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Impact of ICU strain on outcomes. Curr Opin Crit Care 2022; 28:667-673. [PMID: 36226707 DOI: 10.1097/mcc.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE OF REVIEW Acute surge events result in health capacity strain, which can result in deviations from normal care, activation of contingencies and decisions related to resource allocation. This review discusses the impact of health capacity strain on patient centered outcomes. RECENT FINDINGS This manuscript discusses the lack of validated metrics for ICU strain capacity and a need for understanding the complex interrelationships of strain with patient outcomes. Recent work through the coronavirus disease 2019 pandemic has shown that acute surge events are associated with significant increase in hospital mortality. Though causal data on the differential impact of surge actions and resource availability on patient outcomes remains limited the overall signal consistently highlights the link between ICU strain and critical care outcomes in both normal and surge conditions. SUMMARY An understanding of ICU strain is fundamental to the appropriate clinical care for critically ill patients. Accounting for stain on outcomes in critically ill patients allows for minimization of variation in care and an ability of a given healthcare system to provide equitable, and quality care even in surge scenarios.
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Melnikov S, Kagan I, Felizardo H, Lynch M, Jakab-Hall C, Langan L, Vermeir P, Luiking-Martin ML. Practices and experiences of European frontline nurses under the shadow of COVID-19. Nurs Health Sci 2022; 24:405-413. [PMID: 35238460 PMCID: PMC9115500 DOI: 10.1111/nhs.12936] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 02/16/2022] [Accepted: 02/26/2022] [Indexed: 11/28/2022]
Abstract
The COVID-19 pandemic has caused health professionals to deal with new situations they have not encountered before. Nurses were forced to cope with increased workloads, seriously ill patients, numerous patient deaths, and unresolved ethical dilemmas. This study aimed to examine the lived experiences of nurses across Europe during the first wave of the COVID-19 pandemic. This was a qualitative narrative research study. Eighteen nurses from eight European countries (four each from the UK and Israel, three from Portugal, two each from the Netherlands and Ireland, and one each from Belgium, Italy, and Sweden) submitted narratives about their professional experiences during May-June 2020. The narratives were analyzed using thematic analysis. Seven categories across the narratives were condensed and interpreted into three themes: opportunities and growth, care management, and emotional and ethical challenges. The COVID-19 pandemic has affected nurses emotionally and provided an opportunity to actively develop systems and skills needed to minimize harm and maximize benefits to patients and nurses.
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Affiliation(s)
- Semyon Melnikov
- Nursing Department, Steyer School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilya Kagan
- Nursing Department, Ashkelon Academic College, Ashkelon, Israel
| | | | | | | | - Lisa Langan
- Department of Nursing and Healthcare Sciences, Institute of Technology, Tralee, Ireland
| | - Peter Vermeir
- Faculteit Geneeskunde en Gezondheidswetenschappen Universiteit Gent, Gent, Belgium
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3
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Gold S, Clarfield L, Johnstone J, Diambomba Y, Shah PS, Whittle W, Abbasi N, Arzola C, Ashraf R, Biringer A, Chitayat D, Czikk M, Forte M, Franklin T, Jacobson M, Keunen J, Kingdom J, Lapinsky S, MacKenzie J, Maxwell C, Preisman M, Ryan G, Selk A, Sermer M, Silversides C, Snelgrove J, Watts N, Young B, De Castro C, D'Souza R. Adapting obstetric and neonatal services during the COVID-19 pandemic: a scoping review. BMC Pregnancy Childbirth 2022; 22:119. [PMID: 35148698 PMCID: PMC8840792 DOI: 10.1186/s12884-022-04409-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 01/18/2022] [Indexed: 12/02/2022] Open
Abstract
Background The provision of care to pregnant persons and neonates must continue through pandemics. To maintain quality of care, while minimizing physical contact during the Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV2) pandemic, hospitals and international organizations issued recommendations on maternity and neonatal care delivery and restructuring of clinical and academic services. Early in the pandemic, recommendations relied on expert opinion, and offered a one-size-fits-all set of guidelines. Our aim was to examine these recommendations and provide the rationale and context to guide clinicians, administrators, educators, and researchers, on how to adapt maternity and neonatal services during the pandemic, regardless of jurisdiction. Method Our initial database search used Medical subject headings and free-text search terms related to coronavirus infections, pregnancy and neonatology, and summarized relevant recommendations from international society guidelines. Subsequent targeted searches to December 30, 2020, included relevant publications in general medical and obstetric journals, and updated society recommendations. Results We identified 846 titles and abstracts, of which 105 English-language publications fulfilled eligibility criteria and were included in our study. A multidisciplinary team representing clinicians from various disciplines, academics, administrators and training program directors critically appraised the literature to collate recommendations by multiple jurisdictions, including a quaternary care Canadian hospital, to provide context and rationale for viable options. Interpretation There are different schools of thought regarding effective practices in obstetric and neonatal services. Our critical review presents the rationale to effectively modify services, based on the phase of the pandemic, the prevalence of infection in the population, and resource availability. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04409-4.
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Affiliation(s)
- Shira Gold
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | | | - Jennie Johnstone
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON, Canada
| | - Yenge Diambomba
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Prakesh S Shah
- Department of Paediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Nimrah Abbasi
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Cristian Arzola
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rizwana Ashraf
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Anne Biringer
- Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - David Chitayat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Marie Czikk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Milena Forte
- Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Tracy Franklin
- Department of Family and Community Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Michelle Jacobson
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Johannes Keunen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - John Kingdom
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | | | - Joanne MacKenzie
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Cynthia Maxwell
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Mary Preisman
- Department of Psychiatry, Mount Sinai Hospital, Toronto, ON, Canada
| | - Greg Ryan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Amanda Selk
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Mathew Sermer
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Candice Silversides
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - John Snelgrove
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Nancy Watts
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada
| | - Beverly Young
- Department of Psychiatry, Mount Sinai Hospital, Toronto, ON, Canada
| | | | - Rohan D'Souza
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, 700 University Avenue, Room 3-908, Toronto, ON, M5G 1X5, Canada.
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Tang A, Neeman E, Vuong B, Arasu VA, Liu R, Kuehner GE, Savitz AC, Lyon LL, Anshu P, Seaward SA, Patel MD, Habel LA, Kushi LH, Mentakis M, Thomas ES, Kolevska T, Chang SB. Care in the time of COVID-19: impact on the diagnosis and treatment of breast cancer in a large, integrated health care system. Breast Cancer Res Treat 2022; 191:665-675. [PMID: 34988767 PMCID: PMC8731186 DOI: 10.1007/s10549-021-06468-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 11/28/2021] [Indexed: 12/19/2022]
Abstract
PURPOSES To delineate operational changes in Kaiser Permanente Northern California breast care and evaluate the impact of these changes during the initial COVID-19 Shelter-in-Place period (SiP, 3/17/20-5/17/20). METHODS By extracting data from institutional databases and reviewing electronic medical charts, we compared clinical and treatment characteristics of breast cancer patients diagnosed 3/17/20-5/17/20 to those diagnosed 3/17/19-5/17/2019. Outcomes included time from biopsy to consultation and treatment. Comparisons were made using Chi-square or Wilcoxon rank-sum tests. RESULTS Fewer new breast cancers were diagnosed in 2020 during the SiP period than during a similar period in 2019 (n = 247 vs n = 703). A higher percentage presented with symptomatic disease in 2020 than 2019 (78% vs 37%, p < 0.001). Higher percentages of 2020 patients presented with grade 3 (37% vs 25%, p = 0.004) and triple-negative tumors (16% vs 10%, p = 0.04). A smaller percentage underwent surgery first in 2020 (71% vs 83%, p < 0.001) and a larger percentage had neoadjuvant chemotherapy (16% vs 11%, p < 0.001). Telehealth utilization increased from 0.8% in 2019 to 70.0% in 2020. Times to surgery and neoadjuvant chemotherapy were shorter in 2020 than 2019 (19 vs 26 days, p < 0.001, and 23 vs 28 days, p = 0.03, respectively). CONCLUSIONS During SiP, fewer breast cancers were diagnosed than during a similar period in 2019, and a higher proportion presented with symptomatic disease. Early-stage breast cancer diagnoses decreased, while metastatic cancer diagnoses remained similar. Telehealth increased significantly, and times to treatment were shorter in 2020 than 2019. Our system continued to provide timely breast cancer treatment despite significant pandemic-driven disruption.
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Affiliation(s)
- Annie Tang
- Department of Surgery, University of California San Francisco, San Francisco, USA
| | - Elad Neeman
- Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA
| | - Brooke Vuong
- Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA
| | - Vignesh A Arasu
- Department of Radiology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Raymond Liu
- Department of Medical Oncology, San Francisco Medical Center, Kaiser Permanente, San Francisco, USA.,Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Gillian E Kuehner
- Department of Surgery, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Alison C Savitz
- Department of Surgery, Kaiser Permanente Walnut Creek Medical Center, Walnut Creek, USA
| | - Liisa L Lyon
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Prachi Anshu
- Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA
| | - Samantha A Seaward
- Department of Radiation Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Milan D Patel
- Department of Radiation Oncology, Kaiser Permanente South San Francisco Medical Center, South San Francisco, USA
| | - Laurel A Habel
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Lawrence H Kushi
- Division of Research, Kaiser Permanente Northern California, Oakland, USA
| | - Margaret Mentakis
- Department of Surgery, South Sacramento Medical Center, Kaiser Permanente, Sacramento, USA
| | - Eva S Thomas
- Department of Medical Oncology, Kaiser Permanente Oakland Medical Center, Oakland, USA
| | - Tatjana Kolevska
- Department of Medical Oncology, Kaiser Permanente Vallejo Medical Center, Vallejo, USA
| | - Sharon B Chang
- Department of Surgery, Fremont Medical Center, Kaiser Permanente, Fremont Medical Center - 39400 Paseo Padre Pkwy, Fremont, CA, 94538, USA.
