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Sun Y, Li H, Luo G, Meng X, Guo W, Fitzpatrick T, Ao Y, Feng A, Liang B, Zhan Y, Sande A, Xie F, Wang Y, Qian H, Cai Y, Zou H. Antiretroviral treatment interruption among people living with HIV during COVID-19 outbreak in China: a nationwide cross-sectional study. J Int AIDS Soc 2020; 23:e25637. [PMID: 33247541 PMCID: PMC7645858 DOI: 10.1002/jia2.25637] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 10/09/2020] [Accepted: 10/20/2020] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Social disruption associated with coronavirus disease 2019 (COVID-19) threatens to impede access to regular healthcare, including for people living with HIV (PLHIV), potentially resulting in antiretroviral therapy (ART) interruption (ATI). We aimed to explore the characteristics and factors associated with ATI during the COVID-19 outbreak in China. METHODS We conducted an online survey among PLHIV by convenience sampling through social media between 5 and 17 February 2020. Respondents were asked to report whether they were at risk of ATI (i.e. experienced ATI, risk of imminent ATI, threatened but resolved risk of ATI [obtaining ART prior to interruption]) or were not at risk of ATI associated with the COVID-19 outbreak. PLHIV were also asked to report perceived risk factors for ATI and sources of additional ART. The factors associated with the risk of ATI were assessed using logistic regression. We also evaluated the factors associated with experienced ATI. RESULTS A total of 5084 PLHIV from 31 provinces, autonomous regions and municipalities in mainland China completed the survey, with valid response rate of 99.4%. The median age was 31 years (IQR 27 to 37), 96.5% of participants were men, and 71.3% were men who had sex with men. Over one-third (35.1%, 1782/5084) reported any risk of ATI during the COVID-19 outbreak, including 2.7% (135/5084) who experienced ATI, 18.0% (917/5084) at risk of imminent ATI and 14.4% (730/5084) at threatened but resolved risk. PLHIV with ATI were more likely to have previous interruptions in ART (aOR 8.3, 95% CI 5.6 to 12.3), travelled away from where they typically receive HIV care (aOR 3.0, 95% CI 2.1 to 4.5), stayed in an area that implemented citywide lockdowns or travel restrictions to control COVID-19 (aOR 2.5, 95% CI 1.4 to 4.6), and be in permanent residence in a rural area (aOR 3.7, 95% CI 2.3 to 5.8). CONCLUSIONS A significant proportion of PLHIV in China are at risk of ATI during the COVID-19 outbreak and some have already experienced ATI. Correlates of ATI and self-reported barriers to ART suggest that social disruptions from COVID-19 have contributed to ATI. Our findings demonstrate an urgent need for policies and interventions to maintain access to HIV care during public health emergencies.
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Affiliation(s)
- Yinghui Sun
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | - Hui Li
- Shizhong District Center for Disease Control and PreventionJinanChina
| | - Ganfeng Luo
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | - Xiaojun Meng
- Wuxi Municipal Center for Disease Control and PreventionWuxiChina
| | - Wei Guo
- UNAIDS China OfficeBeijingChina
| | | | - Yunlong Ao
- Department of Infectious DiseasesGuangzhou Eighth People’s Hospital affiliated to Guangzhou Medical SchoolGuangzhouChina
| | - Anping Feng
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | - Bowen Liang
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | - Yuewei Zhan
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
| | | | - Feng Xie
- Chongqing Blue Sky nongovernment organizationChongqingChina
| | - Ying Wang
- School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Han‐Zhu Qian
- SJTU‐Yale Joint Center for Biostatistics and Data ScienceDepartment of Bioinformatics and BiostatisticsSchool of Life Science and BiotechnologyShanghai Jiao Tong University (SJTU)ShanghaiChina
- Yale School of Public HealthNew HavenCTUSA
| | - Yong Cai
- School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Huachun Zou
- School of Public Health (Shenzhen)Sun Yat‐sen UniversityShenzhenChina
- School of Public HealthShanghai Jiao Tong University School of MedicineShanghaiChina
- Shenzhen Center for Disease Control and PreventionShenzhenChina
- Kirby InstituteUniversity of New South WalesSydneyAustralia
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Abstract
