Surgical intervention for acute pancreatitis in the COVID-19 era

Approximately 15%-19% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. Acute pancreatitis (AP) has been reported in 0.1% of patients with coronavirus disease 2019 (COVID-19). Biliary AP was most common (78.4%) before the COVID-19 pandemic; idiopathic AP is most common in patients with COVID-19 (up to 57.1%). The number of emergency department presentations decreased by 23.3% during the pandemic and many governments made national recommendations to delay nonurgent endoscopic procedures, leading to decrements of 22% in combined esophagogastroduodenoscopy (EGD) and colonoscopy and 20% in EGD after the COVID-19 pandemic. The symptoms and signs of COVID-19-related AP are fever (63%), abdominal pain (58%), respiratory symptoms (40%), nausea and vomiting (39%), and headache (4%). Approximately 5-10% of patients develop necrotizing or hemorrhagic AP, and patients who required surgical intervention had a higher mortality risk. Compared to 2019, the rates of elective surgery decreased by 41.8% in 2020; including cholecystectomy (40.1% decrease) and pancreas (111.1% decrease). Surgical volumes also decreased by 18.7% in 2020; device-assisted laparoscopic and robot-assisted procedures reduced by 45.4% and 61.9% during the COVID-19 Lockdown in 2020.     

Fecal Microbiota Transplantation for Recurrent C difficile Infection During the COVID-19 Pandemic: Experience and Recommendations

ObjectiveTo report experience with fecal microbiota transplantation (FMT) for recurrent Clostridioides difficile infection (rCDI) and provide recommendations for management of rCDI and donor testing during the COVID-19 pandemic.MethodsA retrospective study of patients with rCDI who underwent FMT from May 26, 2020, to September 30, 2020, with stool from well-screened donors with health and infectious screening and a newly implemented strategy for COVID-19 screening with every 2-week bookend testing with stool quarantine. Patients were followed up for development of rCDI and COVID-19.ResultsOf the 57 patients who underwent FMT for rCDI, 29 were tested for COVID-19 via nasopharyngeal polymerase chain reaction (PCR) and 22 via serology. All results were negative, except for 1 positive serology. Donor testing every 2 weeks for COVID-19 via serology and nasopharyngeal swab PCR was negative, except for 2 donors at 1 center who were excluded. Three patients had rCDI after FMT, and 1 underwent repeat FMT. One patient developed respiratory symptoms suggestive of COVID-19 and tested negative via nasopharyngeal PCR. Eleven patients who underwent COVID-19 testing for elective procedures or hospitalizations tested negative. No SARS-CoV-2 transmission was noted.ConclusionsWith appropriate donor screening, FMT can be performed safely for rCDI during the COVID-19 pandemic. Development of a validated stool assay for SARS-CoV-2 will simplify this process further.     

Problematics of neurosurgical service during the COVID-19 pandemic in Slovenia

The novel coronavirus disease 2019 (COVID-19) is an ongoing disease caused by severe acute respiratory syndrome coronavirus-2 that still poses an important and urgent threat to global health. In Slovenia, the epidemic was declared on March 12^th, 2020, and since then COVID-19 has had a great impact on our health system. The field of neurosurgery in particular has been experiencing difficulties in both elective and emergency service. In this article, we described epidemiologic protocols and the effect that the COVID-19 pandemic had on the surgical practice and workflow of the Department of Neurosurgery at the University Medical Centre Ljubljana. We analyzed and compared the number of elective and emergency neurosurgical procedures in a 2-year period before and during the pandemic. We recorded a drop in cases mostly on account of elective procedures whilst emergency service remained relatively unaffected.     