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5
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Tsai TC, Bryan AF, Rosenthal N, Zheng J, Orav EJ, Frakt AB, Figueroa JF. Variation in Use of Surgical Care During the COVID-19 Pandemic by Surgical Urgency and Race and Ethnicity. JAMA HEALTH FORUM 2021; 2:e214214. [PMID: 35977293 PMCID: PMC8796934 DOI: 10.1001/jamahealthforum.2021.4214] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/27/2021] [Indexed: 12/18/2022] Open
Abstract
Question To what extent did the COVID-19 pandemic reduce access to surgical care, and were racial and ethnic minority groups more likely to have reduced access to surgical care? Findings In this cohort study of more than 13 million inpatient and outpatient surgical encounters in 767 US hospitals in a hospital administrative database, surgical use was 13% lower in 2020 compared with 2019, with the greatest decrease concentrated in elective surgical procedures. While Black and Hispanic patients experienced a reduction in surgical encounters, White patients experienced the greatest reduction in surgical encounters. Meaning Despite severe and persistent disruptions to health systems during the COVID-19 pandemic, racial and ethnic minority groups did not experience a disproportionate decrease in access to surgical care. Importance The extent of the disruption to surgical care during the COVID-19 pandemic has not been empirically characterized on a national level. Objective To characterize the use of surgical care across cohorts of surgical urgency during the COVID-19 pandemic, and to assess for racial and ethnic disparities. Design, Setting, and Participants This was a retrospective observational study using the geographically diverse, all payer data from 767 hospitals in the Premier Healthcare Database. Procedures were categorized into 4 cohorts of surgical urgency (elective, nonelective, emergency, and trauma). A generalized linear regression model with hospital-fixed effects assessed the relative monthly within-hospital reduction in surgical encounters in 2020 compared with 2019. Main Outcomes and Measures Outcomes were the monthly relative reduction in overall surgical encounters and across surgical urgency cohorts and race and ethnicity. Results The sample included 13 175 087 inpatient and outpatient surgical encounters. There was a 12.6% relative reduction in surgical use in 2020 compared to 2019. Across all surgical cohorts, the most prominent decreases in encounters occurred during Spring 2020 . For example, elective encounters began falling in March, reached a trough in April, and subsequently recovered but never to prepandemic levels (March: −26.8%; 95% CI, −29.6% to −23.9%; April: −74.6%; 95% CI, −75.5% to −73.5%; December: −13.3%; 95% CI, −16.6%, −9.8%). Across all operative surgical urgency cohorts, White patients had the largest relative reduction in encounters. Conclusions and Relevance As shown by this cohort study, the COVID-19 pandemic resulted in large disruptions to surgical care across all categories of operative urgency, especially elective procedures. Racial and ethnic minority groups experienced less of a disruption to surgical care than White patients. Further research is needed to explore whether the decreased surgical use among White patients was owing to patient discretion and to document whether demand for surgical care will rebound to baseline levels.
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Affiliation(s)
- Thomas C Tsai
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts.,Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ava Ferguson Bryan
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Center for Surgery and Public Health, Boston, Massachusetts.,Department of Surgery, The University of Chicago, Chicago, Illinois
| | - Ning Rosenthal
- Premier Applied Sciences, Premier, Inc, Charlotte, North Carolina
| | - Jie Zheng
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - E John Orav
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Austin B Frakt
- Boston VA Healthcare System, Boston, Massachusetts.,Boston University School of Public Health, Boston, Massachusetts
| | - Jose F Figueroa
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.,Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
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Impact of the First Wave of COVID-19 on the Number of General Anesthesia Cases in 34 Tertiary Hospitals in Japan: A Multicenter Retrospective Study. Anesthesiol Res Pract 2021; 2021:8144794. [PMID: 34512750 PMCID: PMC8426062 DOI: 10.1155/2021/8144794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/29/2021] [Accepted: 08/17/2021] [Indexed: 11/23/2022] Open
Abstract
Since the first case of coronavirus disease 2019 (COVID-19) was reported in Japan in January 2020, the COVID-19 pandemic has brought about a significant change in people's lives. Although the COVID-19 pandemic is expected to have had an impact on the work of anesthesiologists, the specific impact has been largely unreported. We hypothesized that the number of general anesthesia (GA) cases has decreased due to the COVID-19 pandemic. To test this hypothesis, we conducted a retrospective survey at 34 facilities in Japan as a part of the Japanese Epidemiologic Study for Perioperative Anaphylaxis. The results showed that the number of GA cases had significantly decreased, particularly in May 2020, under the government's declaration of a state of emergency. The decline in GA caseload had not fully recovered by July 2020. Furthermore, there were regional differences in the decline in the number of GA cases. The impact of the COVID-19 pandemic on the work of anesthesiologists was greater in prefectures where there were more COVID-19 patients and where the state of emergency was declared earlier. Our study suggested a region-dependent decrease in the number of GA cases due to the COVID-19 pandemic.
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Crowe CS, Lopez J, Morrison SD, Drolet BC, Janis JE. The Effects of the COVID-19 Pandemic on Resident Education and Wellness: A National Survey of Plastic Surgery Residents. Plast Reconstr Surg 2021; 148:462e-474e. [PMID: 34432706 DOI: 10.1097/prs.0000000000008281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The coronavirus disease of 2019 (COVID-19) pandemic has had a profound effect on surgical training programs, reflecting decreases in elective surgical cases and emergency restructuring of clinical teams. The effect of these measures on U.S. plastic surgery resident education and wellness has not been characterized. METHODS An institutional review board-exempted anonymous survey was developed through expert panel discussion and pilot testing. All current U.S. plastic surgery trainees were invited to complete a cross-sectional 28-question survey in April of 2020. Respondents were queried regarding demographic information, educational experiences, and wellness during the COVID-19 pandemic. RESULTS A total of 668 residents responded to the survey, corresponding to a 56.1 percent response rate. Sex, training program type, postgraduate year, and region were well represented within the sample. Nearly all trainees (97.1 percent) reported restructuring of their clinical teams. One-sixth of respondents were personally redeployed to assist with the care of COVID-19 patients. A considerable proportion of residents felt that the COVID-19 pandemic had a negative impact on their education (58.1 percent) and wellness (84.8 percent). Residents found virtual curriculum effective and meaningful, and viewed an average of 4.2 lectures weekly. Although most residents did not anticipate a change in career path, some reported negative consequences on job prospects or fellowship. CONCLUSIONS The COVID-19 pandemic had a considerable impact on U.S. plastic surgery education and wellness. Although reductions in case volume may be temporary, this may represent a loss of critical, supervised clinical experience. Some effects may be positive, such as the development of impactful virtual lectures that allow for cross-institutional curriculum.
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Affiliation(s)
- Christopher S Crowe
- From the Division of Plastic and Reconstructive Surgery, University of Washington School of Medicine; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; Department of Plastic Surgery, Vanderbilt University Medical Center; and Department of Plastic Surgery, Wexner Medical Center, The Ohio State University
| | - Joseph Lopez
- From the Division of Plastic and Reconstructive Surgery, University of Washington School of Medicine; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; Department of Plastic Surgery, Vanderbilt University Medical Center; and Department of Plastic Surgery, Wexner Medical Center, The Ohio State University
| | - Shane D Morrison
- From the Division of Plastic and Reconstructive Surgery, University of Washington School of Medicine; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; Department of Plastic Surgery, Vanderbilt University Medical Center; and Department of Plastic Surgery, Wexner Medical Center, The Ohio State University
| | - Brian C Drolet
- From the Division of Plastic and Reconstructive Surgery, University of Washington School of Medicine; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; Department of Plastic Surgery, Vanderbilt University Medical Center; and Department of Plastic Surgery, Wexner Medical Center, The Ohio State University
| | - Jeffrey E Janis
- From the Division of Plastic and Reconstructive Surgery, University of Washington School of Medicine; Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine; Department of Plastic Surgery, Vanderbilt University Medical Center; and Department of Plastic Surgery, Wexner Medical Center, The Ohio State University
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8
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Khusid JA, Kashani M, Fink LE, Weinstein CS, Gupta M. The Impact of the COVID-19 Pandemic on Urology Residents: a Narrative Review. Curr Urol Rep 2021; 22:45. [PMID: 34427779 PMCID: PMC8382932 DOI: 10.1007/s11934-021-01063-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2021] [Indexed: 12/30/2022]
Abstract
Purpose of Review The COVID-19 pandemic brought unprecedented challenges for urology resident education. In this review, we discuss the pandemic’s impact on urology trainees and their education. Recent Findings Urology trainees were often redeployed to frontline services in unfamiliar clinical settings. Residents often experienced increased levels of stress, anxiety, and depression. Many programs instituted virtual “check-ins” and formed liaisons with mental health services to foster cohesiveness. Urology trainees experienced the integration of telehealth into the clinical realm. Virtual surgery lectures and simulations were utilized to augment surgical education. Academic governing bodies upheld resident protections and provided dynamic guidance for training requirement throughout the pandemic. Medical students were unable to participate in traditional in-person away rotations and interviews, complicating the residency application process. Summary The COVID-19 pandemic shook the healthcare system and ushered in seismic changes for urology trainees worldwide. Though the longstanding effects of the pandemic remain to be seen, urology residents have demonstrated tremendous resilience and bravery throughout this challenging period, and those qualities will undeniably withstand the test of time.
