# bib

id: cord-335648-lbmhprjn
title: Estimating COVID-19 prevalence and infection control practices among US dentists
author: Estrich, Cameron G.
date: 2020-10-15
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url: https://www.ncbi.nlm.nih.gov/pubmed/33071007/
doi: 10.1016/j.adaj.2020.09.005
summary:
  Dentists from every US state (n = 2,195) answered questions about COVID-19–associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices. As early as March 2020, Journal of Dental Research published the infection control guidelines that dentists at Wuhan University used, 7 and, in April and May 2020, the American Dental Association (ADA) and the Centers for Disease Control and Prevention (CDC), respectively, released interim guidance on infection control protocols and changes to the practice and office environments. In this article, we used the first month of study data to estimate the prevalence of COVID-19 among US dentists and to determine the rate of compliance with CDC and ADA infection prevention and control procedures. 14, 15 Respondents who reported providing oral health care in the past month were asked about infection prevention or control procedures in their primary dental practice.

abstract:
  BACKGROUND: Understanding the risks associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during oral health care delivery and assessing mitigation strategies for dental offices are critical to improving patient safety and access to oral health care. METHODS: The authors invited licensed US dentists practicing primarily in private practice or public health to participate in a web-based survey in June 2020. Dentists from every US state (n = 2,195) answered questions about COVID-19–associated symptoms, SARS-CoV-2 infection, mental and physical health conditions, and infection control procedures used in their primary dental practices. RESULTS: Most of the dentists (82.2%) were asymptomatic for 1 month before administration of the survey; 16.6% reported being tested for SARS-CoV-2; and 3.7%, 2.7%, and 0% tested positive via respiratory, blood, and salivary samples, respectively. Among those not tested, 0.3% received a probable COVID-19 diagnosis from a physician. In all, 20 of the 2,195 respondents had been infected with SARS-CoV-2; weighted according to age and location to approximate all US dentists, 0.9% (95% confidence interval, 0.5 to 1.5) had confirmed or probable COVID-19. Dentists reported symptoms of depression (8.6%) and anxiety (19.5%). Enhanced infection control procedures were implemented in 99.7% of dentists’ primary practices, most commonly disinfection, COVID-19 screening, social distancing, and wearing face masks. Most practicing dentists (72.8%) used personal protective equipment according to interim guidance from the Centers for Disease Control and Prevention. CONCLUSIONS: COVID-19 prevalence and testing positivity rates were low among practicing US dentists. This indicates that the current infection control recommendations may be sufficient to prevent infection in dental settings. PRACTICAL IMPLICATIONS: Dentists have enhanced their infection control practices in response to COVID-19 and may benefit from greater availability of personal protective equipment. ClinicalTrials.gov: NCT04423770.


id: cord-335704-qejpc4x8
author: Kuhar, Hannah N.
date: 2020-06-02
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url: https://doi.org/10.1177/0194599820930214
doi: 10.1177/0194599820930214
summary:
  5 Regarding surgical management of otolaryngologic cases, it is recommended that patient COVID-19 status be determined ahead of surgery, that high-risk operations be performed in negativepressure operating rooms with appropriate personal protective equipment (PPE) worn by all staff, and that only essential staff be in the operating room for intubation and extubation. Immediately following the present study period of data collection (March 18-April 8, 2020), with the increasing availability of PPE, OHNS departments across all 3 centers developed standardized protocols for universal use of aerosol-protective PPE for all AGPs, regardless of the patient''s COVID-19 status. From the experience of OHNS departments at pediatric and adult academic medical centers, we identified availability of rapid COVID-19 testing and adequate aerosol-protective PPE to be significant limitations to operationalizing society recommendations.

title:
  Otolaryngology in the Time of Corona: Assessing Operative Impact and Risk During the COVID-19 Crisis

abstract:
  OBJECTIVE: Limited research exists on the coronavirus disease 2019 (COVID-19) pandemic pertaining to otolaryngology–head and neck surgery (OHNS). The present study seeks to understand the response of OHNS workflows in the context of policy changes and to contribute to developing preparatory guidelines for perioperative management in OHNS. STUDY DESIGN: Retrospective cohort study. SETTING: Pediatric and general adult academic medical centers and a Comprehensive Cancer Center (CCC). SUBJECTS AND METHODS: OHNS cases from March 18 to April 8, 2020—the 3 weeks immediately following the Ohio state-mandated suspension of all elective surgery on March 18, 2020—were compared with a 2019 control data set. RESULTS: During this time, OHNS at the general adult and pediatric medical centers and CCC experienced 87.8%, 77.1%, and 32% decreases in surgical procedures as compared with 2019, respectively. Aerosol-generating procedures accounted for 86.8% of general adult cases, 92.4% of pediatric cases, and 62.0% of CCC cases. Preoperative COVID-19 testing occurred in 7.1% of general adult, 9% of pediatric, and 6.9% of CCC cases. The majority of procedures were tiers 3a and 3b per the Centers for Medicare & Medicaid Services. Aerosol-protective personal protective equipment (PPE) was worn in 28.6% of general adult, 90% of pediatric, and 15.5% of CCC cases. CONCLUSION: For OHNS, the majority of essential surgical cases remained high-risk aerosol-generating procedures. Preoperative COVID-19 testing and intraoperative PPE usage were initially inconsistent; systemwide guidelines were developed rapidly but lagged behind recommendations of the OHNS department and its academy. OHNS best practice standards are needed for preoperative COVID-19 status screening and PPE usage as we begin national reopening.


id: cord-337499-jzpgtkai
author: Yong Choi, Sung
date: 2020-06-17
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url: https://api.elsevier.com/content/article/pii/S1368837520302979
doi: 10.1016/j.oraloncology.2020.104861
summary:
  title: Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea RESULTS: Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. In contrast, the surgical tracheostomy for the COVID-19 patient was performed by one dedicated head and neck surgeon and ICU medical staff (two intensivists and one senior nurse), who worked only in the negative pressure room for COVID-19, and assisted with all procedures (Supplementary Figure 1) . The first cannula change for the COVID-19 patient was performed by the same surgeon with enhanced PPE at 13 days because that patient had three consecutive negative SARS-CoV-2 PCR tests 11 days after tracheostomy.

title:
  Safe surgical tracheostomy during the COVID-19 pandemic: A protocol based on experiences with Middle East Respiratory Syndrome and COVID-19 outbreaks in South Korea

abstract:
  BACKGROUND: A subset of patients with COVID-19 require intensive respiratory care and tracheostomy. Several guidelines on tracheostomy procedures and care of tracheostomized patients have been introduced. In addition to these guidelines, further details of the procedure and perioperative care would be helpful. The purpose of this study is to describe our experience and tracheostomy protocol for patients with MERS or COVID-19. MATERIALS AND METHODS: Thirteen patients with MERS were admitted to the ICU, 9 (69.2%) of whom underwent surgical tracheostomy. During the COVID-19 outbreak, surgical tracheostomy was performed in one of seven patients with COVID-19. We reviewed related documents and collected information through interviews with healthcare workers who had participated in designing a tracheostomy protocol. RESULTS: Compared with previous guidelines, our protocol consisted of enhanced PPE, simplified procedures (no limitation in the use of electrocautery and wound suction, no stay suture, and delayed cannula change) and a validated screening strategy for healthcare workers. Our protocol allowed for all associated healthcare workers to continue their routine clinical work and daily life. It guaranteed safe return to general patient care without any related complications or nosocomial transmission during the MERS and COVID-19 outbreaks. CONCLUSION: Our protocol and experience with tracheostomies for MERS and COVID-19 may be helpful to other healthcare workers in building an institutional protocol optimized for their own COVID-19 situation.


id: cord-337633-arivuags
title: COVID-19 Global Pandemic Planning: Decontamination and Reuse Processes for N95 Respirators
author: Perkins, Douglas Jay
date: 2020-04-14
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url: https://doi.org/10.1101/2020.04.09.20060129
doi: 10.1101/2020.04.09.20060129
summary:
  Here, we describe the development of a process that began in late February 2020 for selecting and implementing the use of hydrogen peroxide vapor (HPV) as viable method to reprocess N95 respirators. Since pre-existing HPV decontamination chambers were not available, we optimized the sterilization process in an operating room after experiencing initial challenges in other environments. Details are provided about the prioritization and implementation of processes for collection and storage, pre-processing, HPV decontamination, and post-processing of filtering facepiece respirators (FFRs). The primary means of protecting frontline healthcare personnel (HCP) from contracting COVID-19 is through the proper use of personal protective equipment (PPE), such as N95 filtering facepiece respirators (FFRs). The two most important lessons learned from our experience are: 1) develop an adequate reserve of PPE for efficiently implementing the reprocessing workflow, and 2) locate a suitable environment for the HPV decontamination procedure, such as an operating room, which has the pre-existing conditions required for conducing the HPV decontamination process.

