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1.
World J Surg ; 45(1): 10-17, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33118075

RESUMO

BACKGROUND: The COVID-19 pandemic has drastically impacted postgraduate training programmes worldwide. This study aims to evaluate the Nigerian situation with respect to surgical training, with a view to identifying gaps and proffering solutions. METHODS: A cross-sectional survey of surgical residents in Nigeria was conducted between 27 July 2020 and 14 August 2020. A structured questionnaire designed using the free software Google Forms® was utilised for the study. The questionnaire was electronically distributed randomly to 250 surgical residents via emails and social media platforms including WhatsApp and Telegram. The data obtained was analysed by Google Forms®. Ethical approval for the study was obtained from the ethics and research unit of the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun State, Nigeria. RESULTS: At the end of the study period, 207 surgical residents completed and submitted the questionnaire, giving a response rate of 82.8%. The majority of respondents reported a reduction (164, 79.2%) or cancellation (11, 5.3%) of postgraduate programmes in their institutions. Of those who had academic programmes, meetings were done using virtual technology in all instances. The majority of respondents reported seeing fewer patients in the outpatient clinics (173, 83.6%), as well as a reduction in the number of emergency and elective operations (58.5% and 90.8%, respectively). About a third of the respondents (70, 33.8%) were contemplating emigrating from the country. CONCLUSION: The COVID-19 pandemic has significantly affected the clinical, research and teaching components of surgical training in Nigeria. It has, however, led to increased adoption of digital technology which should be further explored in the face of current realities.


Assuntos
/epidemiologia , Países em Desenvolvimento/estatística & dados numéricos , Cirurgia Geral/educação , Internato e Residência , Pandemias , Adulto , Estudos Transversais , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Nigéria/epidemiologia , Pobreza , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Inquéritos e Questionários
4.
S Afr Med J ; 0(0): 13182, 2020 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-33334391

RESUMO

BACKGROUND: The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output. OBJECTIVES: To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa. METHODS: A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted. RESULTS: Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques. CONCLUSIONS: The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções , Centro Cirúrgico Hospitalar , Atenção Terciária à Saúde , Adulto , /prevenção & controle , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Política de Saúde , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Masculino , Mortalidade , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , Gestão da Segurança/tendências , África do Sul/epidemiologia , Centro Cirúrgico Hospitalar/organização & administração , Centro Cirúrgico Hospitalar/estatística & dados numéricos , Atenção Terciária à Saúde/organização & administração , Atenção Terciária à Saúde/tendências
5.
G Ital Cardiol (Rome) ; 21(11): 45-47, 2020 Nov.
Artigo em Italiano | MEDLINE | ID: mdl-33295334

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to deferral of many non-urgent procedures in most healthcare systems worldwide. With this study we aimed to quantify the impact of COVID-19 on interventional treatment of structural heart disease (SHD) in Italy. METHODS: Numbers of transfemoral transcatheter aortic valve replacement (TAVR), percutaneous mitral valve repair (PMVR), left atrial appendage occlusion (LAAO), patent foramen ovale (PFO) closures performed over a 4-week period during the national lockdown in Italian centers performing over 60 structural heart interventions (SHI)/year were compared with the same 4-week period in 2019. Incidence rate reductions (IRR) were estimated by zero-inflated negative binomial regression. RESULTS: According to our nationwide analysis, SHIs were reduced by 79% as compared to the same period in 2019 (IRR 0.21, 95% confidence interval [CI] 0.15-0.29). This reduction was more substantial for PFO closure (IRR 0.03, 95% CI 0.01-0.07), LAAO (IRR 0.11, 95% CI 0.05-0.25) and PMVR (IRR 0.12, 95% CI 0.04-0.36) as compared to TAVR (IRR 0.31, 95% CI 0.22-0.47). CONCLUSIONS: The COVID-19 pandemic caused a 79% drop in SHI volumes in Italy. PFO closure, LAAO and PMVR decreased more significantly as compared to TAVR. Further studies are needed to evaluate the impact of this reduction on outcomes of patients with SHD.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Pandemias , Apêndice Atrial/cirurgia , Intervalos de Confiança , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Forame Oval Patente/cirurgia , Humanos , Itália/epidemiologia , Masculino , Valva Mitral/cirurgia , Prevalência , Fatores de Tempo , Substituição da Valva Aórtica Transcateter/estatística & dados numéricos
6.
BMC Health Serv Res ; 20(1): 1119, 2020 Dec 03.
Artigo em Inglês | MEDLINE | ID: mdl-33272278