BACKGROUND Surgeons urgently need guidance on how to deliver surgical services safely and effectively during the COVID-19 pandemic. The aim was to identify the key domains that should be considered when developing pandemic preparedness plans for surgical services. METHODS A scoping search was conducted to identify published articles relating to management of surgical patients during pandemics. Key informant interviews were conducted with surgeons and anaesthetists with direct experience of working during infectious disease outbreaks, in order to identify key challenges and solutions to delivering effective surgical services during the COVID-19 pandemic. RESULTS Thirteen articles were identified from the scoping search, and surgeons and anaesthetists representing 11 territories were interviewed. To mount an effective response to COVID-19, a pandemic response plan for surgical services should be developed in advance. Key domains that should be included are: provision of staff training (such as patient transfers, donning and doffing personal protection equipment, recognizing and managing COVID-19 infection); support for the overall hospital response to COVID-19 (reduction in non-urgent activities such as clinics, endoscopy, non-urgent elective surgery); establishment of a team-based approach for running emergency services; and recognition and management of COVID-19 infection in patients treated as an emergency and those who have had surgery. A backlog of procedures after the end of the COVID-19 pandemic is inevitable, and hospitals should plan how to address this effectively to ensure that patients having elective treatment have the best possible outcomes. CONCLUSION Hospitals should prepare detailed context-specific pandemic preparedness plans addressing the identified domains. Specific guidance should be updated continuously to reflect emerging evidence during the COVID-19 pandemic.
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Recommended operating room practice during the COVID-19 pandemic: systematic review. BJS Open 2020; 4:748-756. [PMID: 32395909 PMCID: PMC7272923 DOI: 10.1002/bjs5.50304] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023] Open
Abstract
Background The COVID‐19 pandemic poses a critical global public health crisis. Operating room (OR) best practice in this crisis is poorly defined. This systematic review was performed to identify contemporary evidence relating to OR practice in the context of COVID‐19. Methods MEDLINE was searched systematically using PubMed (search date 19 March 2020) for relevant studies in accordance with PRISMA guidelines. Documented practices and guidance were assessed to determine Oxford Centre for Evidence‐Based Medicine (OCEBM) levels of evidence, and recommendations for practice within five domains were extracted: physical OR, personnel, patient, procedure, and other factors. Results Thirty‐five articles were identified, of which 11 met eligibility criteria. Nine articles constituted expert opinion and two were retrospective studies. All articles originated from the Far East (China, 9; Singapore, 2); eight of the articles concerned general surgery. Common themes were identified within each domain, but all recommendations were based on low levels of evidence (median OCEBM level 5 (range 4–5)). The highest number of overlapping recommendations related to physical OR (8 articles) and procedural factors (13). Although few recommendations related to personnel factors, consensus was high in this domain, with all studies mandating the use of personal protective equipment. Conclusion There was little evidence to inform this systematic review, but there was consensus regarding many aspects of OR practice. Within the context of a rapidly evolving pandemic, timely amalgamation of global practice and experiences is needed to inform best practice.
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic. J Visc Surg 2020; 157:S7-S12. [PMID: 32249098 PMCID: PMC7269902 DOI: 10.1016/j.jviscsurg.2020.03.008] [Citation(s) in RCA: 105] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The Covid-19 pandemic is changing the organization of healthcare and has a direct impact on digestive surgery. Healthcare priorities and circuits are being modified. Emergency surgery is still a priority. Functional surgery is to be deferred. Laparoscopic surgery must follow strict rules so as not to expose healthcare professionals (HCPs) to added risk. The question looms large in cancer surgery-go ahead or defer? There is probably an added risk due to the pandemic that must be balanced against the risk incurred by deferring surgery. For each type of cancer-colon, pancreas, oesogastric, hepatocellular carcinoma-morbidity and mortality rates are stated and compared with the oncological risk incurred by deferring surgery and/or the tumour doubling time. Strategies can be proposed based on this comparison. For colonic cancers T1-2, N0, it is advisable to defer surgery. For advanced colonic lesions, it seems judicious to undertake neoadjuvant chemotherapy and then wait. For rectal cancers T3-4 and/or N+, chemoradiotherapy is indicated, short radiotherapy must be discussed (followed by a waiting period) to reduce time of exposure in the hospital and to prevent infections. Most complex surgery with high morbidity and mortality-oesogastric, hepatic or pancreatic-is most often best deferred.