abstract:
  Coronavirus disease 2019 (COVID-19) is an illness caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was first identified as a cluster of respiratory illness in Wuhan City, Hubei Province, China in December 2019, and has rapidly spread across the globe to greater than 200 countries. Healthcare providers are at an increased risk for contracting the disease due to occupational exposure and require appropriate personal protective equipment (PPE), including N95 respirators. The rapid worldwide spread of high numbers of COVID-19 cases has facilitated the need for a substantial supply of PPE that is largely unavailable in many settings, thereby creating critical shortages. Creative solutions for the decontamination and safe reuse of PPE to protect our frontline healthcare personnel are essential. Here, we describe the development of a process that began in late February 2020 for selecting and implementing the use of hydrogen peroxide vapor (HPV) as viable method to reprocess N95 respirators. Since pre-existing HPV decontamination chambers were not available, we optimized the sterilization process in an operating room after experiencing initial challenges in other environments. Details are provided about the prioritization and implementation of processes for collection and storage, pre-processing, HPV decontamination, and post-processing of filtering facepiece respirators (FFRs). Important lessons learned from this experience include, developing an adequate reserve of PPE for effective reprocessing and distribution, and identifying a suitable location with optimal environmental controls (i.e., operating room). Collectively, information presented here provides a framework for other institutions considering decontamination procedures for N95 respirators.


id: cord-337785-fwo0r4bb
title: A Comparative Study Looking at Trauma and Orthopaedic Operating Efficiency in the COVID-19 Era
author: Mercer, Scott Thomas
date: 2020-10-21
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url: https://api.elsevier.com/content/article/pii/S2405603020300571
doi: 10.1016/j.pcorm.2020.100142
summary:
  No increase in surgical time was observed in hand and wrist surgery or for debridement and washouts. The other increases in time demonstrated can largely be attributed to the PPE required for aerosol generating procedures and other measures taken to reduce spread of the virus. During the pandemic due to redeployment of staff members and overall reduced trauma/ urgent orthopaedic cases, we had 2 all day lists from 8am to 8pm. A further sub-group analysis of hand and wrist surgery showed that there was no significant increase in surgical time in 2020 (Table 5) . Changes implemented during COVID-19 have led to a significant reduction in the efficiency of ORs. This will have significant effect on increased waiting times for elective surgery. Increasing frequency of regional anaesthesia concurrently with safe non-aerosol generating surgeries may improve operating room efficiency however, further research is needed to prove this.

abstract:
  BACKGROUD: COVID-19 has led to a reduction in operating efficiency. We aim to identify these inefficiencies and possible solutions as we begin to pursue a move to planned surgical care. METHODS: All trauma and orthopaedic emergency surgery were analysed for May 2019 and May 2020. Timing data was collated to look at the following: anaesthetic preparation time, anaesthetic time, surgical preparation time, surgical time, transfer to recovery time and turnaround time. Data for 2019 was collected retrospectively and data for 2020 was collected prospectively. RESULTS: A total of 222 patients underwent emergency orthopaedic surgery in May 2019 and 161 in May 2020. A statistically significant increase in all timings was demonstrated in 2020 apart from anaesthetic time which demonstrated a significant decrease. A subgroup analysis for hip fractures demonstrated a similar result. No increase in surgical time was observed in hand and wrist surgery or for debridement and washouts. Although the decrease in anaesthetic time is difficult to explain, this could be attributed to a reduction in combined anaesthetic techniques and possibly the effect of fear. The other increases in time demonstrated can largely be attributed to the PPE required for aerosol generating procedures and other measures taken to reduce spread of the virus. These procedures currently form a large amount of the orthopaedic case load. CONCLUSION: COVID-19 has led to significant reductions in operating room efficiency. This will have significant impact on waiting times. Increasing frequency of regional anaesthesia concurrently with non-aerosol generating surgeries may improve efficiency.


id: cord-338365-9sd62a2w
title: Increased plastic pollution due to Covid-19 pandemic: challenges and recommendations
author: Patrício Silva, Ana L.
date: 2020-08-17
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url: https://www.sciencedirect.com/science/article/pii/S1385894720328114?v=s5
doi: 10.1016/j.cej.2020.126683
summary:
  This paper provides a comprehensive review on the potential impact of COVID-19 pandemic precautionary measures in the environment while considering the shift on public behaviour and policies towards single-use items and waste management. At first glance COVID-19 pandemic seems to be indirectly contributing towards the UN 2030 Sustainable Development Goals (namely 11, 12, 13, 15 SGDs) by increasing overall health and safety of cities by reducing the greenhouse gas emissions (GHG), outdoor air pollution, environmental noise level (including underwater noise due to reduced marine transportation activities), land and wildlife pressure. While the positive impacts of COVID-19 in the environment are resulting from a "postponed" anthropogenic activity that soon will entail after the pandemic scenario; the negative short-term effects (that are mostly related with plastic use, consumption and waste mismanagement as discussed below) will shortly add-up to the current environmental issues, aggravating their impact in the natural ecosystems and compromising potential mitigation/remediation measures.

abstract:
  Plastics have become a severe transboundary threat to natural ecosystems and human health, with studies predicting a twofold increase in the number of plastic debris (including micro and nano-sized plastics) by 2030. However, such predictions will likely be aggravated by the excessive use and consumption of single-use plastics (including personal protective equipment such as masks and gloves) due to COVID-19 pandemic. This review aimed to provide a comprehensive overview on the effects of COVID-19 on macroplastic pollution and its potential implications on the environment and human health considering short- and long-term scenarios; addressing the main challenges and discussing potential strategies to overcome them. It emphasises that future measures, involved in an emergent health crisis or not, should reflect a balance between public health and environmental safety as they are both undoubtedly connected. Although the use and consumption of plastics significantly improved our quality of life, it is crucial to shift towards sustainable alternatives, such as bio-based plastics. Plastics should remain in the top of the political agenda in Europe and across the world, not only to minimise plastic leakage and pollution, but to promote sustainable growth and to stimulate both green and blue- economies. Discussions on this topic, particularly considering the excessive use of plastic, should start soon with the involvement of the scientific community, plastic producers and politicians in order to be prepared for the near future.


id: cord-339517-93nuovsj
author: Consolo, Ugo
date: 2020-05-15
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url: https://www.ncbi.nlm.nih.gov/pubmed/32429193/
doi: 10.3390/ijerph17103459
summary:
  The one-way ANOVA showed a main effect of age group for perceived patient''s likelihood of contracting the infection (F 2,353 -Statistic = 1157, p < 0.001), and reported levels of concern about the professional future ( To the question "During clinical activity, which measures do you use to prevent COVID-19 infection?", dentists replied highlighting a good knowledge of what is reported in the most recent indications from the literature. To the question "Which aids do you think could help dental professionals during COVID-19 pandemic?", for which two preferences could be expressed, the dentists replied indicating "Economic relieves from Italian government" (65.7%), "Social security institutions support and subsidy" (44.1%)," Economic relieves from dental associations" (32.1%) and "Improvement of communication with patients" (8.1%).

title:
  Epidemiological Aspects and Psychological Reactions to COVID-19 of Dental Practitioners in the Northern Italy Districts of Modena and Reggio Emilia

abstract:
  The outbreak and diffusion of the Severe Acute Respiratory Syndrome-Coronavirus-2 (Sars-CoV-2) and COronaVIrus Disease 19 (COVID-19) have caused an emergency status in the health system, including in the dentistry environment. Italy registered the third highest number of COVID-19 cases in the world and the second highest in Europe. An anonymous online survey composed of 40 questions has been sent to dentists practicing in the area of Modena and Reggio Emilia, one of the areas in Italy most affected by COVID-19. The survey was aimed at highlighting the practical and emotional consequences of COVID-19 emergence on daily clinical practice. Specifically, it assessed dentists’ behavioral responses, emotions and concerns following the Sars-CoV-2 pandemic restrictive measures introduced by the Italian national administrative order of 10 March 2020 (DM-10M20), as well as the dentists’ perception of infection likelihood for themselves and patients. Furthermore, the psychological impact of COVID-19 was assessed by means of the Generalized Anxiety Disorder-7 test (GAD-7), that measures the presence and severity of anxiety symptoms. Using local dental associations (ANDI-Associazione Nazionale Dentisti Italiani, CAO-Commissione Albo Odontoiatri) lists, the survey was sent by email to all dentists in the district of Modena and Reggio Emilia (874 practitioners) and was completed by 356 of them (40%). All dental practitioners closed or reduced their activity to urgent procedures, 38.2% prior to and 61.8% after the DM-10M20. All reported a routinely use of the most common protective personal equipment (PPE), but also admitted that the use of PPE had to be modified during COVID-19 pandemic. A high percentage of patients canceled their previous appointments after the DM-10M20. Almost 85% of the dentists reported being worried of contracting the infection during clinical activity. The results of the GAD-7 (General Anxiety Disorder-7) evaluation showed that 9% of respondents reported a severe anxiety. To conclude, the COVID-19 emergency is having a highly negative impact on the activity of dentists practicing in the area of Modena and Reggio Emilia. All respondents reported practice closure or strong activity reduction. The perception of this negative impact was accompanied by feelings of concern (70.2%), anxiety (46.4%) and fear (42.4%). The majority of them (89.6%) reported concerns about their professional future and the hope for economic measures to help dental practitioners.