基于新型冠状病毒肺炎疫情防控的大型公立医院医疗流程构建

新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战。大型公立医院作为应对新型冠状病毒肺炎的主战场，应从门诊、急诊、住院、手术、出院全流程进行把控。预检分诊作为医院的首层关卡，是疫情防控的关键节点，需重点关注并加强相关应对机制的建设，以快速遏制外源性/内源性危险因素；同时落实全员培训与考核，加强互联网诊疗等信息化建设，为医院诊疗工作的有序开展保驾护航。     

基于新型冠状病毒肺炎疫情防控的大型公立医院医疗流程构建

新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战。大型公立医院作为应对新型冠状病毒肺炎的主战场,应从门诊、急诊、住院、手术、出院全流程进行把控。预检分诊作为医院的首层关卡,是疫情防控的关键节点,需重点关注并加强相关应对机制的建设,以快速遏制外源性/内源性危险因素;同时落实全员培训与考核,加强互联网诊疗等信息化建设,为医院诊疗工作的有序开展保驾护航。     

Management of blood supply and demand during the COVID-19 pandemic in King Abdullah Hospital,Bisha, Saudi Arabia

BackgroundMaintaining blood supply is essential since blood transfusions are lifesaving in many conditions. The 2003 infectious outbreak of SARS-CoV had a negative impact on blood supply. This study aimed to measure donor attendance and blood demand in order to help find efficient ways of managing blood supply and demand during the COVID-19 pandemic and similar public emergencies in the future.Materials and methodsData from donor attendance, mobile blood drives and blood inventory records were retrospectively obtained for the period between 1 September 2019 and 1 May 2020 to assess the impact of COVID-19 on donor attendance and the management of blood supply and demand in King Abdullah Hospital, Bisha, Saudi Arabia. Data were analysed using SPSSStatistics, version 25.0. Categorical variables were described using frequencies and percentages.ResultsAfter imported cases of COVID-19 were reported in Saudi Arabia, donor attendance and blood supply at blood bank-based collections showed a drop of 39.5%. On the other hand, blood demand during the same period was reduced by 21.7%.ConclusionsThe COVID-19 pandemic had a negative impact on donor attendance and blood supply and adversely affected blood transfusion services. Guidelines that prioritize blood transfusion should prepare at the beginning of emergencies similar to this pandemic. Close monitoring of blood needs and blood supply and appropriate response is essential for avoiding sudden blood shortage. An evidence-based emergency blood management plan and flexible regulatory policy should be ready to deal with any disaster and to respond quickly in the case of blood shortage.     

The Work Experience of Newly Recruited Male Nurses during COVID-19: A Qualitative Study

PurposeThis study was to investigate the work experience of newly recruited male nurses during the COVID-19 pandemic.MethodsWith a phenomenological approach, this qualitative study was adopted semistructured interviews by phone or video calls. A total of 9 male nurses newly recruited for the COVID-19 wards in Chinese hospitals were interviewed for this study. And Colaizzi's method was applied for evaluation in the data analysis.ResultsBased on our findings, three themes were extracted. First, the newly recruited male nurses showed negative emotions at the beginning of COVID-19 epidemic, which was caused by changes in working conditions and content, but also prompted the nurses to change the way of coping with the crisis. Second, they gradually mastered the working skills and psychological training to cope with COVID-19 and developed a positive attitude toward life and a high sense of professional responsibility. Finally, we learned about their needs to respond to public health emergencies such as the COVID-19 pandemic.ConclusionCOVID-19 is a disaster for all of humanity. The newly recruited male nurses are an important force in emergency rescue. Although they suffered from short-term negative emotions, they quickly adapted to the crisis. In order to better prepare for future emergencies, the disaster response capacity of newly recruited male nurses needs to be further improved. In addition, newly recruited male nurses have a strong demand for timely and personalized career development guidance.     

Reconstruction surgery in head and neck cancer patients amidst the COVID-19 pandemic: Current practice and lessons for the future