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Affiliation(s)
- J-J Tuech
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France.
| | - A Gangloff
- Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - F Di Fiore
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - P Michel
- Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France; Rouen University Hospital, Department of Digestive Oncology, 1, rue de Germont, 76031 Rouen cedex, France
| | - C Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K Slim
- Department of digestive surgery, CHU Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M Pocard
- Université de Paris, UMR 1275 CAP Paris-Tech, 75010 Paris, France; Service de chirurgie digestive et cancérologique Hôpital Lariboisière, 2, rue Ambroise Paré, 75010 Paris, France
| | - L Schwarz
- Rouen University Hospital, Department of Digestive Surgery, 1, rue de Germont, 76031 Rouen cedex, France; Normandie University, UNIROUEN, UMR 1245 Inserm, Rouen University Hospital, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, 76000 Rouen, France
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Moujaess E, Kourie HR, Ghosn M. Cancer patients and research during COVID-19 pandemic: A systematic review of current evidence. Crit Rev Oncol Hematol 2020; 150:102972. [PMID: 32344317 PMCID: PMC7174983 DOI: 10.1016/j.critrevonc.2020.102972] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 02/06/2023] Open
Abstract
The novel coronavirus, also known as SARS-Cov-2 or COVID-19 has become a worldwide threat and the major healthcare concern of the year 2020. Cancer research was directly affected by the emerging of this disease. According to some Chinese studies, cancer patients are more vulnerable to COVID-19 complications. This observation led many oncologists to change their daily practice in cancer care, without solid evidence and recommendations. Moreover, the COVID-19 manifestations as well as its diagnosis are particular in this special population. In this review paper we expose the challenges of cancer management in the era of SARS-CoV-2, the epidemiological, clinical, pathological and radiological characteristics of the disease in cancer patients and its outcomes on this population. Finally, we focus on strategies that are followed in cancer management with review of national and international guidelines.
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Affiliation(s)
- Elissar Moujaess
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Hampig Raphael Kourie
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon.
| | - Marwan Ghosn
- Hematology-Oncology Department, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
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Søreide K, Hallet J, Matthews JB, Schnitzbauer AA, Line PD, Lai PBS, Otero J, Callegaro D, Warner SG, Baxter NN, Teh CSC, Ng-Kamstra J, Meara JG, Hagander L, Lorenzon L. Immediate and long-term impact of the COVID-19 pandemic on delivery of surgical services. Br J Surg 2020; 107:1250-1261. [PMID: 32350857 PMCID: PMC7267363 DOI: 10.1002/bjs.11670] [Citation(s) in RCA: 474] [Impact Index Per Article: 118.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/09/2020] [Indexed: 12/13/2022]
Abstract
Background The ongoing pandemic is having a collateral health effect on delivery of surgical care to millions of patients. Very little is known about pandemic management and effects on other services, including delivery of surgery. Methods This was a scoping review of all available literature pertaining to COVID-19 and surgery, using electronic databases, society websites, webinars and preprint repositories. Results Several perioperative guidelines have been issued within a short time. Many suggestions are contradictory and based on anecdotal data at best. As regions with the highest volume of operations per capita are being hit, an unprecedented number of operations are being cancelled or deferred. No major stakeholder seems to have considered how a pandemic deprives patients with a surgical condition of resources, with patients disproportionally affected owing to the nature of treatment (use of anaesthesia, operating rooms, protective equipment, physical invasion and need for perioperative care). No recommendations exist regarding how to reopen surgical delivery. The postpandemic evaluation and future planning should involve surgical services as an essential part to maintain appropriate surgical care for the population during an outbreak. Surgical delivery, owing to its cross-cutting nature and synergistic effects on health systems at large, needs to be built into the WHO agenda for national health planning. Conclusion Patients are being deprived of surgical access, with uncertain loss of function and risk of adverse prognosis as a collateral effect of the pandemic. Surgical services need a contingency plan for maintaining surgical care in an ongoing or postpandemic phase.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - J Hallet