id: cord-339614-28s205p8
author: Dover, Jeffrey S.
date: 2020-05-01
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url: https://www.ncbi.nlm.nih.gov/pubmed/32374192/
doi: 10.1089/fpsam.2020.0239
abstract: nan
summary:
  Patient communication-establishing appropriate expectations for office visits and attendant risks; Clinic schedule management-considerations for schedule modification to convert non-treatment interactions to telehealth consultations, separate patients from one another in the office and avoid unnecessary staff contact; Facility management-physical modification of office common areas and treatment rooms, as well as check-in and check-out procedures, to promote safe practices and physical distancing; Cleaning procedures-discussion of disinfection methods and practices in each office area, ranging from medical instruments and treatment rooms to administrative items and reception areas; Personal Protective Equipment (PPE) for providers, staff and patients-recommendations for PPE types and use depending upon procedure-based risk assessment, and recognizing current global equipment shortages; Employee health screening and training-procedures and methods for identifying staff members who may be unwell before, during, and after work, and training of staff to identify potential COVID-19 presentation in coworkers, patients, and other office visitors; risks associated with exposure to known or suspected COVID-19-positive individuals are also discussed; Patient health and screening-procedures and methods for symptom recognition in patients before, during, and after office visits, with follow-up monitoring where appropriate; Remedial measures following onsite symptom presentation-a framework for addressing isolation of symptomatic individuals, office containment and disinfection, and contact tracing; Treatment room setup-preparing and securing treatment rooms for patient entry to contain office contamination and reduce overall potential COVID-19 exposure; and Aesthetic treatment considerations-pretreatment preparation and precautions, and other suggestions for minimizing risk of transmission in performing the most common types of office-based aesthetic procedures, such as neurotoxin and dermal filler injections, noninvasive body contouring, lasers and other similar energy-emitting devices, and a range of medical skin care treatments.

title:
  A Path to Resume Aesthetic Care: Executive Summary of Project AesCert Guidance Supplement—Practical Considerations for Aesthetic Medicine Professionals Supporting Clinic Preparedness in Response to the SARS-CoV-2 Outbreak


id: cord-340799-1awmtj52
author: Krajewska, Joanna
date: 2020-06-06
txt: ./txt/cord-340799-1awmtj52.txt
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url: https://doi.org/10.1016/j.anl.2020.05.022
doi: 10.1016/j.anl.2020.05.022
summary:
  Laryngectomy patients and individuals after tracheotomy with COVID-19 carry a particularly high risk of infecting ENT specialists and other members of medical staff as the way of breathing is these individuals is modified and enables the easy spread of SARS-CoV-2 containing aerosolized tracheal secretions [11] . In accordance with such high risk of infection, only emergency consultations and procedures should be performed by ENT specialists in times of COVID-19 pandemic in areas with confirmed SARS-CoV-2 cases [23, 28] . American Head and Neck Society, AAO-HNS, and the American Colleges of Surgeons, recommended that preoperative testing for SARS-CoV-2 presence should be performed in all individuals undergoing high-risk procedures [22, 30] . Patients with acute airway obstruction requiring tracheotomy should be considered as COVID-19 positive, as there is no time for SARS-CoV-2 testing in case of such urgent surgery [29] .

title:
  Review of practical recommendations for otolaryngologists and head and neck surgeons during the COVID-19 pandemic: Recommendations for otolaryngologists during the COVID-19 pandemic

abstract:
  INTRODUCTION: Otolaryngologists are at very high risk of COVID-19 infection while performing examination or surgery. Strict guidelines for these specialists have not already been provided, while currently available recommendations could presumably change in course of COVID-19 pandemic as the new data increases. OBJECTIVES: This study aimed to synthesize evidence concerning otolaryngology during COVID‐19 pandemic. It presents a review of currently existing guidelines and recommendations concerning otolaryngological procedures and surgeries during COVID-19 pandemic, and provides a collective summary of all crucial information for otolaryngologists. It summarizes data concerning COVID-19 transmission, diagnosis, and clinical presentation highlighting the information significant for otolaryngologists. METHODS: The Medline and Web of Science databases were searched without time limit using terms ‘‘COVID-19”, “SARS-CoV-2” in conjunction with “head and neck surgery”, “otorhinolaryngological manifestations”. RESULTS: Patients in stable condition should be consulted using telemedicine options. Only emergency consultations and procedures should be performed during COVID-19 pandemic. Mucosa-involving otolaryngologic procedures are considered high risk procedures and should be performed using enhanced PPE (N95 respirator and full face shield or powered air-purifying respirator, disposable gloves, surgical cap, gown, shoe covers). Urgent surgeries for which there is not enough time for SARS-CoV-2 screening are also considered high risk procedures. These operations should be performed in a negative pressure operating room with high-efficiency particulate air filtration. Less urgent cases should be tested for COVID-19 twice, 48 hours preoperatively in 24 hours’ interval. CONCLUSIONS: This review serves as a collection of current recommendations for otolaryngologists for how to deal with their patients during COVID-19 pandemic.


id: cord-340887-k88hchau
author: Khusid, Johnathan A.
date: 2020-05-27
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url: https://www.ncbi.nlm.nih.gov/pubmed/32460433/
doi: 10.1111/ijcp.13559
summary:
  To address this gap, in the current study we aim to assess the well-being, clinical practice, and education of urology residents throughout the USA during the COVID-19 pandemic through the use of an anonymous survey. Potential risk factors included: resident age, gender identity, level of training, practice setting (urban/suburban/rural), AUA geographical section, perception of local COVID-19 severity (Likert), marital status, children, perceived household susceptibility to disease (Likert), history of COVID-19 symptoms, months of intensive care unit training, redeployment status, perceptions of availability of PPE (Likert) and COVID-19 testing, cancellation of elective cases, number of weekly operations before the pandemic, perceived program and hospital support (Likert), perception of shared responsibility with attendings (Likert), and perceived difficulty meeting case minimums (Likert). Perception of support from hospital administration (β=-0.23, 95% CI=-0.40, -0.05) and shared responsibility between residents and attendings (β=-0.22, 95% CI=-0.39, -0.07) were associated with lower declination of redeployment whereas concern regarding ability to reach graduation case requirements was associated with higher declination of redeployment (β=0.16, 95% CI=0.00, 0.32).

title:
  Well‐Being and Education of Urology Residents During the COVID‐19 Pandemic: Results of an American National Survey

abstract:
  BACKGROUND: The rapid spread of COVID‐19 has placed tremendous strain on the American healthcare system. Few prior studies have evaluated the well‐being of or changes to training for American resident physicians during the COVID‐19 pandemic. We aim to study predictors of trainee well‐being and changes to clinical practice using an anonymous survey of American urology residents. METHODS: An anonymous, voluntary, 47‐question survey was sent to all ACGME‐accredited urology programs in the United States. We executed a cross‐sectional analysis evaluating risk factors of perception of anxiety and depression both at work and home and educational outcomes. Multiple linear regressions models were used to estimate beta coefficients and 95% confidence intervals. RESULTS: Among approximately 1,800 urology residents in the USA, 356 (20%) responded. Among these respondents, 24 had missing data leaving a sample size of 332. Important risk factors of mental health outcomes included perception of access to PPE, local COVID‐19 severity, and perception of susceptible household members. Risk factors for declination of redeployment included current redeployment, having children, and concerns regarding ability to reach case minimums. Risk factors for concern of achieving operative autonomy included cancellation of elective cases and higher level of training. CONCLUSIONS: Several potential actions, which could be taken by urology residency program directors and hospital administration, may optimize urology resident well‐being, morale, and education. These include advocating for adequate access to PPE, providing support at both the residency program and institutional levels, instituting telehealth education programs, and fostering a sense of shared responsibility of COVID‐19 patients.