RESUMO

BACKGROUND: To increase bed capacity and resources, hospitals have postponed elective surgeries, although the financial impact of this decision is unknown. We sought to report elective surgical case distribution, associated gross hospital revenue and regional hospital and intensive care unit (ICU) bed capacity as elective surgical cases are cancelled and then resumed under simulated trends of COVID-19 incidence. METHODS: A retrospective, cohort analysis was performed using insurance claims from 161 million enrollees from the MarketScan database from January 1, 2008 to December 31, 2017. COVID-19 cases were calculated using Institute for Health Metrics and Evaluation models. Centers for Disease Control (CDC) reports on the number of hospitalized and intensive care patients by age estimated the number of cases seen in the ICU, the reduction in elective surgeries and the financial impact of this from historic claims data, using a denominator of all inpatient revenue and outpatient surgeries. RESULTS: Assuming 5% infection prevalence, cancelling all elective procedures decreases ICU overcapacity from 160 to 130%, but these elective surgical cases contribute 78% (IQR 74, 80) (1.1 trillion (T) US dollars) to inpatient hospital plus outpatient surgical gross revenue per year. Musculoskeletal, circulatory and digestive category elective surgical cases compose 33% ($447B) of total revenue. CONCLUSIONS: Procedures involving the musculoskeletal, cardiovascular and digestive system account for the largest loss of hospital gross revenue when elective surgery is postponed. As hospital bed capacity increases following the COVID-19 pandemic, restoring volume of these elective cases will help maintain revenue. In these estimates, adopting universal masking would help to avoid overcapacity in all states.


Assuntos
/epidemiologia , Procedimentos Cirúrgicos Eletivos/economia , Número de Leitos em Hospital/estatística & dados numéricos , Pandemias , Economia Hospitalar , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Estudos Retrospectivos , Estados Unidos/epidemiologia
7.
Can J Surg ; 63(6): E527-E529, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33180692

RESUMO

SUMMARY: The cancellation of large numbers of surgical procedures because of the coronavirus disease 2019 (COVID-19) pandemic has drastically extended wait lists and negatively affected patient care and experience. As many facilities resume clinical work owing to the currently low burden of disease in our community, we are faced with operative booking protocols and procedures that are not mathematically designed to optimize efficiency. Using a subset of artificial intelligence called "machine learning," we have shown how the use of operating time can be optimized with a custom Python (a high-level programming language) script and an open source machine-learning algorithm, the ORTools software suite from the Google AI division of Alphabet Inc. This allowed the creation of customized models to optimize the efficiency of operating room booking times, which resulted in a reduction in nursing overtime of 21% - a theoretical cost savings of $469 000 over 3 years.


Assuntos
Agendamento de Consultas , Infecções por Coronavirus/prevenção & controle , Eficiência Organizacional/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Aprendizado de Máquina , Salas Cirúrgicas/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Ontário , Duração da Cirurgia , Pandemias/estatística & dados numéricos , Pneumonia Viral/epidemiologia
8.
J Ayub Med Coll Abbottabad ; 32(4): 470-475, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33225646