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Affiliation(s)
- Johnathan A Khusid
- Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA.
| | - Mahyar Kashani
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Lauren E Fink
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Corey S Weinstein
- Department of Urology, SUNY Downstate Health Sciences University, Brooklyn, NY, USA
| | - Mantu Gupta
- Department of Urology, Icahn School of Medicine At Mount Sinai, New York, NY, USA
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9
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Purdy AC, de Virgilio C, Kaji AH, Shields Frey E, Lee-Kong S, Inaba K, Gauvin JM, Neville AL, Donahue TR, Smith BR, Salcedo ES, Calhoun KE, Poola VP, Namm JP, Spain DA, Dickinson KJ, Tanner T, Wolfe M, Amersi F. Factors Associated With General Surgery Residents' Operative Experience During the COVID-19 Pandemic. JAMA Surg 2021; 156:767-774. [PMID: 33929493 DOI: 10.1001/jamasurg.2021.1978] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Importance The suspension of elective operations in March 2020 to prepare for the COVID-19 surge posed significant challenges to resident education. To mitigate the potential negative effects of COVID-19 on surgical education, it is important to quantify how the pandemic influenced resident operative volume. Objective To examine the association of the pandemic with general surgical residents' operative experience by postgraduate year (PGY) and case type and to evaluate if certain institutional characteristics were associated with a greater decline in surgical volume. Design, Setting, and Participants This retrospective review included residents' operative logs from 3 consecutive academic years (2017-2018, 2018-2019, and 2019-2020) from 16 general surgery programs. Data collected included total major cases, case type, and PGY. Faculty completed a survey about program demographics and COVID-19 response. Data on race were not collected. Operative volumes from March to June 2020 were compared with the same period during 2018 and 2019. Data were analyzed using Kruskal-Wallis test adjusted for within-program correlations. Main Outcome and Measures Total major cases performed by each resident during the first 4 months of the pandemic. Results A total of 1368 case logs were analyzed. There was a 33.5% reduction in total major cases performed in March to June 2020 compared with 2018 and 2019 (45.0 [95% CI, 36.1-53.9] vs 67.7 [95% CI, 62.0-72.2]; P < .001), which significantly affected every PGY. All case types were significantly reduced in 2020 except liver, pancreas, small intestine, and trauma cases. There was a 10.2% reduction in operative volume during the 2019-2020 academic year compared with the 2 previous years (192.3 [95% CI, 178.5-206.1] vs 213.8 [95% CI, 203.6-223.9]; P < .001). Level 1 trauma centers (49.5 vs 68.5; 27.7%) had a significantly lower reduction in case volume than non-level 1 trauma centers (33.9 vs 63.0; 46%) (P = .03). Conclusions and Relevance In this study of operative logs of general surgery residents in 16 US programs from 2017 to 2020, the first 4 months of the COVID-19 pandemic was associated with a significant reduction in operative experience, which affected every PGY and most case types. Level 1 trauma centers were less affected than non-level 1 centers. If this trend continues, the effect on surgical training may be even more detrimental.
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Affiliation(s)
- Amanda C Purdy
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Christian de Virgilio
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Amy H Kaji
- Department of Emergency Medicine, Harbor-University of California, Los Angeles Medical Center, Torrance.,Statistical Editor, JAMA Surgery
| | - Edgar Shields Frey
- Department of Surgery, Brookwood Baptist Medical Center, Birmingham, Alabama
| | - Steven Lee-Kong
- Department of Surgery, Columbia University Medical Center, New York, New York
| | - Kenji Inaba
- Department of Surgery, University of Southern California/Los Angeles County Medical Center, Los Angeles
| | - Jeffrey M Gauvin
- Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California
| | - Angela L Neville
- Department of Surgery, Harbor-University of California, Los Angeles Medical Center, Torrance
| | - Timothy R Donahue
- Department of Surgery, University of California, Los Angeles Health, Los Angeles
| | - Brian R Smith
- Department of Surgery, University of California, Irvine, Medical Center, Orange
| | - Edgardo S Salcedo
- Department of Surgery, University of California, Davis, School of Medicine, Sacramento
| | | | - V Prasad Poola
- Department of Surgery, Southern Illinois School of Medicine, Springfield
| | - Jukes P Namm
- Department of Surgery, Loma Linda University Health, Loma Linda, California
| | - David A Spain
- Department of Surgery, Stanford University, Stanford, California
| | | | - Tiffany Tanner
- Department of Surgery, University of Nebraska Medical Center, Omaha
| | - Mary Wolfe
- Department of Surgery, University of California, San Francisco, at Fresno, Fresno
| | - Farin Amersi
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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10
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Kovoor JG, Tivey DR, Ovenden CD, Babidge WJ, Maddern GJ. Evidence, not eminence, for surgical management during COVID-19: a multifaceted systematic review and a model for rapid clinical change. BJS Open 2021; 5:6342605. [PMID: 34355242 PMCID: PMC8342932 DOI: 10.1093/bjsopen/zrab048] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus (COVID-19) forced surgical evolution worldwide. The extent to which national evidence-based recommendations, produced by the current authors early in 2020, remain valid, is unclear. To inform global surgical management and a model for rapid clinical change, this study aimed to characterize surgical evolution following COVID-19 through a multifaceted systematic review. METHODS Rapid reviews were conducted targeting intraoperative safety, personal protective equipment and triage, alongside a conventional systematic review identifying evidence-based guidance for surgical management. Targeted searches of PubMed and Embase from 31 December 2019 were repeated weekly until 7 August 2020, and systematic searches repeated monthly until 30 June 2020. Literature was stratified using Evans' hierarchy of evidence. Narrative data were analysed for consistency with earlier recommendations. The systematic review rated quality using the AGREE II and AMSTAR tools, was registered with PROSPERO, CRD42020205845. Meta-analysis was not conducted. RESULTS From 174 targeted searches and six systematic searches, 1256 studies were identified for the rapid reviews and 21 for the conventional systematic review. Of studies within the rapid reviews, 903 (71.9 per cent) had lower-quality design, with 402 (32.0 per cent) being opinion-based. Quality of studies in the systematic review ranged from low to moderate. Consistency with recommendations made previously by the present authors was observed despite 1017 relevant subsequent publications. CONCLUSION The evidence-based recommendations produced early in 2020 remained valid despite many subsequent publications. Weaker studies predominated and few guidelines were evidence-based. Extracted clinical solutions were globally implementable. An evidence-based model for rapid clinical change is provided that may benefit surgical management during this pandemic and future times of urgency.
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Affiliation(s)
- J G Kovoor
- University of Adelaide, Adelaide, South Australia, Australia.,Australian Safety and Efficacy Register of New Interventional Procedures-Surgical, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia
| | - D R Tivey
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - C D Ovenden
- University of Adelaide, Adelaide, South Australia, Australia
| | - W J Babidge
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - G J Maddern
- Research, Audit and Academic Surgery, Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
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11
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Toh KHQ, Barazanchi A, Rajaretnam NS, Tan J, Linton T, Murray M, Fagan P, Koea J. COVID-19 response by New Zealand general surgical departments in tertiary metropolitan hospitals. ANZ J Surg 2021; 91:1352-1357. [PMID: 34224196 PMCID: PMC8420382 DOI: 10.1111/ans.17044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/12/2021] [Accepted: 06/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Worldwide, coronavirus disease 2019 (COVID-19) has significantly challenged the delivery of healthcare. New Zealand (NZ) faced similar potential challenges despite being geographically isolated. Given the rapid change in the COVID-19 pandemic, hospitals in NZ were tasked with formulating their own COVID-19 responses based on the Ministry of Health's (MoH) recommendations. METHODS This paper evaluates how six metropolitan general surgical departments in NZ had responded to COVID-19 in terms of changes made to rosters, theatres, clinics, acute admissions as well as additional measures taken to reduce the risk of staff exposure. It also explores how NZ fared in comparison with international guidelines and recommendations. Data from each centre were provided by an appointed clinician. RESULTS All centres had adapted new rosters and a restructuring of teams. Handovers, multidisciplinary team meetings and educational sessions were held virtually. Different strategies were implemented to ration hospital resources and reduce the risk of staff exposure. Non-urgent operations, endoscopies and clinics were deferred with allocation of dedicated COVID-19 operating theatres. Potential COVID-19 suspects were screened prior to admission and treated separately. Various admission and imaging pathways were utilised to increase efficiency. CONCLUSION General surgical departments in NZ had implemented a comprehensive COVID-19 response but there is room to work towards a more unified national response. Our analysis shows that these centres across NZ had taken a similar approach which was aligned with international practices.