id: cord-341531-w788qwya
author: Montero Feijoo, A.
date: 2020-05-04
txt: ./txt/cord-341531-w788qwya.txt
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url: https://www.sciencedirect.com/science/article/pii/S2341192920300597
doi: 10.1016/j.redare.2020.03.002
summary:
  Protective measures should be maximised when caring for patients with confirmed infection, in critically ill patients with a high viral load, and in patients that require invasive aerosol-generating procedures and manoeuvres such as aerosol therapy and nebulisation, aspiration of respiratory secretions, bag-mask ventilation, non-invasive ventilation, intubation, respiratory sampling, bronchoalveolar lavage, tracheostomy or cardiopulmonary resuscitation. If postoperative surveillance is necessary, it will be carried out in adequately monitored isolation units, preferably with negative pressure Avoid using aerosols, high-flow nasal oxygen or non-invasive ventilation as far as possible in patients requiring postoperative oxygen therapy Healthcare personnel who care for patients during postoperative surveillance must wear appropriate personal protective equipment at all times and must be taught donning and doffing techniques The same recommendations for transferring patients to the operating room apply to postoperative transfer

title:
  Practical recommendations for the perioperative management of patients with suspicion or serious infection by coronavirus SARS-CoV

abstract:
  Abstract In December 2019, the Wuhan Municipal Health and health Commission (Hubei Province, China) reported a series of cases of pneumonia of unknown aetiology. On January 7, 2020, the Chinese authorities identified as a causative agent of the outbreak a new type of virus of the Coronaviridiae family, called SARS-CoV-2. Since then, thounsands of cases have been reported with global dissemination. Infections in humans cause a broad clinical spectrum ranging from mild upper respiratory tract infection, to severe acute respiratory distress syndrome and sepsis. There is not specific treatment for SARS-CoV-2, which is why the fundamental aspects are to establish adequate prevention measures and support treatment and management of complications.


id: cord-341715-8h57tppr
title: Treatment of nasal bridge ulceration related to protective measures for the COVID‐19 epidemic
author: Sernicola, Alvise
date: 2020-05-07
txt: ./txt/cord-341715-8h57tppr.txt
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mime: text/plain
url: https://doi.org/10.1111/iwj.13397
doi: 10.1111/iwj.13397
abstract: nan
summary:
  Effective use of personal protective equipment (PPE) is of paramount importance to reduce the rates of infection among medical personnel, which is a leading cause of nosocomial spread among hospitalised patients and of loss of response capacity for health facilities, with HCWs constituting up to nine percent of total COVID-19 cases. 9 A 2019 study analysed the use of hydrocolloid medication in patients requiring NIV demonstrating a significantly reduced incidence of grade 2 pressure ulcers when a preventative hydrocolloid dressing was positioned on the nasal bridge compared with when the NIV mask was directly applied. We propose the use of a hydrocolloid dressing that successfully treated nasal bridge ulceration in our patient, to be applied as a simple and effective protection procedure in this setting, thanks to the specific properties of this advanced medication. The preventative effect of hydrocolloid dressings on Nasal bridge pressure ulceration in acute noninvasive ventilation


id: cord-342642-qzoowc97
title: Anesthesiologists and the High Risk of Exposure to COVID-19
author: García-Méndez, Nayely
date: 2020-05-04
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mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004919
doi: 10.1213/ane.0000000000004919
abstract: nan
summary:
  key: cord-342642-qzoowc97 title: Anesthesiologists and the High Risk of Exposure to COVID-19 cord_uid: qzoowc97 (1) PPE are all the set of elements and devices, that are specifically designed to protect the HCP against accidents and illnesses that could be caused by agents during the performance of their daily basis activities as well as in the emergency care; and (2) the occupational risk related to the exposure of the HCP must be identified and analyzed. The JCI has been calling for action at all government levels to address the shortage and protect those who work heroically to care for infected patients with COVID-19. We can confirm that in Mexico, there have been "hospital outbreaks" with 329 HCPs who have been infected with COVID-19 throughout the country. Prevención y control de infección en enfermedades respiratorias agudas con tendencia epidémica y pandémica durante la atención sanitaria Pautas. Available at: www.paho.org/es/documentos/ prevencion-control-infeccion-enfermedades-respiratoriasagudas-con-tendencia-epidemica Anesthesiologists and the High Risk of Exposure to COVID-19


id: cord-342666-7el8o6qq
author: Mahmood, Syed Uzair
date: 2020-05-23
txt: ./txt/cord-342666-7el8o6qq.txt
cache: ./cache/cord-342666-7el8o6qq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32596068/
doi: 10.7759/cureus.8248
summary:
  title: Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. It should be noted that according to the World Health Organization (WHO) guidelines, medical masks and respirators should only be reserved for healthcare workers [10] . 1) The healthcare professionals who are working with patients of COVID-19 and are in direct contact should have PPE consisting of gloves, gowns, masks, face shields, and goggles. Use Personal Protective Equipment (PPE) When Caring for Patients with Confirmed or Suspected COVID-19 Rational Use of Personal Protective Equipment ( PPE) for Coronavirus Disease ( COVID-19) : Interim Guidance

title:
  Strategies for Rational Use of Personal Protective Equipment (PPE) Among Healthcare Providers During the COVID-19 Crisis

abstract:
  As the coronavirus 2019 (COVID-19) began spreading globally with no clear treatment in sight, prevention became a major part of controlling the disease and its effects. COVID-19 spreads from the aerosols of an infected individual whether they are showing any symptoms or not. Therefore, it becomes nearly impossible to point exactly where the patient is. This is where personal protective equipment (PPE) comes in. These are masks, respirators, gloves, and in hospitals where the contact with the infected and confirmed patient is direct, also gowns or body covers. The PPEs play a major role in the prevention and control of the COVID-19. The PPE is able to prevent any invasion of the virus particles into the system of an individual which is why it is an essential item to have for healthcare workers. Due to the high demand for PPEs all around the world, it is important to optimize the use of protective gear and ration the supplies so that the demand are met. However, there are guidelines recommended by the World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) to maintain the supply in the wake of this increased demand of PPE, how the manufacturers should track their supplies, and how the recipients should manage them. Various strategies can be used to increase the re-use of PPEs during the COVID-19 pandemic that has modified the donning and doffing procedure.


id: cord-342810-41dghl0c
author: Nguyen, Thanh N.
date: 2020-06-05
txt: ./txt/cord-342810-41dghl0c.txt
cache: ./cache/cord-342810-41dghl0c.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105010
doi: 10.1016/j.jstrokecerebrovasdis.2020.105010
summary:
  Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Previously established SAH treatment protocols are impractical to impossible to adhere to in the current Coronavirus-Disease-2019 (COVID-19) crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE) and health care providers. When a patient with suspected or confirmed COVID-19 is at risk for impending respiratory failure (i.e. orthopnea or respiratory distress lying flat, high oxygen requirement, rapid neurological decline), consider early and controlled intubation in a negative pressure room in the ER/ICU/OR with staff wearing full PPE including N95 mask, gown, double gloves, face shield or per local institutional COVID-19 intubation policy.

title:
  Subarachnoid hemorrhage guidance in the era of the COVID-19 pandemic -An opinion to mitigate exposure and conserve personal protective equipment

abstract:
  Aneurysmal subarachnoid hemorrhage (SAH) patients require frequent neurological examinations, neuroradiographic diagnostic testing and lengthy intensive care unit stay. Previously established SAH treatment protocols are impractical to impossible to adhere to in the current COVID-19 crisis due to the need for infection containment and shortage of critical care resources, including personal protective equipment (PPE). Centers need to adopt modified protocols to optimize SAH care and outcomes during this crisis. In this opinion piece, we assembled a multidisciplinary, multicenter team to develop and propose a modified guidance algorithm that optimizes SAH care and workflow in the era of the COVID-19 pandemic. This guidance is to be adapted to the available resources of a local institution and does not replace clinical judgment when faced with an individual patient.


