

The COVID-19 pandemic has strained health care system resources and reduced the availability of life-sustaining and medical-grade personal protective equipment (PPE) though the combination of increased demand and disrupted manufacturing supply chains. As a result of these shortages, many health care providers have temporarily used largely untested, improvised PPE (iPPE). Lack of quality control for makeshift PPE and frequent repurposing of used items to conserve supplies increase both the risk of provider infection and nosocomial spread to uninfected patients. One strategy to reduce risk of infection and preserve existing equipment is the implementation of secondary barrier devices placed directly over patients or providers. The authors describe an inexpensive, disposable, positive-pressure head isolation unit that can be rapidly constructed from materials readily available in nearly all health care settings for under five US dollars. The unit was successfully deployed in Taiwan during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak, and again during the COVID-19 pandemic. The iPPE worn directly by the health care workers (HCWs) can be donned prior to patient contact in the presence of an air source. This strategy may be more protective than a covering placed over the patient in an aerosol-generating environment, which requires the HCW to be in close contact with the patient prior to securing the protective device.


Assuntos
Infecções por Coronavirus/prevenção & controle , Equipamentos Descartáveis , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Aerossóis/efeitos adversos , Betacoronavirus , Líquidos Corporais/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Equipamentos Descartáveis/economia , Desenho de Equipamento , Humanos , Equipamento de Proteção Individual/economia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Taiwan/epidemiologia
8.
Biofouling ; 36(3): 292-307, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32367731

RESUMO

Microbial cells can rapidly form biofilm on endotracheal tubes (ETT) causing ventilator-associated pneumonia, a serious complication in patients receiving mechanical ventilation. A novel polyamide with a good balance of hydrophilic/hydrophobic moieties was used for the embedment of green-reduction silver nanoparticles (AgNPs) for the composite-coated ETT. The films were conformal with a thickness of ∼ 17 ± 3 µm accommodating high loading of 60 ± 35 nm spherical-shaped AgNPs. The coated ETT resulted in a significant difference in reducing both planktonic growth and microbial adhesion of single and mixed-species cultures, compared with uncoated ETT (p < 0.05). A time-kill assay demonstrated rapid bactericidal effects of the coating on bacterial growth and cell adhesion to ETT surface. Biofilm formation by Pseudomonas aeruginosa and Staphylococcus aureus, commonly encountered pathogens, was inhibited by > 96% after incubation for 72 h. Polyamide/AgNP composite-coated ETT provided a broad-spectrum activity against both Gram-positive and Gram-negative bacteria as well as Candida albicans and prolonged antimicrobial activity.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Equipamentos Descartáveis/microbiologia , Nanopartículas Metálicas/química , Nylons/farmacologia , Plâncton/efeitos dos fármacos , Pneumonia Associada à Ventilação Mecânica/microbiologia , Prata/farmacologia , Antibacterianos/química , Biofilmes/crescimento & desenvolvimento , Candida albicans/efeitos dos fármacos , Contaminação de Equipamentos/prevenção & controle , Humanos , Intubação Intratraqueal , Nylons/química , Plâncton/crescimento & desenvolvimento , Plâncton/microbiologia , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Pseudomonas aeruginosa/efeitos dos fármacos , Prata/química , Staphylococcus aureus/efeitos dos fármacos
11.
Lab Med ; 51(4): e45-e46, 2020 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-32386057

RESUMO

The recent SARS-CoV-2 outbreak has placed immense pressure on supply chains, including shortages in nasopharyngeal (NP) swabs. Here, we report our experience of using 3D-printing to rapidly develop and deploy custom-made NP swabs to address supply shortages at our healthcare institution.


Assuntos
Técnicas de Laboratório Clínico/instrumentação , Equipamentos para Diagnóstico/provisão & distribução , Nasofaringe/patologia , Impressão Tridimensional , Biópsia/instrumentação , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Equipamentos para Diagnóstico/normas , Equipamentos Descartáveis/normas , Equipamentos Descartáveis/provisão & distribução , Humanos , Nasofaringe/virologia , Mucosa Respiratória/patologia , Mucosa Respiratória/virologia
17.
Zhongguo Yi Liao Qi Xie Za Zhi ; 44(1): 80-84, 2020 Jan 08.
Artigo em Chinês | MEDLINE | ID: mdl-32343074

RESUMO

The supply chain management of medical consumables in hospitals is an important guarantee for the improvement of clinical diagnosis and treatment. It requires continuous re-engineering and optimization on procurement and supplier management, costs and efficiency of daily operation. Based on the practical case of Shanghai Yueyang Integrated Traditional Chinese Medicine and Western Medicine Hospital, the study discusses the practical path and key points as well as improvement results in hospital medical consumables supply chain re-engineering via SPD model. Also, the research can provide references on medical consumables supply chain management to large and medium-size hospitals.


Assuntos
Equipamentos Descartáveis/provisão & distribução , Hospitais , China , Custos e Análise de Custo
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