RESUMO

BACKGROUND: Enhanced recovery after surgery (ERAS) is a perioperative bundle aimed to reduce surgical stress. Significant reductions in length of hospital stay and associated costs have been reported in multiple studies in all surgical specialties. Purpose of the study was to compare the effect of Enhanced recovery protocols vs. conventional care on perioperative length of hospital stay and cost per patient in a government funded hospital. METHODS: this randomized controlled trial was conducted in the department of General Surgery, unit B, Lady reading hospital, Peshawar from April to December 2018. One hundred and fifty patients were selected based on consecutive sampling. Random allocation into two groups of 75 (ERAS vs Conventional) was done based on computer generated numbers. Length of hospital stay and total direct costs were calculated. Frequency of Surgical site infections, readmissions and mortality was also recorded. Patient reported outcomes were recorded by Surgical Recovery Scale SRS. RESULTS: Patients in the Enhanced recovery group showed a significant reduction in length of hospital stay 28.9 hours in ERAS group vs 40.5 hours in Conventional care group (p<0.001). Total per patient cost was reduced in the ERAS group PKR 6804 in comparison to the conventional care PKR 7682 (p<0.001). Patient reported outcomes measured on Surgical Recovery Scale SRS on discharge, day 3 of discharge and day 10 of discharge showed no significant difference between the two groups. CONCLUSIONS: Enhanced recovery protocols demonstrated a reduction in length of perioperative hospital stay and total cost despite similar post discharge recovery scores on Surgical Recovery Scale SRS and no increase in readmissions.


Assuntos
Colecistectomia Laparoscópica , Recuperação Pós-Cirúrgica Melhorada , Custos Hospitalares/estatística & dados numéricos , Colecistectomia Laparoscópica/economia , Colecistectomia Laparoscópica/métodos , Colecistectomia Laparoscópica/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/economia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos
9.
Orthopedics ; 43(6): 351-355, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33211903

RESUMO

This study was performed to analyze the effect that coronavirus 2019 (COVID-19) has had on orthopedic surgeons' practices, their patients, and orthopedic surgeons themselves through a survey distributed to members of the Louisiana Orthopaedic Association (LOA). An anonymous 22-question online survey was created and distributed to 323 LOA members. Of the 323 recipients of the survey, 99 (30.7%) responded. As a part of a multiple response set, in which respondents could choose more than one answer, the majority reported delayed care for routine orthopedic injuries (81 of 97, 83.5%). Almost every surgeon (n=95, 96.0%) reported stopping or delaying elective surgery because of COVID-19 and an increase in pain/disability/deformity in patients due to delay in elective procedures (73 of 97, 75.3%) and delay in seeking care (66 of 97, 68.0%). The majority reported an increased use of telehealth visits (68 of 97, 70.1%), a decrease in patient volume (88 of 97, 90.7%), and a reduction in income (79 of 98, 80.6%) during the past 6 months. A majority of surgeons (58 of 98, 59.2%) reported that they had applied for government assistance or took out loans. Via a multiple response set, respondents indicated that as a result of the pandemic, telehealth will become more widespread (64 of 98, 65.3%) and hospitals will exert a stronger influence over health care (64 of 98, 65.3%). The COVID-19 pandemic has had lasting effects on orthopedic surgeons in Louisiana and their practices, with a substantial decrease in the number of patients treated (90.5%), surgical volume, and revenue (80.6%). Orthopedic surgeons affected by the pandemic could use these data to further understand future challenges with patient care and changing orthopedic practice dynamics during this unique time. [Orthopedics. 2020;43(6):351-355.].


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Ortopédicos/estatística & dados numéricos , Cirurgiões Ortopédicos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica , Betacoronavirus , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Pesquisas sobre Serviços de Saúde , Administração Hospitalar , Humanos , Renda , Louisiana/epidemiologia , Masculino , Cirurgiões Ortopédicos/economia , Pandemias , Consulta Remota
10.
Cir. Esp. (Ed. impr.) ; 98(9): 525-532, nov. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-188232

