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Zeng H, Li G, Weng J, Xiong A, Xu C, Yang Y, Wang D. The strategies of perioperative management in orthopedic department during the pandemic of COVID-19. J Orthop Surg Res 2020; 15:474. [PMID: 33059739 PMCID: PMC7558248 DOI: 10.1186/s13018-020-01978-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/23/2020] [Indexed: 12/18/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has broken out and spread rapidly nationwide at the beginning of 2020, which has brought huge impacts to people and work. The current situation of prevention and control is severe and urges guidance for clinicians, especially for medical systems. In the hope of providing a reference and recommendation for the prevention and control of the COVID-19, we carried out research to improve the quality of patient care and prevention during this epidemic. Methods All of the staff were trained rapidly to master personal protection in our department. We reviewed the patients’ discharged records who underwent surgery in our department during January 1 to March 1, 2019, and January 1 to March 1, 2020. The management of the surgery patients and flow charts were described and analyzed. Post-operation outcomes of the patients include duration, complications, surgical site infection (SSI), system infection, re-operation, and mortality. Both chi-squared test and Student’s t test were performed to determine the relationship between the two periods in terms of post-operation outcomes. Results Descriptive statistics analysis revealed that demographic of the patients between the two periods is similar. We had benefited from the strict flowcharts, smart robot, and protection equipment during the perioperative managements for orthopedic patients. With the help of the strict flow charts and smart equipment, post-operation outcomes of the patients revealed that the rates of the complications and re-operation had been reduced significantly (p < 0.05), while duration of operation, SSI, and system infection had no significant difference between two periods (p > 0.05). No patient and staff caught COVID-19 infection or mortality during the epidemic. Conclusions Our study indicated that medical quality and efficiency were affected little with the help of strategies described above during the epidemic, which could be a reference tool for medical staff in routine clinical practice for admission of patients around the world. What is more, the provided strategies, which may evolve over time, could be used as empirical guidance and reference for orthopedic peers to get through the pandemic and ensure the normal operation of the hospital.
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Affiliation(s)
- Hui Zeng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China. .,National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery , Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
| | - Guoqing Li
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.,National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery , Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Jian Weng
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.,National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery , Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Ao Xiong
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.,National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery , Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Chang Xu
- Department of Medical Administration, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Yifei Yang
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China
| | - Deli Wang
- Department of Bone & Joint Surgery, Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China. .,National & Local Joint Engineering Research Center of Orthopaedic Biomaterials, Department of Bone & Joint Surgery , Peking University Shenzhen Hospital, Shenzhen, 518036, People's Republic of China.
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Nightingale R, Nwosu N, Kutubudin F, Fletcher T, Lewis J, Frost F, Haigh K, Robinson R, Kumar A, Jones G, Brown D, Abouyannis M, Beadsworth M, Hampshire P, Aston S, Gautam M, Burhan H. Is continuous positive airway pressure (CPAP) a new standard of care for type 1 respiratory failure in COVID-19 patients? A retrospective observational study of a dedicated COVID-19 CPAP service. BMJ Open Respir Res 2020; 7:7/1/e000639. [PMID: 32624495 PMCID: PMC7337881 DOI: 10.1136/bmjresp-2020-000639] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/23/2020] [Indexed: 01/25/2023] Open
Abstract
The aim of this case series is to describe and evaluate our experience of continuous positive airway pressure (CPAP) to treat type 1 respiratory failure in patients with COVID-19. CPAP was delivered in negative pressure rooms in the newly repurposed infectious disease unit. We report a cohort of 24 patients with type 1 respiratory failure and COVID-19 admitted to the Royal Liverpool Hospital between 1 April and 30 April 2020. Overall, our results were positive; we were able to safely administer CPAP outside the walls of a critical care or high dependency unit environment and over half of patients (58%) avoided mechanical ventilation and a total of 19 out of 24 (79%) have survived and been discharged from our care.
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Affiliation(s)
- Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK .,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Nneka Nwosu
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Farheen Kutubudin
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Tom Fletcher
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Joe Lewis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Frederick Frost
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Kathryn Haigh
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ryan Robinson
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Ayesha Kumar
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Gareth Jones
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Deborah Brown
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Michael Abouyannis
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Mike Beadsworth
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Peter Hampshire
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Aston
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Institute of Infection and Global Health, University of Liverpool, Liverpool, Merseyside, UK
| | - Manish Gautam
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Hassan Burhan
- Department of Respiratory Medicine, Tropical and Infectious Disease Unit, Intensive Care Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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Dai J, Xiong Y, Li H, Qian Y, Xu Y, Xu Q, Yan X, Tang J. Corticosteroid treatment in severe COVID-19 pneumonia: two cases and literature review. Clin Rheumatol 2020; 39:2031-2037. [PMID: 32451729 PMCID: PMC7247779 DOI: 10.1007/s10067-020-05172-7] [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] [Received: 04/21/2020] [Revised: 05/05/2020] [Accepted: 05/15/2020] [Indexed: 01/19/2023]
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia, firstly reported in Wuhan, Hubei province, China, has rapidly spread around the world with high mortality rate among critically ill patients. The use of corticosteroids in COVID-19 remains a major controversy. Available evidences are inconclusive. According to WHO guidance, corticosteroids are not recommended to be used unless for another reason. Chinese Thoracic Society (CTS) proposes an expert consensus statement that suggests taking a prudent attitude of corticosteroid usage. In our clinical practice, we do not use corticosteroids routinely; only low-to-moderate doses of corticosteroids were given to several severely ill patients prudently. In this paper, we will present two confirmed severe COVID-19 cases admitted to isolation wards in Optical Valley Campus of Tongji hospital, Tongji Medical College, Huazhong University of Science and Technology. We will discuss questions related to corticosteroids usages.
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Affiliation(s)
- Jinghong Dai
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu, China.
| | - Yali Xiong
- Department of Infectious Diseases, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Hui Li
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu, China
| | - Yajun Qian
- Department of Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Ying Xu
- Department of Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
| | - Qingqing Xu
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu, China
| | - Xin Yan
- Department of Pulmonary and Critical Care Medicine, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Zhongshan Road 321, Nanjing, 210008, Jiangsu, China
| | - Jian Tang
- Department of Intensive Care Unit, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, China
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