- Department of Surgery, Sunnybrook and University of Toronto, Toronto, Ontario, Canada
| | - J B Matthews
- Department of Surgery, University of Chicago, Chicago, Illinois, USA
| | - A A Schnitzbauer
- Department for General, Visceral and Transplant Surgery, Frankfurt University Hospital, Goethe University, Frankfurt/Main, Germany
| | - P D Line
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - P B S Lai
- Department of Surgery, Chinese University of Hong Kong, Hong Kong, China
| | - J Otero
- Department of Surgery, Hospital Clinico San Carlos, Madrid, Spain
| | - D Callegaro
- Department of Surgery, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Nazionale Tumori, Milan, Spain
| | - S G Warner
- City of Hope Comprehensive Cancer Center, Duarte, California, USA
| | - N N Baxter
- Melbourne School of Public Health, University of Melbourne, Melbourne, Victoria, Australia
| | - C S C Teh
- Institute of Surgery, St Luke's Medical Centre, Metro Manila, Philippines.,Department of Surgery, Makati Medical Centre, Makati, Philippines.,Department of General Surgery, National Kidney and Transplant Institute, Quezon City, Philippines
| | - J Ng-Kamstra
- Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada
| | - J G 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
| | - L Hagander
- Lund University WHO Collaborating Centre for Surgery and Public Health, Paediatric Surgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - L Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, Rome, Italy
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Tuech JJ, Gangloff A, Di Fiore F, Michel P, Brigand C, Slim K, Pocard M, Schwarz L. [Strategy for the practice of digestive and oncologic surgery in COVID-19 epidemic situation]. ACTA ACUST UNITED AC 2020; 157:S6-S12. [PMID: 32834885 PMCID: PMC7271206 DOI: 10.1016/j.jchirv.2020.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
La pandémie due au COVID-19 modifie l’organisation des soins et change la réalisation de la chirurgie digestive. Les priorités sanitaires et les circuits de soins sont modifiés. La chirurgie d’urgence reste prioritaire. Les interventions pour chirurgie fonctionnelles sont à reporter. La chirurgie par laparoscopie doit suivre des règles strictes pour ne pas exposer les professionnels à un surrisque. Le questionnement principal concerne la chirurgie oncologique, opérer ou reporter ? Il existe probablement un sur risque opératoire induit par la pandémie qui doit être mis en balance avec le retard de prise en charge chirurgical. Pour chaque type de cancer, colon, pancréas, œsogastrique, hépatocarcinome, la morbi-mortalité est rappelée et mise en parallèle avec le risque oncologique lié au retard à la chirurgie et/ou au temps de doublement de la tumeur. Cette comparaison permet de proposer des stratégies, ainsi pour les cancers coliques (T1-2, N0), il est souhaitable de retarder la chirurgie. Pour les lésions coliques avancées, il semble prudent de recommander une chimiothérapie néo adjuvante et d’attendre. Pour les cancers du rectum T3-4 et/ou N+, une radio-chimiothérapie est indiquée, une radiothérapie courte devra être discutée (suivie d’une période d’attente) afin de réduire le temps d’exposition à l’hôpital et d’éviter les infections. La majorité des chirurgies complexes à forte morbi-mortalité, œsogastrique, hépatique ou pancréatique doivent sans doute le plus souvent être reportée.
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Affiliation(s)
- J.-J. Tuech
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Auteur correspondant.
| | - A. Gangloff
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - F. Di Fiore
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - P. Michel
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
- Department of Digestive Oncology, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
| | - C. Brigand
- Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 67200 Strasbourg, France
| | - K. Slim
- Department of digestive surgery, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France
| | - M. Pocard
- UMR 1275 CAP Paris-Tech, université de Paris, 75010 Paris, France
- Service de chirurgie digestive et cancérologique, hôpital Lariboisière, 2, rue Ambroise-Paré, 75010 Paris, France
| | - L. Schwarz
- Department of Digestive Surgery, Rouen University Hospital, 1, rue de Germont, 76031 Rouen cedex, France
- UMR 1245 Inserm, Department of Genomic and Personalized Medicine in Cancer and Neurological Disorders, UNIROUEN, Rouen University Hospital, Normandie Université, 76000 Rouen, France
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