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Affiliation(s)
- Karen Hui Qi Toh
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Ahmed Barazanchi
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | | | - Jeffrey Tan
- Christchurch Hospital, Canterbury District Health Board, Auckland, New Zealand
| | - Tara Linton
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Mark Murray
- Wellington Hospital, Capital and Coast District Health Board, Auckland, New Zealand
| | - Paul Fagan
- Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Jonathan Koea
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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12
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Lo B, Nagle LM, White P, Kleib M, Kennedy MA, Strudwick G. Digital and informatics competencies: Requirements for nursing leaders in Canada. Healthc Manage Forum 2021; 34:320-325. [PMID: 34018421 DOI: 10.1177/08404704211015428] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The use of health information technologies continues to grow, especially with the increase in virtual care in response to COVID-19. As the largest health professional group in Canada, nurses are key stakeholders and their active engagement is essential for the meaningful adoption and use of digital health technologies to support patient care. Nurse leaders in particular are uniquely positioned to inform key technology decisions; therefore, enhancing their informatics capacity is paramount to the success of digital health initiatives and investments. The purpose of this commentary is to reflect on current projects relevant to the development of informatics competencies for nurse leaders in the Canadian context and offer our perspectives on ways to enhance current and future nurse leaders' readiness for participation in digital health initiatives. Addressing the digital health knowledge and abilities of nurse leaders will improve their capacity to champion and lead transformative health system changes through digital innovation.
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Affiliation(s)
- Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lynn M Nagle
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Peggy White
- Canadian Nurses' Association, Ottawa, Ontario, Canada
| | - Manal Kleib
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | | | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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13
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Leveraging Videoconferencing Technology to Augment Surgical Training During a Pandemic. ANNALS OF SURGERY OPEN 2021; 2:e035. [PMID: 36590033 PMCID: PMC9793996 DOI: 10.1097/as9.0000000000000035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/01/2021] [Indexed: 01/04/2023] Open
Abstract
Our objective was to review the use of videoconferencing as a practical tool for remote surgical education and to propose a model to overcome the impact of a pandemic on resident training. Summary Background Data In response to the coronavirus disease 2019 pandemic, most institutions and residency programs have been restructured to minimize the number of residents in the hospital as well as their interactions with patients and to promote physical distancing measures. This has resulted in decreased resident operative exposure, responsibility, and autonomy, hindering their educational goals and ability to achieve surgical expertise necessary for independent practice. Methods We conducted a narrative review to explore the use of videoconferencing for remote broadcasting of surgical procedures, telecoaching using surgical videos, telesimulation for surgical skills training, and establishing a didactic lecture series. Results and Conclusions We present a multimodal approach for using practical videoconferencing tools that provide the means for audiovisual communication to help augment residents' operative experience and limit the impact of self-isolation, redeployment, and limited operative exposure on surgical training.
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14
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Agcaoglu O, Sezer A, Makay O, Erdogan MF, Bayram F, Guldiken S, Raffaelli M, Sonmez YA, Lee YS, Vamvakidis K, Mihai R, Duh QY, Akinci B, Alagol F, Almquist M, Barczynski M, Bayraktaroglu T, Berber E, Bukey Y, Cakmak GK, Canturk NZ, Canturk Z, Celik M, Celik O, Ceyhan BO, Cherenko S, Clerici T, Coombes DS, Demircan O, Deyneli O, Dionigi G, Emre AU, Erbil Y, Filiz AI, Gozu HI, Gurdal SO, Gurleyik G, Haciyanli M, Kebudi A, Kim S, Koutelidakis G, Kuru B, Mert M, Oruk GG, Ozbas S, Palazzo F, Pandev R, Riss P, Sabuncu T, Sahin I, Sakman G, Saygili F, Senyurek YG, Sleptsov I, Van Slycke S, Teksoz S, Terzioglu T, Tezelman S, Tunca F, Ugurlu MU, Uludag M, Villar-Del-Moral J, Vriens M, Yazici D. Management of endocrine surgical disorders during COVID-19 pandemic: expert opinion for non-surgical options. Updates Surg 2021; 74:325-335. [PMID: 33840069 PMCID: PMC8036242 DOI: 10.1007/s13304-021-00979-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 01/12/2021] [Indexed: 12/03/2022]
Abstract
Purpose The COVID-19 pandemic brought unprecedented conditions for overall health care systems by restricting resources for non-COVID-19 patients. As the burden of the disease escalates, routine elective surgeries are being cancelled. The aim of this paper was to provide a guideline for management of endocrine surgical disorders during a pandemic. Methods We used Delphi method with a nine-scale Likert scale on two rounds of voting involving 64 experienced eminent surgeons and endocrinologists who had the necessary experience to provide insight on endocrine disorder management. All voting was done by email using a standard questionnaire. Results Overall, 37 recommendations were voted on. In two rounds, all recommendations reached an agreement and were either endorsed or rejected. Endorsed statements include dietary change in primary hyperparathyroidism, Cinacalcet treatment in secondary hyperparathyroidism, alpha-blocker administration for pheochromocytoma, methimazole ± β-blocker combination for Graves’ disease, and follow-up for fine-needle aspiration results of thyroid nodules indicated as Bethesda 3–4 cytological results and papillary microcarcinoma. Conclusion This survey summarizes expert opinion for the management of endocrine surgical conditions during unprecedented times when access to surgical treatment is severely disrupted. The statements are not applicable in circumstances in which surgical treatment is possible.
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Affiliation(s)
- Orhan Agcaoglu
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Atakan Sezer
- Department of General Surgery, School of Medicine, Trakya University, Balkan Yerleskesi, 22030, Edirne, Turkey.
| | - Ozer Makay
- Department of General Surgery, School of Medicine, Ege University, Bornova, Turkey
| | - Murat Faik Erdogan
- Department of Endocrinology and Metabolism, School of Medicine, Ankara University, Ankara, Turkey
| | - Fahri Bayram
- Department of Endocrinology and Metabolism, School of Medicine, Erciyes University, Kayseri, Turkey
| | - Sibel Guldiken
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, Edirne, Turkey
| | - Marco Raffaelli
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Milan, Italy
| | - Yusuf Alper Sonmez
- Department of Endocrinology and Metabolism, Gulhane School of Medicine, University of Health Sciences, Istanbul, Turkey
| | - Yong-Sang Lee
- Department of General Surgery, Gangnam Severance Thyroid Center, Yonsei University, Seoul, South Korea
| | | | - Radu Mihai
- Department of General Surgery, Churchill Cancer Center, Oxford University, Oxford, UK
| | - Quan-Yang Duh
- Department of General Surgery, University of California, San Francisco, USA
| | - Baris Akinci
- Department of Endocrinology and Metabolism, School of Medicine, Dokuz Eylul University, İzmir, Turkey
| | - Faruk Alagol
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
| | - Martin Almquist
- Department of General Surgery, Skåne University Hospital, Malmö, Sweden
| | - Marcin Barczynski
- Department of General Surgery, Jagiellonian University Medical College, Kraków, Poland
| | - Taner Bayraktaroglu
- Department of Endocrinology and Metabolism, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Eren Berber
- Division of Endocrine Surgery, Department of General Surgery, Cleveland Clinic Foundation, Cleveland, USA
| | - Yusuf Bukey
- Department of General Surgery, School of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Guldeniz Karadeniz Cakmak
- Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Nuh Zafer Canturk
- Department of General Surgery, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Zeynep Canturk
- Department of Endocrinology and Metabolism, School of Medicine, Kocaeli University, İzmit, Turkey
| | - Mehmet Celik
- Department of Endocrinology and Metabolism, School of Medicine, Trakya University, Edirne, Turkey
| | - Ozlem Celik
- Department of Endocrinology and Metabolism, School of Medicine, Acibadem University, Istanbul, Turkey
| | | | - Sergii Cherenko
- Department of General Surgery, International Medical Center, Kyiv, Ukraine
| | - Thomas Clerici
- Department of Endocrinology and Metabolism, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Orhan Demircan
- Department of General Surgery, School of Medicine, Acibadem University, Istanbul, Turkey
| | - Oguzhan Deyneli
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
| | - Gianlorenzo Dionigi
- Department of General Surgery, School of Medicine, Messina University, Messina, Italy
| | - Ali Ugur Emre
- Department of General Surgery, School of Medicine, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | | | - Ali Ilker Filiz
- Department of General Surgery, School of Medicine, Okan University, Istanbul, Turkey
| | - Hulya Ilıksu Gozu
- Department of Endocrinology and Metabolism, School of Medicine, Marmara University, Istanbul, Turkey
| | - Sibel Ozkan Gurdal
- Department of General Surgery, Namik Kemal University, Zonguldak, Turkey
| | - Gunay Gurleyik
- Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Haciyanli
- Department of General Surgery, İzmir Ataturk Training and Research Hospital, İzmir, Turkey
| | - Abut Kebudi
- Department of General Surgery, School of Medicine, Okan University, Istanbul, Turkey
| | - Seokmo Kim
- Department of General Surgery, Gangnam Severance Thyroid Center, Yonsei University, Seoul, South Korea
| | - Giannis Koutelidakis
- Department of General Surgery, Aristoteleio University of Thessaloniki, Thessaloniki, Greece
| | - Bekir Kuru
- Department of General Surgery, School of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Meral Mert
- Department of Endocrinology and Metabolism, Bakirkoy Sadi Konuk Training and Research Hospital, İstanbul, Turkey