id: cord-343865-wbd0hqqc
author: Singh, Ajay
date: 2020-05-12
txt: ./txt/cord-343865-wbd0hqqc.txt
cache: ./cache/cord-343865-wbd0hqqc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32366767/
doi: 10.1213/ane.0000000000004940
abstract: nan
summary:
  Worldwide a significant number of health care workers (HCWs) have been infected till to date with Asia-Pacific region reporting 35 deaths and over 4000 quarantined cases, as on April 3, 2020. Effective use of PPE by HCWs is an integral part of COVID-19 prevention in the health care setting. Two-way audio-visual communication system with closed circuit television (CCTV) cameras in the doffing area has the potential to ensure HCW safety from the offsite location through a trained observer, qualified to guide round the clock (Figure) . He will communicate, visually inspect, protect, and guide HCWs through the protocols of doffing PPE. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance Use of personal protective equipment among health care personnel: results of clinical observations and simulations Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting

title:
  Real-Time Remote Surveillance of Doffing During COVID-19 Pandemic: Enhancing Safety of Health Care Workers


id: cord-344262-5yk1keg3
author: Evans, Lauran K.
date: 2020-09-02
txt: ./txt/cord-344262-5yk1keg3.txt
cache: ./cache/cord-344262-5yk1keg3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1017/dmp.2020.313
doi: 10.1017/dmp.2020.313
summary:
  METHODS: Initially, a small drive-through site was constructed at a converted tuberculosis clinic, but due to an increase in testing needs, an expanded point of screening and testing (POST) system was developed in an event center parking lot to administer tests to a higher volume of patients. CONCLUSIONS: This POST drive-through system serves as an efficient, safe, and adaptable model for high volume COVID-19 nasopharyngeal swabbing that the authors recommend other COVID-19 testing sites nationwide consider adopting for their own use. The authors also believe that the WCHD POST system, similar to those previously reported in the literature, represents a particularly efficient, safe, and adaptable model for COVID-19 testing, and recommend that other COVID-19 testing sites nationwide consider adopting it for their own purposes. The following parameters were collected from the WCHD: COVID-19 tests performed each day, number of required staff and their responsibilities, positive COVID-19 tests per week, PPE use per shift, distances of the POST system route via measurement wheel, and safety concerns.

title:
  COVID-19 Drive-Through Point of Screening and Testing (POST) System: A Safe, Efficient, and Adaptable Model for Nasopharyngeal Swab Collection

abstract:
  OBJECTIVE: The authors aim to demonstrate that the current drive-through testing model at a health district was improved in certain parameters compared with a previous testing protocol, and to provide the methodology of the current model for other coronavirus disease (COVID-19) testing sites to potentially emulate. METHODS: Initially, a small drive-through site was constructed at a converted tuberculosis clinic, but due to an increase in testing needs, an expanded point of screening and testing (POST) system was developed in an event center parking lot to administer tests to a higher volume of patients. RESULTS: An average of 51.1 patients was tested each day (2.0 tests per personnel in personal protective equipment [PPE] per hour) at the initial tuberculosis clinic drive-through site, which increased to 217.8 patients tested each day (5.9 tests per personnel in PPE per hour) with the new drive-through POST system (P < 0.001). Mean testing time was 3.4 minutes and the total time on-site averaged 14.4 minutes. CONCLUSIONS: This POST drive-through system serves as an efficient, safe, and adaptable model for high volume COVID-19 nasopharyngeal swabbing that the authors recommend other COVID-19 testing sites nationwide consider adopting for their own use.


id: cord-345210-6f8niif5
author: Tadavarthy, Silpa N.
date: 2020-07-19
txt: ./txt/cord-345210-6f8niif5.txt
cache: ./cache/cord-345210-6f8niif5.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S019665532030691X?v=s5
doi: 10.1016/j.ajic.2020.07.006
summary:
  The rapid creation and unusual configuration of this facility, together with the challenges of new clinical teams unfamiliar with one another, and working together in uncomfortable PPE to provide high-quality patient care, necessitated some basic approaches to the development of our IPC program. The plan identified the need for engineering controls (e.g. specifications for heating, ventilation, and air conditioning systems) and specified occupational IPC health and safety requirements, including PPE standards, daily monitoring of staff for acute illness, sanitation standards for both hand hygiene and equipment sanitation, as well as laundry and waste management recommendations. Key lessons learned included the need to: develop strategies to cope with real and potential shortages of critical supplies; adapt existing guidance for unique sites of care; standardize and continually assess staff use of PPE and fundamental IPC practices; and the importance of communication of IPC principles and concerns throughout the planning and management of this COVID ACS.

title:
  Developing and Implementing an Infection Prevention and Control Program for a COVID-19 Alternative Care Site in Philadelphia, PA

abstract:
  BACKGROUND: On March 27, 2020, the city of Philadelphia was given permission by Temple University to convert the Liacouras Center gymnasium to an alternate care site (ACS) to treat low-acuity COVID-19 patients. ACS's, especially those created to specifically care for infectious patients, require a robust infection prevention and control (IPC) program. METHODS: The IPC program was led by a physician and nurse partnership, both of whom had substantial experience developing IPC programs in U.S. and low-resource settings. The IPC program was framed on a previously described conceptual model commonly referred to as the “4S's”: Space, Staff, Stuff, and Systems. RESULTS: The gymnasium was transformed into red, yellow and green infection hazard zones. The IPC team trained 425 staff in critical IPC practices and personal protective equipment (PPE) standards. Systems to detect staff illness were created and over 3550 staff health screening surveys completed. DISCUSSION: Use of existing guidance and comprehensive facility and patient management assessments guided the development of the IPC program. Program priorities were to keep staff and patients safe and implement procedures to judiciously use limited resources that affect infection transmission. CONCLUSION: Planning, executing and evaluating IPC standards and requirements of an ACS during a pandemic requires creative and nimble strategies to adapt, substitute, conserve, reuse, and reallocate IPC space, staff, stuff and systems.


id: cord-345806-3ghtpji4
title: Obstetric Protocols in the Setting of a Pandemic
author: Boelig, Rupsa C.
date: 2020-07-24
txt: ./txt/cord-345806-3ghtpji4.txt
cache: ./cache/cord-345806-3ghtpji4.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S0146000520300781?v=s5
doi: 10.1016/j.semperi.2020.151295
summary:
  The purpose of this article is to review key areas that should be considered and modified in our obstetric protocols, specifically: 1) Patient triage, 2) Labor and delivery unit policies, 3) Special considerations for personal protective equipment (PPE) needs in obstetrics, 4) Intrapartum management, and 5) Postpartum care The purpose of this article is to review key areas that should be considered and modified in our obstetric protocols, specifically: 1) Patient triage, 2) Labor and delivery unit policies, 3) Special considerations for personal protective equipment (PPE) needs in obstetrics, 4) Intrapartum management, and 5) Postpartum care If patients cannot be appropriately isolated on labor and delivery unit, there need to be contingency plans for isolation off of the unit while still providing maternal and fetal monitoring and care. Labor unit leaders should work closely with hospital administration, nursing, anesthesia, neonatalogy/pediatrics, infectious disease, and critical care medicine to best address the unique needs and challenges of labor and delivery in the setting of particular pathogens.

abstract:
  The purpose of this article is to review key areas that should be considered and modified in our obstetric protocols, specifically: 1) Patient triage, 2) Labor and delivery unit policies, 3) Special considerations for personal protective equipment (PPE) needs in obstetrics, 4) Intrapartum management, and 5) Postpartum care.


id: cord-346176-w6uaet7l
title: Conducting Translational Gastrointestinal Research in the Era of COVID-19
author: Nayeri, Shadi
date: 2020-08-26
txt: ./txt/cord-346176-w6uaet7l.txt
cache: ./cache/cord-346176-w6uaet7l.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1093/ecco-jcc/jjaa171
doi: 10.1093/ecco-jcc/jjaa171
summary:
  In this document we provide a suggested roadmap for resuming gastrointestinal translational research activities, emphasising physical distancing and use of personal protective equipment. We discuss modes of virus transmission in enclosed environments [including clinical workplaces and laboratories] and potential risks of exposure in the endoscopy environment for research staff. Efforts focus primarily on physical distancing, use of PHASE personal protective equipment [PPE] , and addressing capacity needs of health care systems to deal with the outbreak. Local and institutional guidance is required to resume translational research activities, including patient interactions. • Invitation of persons currently infected with SARS-CoV-2 from the community into the research environment would cause unnecessary and inappropriate risk of viral transmission. These guidelines address safety precautions in relevant workspaces [including laboratory and endoscopy environments] as well as in specific research activities such as sample collection, handling, and transportation.

abstract:
  Abstract Spread of the novel coronavirus SARS-CoV-2 has resulted in a global pandemic that is affecting the health and economy of all World Health Organization [WHO] regions. Clinical and translational research activities have been affected drastically by this global catastrophe. In this document we provide a suggested roadmap for resuming gastrointestinal translational research activities, emphasising physical distancing and use of personal protective equipment. We discuss modes of virus transmission in enclosed environments [including clinical workplaces and laboratories] and potential risks of exposure in the endoscopy environment for research staff. The proposed guidelines should be considered in conjunction with local institutional and government guidelines so that translational research can be resumed as safely as possible.


