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Ferry AM, Dibbs RP, Ward A, Velez V, Ringold SL, Archer NM, Winebar JM, Andropoulos DB, Hollier Jr LH. Operational Effect of COVID-19 on Surgical Care at a Tertiary Pediatric Hospital. AORN J 2022; 115:147-155. [PMID: 35084769 PMCID: PMC9011624 DOI: 10.1002/aorn.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 04/12/2021] [Indexed: 11/12/2022]
Abstract
The detrimental effects of the coronavirus disease 2019 (COVID‐19) pandemic have profoundly disrupted surgical care at health care facilities worldwide. At our tertiary pediatric hospital, we made substantial adjustments to surgical suite utilization and staff member scheduling to account for reductions in surgical volume, increased demand for staff members in other sectors of the hospital, and the highly infectious properties of the virus. Perioperative leaders took advantage of the pandemic’s disruption to clinical activities to design and implement a new procedure‐scheduling process to rectify the inefficiencies that had accumulated as the previous system evolved. The implementation of said directives was largely facilitated by establishing communication with all involved parties for their input and feedback throughout the process. Although COVID‐19 has had varying effects on procedural operations across pediatric health care facilities, we believe our institutional response to the disruptive forces of COVID‐19 is of benefit to pediatric hospitals worldwide.
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Brown CA, Amerson-Brown MH, Rahman A, Webb CR, Singh IR, Dunn JJ. Performance of six SARS-CoV-2 RNA detection systems in symptomatic and asymptomatic pediatric and maternal patients. Future Virol 2022. [PMID: 35027939 PMCID: PMC8734120 DOI: 10.2217/fvl-2021-0311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023]
Abstract
Aim: This study evaluated the real-world performance of six test systems for detection of SARS-CoV-2 in 138 pediatric and 110 adult maternal patients. Materials & methods: Nasopharyngeal swabs were tested directly using the Aptima™ SARS-CoV-2 (Aptima) and Simplexa™ COVID-19 Direct (Simplexa), and with Altona RealStar® RT-PCR and CDC RT-PCR with nucleic acid extracted on the Roche® MagNA Pure 96 (Altona-MP96) or bioMérieux EMAG® (Altona-EMAG). Results/Conclusion: Overall percent-positive and percent-negative agreements among the six test systems were, respectively: Aptima: 94.8 and 100%; Altona-MP96: 96.5 and 99.3%; CDC-MP96: 100 and 99.3%; Altona-EMAG: 86.1 and 100%; CDC-EMAG: 98.2 and 100%; Simplexa: 87 and 99.2%. The six test systems showed agreement ranging from 92.7 (κ = 0.85) to 98.8% (κ = 0.98).
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Affiliation(s)
- Cameron A Brown
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Megan H Amerson-Brown
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - Aliza Rahman
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA
| | - Charity R Webb
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA
| | - Ila R Singh
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
| | - James J Dunn
- Department of Pathology, Texas Children's Hospital, Houston, TX 77030, USA.,Department of Pathology & Immunology, Baylor College of Medicine, Houston, TX 77030, USA
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Dibbs RP, Ferry AM, Mehl SC, Ferguson SM, Versalovic J, Dunn JJ, Enochs J, Monson LA, Hollier LH. Screening pediatric surgical patients during the COVID-19 pandemic. JAAPA 2021; 34:43-48. [PMID: 34582385 DOI: 10.1097/01.jaa.0000791484.37318.d3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ABSTRACT SARS-CoV-2 has profoundly affected the way healthcare is delivered and has created significant strain on medical facilities globally. As a result, hospitals have had to continuously adapt in order to provide optimal patient care while minimizing the risk of SARS-CoV-2 transmission, particularly in the surgical setting. Texas Children's Hospital developed a set of protocols for surgical screening and clearance of patients in the context of the COVID-19 pandemic. These screening protocols were designed to mitigate the risk of exposing patients and healthcare providers to SARS-CoV-2 and have evolved significantly as a result of the emerging changes in medicine, technology, and governmental regulations. In this article, we share the reasoning behind the development, implementation, and successive modification of our institutional screening protocols.
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Affiliation(s)
- Rami P Dibbs
- Rami P. Dibbs and Andrew M. Ferry are research fellows in the Division of Plastic Surgery at Texas Children's Hospital and Baylor College of Medicine in Houston, Tex. Steven C. Mehl is a general surgery resident physician at Baylor College of Medicine. Susannah M. Ferguson is clinical lead of advanced practice providers in the Department of Surgery at Texas Children's Hospital. James Versalovic is pathologist-in-chief at Texas Children's Hospital and director of Texas Children's Microbiome Center. James J. Dunn is the director of medical microbiology and virology at Texas Children's Hospital. Joyce Enochs is manager of nursing perioperative services at Texas Children's Hospital. Laura A. Monson is a pediatric plastic and reconstructive surgeon and chief surgical quality and safety officer at Texas Children's Hospital. Larry H. Hollier, Jr. , is a plastic and reconstructive surgeon and surgeon-in-chief at Texas Children's Hospital. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Truche P, Bowder A, Lalla AT, Crum R, Botelho F, Rice HE, Lopes BC, Greenberg S, Evans F, Meara JG, Ameh EA, Mooney DP. Perspectives on perioperative management of children's surgical conditions during the COVID-19 pandemic in low-income and middle-income countries: a global survey. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000187. [PMID: 38607942 PMCID: PMC7493076 DOI: 10.1136/wjps-2020-000187] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/21/2020] [Accepted: 08/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background Many organizations have issued recommendations to limit elective surgery during the coronavirus disease 2019 (COVID-19) pandemic. We surveyed providers of children's surgical care working in low-income and middle-income countries (LMICs) to understand their perspectives on surgical management in the wake of the COVID-19 pandemic and how they were subsequently modifying their surgical care practices. Methods A survey of children's surgery providers in LMICs was performed. Respondents reported how their perioperative practice had changed in response to COVID-19. They were also presented with 26 specific procedures and asked which of these procedures they were allowed to perform and which they felt they should be allowed to perform. Changes in surgical practice reported by respondents were analyzed thematically. Results A total of 132 responses were obtained from 120 unique institutions across 30 LMICs. 117/120 institutions (97.5%) had issued formal guidance on delaying or limiting elective children's surgical procedures. Facilities in LICs were less likely to have issued guidance on elective surgery compared with middle-income facilities (82% in LICs vs 99% in lower middle-income countries and 100% in upper middle-income countries, p=0.036). Although 122 (97%) providers believed cases should be limited during a global pandemic, there was no procedure where more than 61% of providers agreed cases should be delayed or canceled. Conclusions There is little consensus on which procedures should be limited or delayed among LMIC providers. Expansion of testing capacity and local, context-specific guidelines may be a better strategy than international consensus, given the disparities in availability of preoperative testing and the lack of consensus towards which procedures should be delayed.
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Affiliation(s)
- Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexis Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Robert Crum
- Department of Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Fabio Botelho
- Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Henry Elliot Rice
- Division of Pediatric General Surgery, Duke Children's Hospital and Health Center, Durham, North Carolina, USA
| | - Bellisa Caldas Lopes
- Department of Pediatric Surgery, Instituto de Medicina Integral Prof. Fernando Figueira, Recife, Brazil
| | - Sarah Greenberg
- Department of Surgery, University of Washington, Seattle, Washington, USA
- Division of Pediatric General & Thoracic Surgery, Seattle Children’s Hospital, Seattle, Washington, USA
| | - Faye Evans
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - John Gerard Meara
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Emmanuel Adoyi Ameh
- Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria
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