The coronavirus disease 2019 (COVID-19) pandemic has imposed a radical change in daily life and work routine. In this context, health systems have suffered important and serious repercussions in all fields. Among the changes brought about by the state of global health emergency, adjustments to guidelines, priorities, structures, professional teams, and epidemiological data stand out. In light of this, the oncological field has witnessed several changes in the approach to cancer, whether due to delay in diagnosis, screening deficit, personnel shortage or the psychological impact that the pandemic has had on cancer patients. This article focuses on the management of oral carcinoma and the surgical approaches that oral and maxillofacial specialists have had at their disposal during the health emergency. In this period, the oral and maxillofacial surgeons have faced many obstacles. The proximity of maxillofacial structures to the airways, the need of elective and punctual procedures in cancerous lesions, the aggressiveness of head and neck tumors, and the need for important healthcare costs to support such delicate surgeries are examples of some of the challenges imposed for this field. One of the possible surgical 'solutions' to the difficulties in managing surgical cases of oral carcinoma during the pandemic is locoregional flaps, which in the pre-COVID-19 era were less used than free flaps. However, during the health emergency, its use has been widely reassessed. This setback may represent a precedent for opening up new reflections. In the course of a long-term pandemic, a reassessment of the validity of different medical and surgical therapeutic approaches should be considered. Finally, given that the pandemic has high-lighted vulnerabilities and shortcomings in a number of ways, including the issues of essential resource shortages, underinvestment in public health services, lack of coordination and versatility among politicians, policymakers and health leaders, resulting in overloaded health systems, rapid case development, and high mortality, a more careful analysis of the changes needed in different health systems to satisfactorily face future emergencies is essential to be carried out. This should be directed especially towards improving the management of health systems, their coordination as well as reviewing related practices, even in the surgical field.     

Working experience of certified nursing assistants in the greater New York City area during the COVID-19 pandemic: Results from a survey Study

This study aimed to examine the challenges and needs of certified nursing assistants (CNAs) working in nursing homes during the COVID-19 pandemic in the greater New York City area. Between September and November of 2020, a telephone survey was administered to and completed by 208 CNAs in the study area about various aspects of their working experience during COVID-19. CNAs reported significant exposure to COVID-19 and experienced additional emotional and financial strain due to the pandemic. CNAs also expressed the influence of COVID-19 on their work schedules and intent to continue working as CNAs, and strong interest in financial support and further training. This study offers empirical insights into the experiences of CNAs working in nursing homes during the pandemic, which are of unique value to inform future efforts to support CNAs and other long-term care providers in general and during public health emergencies in New York and beyond.     

2020年10月中国大陆需关注的突发公共卫生事件风险评估

目的评估2020年10月在我国大陆地区发生或者可能由境外输入的突发公共卫生事件风险。方法2020年9月29日中国疾病预防控制中心根据国内外突发公共卫生事件报告及重点传染病监测等各种资料和部门通报信息，采用专家会商法，并通过视频会议形式邀请省（自治区、直辖市）疾病预防控制中心专家参与评估。结果随着学校和托幼机构开学、经济活动恢复，预计2020年10月我国的突发公共卫生事件的报告数将较9月有上升，可能会接近往年同期平均水平。 全球新型冠状病毒肺炎疫情此起彼伏、持续蔓延，我国境内自2020年8月29日以来全部恢复低风险水平。 我国发生新型冠状病毒肺炎输入及其续发本地传播风险持续存在，目前采取积极的外防输入、内防反弹的策略，一旦发现本地疫情则采取常态化精准防控和局部疫情应急处置相结合的措施；在做好合法入境人员管理、加强输入冷冻品监测和非法入境人员管理的情况下，我国能够继续做到有效发现和及时控制再次发生的本地疫情。 10月还需要注意预防诺如病毒感染性腹泻和食物中毒。结论需要对新型冠状病毒肺炎予以特别关注，对诺如病毒感染性腹泻和食物中毒予以一般关注。     

Investigating the initial effect of COVID-19 on the functioning of outpatient diagnostic imaging facilities

IntroductionAs a result of the COVID-19 pandemic, outpatient diagnostic imaging (DI) facilities experienced decreased operations and even unprecedented closures. The purpose of this study was to examine the impact of COVID-19 on the practices of DI clinics, and investigate the reasons for the change in their operations during the initial period of the pandemic starting in mid-March 2020.Materials and methodsA questionnaire was created and distributed to the managers of eighteen outpatient DI clinics in London, Hamilton, and Halton, Ontario, Canada. The managers indicated whether their clinics had closed or decreased operations, the reasons for closure, and the types of imaging examinations conducted in the initial period of the COVID-19 pandemic.ResultsFifty percent of the DI clinics surveyed (9/18) closed as a result of COVID-19, and those that remained open had decreased hours of operation. The clinics that closed indicated decreased referrals as the primary reason for closure, followed by staff shortage, concerns for safety, and suspension of elective imaging. Chest radiography and obstetric ultrasound were the most commonly conducted examinations. Clinics that were in close geographical proximity were able to redistribute imaging examinations amongst themselves. All DI clinics had suspended BMD examinations and elective breast screening, and some transitioned to booked appointments only.ConclusionMany DI clinics needed to close or decrease operations as a result of COVID-19, a phenomenon that is unprecedented in radiological practice. The results of this study can assist outpatient DI clinics in preparing for subsequent waves of COVID-19, future pandemics, and other periods of crisis.     