id: cord-346894-iy35298o
title: A primer for pediatric radiologists on infection control in an era of COVID-19
author: Miranda-Schaeubinger, Monica
date: 2020-07-07
txt: ./txt/cord-346894-iy35298o.txt
cache: ./cache/cord-346894-iy35298o.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00247-020-04713-1
doi: 10.1007/s00247-020-04713-1
summary:
  In pediatric radiology departments, the risk involved ranges from low (e.g., office workers, remote workers, telemedicine) to very high (e.g., workers performing aerosol-generating procedures on known or suspected COVID-19 patients), depending on the job task assigned [28, 29] . Standard precautions to minimize the spread of infection within health care facilities from direct contact with contaminations include hand hygiene, use of PPE based on anticipated contact with contaminated material, respiratory hygiene/ cough etiquette, cleaning and disinfection of the environment, and proper handling of patient care equipment and waste [10] . Appropriate personal protective equipment usage stratified by COVID-19 status (Table 3) Because of the possibility of airborne transmission of the virus, the CDC recommends respirators for care of all patients with COVID-19 if adequate supplies are available. For all aerosol-generating procedures in children who have either unknown or confirmed positive COVID-19 status, radiologists should adhere to the highest level of respiratory protection available: a respirator, an eye shield, a disposable gown and gloves.

abstract:
  Pediatric radiology departments across the globe face unique challenges in the midst of the current COVID-19 pandemic that have not been addressed in professional guidelines. Providing a safe environment for personnel while continuing to deliver optimal care to patients is feasible when abiding by fundamental recommendations. In this article, we review current infection control practices across the multiple pediatric institutions represented on the Society for Pediatric Radiology (SPR) Quality and Safety committee. We discuss the routes of infectious transmission and appropriate transmission-based precautions, in addition to exploring strategies to optimize personal protective equipment (PPE) supplies. This work serves as a summary of current evidence-based recommendations for infection control, and current best practices specific to pediatric radiologists. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00247-020-04713-1) contains supplementary material, which is available to authorized users.


id: cord-347381-nn6jqqy5
title: Maintaining Perioperative Safety in Uncertain Times: COVID‐19 Pandemic Response Strategies
author: Mazzola, Santina M.
date: 2020-09-29
txt: ./txt/cord-347381-nn6jqqy5.txt
cache: ./cache/cord-347381-nn6jqqy5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32990976/
doi: 10.1002/aorn.13195
abstract: nan
summary:
  Perioperative and organizational leaders at the Hospital of the University of Pennsylvania (HUP) were challenged to establish and implement a variety of strategies quickly to help ensure patient and staff member safety during the COVID-19 crisis. At HUP, administrators requested that health care leaders and their teams develop protocols to prioritize patient and staff member safety while also conserving the PPE inventory. The HUP leaders consulted the most recent US Centers for Disease Control and Prevention (CDC) and World Health Organization COVID-19 recommendations before deciding to require all employees, patients, and visitors to wear face masks while inside the health care facility. The leaders directed all perioperative personnel to wear a surgical mask during low-risk AGPs on patients who tested negative for COVID-19, a practice unchanged from the standard process used when preparing the sterile field.


id: cord-348038-9v16k6gi
title: COVID 19—A message from Italy to the global nursing community
author: Bagnasco, Annamaria
date: 2020-05-08
txt: ./txt/cord-348038-9v16k6gi.txt
cache: ./cache/cord-348038-9v16k6gi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1111/jan.14407
doi: 10.1111/jan.14407
summary:
  With the global pandemic now accelerating in areas of the world yet to see Italian levels of infection, it is vital that PPE equipment is procured and delivered to the COVID-19 front-line critical care environments. Learn also from Italian nurses'' experiences of the harm long-term use of PPE: facial lesions and sores produced by the pressure and sweat caused by masks and goggles worn far beyond the usual time frame in normal clinical practice. To healthcare providers and policy makers in areas at the start of their COVID-19 epidemic, our message is to plan for the replacement of staff in critical care areasthink about how this will be done, how they can be prepared and how you plan to recall recently retired nurses back to the hospitals. One last but very important lesson from the epidemic is the need to plan for the possibility of caring for patients in their own homes.

abstract:
  During these difficult times, it is not easy to learn all the nursing lessons from the COVID-19 epidemic in Italy. It is not easy because - at the time of writing - Italian nurses are in the middle of this emergency that shows no sign of diminishing. Whatever is said today can change completely after only 24 hours. As a global community we have only known about this virus for a few months, but it has invaded lives, hospitals and homes, subverting habits, practices, and protocols. Some of the lessons learned will emerge later - after reflection and retrospective analysis. However, some things are now so evident that sharing them now is vital to help prepare those who are getting ready to face this emergency.


id: cord-348614-im7qtr9k
title: International cooperation group of emergency surgery during the COVID-19 pandemic
author: Yánez Benítez, Carlos
date: 2020-10-13
txt: ./txt/cord-348614-im7qtr9k.txt
cache: ./cache/cord-348614-im7qtr9k.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00068-020-01521-y
doi: 10.1007/s00068-020-01521-y
summary:
  These COVID-19 dedicated protocols addressed surgical team organization, operating room (OR) preparation, rational use of personal protective equipment (PPE), considerations on anesthesiology, and intraoperative management of emergency surgical pathology. Continuity performing their regular tasks was reported by 73 (54%) of the respondents, in contrast with the rest, whose newly assigned duties were to the emergency department COVID-19 triage (25%), the intensive care unit (ICU) activities (13%), or had to manage mechanically ventilated patients in the surgical ward (7%). About half (51%) of the respondents had not received training in the use of PPE for airborne infectious risk while performing emergency surgical procedures before the pandemic, and roughly over one-third (37%) had it during the studied period. This study provides an international snapshot of the level of adoption of the guidance for surgical team organization, adequacy of PPE availability and usage, OR preparation, anesthesiologic considerations, and intraoperative management of emergency surgical cases during 2 weeks of the COVID-19 pandemic.

abstract:
  PURPOSE: The COVID-19 pandemic has changed working conditions for emergency surgical teams around the world. International surgical societies have issued clinical recommendations to optimize surgical management. This international study aimed to assess the degree of emergency surgical teams’ adoption of recommendations during the pandemic. METHODS: Emergency surgical team members from over 30 countries were invited to answer an anonymous, prospective, online survey to assess team organization, PPE-related aspects, OR preparations, anesthesiologic considerations, and surgical management for emergency surgery during the pandemic. RESULTS: One-hundred-and-thirty-four questionnaires were returned (N = 134) from 26 countries, of which 88% were surgeons, 7% surgical trainees, 4% anesthetists. 81% of the respondents got involved with COVID-19 crisis management. Social media were used by 91% of the respondents to access the recommendations, and 66% used videoconference tools for team communication. 51% had not received PPE training before the pandemic, 73% reported equipment shortage, and 55% informed about re-use of N95/FPP2/3 respirators. Dedicated COVID operating areas were cited by 77% of the respondents, 44% had performed emergency surgical procedures on COVID-19 patients, and over half (52%), favored performing laparoscopic over open surgical procedures. CONCLUSION: Surgical team members have responded with leadership to the COVID-19 pandemic, with crisis management principles. Social media and videoconference have been used by the vast majority to access guidelines or to communicate during social distancing. The level of adoption of current recommendations is high for organizational aspects and surgical management, but not so for PPE training and availability, and anesthesiologic considerations.


id: cord-349740-xed4aybr
title: Recommendations of protective measures for orthopedic surgeons during COVID-19 pandemic
author: Wang, Yulong
date: 2020-06-10
txt: ./txt/cord-349740-xed4aybr.txt
cache: ./cache/cord-349740-xed4aybr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32524164/
doi: 10.1007/s00167-020-06092-4
summary:
  The appropriate protective measures for orthopedic surgeons and patients were reviewed (on-site first aid, emergency room, operating room, isolation wards, general ward, etc.) during the entire diagnosis and treatment process of traumatic patients. To avoid occupational transmission of COVID-19 to medical staff, appropriate protective measures taken by orthopedic surgeons during pandemic in different sites from pre-hospital, emergency diagnosis and treatment, emergency surgery, anesthesia, and perioperative management are of great importance. Lessons learnt from our experience provide some recommendations of protective measures during the entire diagnosis and treatment process of traumatic patients and help others to manage orthopedic patients with COVID-19, to reduce the risk of cross-infection between patients and to protect healthcare workers during work. Lessons learnt from our experience provide some recommendations of protective measures during the entire diagnosis and treatment process of traumatic patients and help others to manage orthopedic patients with COVID-19, to reduce the risk of cross-infection between patients and to protect healthcare workers during work.