| | - Guzide Gonca Oruk
- Department of Endocrinology and Metabolism, Ataturk Training and Research Hospital, Katip Celebi University, İzmir, Turkey
| | | | - Fausto Palazzo
- Department of Endocrinology and Metabolism, Imperial College, Hammersmith Hospital, London, UK
| | - Rumen Pandev
- Department of General Surgery, School of Medicine, Medical University Sofia, Sofia, Bulgaria
| | - Phillip Riss
- Department of General Surgery, School of Medicine, Medical University of Vienna, Vienna, Austria
| | - Tevfik Sabuncu
- Department of Endocrinology and Metabolism, School of Medicine, Harran University, Şanlıurfa, Turkey
| | - Ibrahim Sahin
- Department of Endocrinology and Metabolism, School of Medicine, Malatya University, Malatya, Turkey
| | - Gurhan Sakman
- Department of General Surgery, School of Medicine, Cukurova University, Adana, Turkey
| | - Fusun Saygili
- Department of Endocrinology and Metabolism, School of Medicine, Ege University, Bornova, Turkey
| | - Yasemin Giles Senyurek
- Department of General Surgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Ilya Sleptsov
- North-West Center of Endocrinology and Metabolism, St. Petersburg State University, St. Petersburg, Russia
| | - Sam Van Slycke
- Department of General Surgery, Vattikutti Foundation, OLV Hospital, Aalst, Belgium
| | - Serkan Teksoz
- Department of General Surgery, School of Medicine, Cerrahpasa University, Istanbul, Turkey
| | - Tarik Terzioglu
- Department of General Surgery, VKV American Hospital, Istanbul, Turkey
| | - Serdar Tezelman
- Department of General Surgery, School of Medicine, Koc University, Istanbul, Turkey
| | - Fatih Tunca
- Department of General Surgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Umit Ugurlu
- Department of General Surgery, School of Medicine, Marmara University, Istanbul, Turkey
| | - Mehmet Uludag
- Department of General Surgery, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | | | - Menno Vriens
- Department of General Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Dilek Yazici
- Department of Endocrinology and Metabolism, School of Medicine, Koc University, Istanbul, Turkey
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15
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Fujii Y, Daijo H, Hirota K. Estimation of the Number of General Anesthesia Cases Based on a Series of Nationwide Surveys on Twitter during COVID-19 Pandemic in Japan: A Statistical Analysis. ACTA ACUST UNITED AC 2021; 57:medicina57020153. [PMID: 33567770 PMCID: PMC7915187 DOI: 10.3390/medicina57020153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 01/08/2023]
Abstract
Background and objectives: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread to more than 200 countries. In light of this situation, the Japanese Government declared a state of emergency in seven regions of Japan on 7 April 2020 under the provisions of the law. The medical care delivery system has been under pressure. Although various surgical societies have published guidelines on which to base their surgical decisions, it is not clear how general anesthesia has been performed and will be performed in Japan. Materials and Methods: One of the services provided by the social network service Twitter is a voting function—Twitter Polls—through which anonymous surveys were conducted. We analyzed the results of a series of surveys 17 times over 22 weeks on Twitter on the status of operating restrictions using quadratic programming to solve the mathematical optimizing problem, and public data provided by the Japanese Government were used to estimate the current changes in the number of general anesthesia performed in Japan. Results: The minimum number of general anesthesia cases per week was estimated at 67.1% compared to 2015 on 27 April 2020. The timeseries trend was compatible with the results reported by the Japanese Society of Anesthesiologists (correlation coefficient r = 0.69, p < 0.001). Conclusions: The number of general anesthesia was reduced up to two-thirds during the pandemic of COVID-19 in Japan and was successfully quantitatively estimated using a quick questionnaire on Twitter.
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Affiliation(s)
- Yosuke Fujii
- Department of Human Stress Response Science, Institute of Biomedical Science, Kansai Medical University, Hirakata, Osaka 573-1010, Japan;
| | - Hiroki Daijo
- Department of Anesthesia, Takarazuka Daiichi Hospital, Takakazuka, Hyogo 665-0832, Japan;
| | - Kiichi Hirota
- Department of Human Stress Response Science, Institute of Biomedical Science, Kansai Medical University, Hirakata, Osaka 573-1010, Japan;
- Correspondence: ; Tel.: +81-72-804-2526
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16
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Cazeau N. Interprofessional Communication: Integrating Evidence to Enhance Systems During a Pandemic. Clin J Oncol Nurs 2021; 25:56-60. [PMID: 33480871 DOI: 10.1188/21.cjon.56-60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 pandemic placed challenges on interprofessional communication patterns among clinical care teams at a time when effective communication was greatly needed. The development of enhanced systems for communication that integrate the latest evidence and communication technologies can offer a solution to this crisis. OBJECTIVES This article provides a framework for ways in which nursing teams can develop evidence-based enhanced interprofessional communication systems during a pandemic. METHODS Based on communication models and related technologies, this article reviews strategies to enhance interprofessional communication. Two case studies are included that illustrate how nursing teams can enhance communication during a pandemic. FINDINGS To improve communication during a pandemic, clinicians can incorporate interprofessional communication models in clinical practice and apply enhanced communication strategies.
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17
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Ghafil C, Matsushima K, Ding L, Henry R, Inaba K. Trends in Trauma Admissions During the COVID-19 Pandemic in Los Angeles County, California. JAMA Netw Open 2021; 4:e211320. [PMID: 33616667 PMCID: PMC7900857 DOI: 10.1001/jamanetworkopen.2021.1320] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
IMPORTANCE Describing the changes in trauma volume and injury patterns during the course of the coronavirus disease 2019 (COVID-19) pandemic could help to inform policy development and hospital resource planning. OBJECTIVE To examine trends in trauma admissions throughout Los Angeles County (LAC) during the pandemic. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, all trauma admissions to the 15 verified level 1 and level 2 trauma centers in LAC from January 1 to June 7, 2020 were reviewed. All trauma admissions from the same period in 2019 were used as historical control. For overall admissions, the study period was divided into 3 intervals based on daily admission trend analysis (January 1 through February 28, March 1 through April 9, April 10 through June 7). For the blunt trauma subgroup analysis, the study period was divided into 3 similar intervals (January 1 through February 27, February 28 through April 5, April 6 through June 7). EXPOSURES COVID-19 pandemic. MAIN OUTCOMES AND MEASURES Trends in trauma admission volume and injury patterns. RESULTS A total of 6777 patients in 2020 and 6937 in 2019 met inclusion criteria. Of those admitted in 2020, the median (interquartile range) age was 42 (28-61) years and 5100 (75.3%) were men. Mechanisms of injury were significantly different between the 2 years, with a higher incidence of penetrating trauma and fewer blunt injuries in 2020 compared with 2019 (penetrating: 1065 [15.7%] vs 1065 [15.4%]; blunt: 5309 [78.3%] vs 5528 [79.7%]). Overall admissions by interval in 2020 were 2681, 1684, and 2412, whereas in 2019 they were 2462, 1862, and 2613, respectively. There was a significant increase in overall admissions per week during the first interval (incidence rate ratio [IRR], 1.02; 95% CI, 1.002-1.04; P = .03) followed by a decrease in the second interval (IRR, 0.92; 95% CI, 0.90-0.94; P < .001) and, finally, an increase in the third interval (IRR, 1.05; CI, 1.03-1.07; P < .001). On subgroup analysis, blunt admissions followed a similar pattern to overall admissions, while penetrating admissions increased throughout the study period. CONCLUSIONS AND RELEVANCE In this study, trauma centers throughout LAC experienced a significant change in injury patterns and admission trends during the COVID-19 pandemic. A transient decrease in volume was followed by a quick return to baseline levels. Trauma centers should prioritize maintaining access, capacity, and functionality during pandemics and other national emergencies.
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Affiliation(s)
- Cameron Ghafil
- Division of Acute Care Surgery, University of Southern California, Los Angeles
| | - Kazuhide Matsushima
- Division of Acute Care Surgery, University of Southern California, Los Angeles
| | - Li Ding
- Department of Preventive Medicine, University of Southern California, Los Angeles
| | - Reynold Henry
- Division of Acute Care Surgery, University of Southern California, Los Angeles
| | - Kenji Inaba
- Division of Acute Care Surgery, University of Southern California, Los Angeles
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18
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Bouchard ME, Sheneman N, Hey MT, Hoemeke L, Abdullah F. Investments in surgical systems contribute to pandemic readiness and health system resilience. J Public Health Policy 2021; 42:493-500. [PMID: 34193939 PMCID: PMC8243617 DOI: 10.1057/s41271-021-00292-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2021] [Indexed: 02/04/2023]
Abstract
Safe surgical care, including anesthesia, obstetrics, and trauma, is an essential component of a functional health system, yet five billion people lack access to high-quality, timely and affordable surgical care. As health decision makers are grappling with how to make appropriate investments for crisis readiness and resilience, investments in surgical care should be considered for their compounding benefits to meet a country's diverse health goals. National Surgical, Obstetric, and Anesthesia Plans (NSOAPs) are developed through global partnerships and multi-stakeholder consensus and provide a dynamic framework for surgical scale-up that also improves the resilience of the larger health system. Our paper applies principles from the literature on health system resilience to surgical systems and examines the unique capabilities of the surgical workforce and infrastructure to be redeployed during times of crisis, using examples from the current pandemic.