Colorectal cancer knowledge, perceptions, and behaviors in African Americans

Disparities in healthcare among racial and ethnic minorities are associated with poor outcomes. African Americans have the highest incidence of colorectal cancer (CRC) among all racial groups. Using a nonrandom sample of 100 African American men and women, 50 years of age and older, the authors explored CRC knowledge, perceptions, and screening behaviors of African American men and women who resided or worked in an urban low-income housing residence. The extent to which screening may be attributed to demographic, sociopsychological, and structural variables was also investigated. Respondents demonstrated inadequate knowledge of CRC, with a significant difference in mean scores between males and females. Self-report of participation in CRC screening was above the national average, with almost half of the sample reporting fecal occult blood home kit use and more than half of the sample reporting completion of sigmoid and colonoscopy exams and double contrast barium enema exam. A majority perceived CRC as a threat. A very high percentage perceived numerous benefits to CRC screening in preventing CRC susceptibility. Perceived barriers of nearly half of the sample included screening may be painful and afraid to find out something is wrong if I have CRC screening, while more than half did not know how to schedule screening. Barriers and threat were correlated with grade school education. Barriers were negatively correlated with secondary education and post-secondary education and moderately correlated with threat. Predictor variables found in the Health Belief Model accounted for a significant amount of the variance in screening behavior, barriers, and threat. Older African American men and women need more information about CRC in order to increase their awareness of CRC and the importance of screening. There is a need to educate healthcare professionals about the causes, prevention, and detection of CRC and the importance of screening.     

Emergency Department Use by Young Adults With Chronic Illness Before and During the COVID-19 Pandemic

IntroductionThere was a significant decrease in emergency department encounters during the COVID-19 pandemic. Our large urban emergency department observed decreased encounters and admissions by youths with chronic health conditions. This study aimed to compare the frequency of emergency department encounters for certain young adults before the pandemic and during the COVID-19 pandemic.MethodsA retrospective cohort study using medical records of patients ages 20 to 26 years from October 2018 to September 2019 and February 2020 to February 2021. Files set for inclusion were those with a primary diagnosis of human immunodeficiency virus, diabetes mellitus, epilepsy, cerebral palsy, sickle cell disease, asthma, and certain psychiatric disorders for potentially preventable health events.ResultsWe included 1203 total encounters (853 before the pandemic and 350 during the pandemic), with the total number of subjects included in the study 568 (293 before the pandemic to 239 during the pandemic). During the pandemic, young adults with mental health conditions (53.1%) accounted for most encounters. Encounters requiring hospital admissions increased from 27.4% to 52.5% during the pandemic, primarily among patients with diabetes (41.8% vs 61.1%) and mental health conditions (50% vs 73.3%).DiscussionThe number of young adults with certain chronic health conditions decreased during COVID-19, with encounters for subjects with mental health conditions increasing significantly. The proportion of admissions increased during the pandemic with increases for subjects with mental health disorders and diabetes. The number of frequent users decreased during COVID-19. Future research is needed to understand better the causes for these disparities in young adults with chronic conditions who use the emergency department as a source of care.     

Pain,mental health and healthcare utilization: Impact of the COVID-19 pandemic on youth with chronic pain,parents and siblings

Background

Paediatric chronic pain was a public health emergency before the novel coronavirus (COVID-19) pandemic, and this problem is predicted to escalate. Pain tends to occur intergenerationally in families, and youth with chronic pain and their parents have high rates of mental health issues, which can further exacerbate pain. Siblings of youth with chronic pain have been largely overlooked in research, as well as the impact of the pandemic on posttraumatic stress disorder (PTSD) symptoms and healthcare utilization.