abstract:
  PURPOSE: It was the primary purpose of the present systematic review to identify the optimal protection measures during COVID-19 pandemic and provide guidance of protective measures for orthopedic surgeons. The secondary purpose was to report the protection experience of an orthopedic trauma center in Wuhan, China during the pandemic. METHODS: A systematic search of the PubMed, Cochrane, Web of Science, Google Scholar was performed for studies about COVID-19, fracture, trauma, orthopedic, healthcare workers, protection, telemedicine. The appropriate protective measures for orthopedic surgeons and patients were reviewed (on-site first aid, emergency room, operating room, isolation wards, general ward, etc.) during the entire diagnosis and treatment process of traumatic patients. RESULTS: Eighteen studies were included, and most studies (13/18) emphasized that orthopedic surgeons should pay attention to prevent cross-infection. Only four studies have reported in detail how orthopedic surgeons should be protected during surgery in the operating room. No detailed studies on multidisciplinary cooperation, strict protection, protection training, indications of emergency surgery, first aid on-site and protection in orthopedic wards were found. CONCLUSION: Strict protection at every step in the patient pathway is important to reduce the risk of cross-infection. Lessons learnt from our experience provide some recommendations of protective measures during the entire diagnosis and treatment process of traumatic patients and help others to manage orthopedic patients with COVID-19, to reduce the risk of cross-infection between patients and to protect healthcare workers during work. LEVEL OF EVIDENCE: IV.


id: cord-351527-u12obtvp
title: Perspectives COVID-19 and PPE in context: an interview with China
author: Harvey, Jessica
date: 2020-05-30
txt: ./txt/cord-351527-u12obtvp.txt
cache: ./cache/cord-351527-u12obtvp.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32478853/
doi: 10.1093/pubmed/fdaa077
summary:
  In addition, the time taken to transport product ex-China has increased-previously our freight forwarder could move express items to the UK within 3 working days direct from our Chinese factories by air. We are advising our customers to seriously consider ordering with a buffer of 1-3 months worth of stock as lead time for PPE such as gowns and aprons is now up to 30 days including shipping to the UK even via express air freight. Under the extensive lead times currently required (and increasing) and the inherent uncertainty in the situation we are advising our customers, including NHS and care homes, to put in orders now and plan to stock up for the near future''. New rules imposed by the Chinese government mean that PPE for the international market is subject to stricter quality requirements compared to the products meant for the local Chinese health service.

abstract:
  The author aims to depict the current COVID-19 pandemic and personal protective equipment (PPE) crisis in the UK. The current situation is put into context exploring the history of global outbreaks of infectious disease and what has been learnt. These lessons are then applied and weighed against the recent response to coronavirus. An in depth interview with a UK biomedical SME based in Shanghai, China is reported in order to inform future procurement of PPE. It is hoped that an appreciation of the dynamic nature of the market will allow adaptations to be made in order to secure reliable supply chains moving forwards.


id: cord-352233-avov4yxv
author: Liu, Antonio
date: 2020-05-12
txt: ./txt/cord-352233-avov4yxv.txt
cache: ./cache/cord-352233-avov4yxv.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32407796/
doi: 10.1016/j.ijsu.2020.05.012
abstract: nan
summary:
  title: Philanthropy and Humanity in the Face of a Pandemic – A letter to the editor on "World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)" (Int J Surg 2020; 76:71-6) The enormous pressure and struggles to secure sufficient and appropriate PPE for the front -line workers in order to provide safe and compassionate care to the COVID patients inevitably add to the tremendous difficulty we face in combating this aggressive and vicious disease, not only at home in the United States, but also resonating around the world. With no clear indication or assurance of assistance coming from the government, many institutions and organizations have ramped up their philanthropy effort to secure proper equipment and protective gears for their staff. World Health Organization Declares Global Emergency: A Review of the 2019 Novel Coronavirus (COVID-19)

title:
  Philanthropy and Humanity in the Face of a Pandemic – A letter to the editor on “World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)” (Int J Surg 2020; 76:71-6)


id: cord-352324-tle14vtm
author: Martini, Chiara
date: 2020-10-23
txt: ./txt/cord-352324-tle14vtm.txt
cache: ./cache/cord-352324-tle14vtm.txt
extension: .txt
mime: text/plain
url: https://www.sciencedirect.com/science/article/pii/S1939865420302629?v=s5
doi: 10.1016/j.jmir.2020.08.019
summary:
  The aim of this document is therefore to provide useful and operative recommendations to radiographers who perform imaging services, such as chest X-ray (XR) and Computer Tomography (CT) scans to three types of patients: negative, suspected or suffering from Severe Acute Respiratory Syndrome by Coronavirus (SARS-CoV-2). The aim of this document is therefore to provide useful and operative recommendations to radiographers who perform imaging services, such as chest X-ray (XR) and Computer Tomography (CT) scans to three types of patients: negative, suspected or suffering from Severe Acute Respiratory Syndrome by Coronavirus (SARS-CoV-2). The aim of this document is therefore to provide useful operative recommendations to radiographers who perform imaging services, such as chest X-ray (XR) and Computer Tomography (CT) scans, aimed at three kinds of patients: negative, suspected or suffering from Severe Acute Respiratory Syndrome by Coronavirus (SARS-CoV-2).

title:
  Phase 3 of COVID-19: treat your patients and care for your radiographers. A designed projection for an aware and innovative radiology department.

abstract:
  Since the spread of Covid-19 outbreak, healthcare workers (HCWs) have faced an unprecedented and unpredictable situation on the frontlines. The aim of this document is therefore to provide useful and operative recommendations to radiographers who perform imaging services, such as chest X-ray (XR) and Computer Tomography (CT) scans to three types of patients: negative, suspected or suffering from Severe Acute Respiratory Syndrome by Coronavirus (SARS-CoV-2). It is paramount to design two different paths’ layouts for patients entering the Radiology Department. One path should care for the confirmed and suspected SARS-CoV-2 patients, whereas the other path should be for negative patients. A setting envisaging two radiographers is highly recommended when managing Covid-19 patients. One radiographer fully-equipped with proper personal protective equipment (PPE) should deal with the patient in the scanning or x-ray room. The second one should stay in the console room wearing essential PPE. Disinfection plays a crucial role in reducing the risk of disease transmission. Moreover, having clear protocols is key to ensure personal safety and avoid cross-infections. Taking care of patients and HCWs, such as radiographers, is crucial to minimize the risk of disease transmission. Within a Radiology Department, different designed pathways should be taken into consideration both for everyday and epidemic/pandemic healthcare situations. Though Covid-19 pandemic has been a harsh experience in terms of world health and care systems for patients and health professionals - being radiographers among the most involved - we must not miss this chance to learn from what happened. There is the need to address wider causes through learning and in order to prevent failures. The distinction between passive learning (where lessons are identified but not put into practice) and active learning (where those lessons are embedded into an organization’s culture and practices) is crucial in understanding why truly effective learning so often fails to take place.


id: cord-352902-isc3ek67
title: The Adaptation of Pediatric Exercise Testing Programs to the Coronavirus/COVID-19 Pandemic
author: Powell, Adam W.
date: 2020-09-21
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url: https://doi.org/10.1177/2150135120954816
doi: 10.1177/2150135120954816
summary:
  The primary aims of this study were to (1) better understand current practice patterns in pediatric exercise laboratories in the United States and Canada, (2) assess local and institutional management during the COVID-19 pandemic, and (3) investigate how centers are affected by the lifting of hospital restrictions for COVID-19. Data were recorded regarding program location, changes to exercise laboratory staffing and operational protocols, current PPE use, changes to exercise testing protocols including deviations in measuring metabolic indicators of fitness, baseline pulmonary function testing, and noninvasive measures of cardiac output. Among the programs surveyed, 66% (23/35) reported discontinuing all exercise testing for a period of time during the COVID-19 pandemic, 31% (11/35) continued testing but only for patients triaged by medical need, and 3% (1/35) did not alter testing protocols. Specifically, the authors would like to thank all the pediatric exercise laboratories that responded to this survey for completing this item and for all the effort and diligence they have placed in caring for their patients and staff during the pandemic.

abstract:
  OBJECTIVE: Response to the coronavirus/COVID-19 pandemic has resulted in several initiatives that directly impact hospital operations. There has been minimal information on how COVID-19 has affected exercise testing in pediatric patients. DESIGN: A web-based survey was designed and sent to pediatric exercise testing laboratories in the United States and Canada. Questions were designed to understand the initial and ongoing adaptations made by pediatric exercise testing laboratories in response to COVID-19. Results were analyzed as frequency data. RESULTS: There were responses from 42% (35/85) of programs, with 68% (23/34) of laboratories discontinuing all exercise testing. Of the 23 programs that discontinued testing, 15 (65%) are actively working on triage plans to reopen the exercise laboratory. Personal protective equipment use include gloves (96%; 25/26), surgical masks (88%; 23/26), N-95 masks (54%; 14/26), face shields (69%; 18/26), and gowns (62%; 16/26). Approximately 47% (15/32) of programs that typically acquire metabolic measurements reported either ceasing or modifying metabolic measurements during COVID-19. Additionally, 62% (16/26) of the programs that previously obtained pulmonary function testing reported either ceasing or modifying pulmonary function testing. Almost 60% of respondents expressed a desire for additional guidance on exercise laboratory management during COVID-19. CONCLUSIONS: Pediatric exercise testing laboratories largely closed during the early pandemic, with many of these programs either now open or working on a plan to open. Despite this, there remains heterogeneity in how to minimize exposure risks to patients and staff. Standardization of exercise testing guidelines during the COVID-19 pandemic may help reduce some of these differences.