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Affiliation(s)
- Megan E. Bouchard
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
| | | | - Matthew T. Hey
- The G4 Alliance, Chicago, IL USA ,grid.65456.340000 0001 2110 1845Herbert Wertheim College of Medicine, Florida International University, Miami, FL USA
| | - Laura Hoemeke
- The G4 Alliance, Chicago, IL USA ,grid.10698.360000000122483208Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC USA
| | - Fizan Abdullah
- grid.16753.360000 0001 2299 3507Division of Pediatric Surgery, Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, 225 E. Chicago Ave, Chicago, IL 60611 USA ,The G4 Alliance, Chicago, IL USA
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19
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Morrissey CK, Bledsoe AD, Zimmerman J, Bott SI, Stuart AR, Johnson KB, DeCou JA, Thackeray EM, Kuck K, Chacin AB, Dorsey DP, Chortkoff B, Drennan EL, Smith DW, Jackman CM, Paulsen LF, Egan TD. Reinvention of an academic anaesthesiology department during pandemic times: lessons learnt and adapting to a “new normal”. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.3.2576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- CK Morrissey
- Department of Anesthesiology, University of Utah,
United States of America
| | - AD Bledsoe
- Department of Anesthesiology, University of Utah,
United States of America
| | - J Zimmerman
- Department of Anesthesiology, University of Utah,
United States of America
| | - SI Bott
- Department of Anesthesiology, University of Utah,
United States of America
| | - AR Stuart
- Department of Anesthesiology, University of Utah,
United States of America
| | - KB Johnson
- Department of Anesthesiology, University of Utah,
United States of America
| | - JA DeCou
- Department of Anesthesiology, University of Utah,
United States of America
| | - EM Thackeray
- Department of Anesthesiology, University of Utah,
United States of America
| | - K Kuck
- Department of Anesthesiology, University of Utah,
United States of America
| | - AB Chacin
- Department of Anesthesiology, University of Utah,
United States of America
| | - DP Dorsey
- Department of Anesthesiology, University of Utah,
United States of America
| | - B Chortkoff
- Department of Anesthesiology, University of Utah,
United States of America
| | - EL Drennan
- Department of Anesthesiology, University of Utah,
United States of America
| | - DW Smith
- Department of Anesthesiology, University of Utah,
United States of America
| | - CM Jackman
- Department of Anesthesiology, University of Utah,
United States of America
| | - LF Paulsen
- Department of Anesthesiology, University of Utah,
United States of America
| | - TD Egan
- Department of Anesthesiology, University of Utah,
United States of America
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Meghpara MK, Alapati A, Devanabanda B, Louis MA, Mandava N. Repurposing a Small Community Hospital Surgical Residency Program in an Epicenter of the COVID-19 Pandemic. Am Surg 2020; 86:1623-1628. [PMID: 33228383 DOI: 10.1177/0003134820956355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND COVID-19 put a stop to the operative experience of surgical residents, leaving reassignment of the team, to the frontlines. Each program has adapted uniquely; we discuss how our surgical education changed in our hospital. STUDY DESIGN A retrospective review of changes in general surgery cases, bedside procedures, and utilization of residents before and during the pandemic. Procedures were retrieved from electronic medical records. Operating room (OR) cases 1 month before and 5 weeks after the executive order were collected. Triple lumen catheter (TLC), temporary hemodialysis catheter (HDC), and pneumothorax catheter (PC) insertions by surgical residents were recorded for 5 weeks. RESULTS Before the pandemic, an average of 27.9 cases were done in the OR, with an average of 10.1 general surgery cases. From March 23 to April 30, 2020, the average number of cases decreased to 5.1, and general surgery cases decreased to 2.2. Elective, urgent, and emergent cases represented 83%, 14.6%, and 2.4% prior to the order and 66.7%, 15.1%, and 18.2%, respectively, after the order. Bedside procedures over 5 weeks totaled to 153, 93 TLCs, 39 HDCs, and 21 PCs. CONCLUSION Repurposing the surgical department for the concerns of the pandemic has involved all surgical staff. We worked with other departments to allocate our team to areas of need and re-evaluated daily. The strengths of our team to deliver care and perform many bedside procedures allowed us to meet the demands posed by this disease while remaining as a cohesive unit.
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Affiliation(s)
- Melissa K Meghpara
- Department of Surgery, Flushing Hospital Medical Center, Queens, NY, USA
| | - Amulya Alapati
- Department of Surgery, Flushing Hospital Medical Center, Queens, NY, USA
| | | | - Martine A Louis
- Department of Surgery, Flushing Hospital Medical Center, Queens, NY, USA
| | - Neil Mandava
- Department of Surgery, Flushing Hospital Medical Center, Queens, NY, USA
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21
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Ragauskas AME, Scott AM, Christie DB, Vaughn DM, Christie AB, Ashley DW. Strategies for General Surgery Training Programs During the COVID-19 Pandemic. Am Surg 2020; 86:1501-1507. [PMID: 33135424 PMCID: PMC7669277 DOI: 10.1177/0003134820966271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The COVID-19 pandemic presented a unique challenge for Medical systems worldwide.
Initial response to the crisis situation for the pandemic closely mirrored plans
for a mass casualty event. By leveraging resources including human and physical,
and by dividing our surgeon workforce into micro teams we were able to create a
flexible and responsive infrastructure to address the crisis as it unfolded. By
adoption of virtual platforms and equal division of labor, surgical resident
education was continued. Specific adjustments to the schedule and curriculum for
medical students allowed them to continue their studies safely and on schedule.
Our model serves as an example by which hospital systems of similar size may
utilize principles of mass casualty preparedness to craft their own plan for a
future contagion response strategy.
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Affiliation(s)
| | - Anthony M Scott
- Department of Surgery, 5223The Medical Center Navicent Health, Macon, GA, USA
| | - Dudley B Christie
- 12241Mercer University School of Medicine, Macon, GA, USA.,Department of Surgery, 5223The Medical Center Navicent Health, Macon, GA, USA
| | - Danny M Vaughn
- 12241Mercer University School of Medicine, Macon, GA, USA.,Department of Surgery, 5223The Medical Center Navicent Health, Macon, GA, USA
| | - Amy B Christie
- 12241Mercer University School of Medicine, Macon, GA, USA.,Department of Surgery, 5223The Medical Center Navicent Health, Macon, GA, USA
| | - Dennis W Ashley
- 12241Mercer University School of Medicine, Macon, GA, USA.,Department of Surgery, 5223The Medical Center Navicent Health, Macon, GA, USA
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22
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Meneses E, McKenney M, Elkbuli A. Reforming our general surgery residency program at an urban level 1 Trauma Center during the COVID-19 pandemic: Towards maintaining resident safety and wellbeing. Am J Surg 2020; 220:847-849. [PMID: 32586630 PMCID: PMC7282736 DOI: 10.1016/j.amjsurg.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Evander Meneses
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.
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23
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Affiliation(s)
- Melina R Kibbe
- Department of Surgery and Department of Biomedical Engineering, University of North Carolina at Chapel Hill
- Editor
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24
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Development and emergency implementation of an online surgical education curriculum for a General Surgery program during a global pandemic: The University of Southern California experience. Am J Surg 2020; 221:962-972. [PMID: 32912661 PMCID: PMC7470743 DOI: 10.1016/j.amjsurg.2020.08.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/25/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Physical distancing required by coronavirus disease 2019 (COVID-19) has limited traditional in-person resident education. We present our novel online curriculum for incorporation into traditional surgical educational programs. METHODS The online curriculum utilized weekly sub-specialty themed faculty and resident created lectures, ABSITE practice questions, and weekly sub-specialty synchronized readings. Attendance, resident and faculty surveys, and completed ABSITE practice questions evaluated for curriculum success. Curriculum was adapted as COVID-19 clinical restructuring ended. RESULTS 77% and 80% of clinical residents attended faculty lectures and resident led topic discussions as compared to 66% and 48% attending traditional in-person grand rounds and SCORE curriculum (both p > 0.05). 71.9% of residents and 16.6% of faculty reported improved resident participation while none reported decreased levels of participation (p < 0.001). 87.1% of residents and 66.7% of faculty preferred the online curriculum (p = 0.374). Completed ABSITE practice questions per resident increased from 21 to 31 questions/week (p = 0.541). CONCLUSION Our online educational curriculum demonstrates success and can serve as a model for online restructuring of resident education.