RESUMO

INTRODUCCIÓN: La expansión de la infección por SARS-CoV-2 (COVID-19) ha requerido la adaptación de los hospitales afectados por la pandemia, causando una reducción de la actividad quirúrgica electiva. MÉTODOS: Estudio retrospectivo de pacientes operados durante el mes previo y el pico de la pandemia. Se analizó la tasa de contagio por COVID-19, la gravedad de la infección respiratoria según la Brescia Respiratory COVID-19 Severity Scale, las medidas terapéuticas adoptadas y las complicaciones postoperatorias globales. RESULTADOS: Desde el 17 de febrero hasta el 31 de marzo de 2020 se produjo una reducción progresiva de la actividad quirúrgica, interviniéndose únicamente 213 pacientes: 59 (27,8%) de forma programada por patología tumoral, 97 (45,5%) por patología benigna y 57 (26,7%) de forma urgente. Se produjo un aumento progresivo de la tasa de contagio por COVID-19 con un total de 15 (7%) casos. De los pacientes oncológicos, 10 (16,9%) resultaron afectos; en el grupo de cirugía electiva, un paciente (1%); y en el grupo de cirugía urgente, 4 (7%) (p < 0,001). Cinco pacientes presentaron una infección respiratoria grave de los cuales 4 estaban afectos por enfermedad oncológica. Hubo 3 (1,4%) fallecimientos, todos debidos a progresión de la infección respiratoria. CONCLUSIONES: Los pacientes sometidos a cirugía presentaron una elevada tasa de infección por COVID-19 y de complicaciones postoperatorias, sobre todo en los pacientes oncológicos. La puesta en marcha de la de la actividad quirúrgica debe basarse en una priorización de los casos a operar, respetando unas premisas de seguridad y optimización de los recursos disponibles


INTRODUCTION: The spread of the SARS-CoV-2 infection (COVID-19) has required adaptation by hospitals affected by the pandemic, which has caused a reduction in elective surgical activity. METHODS: Retrospective study of patients operated on in the previous month and during the peak of the pandemic. We analysed the COVID-19 infection rate, the severity of respiratory infection according to the Brescia respiratory COVID-19 severity scale, the adopted therapeutic measures and the overall postoperative complications. RESULTS: From 17th February to 31st March 2020, there was a progressive decrease in surgical activity, with only 213 patients operated on. This comprised 59 (27.8%) elective operations for oncological diseases, 97 (45.5%) elective operations for benign diseases and 57 (26.7%) as urgent procedures. There was a progressive increase in the rate of infection by COVID-19, with a total of 15 cases (7%). This included 10 patients (16.9%) in the elective group for oncological disease, 1 (1%) in the elective surgery group for benign disease and 4 (7%) in the urgent surgery group (P < .001). Five patients presented with a severe respiratory infection, of which 4 were affected by oncological disease. There were 3 deaths (1.4%), which were all due to the worsening of a respiratory infection. CONCLUSIONS: The patients undergoing the surgical procedures showed high rates of COVID-19 infection and postoperative complications, especially the patients with oncological diseases. Local resumption of surgical activity must be based on the prioritisation of the cases to be operated on, respecting certain premises of security and optimisation of the available resources


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Infecções por Coronavirus/transmissão , Pneumonia Viral/transmissão , Pandemias , Estudos Retrospectivos , Segurança do Paciente , Morbidade
12.
BMJ Open ; 10(10): e042392, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33130573

RESUMO

OBJECTIVES: The suspension of elective surgery during the COVID-19 pandemic is unprecedented and has resulted in record volumes of patients waiting for operations. Novel approaches that maximise capacity and efficiency of surgical care are urgently required. This study applies Markov multiscale community detection (MMCD), an unsupervised graph-based clustering framework, to identify new surgical care models based on pooled waiting-lists delivered across an expanded network of surgical providers. DESIGN: Retrospective observational study using Hospital Episode Statistics. SETTING: Public and private hospitals providing surgical care to National Health Service (NHS) patients in England. PARTICIPANTS: All adult patients resident in England undergoing NHS-funded planned surgical procedures between 1 April 2017 and 31 March 2018. MAIN OUTCOME MEASURES: The identification of the most common planned surgical procedures in England (high-volume procedures (HVP)) and proportion of low, medium and high-risk patients undergoing each HVP. The mapping of hospitals providing surgical care onto optimised groupings based on patient usage data. RESULTS: A total of 7 811 891 planned operations were identified in 4 284 925 adults during the 1-year period of our study. The 28 most common surgical procedures accounted for a combined 3 907 474 operations (50.0% of the total). 2 412 613 (61.7%) of these most common procedures involved 'low risk' patients. Patients travelled an average of 11.3 km for these procedures. Based on the data, MMCD partitioned England into 45, 16 and 7 mutually exclusive and collectively exhaustive natural surgical communities of increasing coarseness. The coarser partitions into 16 and seven surgical communities were shown to be associated with balanced supply and demand for surgical care within communities. CONCLUSIONS: Pooled waiting-lists for low-risk elective procedures and patients across integrated, expanded natural surgical community networks have the potential to increase efficiency by innovatively flexing existing supply to better match demand.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Cadeias de Markov , Modelos Organizacionais , Pandemias , Medicina Estatal/organização & administração , Listas de Espera , Adulto , Betacoronavirus , Redes Comunitárias/organização & administração , Infecções por Coronavirus/epidemiologia , Eficiência Organizacional , Procedimentos Cirúrgicos Eletivos/classificação , Inglaterra/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Colaboração Intersetorial , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Medição de Risco , Medicina Estatal/estatística & dados numéricos
13.
PLoS One ; 15(10): e0240397, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031464