id: cord-355431-efwuy8p9
title: The role of the orthopaedic surgeon in the COVID-19 era: cautions and perspectives
author: Ambrosio, Luca
date: 2020-05-27
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url: https://doi.org/10.1186/s40634-020-00255-5
doi: 10.1186/s40634-020-00255-5
summary:
  Due to the higher protective potential, the WHO recommends that all healthcare workers should wear a respirator (≥FFP2/N95) when performing AGPs. In all other situations, wearing a surgical mask is reasonably safe when providing direct care to COVID-19 patients, especially in case of respirator scarcity [51, 58] . (1) Patient and provider safety: interpersonal distancing is required together with proper use of PPE and patient contact restricted to the minimum needed; (2) Provision of necessary care: orthopaedic residents must continue to participate in the diagnosis and treatment of musculoskeletal disorders; (3) System sustainability: resident workforce should be disposed to obtain the maximum output with minimum effort in respect of resource availability and institutional necessities; (4) System flexibility: the strategy should be tailored to the evolving pandemic and able to adapt to future unpredictable changes; (5) Preservation of command and control: hospital overload, redeployment in COVID-19 departments and disruption of the daily routine are posing a significant stress for residents and trainees.

abstract:
  The current coronavirus disease 2019 (COVID-19) pandemic has revolutionized global healthcare in an unprecedented way and with unimaginable repercussions. Resource reallocation, socioeconomic confinement and reorganization of production activities are current challenges being faced both at the national and international levels, in a frame of uncertainty and fear. Hospitals have been restructured to provide the best care to COVID-19 patients while adopting preventive strategies not to spread the infection among healthcare providers and patients affected by other diseases. As a consequence, the concept of urgency and indications for elective treatments have been profoundly reshaped. In addition, several providers have been recruited in COVID-19 departments despite their original occupation, resulting in a profound rearrangement of both inpatient and outpatient care. Orthopaedic daily practice has been significantly affected by the pandemic. Surgical indications have been reformulated, with elective cases being promptly postponed and urgent interventions requiring exceptional attention, especially in suspected or COVID-19(+) patients. This has made a strong impact on inpatient management, with the need of a dedicated staff, patient isolation and restrictive visiting hour policies. On the other hand, outpatient visits have been limited to reduce contacts between patients and the hospital personnel, with considerable consequences on post-operative quality of care and the human side of medical practice. In this review, we aim to analyze the effect of the COVID-19 pandemic on the orthopaedic practice. Particular attention will be dedicated to opportune surgical indication, perioperative care and safe management of both inpatients and outpatients, also considering repercussions of the pandemic on resident education and ethical implications.


id: cord-355577-w1yhtbz8
author: Kowalski, Luiz Paulo
date: 2020-05-22
txt: ./txt/cord-355577-w1yhtbz8.txt
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url: https://www.ncbi.nlm.nih.gov/pubmed/32754234/
doi: 10.1055/s-0040-1712169
summary:
  Conclusion The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil. Specifically, we collected data regarding the impact of de COVID-19 pandemic on: 1) the amount and type of outpatient appointments, surgeries and exams with the risk of generating aerosols; 2) availability of adequate PPE in different settings and practices; 3) the preparedness of the responder''s health institution in orienting their HCPs and developing strategies to manage COVID-19 suspected and confirmed patients. Although the pandemic is already in its 7 th week in Brazil, since the identification of the 1 st case, 45.3% and 48.8% of physicians in the private and public sectors, respectively, reported that they had not received face-to-face or distance training in the management of confirmed or suspected patients with COVID-19.

title:
  Effect of the COVID-19 Pandemic on the Activity of Physicians Working in the Areas of Head and Neck Surgery and Otorhinolaryngology

abstract:
  Introduction Coronavirus disease 2019 (COVID-19) is an acute infection caused by the new coronavirus (SARS-CoV-2) and it is highly transmissible, especially through respiratory droplets. To prepare the health system for the care of these patients also led to a restriction in the activity of several medical specialties. Physicians who work with patients affected by diseases of the head and neck region constitute one of the populations most vulnerable to COVID-19 and also most affected by the interruption of their professional activities. Objective The aim of the present study was to assess the impact of the COVID-19 pandemic on the practice of head and neck surgeons and otorhinolaryngologists in Brazil. Methods An anonymous online survey of voluntary participation was applied, containing 30 questions regarding demographic aspects, availability of personal protective equipment (PPE), and impact on the routine of head and neck surgeons and otorhinolaryngologists, as well as clinical oncologists and radiation oncologists who work with head and neck diseases. Results Seven hundred and twenty-nine answers were received in a period of 4 days, ∼ 40 days after the 1 (st) confirmed case in Brazil. With professionals working in public and private services, there was a high level of concerns with the disease and its consequences, limited availability of PPE and a significant decrease in the volume of specialized medical care. Conclusion The study demonstrated a direct impact of the COVID-19 pandemic on the clinical practice of specialties related to the treatment of patients with diseases of the head and neck region already in the beginning of the illness management in Brazil.


id: cord-355827-e38itktq
title: COVID-19 in Canada and the use of Personal Protective Equipment
author: Adisesh, Anil
date: 2020-05-18
txt: ./txt/cord-355827-e38itktq.txt
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url: https://doi.org/10.1093/occmed/kqaa094
doi: 10.1093/occmed/kqaa094
abstract: nan
summary:
  It lists specific micro-organisms including the virus responsible for SARS, severe acute respiratory syndrome coronavirus (SARS-CoV), for which contact and droplet precautions are advised, except during aerosol-generating medical procedures, when airborne precautions are to be instituted. The routine practices and additional precautions lay out in some detail the PPE to be used together with descriptions of the different types of medical grade gloves, masks and respirators, and eye protection. It is noteworthy that if this approach were followed for exposure to SARS-CoV-2, a biosafety Risk Group 3 organism [7], the choice of respiratory protection for any patient encounter for suspected or known COVID-19 disease would be at least a filtering face-piece respirator. Canada usually tends to align closely with US practices, but it is notable that the guidance from the US Centers for Disease Control and Prevention (CDC) is different in recommending an N95 respirator in all situations for a patient suspected or known to have COVID-19 [9] .


id: cord-356041-tc2cumv2
title: Healthcare Workers in Brazil during the COVID-19 Pandemic: A Cross-Sectional Online Survey
author: Cotrin, Paula
date: 2020-10-09
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url: https://www.ncbi.nlm.nih.gov/pubmed/33034257/
doi: 10.1177/0046958020963711
summary:
  This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists. This way, this study aimed to compare the impact of COVID-19 pandemic in the healthcare workers: physicians, nurses, and dentists, regarding workload, income, PPE, training, behavior, feelings, and level of anxiety. Inclusion criteria were: healthcare workers (physicians, nurses or dentists), above 22 years of age, working in the front line of the pandemic in private and public hospitals, healthcare units and private clinics, but not necessarily with direct contact with COVID-19 infected patients.

abstract:
  Brazil is in a critical situation due to the COVID-19 pandemic. Healthcare workers that are in the front line face challenges with a shortage of personal protective equipment, high risk of contamination, low adherence to the social distancing measures by the population, low coronavirus testing with underestimation of cases, and also financial concerns due to the economic crisis in a developing country. This study compared the impact of COVID-19 pandemic among three categories of healthcare workers in Brazil: physicians, nurses, and dentists, about workload, income, protection, training, feelings, behavior, and level of concern and anxiety. The sample was randomly selected and a Google Forms questionnaire was sent by WhatsApp messenger. The survey comprised questions about jobs, income, workload, PPE, training for COVID-19 patient care, behavior and feelings during the pandemic. The number of jobs reduced for all healthcare workers in Brazil during the pandemic, but significantly more for dentists. The workload and income reduced to all healthcare workers. Most healthcare workers did not receive proper training for treating COVID-19 infected patients. Physicians and nurses were feeling more tired than usual. Most of the healthcare workers in all groups reported difficulties in sleeping during the pandemic. The healthcare workers reported a significant impact of COVID-19 pandemic in their income, workload and anxiety, with differences among physicians, nurses and dentists.