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25
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Defining Best Practices for Videoconferencing in the Era of Telemedicine and COVID-19. J Craniofac Surg 2020; 31:e658-e660. [PMID: 32796315 DOI: 10.1097/scs.0000000000006890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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26
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Error in Acknowledgments. JAMA Surg 2020; 155:790. [DOI: 10.1001/jamasurg.2020.2226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Tzeng CWD, Teshome M, Katz MHG, Weinberg JS, Lai SY, Antonoff MB, Bird JE, Shafer A, Davis JW, Adelman DM, Moon B, Reece G, Prabhu SS, DeSnyder SM, Skibber JM, Mehran R, Schmeler K, Roland CL, Tran Cao HS, Aloia TA, Caudle AS, Swisher SG, Vauthey JN. Cancer Surgery Scheduling During and After the COVID-19 First Wave: The MD Anderson Cancer Center Experience. Ann Surg 2020; 272:e106-e111. [PMID: 32675511 PMCID: PMC7373457 DOI: 10.1097/sla.0000000000004092] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To summarize the multi-specialty strategy and initial guidelines of a Case Review Committee in triaging oncologic surgery procedures in a large Comprehensive Cancer Center and to outline current steps moving forward after the initial wave. SUMMARY OF BACKGROUND DATA The impetus for strategic rescheduling of operations is multifactorial and includes our societal responsibility to minimize COVID-19 exposure risk and propagation among patients, the healthcare workforce, and our community at large. Strategic rescheduling is also driven by the need to preserve limited resources. As many states have already or are considering to re-open and relax stay-at-home orders, there remains a continued need for careful surgical scheduling because we must face the reality that we will need to co-exist with COVID-19 for months, if not years. METHODS The quality officers, chairs, and leadership of the 9 surgical departments in our Division of Surgery provide specialty-specific approaches to appropriately triage patients. RESULTS We present the strategic approach for surgical rescheduling during and immediately after the COVID-19 first wave for the 9 departments in the Division of Surgery at The University of Texas MD Anderson Cancer Center in Houston, Texas. CONCLUSIONS Cancer surgeons should continue to use their oncologic knowledge to determine the window of opportunity for each surgical procedure, based on tumor biology, preoperative treatment sequencing, and response to systemic therapy, to safely guide patients through this cautious recovery phase.
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Affiliation(s)
- Ching-Wei D Tzeng
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mediget Teshome
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Matthew H G Katz
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jeffrey S Weinberg
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen Y Lai
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mara B Antonoff
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Justin E Bird
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Aaron Shafer
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John W Davis
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - David M Adelman
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Bryan Moon
- Department of Orthopedic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Gregory Reece
- Department of Plastics and Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sujit S Prabhu
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah M DeSnyder
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - John M Skibber
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Reza Mehran
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kathleen Schmeler
- Department of Gynecologic Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Christina L Roland
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Hop S Tran Cao
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas A Aloia
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Abigail S Caudle
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen G Swisher
- Department of Thoracic Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jean-Nicolas Vauthey
- Departments of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Dominguez Torres LC, Torregrosa Almonacid L, Sánchez Maldonado W, Lasprilla N, Vargas Barato F, Niño Rodríguez ÁLVAROENRIQUE, Rosero Rosero GA, Hoyos Duque SI, Vega Peña NV, Cadavid LG, Jiménez G, Sarmiento Ramírez JG, Osorio M, Zapata Acevedo CM, Caicedo R, Medina R, Zuluaga-Zuluaga M, Herrera M, Posada JC, Coba Barrios H, León Rodríguez JP, Luna-Jaspe C, Merlano Martínez JJ, Molina Restrepo JJ, Bustillo C, Pacheco Trujillo MA. Educación quirúrgica durante la Pandemia COVID-19: Primer consenso nacional de la División de Educación de la Asociación Colombiana de Cirugía. REVISTA COLOMBIANA DE CIRUGÍA 2020. [DOI: 10.30944/20117582.685] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Este consenso presenta las recomendaciones de la División de Educación de la Asociación Colombiana de Cirugía para los programas de especialización en cirugía general del país, con el fin de enfrentar la Pandemia Covid-19 en los próximos años. Las recomendaciones se realizaron mediante un método informal de consenso de expertos conformado por todos los directores de los programas de especialización en cirugía general en Colombia. Las principales recomendaciones se relacionan con los procesos de selección en los programas, investigación, bioseguridad, vigilancia de volumen operatorio, evaluación, simulación y virtualidad, rotaciones especiales, esquemas de trabajo y evaluación de la calidad programática.
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29
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Askalsky P, Bailey RK, Kantor EM, Stoddard FJ, West JC, Marmar CR. Guidelines for Redeploying Psychiatrists to Medicine During a Pandemic Crisis. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20200610-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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30
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Wong J, Ng SY, Goh MH, Tan KH, Chai HZ, Goh KJ, Soh CR. Anaesthesia and intensive care medicine in a COVID-19 pandemic. Singapore Med J 2020; 63:2-4. [PMID: 32588581 DOI: 10.11622/smedj.2020094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jolin Wong
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - Shin Yi Ng
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - Meng Huat Goh
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - Kian Hian Tan
- Division of Anaesthesiology, Singapore General Hospital, Singapore
| | - Hui Zhong Chai
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Ken Junyang Goh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chai Rick Soh
- Division of Anaesthesiology, Singapore General Hospital, Singapore
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31
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General surgery chief residents' perspective on surgical education during the coronavirus disease 2019 (COVID-19) pandemic. Surgery 2020; 168:222-225. [PMID: 32600881 PMCID: PMC7287487 DOI: 10.1016/j.surg.2020.06.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 06/04/2020] [Accepted: 06/06/2020] [Indexed: 01/22/2023]
Abstract
Background The coronavirus disease 2019 pandemic has negatively affected the training of general surgery chief residents during the last trimester of their residency. Our goal was to evaluate the educational concerns of graduating general surgery chief residents during the coronavirus disease 2019 pandemic. Methods An anonymous web-based survey was distributed between March 31 and April 7, 2020 to all current general surgery chief residents from 6 academic medical centers in Boston, Massachusetts. Interviews were also conducted with attending surgeons from participating institutions. Results A total of 24 of 39 general surgery chief residents participated in our survey (61.5% response rate). General surgery chief residents were most concerned about the potential delay in the date of board examinations, followed by not feeling adequately prepared for the board examinations and a possible delay in the graduation date. Whereas not having enough cases to feel ready for fellowship or job and not achieving a sufficient number of cases to meet the requirements for graduation were only moderately concerning to chief residents, attending surgeons stressed a greater importance on the loss of the operative experience as nearly all (93.3%) of them suggested a personalized approach for additional general surgery training during fellowship or job onboarding. Conclusion In addition to the dramatic impact on public health, the coronavirus disease 2019 outbreak has also caused unprecedented changes to surgical education. Therefore, creative interventions are needed to help general surgery chief residents successfully transition into the next phase of their surgical career.
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Lazizi M, Marusza CJ, Sexton SA, Middleton RG. Orthopaedic surgery in a time of COVID-19: Using a low prevalence COVID-19 trauma surgery model to guide a safe return to elective surgery. Bone Jt Open 2020; 1:229-235. [PMID: 33225294 PMCID: PMC7677729 DOI: 10.1302/2633-1462.16.bjo-2020-0045] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Aims Elective surgery has been severely curtailed as a result of the COVID-19 pandemic. There is little evidence to guide surgeons in assessing what processes should be put in place to restart elective surgery safely in a time of endemic COVID-19 in the community. Methods We used data from a stand-alone hospital admitting and operating on 91 trauma patients. All patients were screened on admission and 100% of patients have been followed-up after discharge to assess outcome. Results Overall, 87 (96%) patients remained symptom-free and recovered well following surgery. Four (4%) patients developed symptoms of COVID-19, with polymerase chain reaction ribonucleiuc acid (PCR-RNA) testing confirming infection. Conclusion Based on our findings, we propose that if careful cohorting and screening is carried out in a stand-alone cold operating site, it is reasonable to resume elective operating, in a time of endemic but low community prevalence of SAR-Cov2. Cite this article: Bone Joint Open 2020;1-6:229–235.
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Affiliation(s)
- Mohamed Lazizi
- Trauma and Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | | | - Shaun A Sexton
- Trauma and Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - Rory G Middleton
- Trauma and Orthopaedic Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK
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Kocher KE, Macy ML. Emergency Department Patients in the Early Months of the Coronavirus Disease 2019 (COVID-19) Pandemic—What Have We Learned? JAMA HEALTH FORUM 2020; 1:e200705. [DOI: 10.1001/jamahealthforum.2020.0705] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Keith E. Kocher
- Department of Emergency Medicine, School of Medicine, University of Michigan, Ann Arbor
- Department of Learning Health Sciences, School of Medicine, University of Michigan, Ann Arbor
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor
| | - Michelle L. Macy
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, Illinois
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Ngatchou W, Temgoua MN, Tochie JN, Betou FSA, Yombi JC, Lemogoum D. How to manage surgical patients during and early after COVID-19 pandemic: a practical approach for low-and middle-income countries (LMICs). Pan Afr Med J 2020; 35:69. [PMID: 33623593 PMCID: PMC7875807 DOI: 10.11604/pamj.supp.2020.35.2.23681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/03/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- William Ngatchou
- Department of Surgery, Douala Faculty of Medicine and Pharmaceutical Sciences, University of Douala
| | - Mazou Ngou Temgoua
- Department of Internal Medicine and sub-Specialities, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- Departement of Cardiovascular and thoracic surgery, University teaching Hospital of Fann, Cheikh Anta Diop University, Dakar, Senegal
| | - Fabrice Stephane Arroye Betou
- Department of Anaesthaesiology and Critical Care Medicine, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Jean Cyr Yombi
- Department of Infectious Diseases and perioperative medicine, Saint Luc University Hospital, Université Catholique de Louvain, Brussels, Belgium
| | - Daniel Lemogoum
- Hypertension clinic, Department of cardiology, UBL-Erasme Hospital, Free Brussels University, Brussels, Brussels, Belgium
- Department of Medicine and specialties, Faculty of Medicine and Pharmaceutical Sciences, University of Douala, Douala, Cameroon
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35
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Patel HV, Srivastava A, Tabakin AL, Jang TL, Singer EA. The patient-urologist relationship in the COVID-19 era and beyond. Can Urol Assoc J 2020; 14:E271-E273. [PMID: 32525803 PMCID: PMC7654670 DOI: 10.5489/cuaj.6688] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
The COVID-19 pandemic has impeded health care delivery and may permanently transform the patient-urologist relationship. Here we examine the long-term implications of COVID-19 pandemic on this relationship and explore the impact it has on urologic care in the post-COVID-19 era.