RESUMO

BACKGROUND: There is a need to understand the impact of COVID-19 on colorectal cancer care globally and determine drivers of variation. OBJECTIVE: To evaluate COVID-19 impact on colorectal cancer services globally and identify predictors for behaviour change. DESIGN: An online survey of colorectal cancer service change globally in May and June 2020. PARTICIPANTS: Attending or consultant surgeons involved in the care of patients with colorectal cancer. MAIN OUTCOME MEASURES: Changes in the delivery of diagnostics (diagnostic endoscopy), imaging for staging, therapeutics and surgical technique in the management of colorectal cancer. Predictors of change included increased hospital bed stress, critical care bed stress, mortality and world region. RESULTS: 191 responses were included from surgeons in 159 centers across 46 countries, demonstrating widespread service reduction with global variation. Diagnostic endoscopy was reduced in 93% of responses, even with low hospital stress and mortality; whilst rising critical care bed stress triggered complete cessation (p = 0.02). Availability of CT and MRI fell by 40-41%, with MRI significantly reduced with high hospital stress. Neoadjuvant therapy use in rectal cancer changed in 48% of responses, where centers which had ceased surgery increased its use (62 vs 30%, p = 0.04) as did those with extended delays to surgery (p<0.001). High hospital and critical care bed stresses were associated with surgeons forming more stomas (p<0.04), using more experienced operators (p<0.003) and decreased laparoscopy use (critical care bed stress only, p<0.001). Patients were also more actively prioritized for resection, with increased importance of co-morbidities and ICU need. CONCLUSIONS: The COVID-19 pandemic was associated with severe restrictions in the availability of colorectal cancer services on a global scale, with significant variation in behaviours which cannot be fully accounted for by hospital burden or mortality.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/terapia , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos , Alocação de Recursos para a Atenção à Saúde , Pneumonia Viral/epidemiologia , Betacoronavirus/fisiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Gastroenterologia/organização & administração , Gastroenterologia/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pandemias , Segurança do Paciente
14.
Isr J Health Policy Res ; 9(1): 59, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126921

RESUMO

INTRODUCTION: Israel ranks very high globally in performing bariatric surgery (BS) per capita. In the first phase of the COVID-19 pandemic the bariatric surgeons' community faced many concerns and challenges, especially in light of a decree issued by the Ministry of Health (MOH) on March 22nd, to ban all elective surgery in public hospitals. The aim of this study is to portray the practices and attitudes of Israeli bariatric surgeons in the first phase of the pandemic. METHODS: Anonymous web-based questionnaire sent to all active bariatric surgeons in Israel. Statistical analysis was performed using SAS software package. RESULTS: 53 out of 63 (84%) active surgeons responded to the survey. 18% practice in the public sector only, 4% in the private sector only and 78% in both sectors. 76% practice BS for more than 10 years and 68% perform more than 100 procedures a year. Almost all the surgeons (98%) experienced a tremendous decrease in operations. Nevertheless, there were substantial differences by sectors. In the public sector, 86% of the surgeons ceased to operate while 14% did not comply with the government's decree. In the public sector 69% of the surgeons were instructed by the administrators to stop operating. The majority of surgeons who continued to operate (77%) changed nothing in the indications or contra-indications for surgery. Among the surgeons who opted to refrain from operating on special sub-groups, the most frequent reasons were pulmonary disease (82%), age above 60 (64%), Ischemic heart disease (55%) and living in heavily affected communities. Roughly only half (57%) of the surgeons implemented changes in informed consent and operating room (OR) measures, contrary to guidelines and recommendations by leading professional societies. When asked about future conditions for reestablishing elective procedures, the reply frequencies were as follows: no special measures - 40%; PCR negativity - 27%; IgG positivity - 15%; waiting until the end of the pandemic- 9%. CONCLUSIONS: We showed in this nation-wide survey that the variance between surgeons, regarding present and future reactions to the COVID-19 pandemic, is high. There were substantial differences between the private and the public sectors. Although the instructions given by the MOH for the public sector were quite clear, the compliance by surgeons and administrators was far from complete. The administrators in the public sector, but more so in the private sector were ambiguous in instructing staff, leading surgeons to a more "personal non-structured" practice in the first phase of the pandemic. These facts must be considered by regulators, administrators and surgeons when planning for reestablishing elective BS or in case a second wave of the pandemic is on its way.