Methods

This cross-sectional study examined pain, mental health and healthcare utilization in three groups: youth with chronic pain (n = 357), parents of youth with chronic pain (n = 233) and siblings of youth with chronic pain (n = 156) during the COVID-19 pandemic in Canada.

Results

More so than with pain symptoms, the results revealed high levels of mental health symptoms (i.e. anxiety, depressive, and PTSD), particularly in individuals more personally impacted by the pandemic. The largest effect was seen on PTSD symptoms for all groups. For parents with chronic pain, greater personal COVID-19 impact was related to worse pain interference. Reported rates of healthcare utilization were strikingly high, with youth with chronic pain, parents (reporting on behalf of their children with chronic pain), and siblings of youth with chronic pain reporting that most consultations were due to pain.

Conclusions

Longitudinal research assessing these outcomes across continued waves of the pandemic is needed to ensure timely, tailored and equitable access to pain and mental health assessment and treatment.

Significance

This study examined pain, mental health, substance use and healthcare utilization in youth with chronic pain, siblings and parents during the COVID-19 pandemic. Greater personal impact of the pandemic was not largely associated with poorer pain outcomes; however, it was associated with mental health, with the largest effect on PTSD symptoms. The high rates and significant association of COVID-19 impact with PTSD symptoms underscore the importance of including PTSD assessment as part of routine screening practices in pain clinics.     

新型冠状病毒肺炎疫情期间血管外科急症救治的“SEAS”原则及策略

血管外科急症临床常见、病情凶险、死亡率高,在新型冠状病毒肺炎(COVID-19)防控期间的救治难度和风险增加。目前鲜见血管外科急诊手术相关原则和策略报道。本文结合血管外科疾病本身急诊和病变特点,以及疫情期间本中心诊疗体会,提出“SEAS”原则及策略,即遵循安全(safe)、有效(effective)的原则,采取避免或减少(avoidance)、简捷(simple)的策略,可在有效防控COVID-19疫情的同时,及时、安全、有效地开展血管外科急症救治。     

粪便SDC2基因甲基化检测联合结肠镜在早期结直肠癌筛查中的意义

目的探讨粪便SDC2基因甲基化检测联合结肠镜在早期结直肠癌(CRC)筛查中的意义。方法选择2018年1月-2019年10月在深圳市宝安区中心医院体检的1 000例体检者作为研究对象,使用试剂盒分别检测粪便SDC2基因甲基化和血浆SEPT9基因甲基化,对两者任一结果为阳性者再行结肠镜检查。比较SDC2和SEPT9基因甲基化检测的阳性率以及两者联合结肠镜对进展性腺瘤和CRC的检出率。结果在1 000例筛查对象中,粪便SDC2基因甲基化检测阳性率明显高于血浆SEPT9基因甲基化〔18.10%(181/1 000)比9.80%(98/1 000)〕,差异有统计学意义(P<0.05);粪便SDC2基因甲基化检测联合结肠镜对进展性腺瘤和CRC的检出率均明显高于血浆SEPT9基因甲基化检测联合结肠镜筛查〔进展性腺瘤检出率:2.50%(25/1 000)比1.00%(10/1 000),CRC检出率:1.50%(15/1 000)比0.50%(5/1 000)〕,差异均有统计学意义(均P<0.05)。结论粪便SDC2基因甲基化检测是一种简单无创的CRC筛查新技术,患者接受程度更高,能够避免大规模肠镜筛查带来的弊端,联合结肠镜检测可作为CRC早期筛查的首选策略。     

Cardiovascular nurses' experiences of working in the COVID-19 intensive care unit: A qualitative study