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Affiliation(s)
- Hiren V Patel
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Arnav Srivastava
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Alexandra L Tabakin
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Thomas L Jang
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Sezer A, Cicin İ, Karadeniz Çakmak G, Özkan Gürdal S, Başaran G, Oyan B, Eralp Y, Güllüoğlu BM. Turkish national consensus on breast cancer management during temporary state of emergency due to COVID-19 outbreak. Turk J Surg 2020; 36:147-163. [PMID: 33015560 PMCID: PMC7515641 DOI: 10.5578/turkjsurg.4815] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 04/29/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVES Cancer care is excessively influenced by the COVID-19 outbreak for various reasons. One of the major concerns is the tendency for delayed surgical treatment of breast cancer patients. The outbreak has urged clinicians to find alternative treatments until surgery is deemed to be feasible and safe. Here in this paper, we report the results of a consensus procedure which aimed to provide an expert opinion-led guideline for breast cancer management during the COVID-19 outbreak in Turkey. MATERIAL AND METHODS We used the Delphi method with a 9-scale Likert scale on two rounds of voting from 51 experienced surgeons and medical oncologists who had the necessary skills and experience in breast cancer management. Voting was done electronically in which a questionnaire-formatted form was used. RESULTS Overall, 46 statements on 28 different case scenarios were voted. In the first round, 37 statements reached a consensus as either endorsement or rejection, nine were put into voting in the second round since they did not reach the necessary decision threshold. At the end of two rounds, for 14 cases scenarios, a statement was endorsed as a recommendation for each. Thirty-two statements for the remaining 14 were rejected. CONCLUSION There was a general consensus for administering neoadjuvant systemic therapy in patients with node-negative, small-size triple negative, HER2-positive and luminal A-like tumors until conditions are improved for due surgical treatment. Panelists also reached a consensus to extend the systemic treatment for patients with HER2-positive and luminal B-like tumors who had clinical complete response after neoadjuvant systemic therapy.
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Affiliation(s)
- Atakan Sezer
- SENATURK Senology Academy-Turkey, Istanbul, Turkey
- Department of General Surgery, Trakya University School of Medicine, Edirne, Turkey
| | - İrfan Cicin
- Department of Medical Oncology, Trakya University School of Medicine, Edirne, Turkey
| | - Güldeniz Karadeniz Çakmak
- SENATURK Senology Academy-Turkey, Istanbul, Turkey
- Department of General Surgery, Bulent Ecevit University School of Medicine, Zonguldak, Turkey
| | - Sibel Özkan Gürdal
- SENATURK Senology Academy-Turkey, Istanbul, Turkey
- Department of General Surgery, Namik Kemal University School of Medicine, Tekirdag, Turkey
| | - Gül Başaran
- SENATURK Senology Academy-Turkey, Istanbul, Turkey
- Department of Medical Oncology, MAA Acibadem University SchooI of Medicine, Istanbul, Turkey
| | - Başak Oyan
- Department of Medical Oncology, MAA Acibadem University SchooI of Medicine, Istanbul, Turkey
| | - Yeşim Eralp
- Department of Medical Oncology, MAA Acibadem University SchooI of Medicine, Istanbul, Turkey
| | - Bahadır M. Güllüoğlu
- SENATURK Senology Academy-Turkey, Istanbul, Turkey
- Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey
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Baud G, Brunaud L, Lifante JC, Tresallet C, Sebag F, Bizard JP, Mathonnet M, Menegaux F, Caiazzo R, Mirallié E, Pattou F. Endocrine surgery during and after the COVID-19 epidemic: Expert guidelines from AFCE. J Visc Surg 2020; 157:S43-S49. [PMID: 32448761 PMCID: PMC7190473 DOI: 10.1016/j.jviscsurg.2020.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The COVID-19 pandemic commands a major reorganisation of the entire French healthcare system. In France, general rules have been issued nationally and implemented by each healthcare centre, both public and private, throughout France. Guidelines drafted by an expert group led by the French-speaking Association of Endocrine Surgery (AFCE) propose specific surgical management principles for thyroid, parathyroid, endocrine pancreas and adrenal surgery during and after the COVID-19 epidemic.
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Affiliation(s)
- G Baud
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - L Brunaud
- Chirurgie viscérale, métabolique et cancérologique (CVMC), CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - J-C Lifante
- Chirurgie digestive, oncologique et endocrinienne, CHU de Lyon, 69310 Pierre-Bénite, France
| | - C Tresallet
- Chirurgie viscérale et digestive, AP-HP, hôpital Avicenne, 93000 Bobigny, France
| | - F Sebag
- Chirurgie générale et endocrinienne, AP-HM, La Conception, 13005 Marseille, France
| | - J-P Bizard
- Chirurgie endocrinienne et viscérale, hôpital privé Arras-les-Bonnettes, 62000 Arras, France
| | - M Mathonnet
- Chirurgie digestive et endocrinienne, CHU de Limoges, 87000 Limoges, France
| | - F Menegaux
- Chirurgie générale digestive et endocrinienne, AP-HP, hôpital Pitié-Salpêtrière, Sorbonne université, 75013 Paris, France
| | - R Caiazzo
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - E Mirallié
- Chirurgie cancérologique, digestive et endocrinienne (CCDE), CHU de Nantes, 44093 Nantes, France
| | - F Pattou
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France.
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Baud G, Brunaud L, Lifante JC, Tresallet C, Sebag F, Bizard JP, Mathonnet M, Menegaux F, Caiazzo R, Mirallié É, Pattou F. [Endocrine surgery during and after the COVID-19 epidemic: Guidelines from AFCE]. ACTA ACUST UNITED AC 2020; 157:S44-S51. [PMID: 32355510 PMCID: PMC7190492 DOI: 10.1016/j.jchirv.2020.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
La pandémie de COVID-19 impose une réorganisation majeure de l’ensemble de notre système de soins. En France, des règles générales ont été diffusées au niveau national et sont déclinées par chaque établissement, public comme privé, sur l’ensemble du territoire. Ces recommandations, rédigées par un groupe d’experts sous l’égide de l’Association francophone de chirurgie endocrinienne (AFCE), ont pour objectif de proposer des principes spécifiques de prise en charge chirurgicale au cours et au décours de l’épidémie de COVID- 19, pour les pathologies chirurgicales de la thyroïde, des parathyroïdes, du pancréas endocrine, et des surrénales.
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Affiliation(s)
- G Baud
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - L Brunaud
- Chirurgie viscérale, métabolique et cancérologique (CVMC), CHRU de Nancy, 54511 Vandœuvre-lès-Nancy, France
| | - J C Lifante
- Chirurgie digestive, oncologique et endocrinienne, CHU de Lyon, 69310 Pierre-Bénite, France
| | - C Tresallet
- Chirurgie digestive, bariatrique et endocrinienne, AP-HP, Hôpital Avicenne, université Sorbonne Paris Nord, 93000 Bobigny, France
| | - F Sebag
- Chirurgie générale et endocrinienne, AP-HM, La Conception, 13005 Marseille, France
| | - J P Bizard
- Chirurgie endocrinienne et viscérale, hôpital privé Arras-lès-Bonnettes, 62000 Arras, France
| | - M Mathonnet
- Chirurgie digestive et endocrinienne, CHU de Limoges, 87000 Limoges, France
| | - F Menegaux
- Chirurgie générale digestive et endocrinienne, Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - R Caiazzo
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
| | - É Mirallié
- Chirurgie cancérologique, digestive et endocrinienne (CCDE), CHU de Nantes, 44093 Nantes, France
| | - F Pattou
- Chirurgie générale et endocrinienne, CHU de Lille, 59000 Lille, France
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Kwon YS, Tabakin AL, Patel HV, Backstrand JR, Jang TL, Kim IY, Singer EA. Adapting Urology Residency Training in the COVID-19 Era. Urology 2020; 141:15-19. [PMID: 32339555 PMCID: PMC7194676 DOI: 10.1016/j.urology.2020.04.065] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- Young Suk Kwon
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Alexandra L Tabakin
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Hiren V Patel
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | | | - Thomas L Jang
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Isaac Y Kim
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Eric A Singer
- Division of Urology, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ.
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