Assuntos
Atitude , Bariatria , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Padrões de Prática Médica , Cirurgiões/estatística & dados numéricos , Adulto , Betacoronavirus , Feminino , Humanos , Israel , Masculino , Pessoa de Meia-Idade , Setor Privado , Setor Público , Inquéritos e Questionários
15.
BMC Med ; 18(1): 329, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066777

RESUMO

BACKGROUND: To calculate hospital surge capacity, achieved via hospital provision interventions implemented for the emergency treatment of coronavirus disease 2019 (COVID-19) and other patients through March to May 2020; to evaluate the conditions for admitting patients for elective surgery under varying admission levels of COVID-19 patients. METHODS: We analysed National Health Service (NHS) datasets and literature reviews to estimate hospital care capacity before the pandemic (pre-pandemic baseline) and to quantify the impact of interventions (cancellation of elective surgery, field hospitals, use of private hospitals, deployment of former medical staff and deployment of newly qualified medical staff) for treatment of adult COVID-19 patients, focusing on general and acute (G&A) and critical care (CC) beds, staff and ventilators. RESULTS: NHS England would not have had sufficient capacity to treat all COVID-19 and other patients in March and April 2020 without the hospital provision interventions, which alleviated significant shortfalls in CC nurses, CC and G&A beds and CC junior doctors. All elective surgery can be conducted at normal pre-pandemic levels provided the other interventions are sustained, but only if the daily number of COVID-19 patients occupying CC beds is not greater than 1550 in the whole of England. If the other interventions are not maintained, then elective surgery can only be conducted if the number of COVID-19 patients occupying CC beds is not greater than 320. However, there is greater national capacity to treat G&A patients: without interventions, it takes almost 10,000 G&A COVID-19 patients before any G&A elective patients would be unable to be accommodated. CONCLUSIONS: Unless COVID-19 hospitalisations drop to low levels, there is a continued need to enhance critical care capacity in England with field hospitals, use of private hospitals or deployment of former and newly qualified medical staff to allow some or all elective surgery to take place.


Assuntos
Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/terapia , Capacidade de Resposta ante Emergências , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Inglaterra , Hospitais , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Medicina Estatal
18.
J Clin Neurosci ; 80: 156-161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33099339

RESUMO

BACKGROUND: There has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era. METHODS: Details of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups. RESULTS: Our study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were non-emergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043). CONCLUSIONS: The drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for 'elective' surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Adulto Jovem
20.
Otolaryngol Clin North Am ; 53(6): 1139-1151, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33039097

RESUMO

This review summarizes the challenges and adaptations that have taken place in rhinology and facial plastics in response to the ongoing coronavirus disease-19 pandemic. In particular, the prolonged exposure and manipulation of the nasal and oral cavities portend a high risk of viral transmission. We discuss evidence-based recommendations to mitigate the risk of viral transmission through novel techniques and device implementation as well as increasing conservative management of certain pathologies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Rinoplastia/métodos , Ritidoplastia/métodos , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Boca/virologia , Cavidade Nasal/virologia , Saúde do Trabalhador , Pandemias/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/epidemiologia , Rinoplastia/efeitos adversos , Ritidoplastia/efeitos adversos , Gestão da Segurança/métodos
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