BackgroundCardiovascular nurses’ skills and experiences of cardiac critical care, management of cardiovascular emergencies, and mechanical circulatory support have been considered vital in providing nursing care for COVID-19 patients in intensive care units during the COVID-19 pandemic. To our knowledge, there are no studies have focused on the contribution and experiences of cardiovascular nurses in the critical care of COVID-19 patients.ObjectivesTo explore the experiences of cardiovascular nurses working in a COVID-19 intensive care unit during the pandemic.MethodsThe study was conducted as a qualitative study with phenomenological approach in June-December 2020. Study data were gathered from ten cardiovascular nurses through semi-structured interviews.ResultsSix themes emerged from the interview data: the duties and responsibilities in a COVID-19 intensive care unit; the differences of COVID-19 intensive care unit practices from cardiovascular practices; the transferrable skills of cardiovascular nurses in a COVID-19 intensive care unit; the difficulties encountered working in a COVID-19 intensive care unit; the difficulty of working with personal protective equipment; and the psychosocial effects of working in a COVID-19 intensive care unit.ConclusionCardiovascular nurses made an important contribution to the management of nursing services with their experiences and skills in the COVID-19 pandemic.     

新型冠状病毒肺炎疫情期间单孔胸腔镜在胸部急诊手术中的优势及围手术期处理

目的探讨新型冠状病毒肺炎（新冠肺炎）疫情下单孔胸腔镜急诊手术的优势及围手术期注意事项。 方法回顾性分析涿州市医院在2020年1月至2月新冠肺炎疫情期间6例急诊单孔胸腔镜手术的术前筛查、手术室预防、麻醉、围手术期处理的特点及诊治要点,总结单孔胸腔镜手术的优势。 结果6例患者术前CT及血常规筛查均为阴性,经过术后证实最终均未检出新型冠状病毒感染。急诊手术按照潜在感染进行防护准备,尽量缩短麻醉和手术过程。6例手术胸腔内操作均采用单孔胸腔镜手术,术中另备一套吸引器加强胸腔内烟雾气体吸引。1例行支气管肺修补,4例行肺部分切除术,其中2例合并肋骨骨折的患者加行腔镜辅助下肋骨骨折固定术,1例在全麻双腔气管插管下行单孔胸腔镜下肺叶切除术。术后住院时间平均为5.8 d。无严重并发症发生,但一次性器材及消毒处理的费用较疫情前平均增加约30%。 结论单孔胸腔镜手术具有创伤小、烟雾密闭性好的特点,适宜疫情期间急诊手术采用;疫情期间围手术期预防处理应加强防护等级,即使初次CT及血常规筛查新型冠状病毒感染阴性的患者也应按照潜在感染患者对待。     

新冠肺炎流行期间护理本科实习生职业认同现状及其对突发公共卫生事件应急态度的影响

目的:调查新冠肺炎流行期间护理本科实习生职业认同现状,并探讨其对突发公共卫生事件应急态度的影响。方法:采用一般资料调查表、护生职业认同量表和护士突发公共卫生事件应急态度量表对河南省某三级甲等综合医院的301名护理本科实习生进行调查。结果:护理本科实习生职业认同得分为(64.04±12.02)分,突发公共卫生事件应急态度条目均分为(3.95±0.54)分。职业认同和突发公共卫生事件应急态度呈正相关(r=0.588,P<0.01)。分层回归分析结果显示,职业认同独立解释突发公共卫生事件应急态度变异的24.8%。结论:新冠肺炎流行期间护理本科实习生职业认同良好,突发公共卫生事件应急态度处于中等水平,职业认同是突发公共卫生事件应急态度的重要影响因素。本科院校应为护理专业在读学生设置突发公共卫生事件应对相关课程,同时重视职业认同的培养,从而提高其突发公共卫生事件应急态度积极程度。     

Risk perception trajectory of elderly chronic disease patients in the community under COVID-19: A qualitative research

IntroductionWhile traditional “non-medical” prevention and control measures have achieved remarkable results during the COVID-19 pandemic, they have generated difficult situations for older adult patients with chronic disease. The purpose of this study was to understand and identify the COVID-19 risk perception process and trajectory among older adults with chronic disease living in the community.Material and methodsThis was a qualitative research study that used in-depth semi-structured interviews to explore the experiences of 21 older adult patients with chronic disease. Data were analyzed using conventional content analysis methods.ResultsThree themes emerged: restricted travel, psychological shock and panic, and unintended consequences.ConclusionsThe perceptions of epidemic risk among older adult patients with chronic disease living in the community had varying characteristics at different stages. Correct identification of risk perception processes and trajectories will assist in formulating more scientific emergency measures in the event of future public health emergencies.