泌尿外科新型冠状病毒肺炎防控的医护一体化管理

目的总结医护一体化管理模式在泌尿外科新型冠状病毒肺炎防控中的应用效果。方法成立医护一体化新型冠状病毒肺炎防控小组,强化入院流程管理,精细化病房管理,手术配合管理,优化疾病治疗和护理方法。结果 2020年2月2～24日共收治患者39例,其中5例发热患者经防控小组会诊排除新型冠状病毒肺炎,均顺利进行手术治疗后体温正常。结论医护一体化管理模式在新型冠状病毒肺炎防控中有利于保证患者得到有效治疗和护理,保障患者及医务人员的生命健康。     

新型冠状病毒肺炎疫情期间外科医生的职责与坚守

自2019年12月首例不明来源肺炎在我国武汉市被确认以来[1],疫情迅速蔓延,新型冠状病毒也逐渐被发现与确认[2].这场由新型冠状病毒引发的"疫情大会战"拉开了大幕.2020年1月12日,世界卫生组织(WHO)正式将这一病毒命名为2019新型冠状病毒(2019-nCoV)[3].国家卫生健康委员会已将新型冠状病毒肺炎纳入乙类传染病并按甲类传染病进行防治.已证实,新冠肺炎可在人际间传播,且具有传染性强、人群易感性高、潜伏期长、临床表现多样化等特点,给人民群众生命财产造成巨大损失,给人民群众健康造成巨大威胁,同时也对全国人民的正常工作与生活产生了严重影响.截至2020年2月11日24时,我国累计报告确诊病例44653例,疑似病例16067例,尚有密切医学观察密切接触者185037人,疫情防控形势依然严峻.     

意大利北部新型冠状病毒肺炎合并股骨近端脆性骨折的治疗/CATELLANI F,

正2020年2～4月,意大利北部新型冠状病毒肺炎爆发,骨科病房重点关注老年创伤,尤其是新型冠状病毒肺炎合并股骨颈骨折的治疗。16例股骨近端骨折收入急诊室,近期有发热、气短、血氧饱和度降低等表现,胸部CT和咽拭子检查证实合并新型冠状病毒肺炎,需要住院并给予低分子肝素预防治疗。3     

新型冠状病毒肺炎住院患者心理护理专家共识

目的建立系统的新型冠状病毒肺炎住院患者心理护理模式,规范对新型冠状病毒肺炎患者的心理护理。方法全面回顾国内外新型冠状病毒肺炎相关文献,根据新型冠状病毒肺炎诊疗方案及相关政策,结合心理护理实践,形成初版专家共识,在全国多家医疗机构及院校相关领域专家共同参与下,通过5轮线上线下会议讨论和专家咨询,进行整理和总结,形成终版共识。结果共识包括新型冠状病毒肺炎住院患者心理护理的相关定义、常见心理反应、心理护理流程、特殊人群的心理护理。结论该共识具有一定的科学性和实用性,可为规范新型冠状病毒肺炎住院患者心理护理提供参考。     

新型冠状病毒肺炎患者安全转运的管理

目的探讨安全转运新型冠状病毒肺炎患者的管理。方法参与组织实施1 487例新型冠状病毒肺炎患者的转运,做到周密计划,落实患者准备及物品准备,严格消毒防护。结果患者均安全转移至指定医疗点,参与转运工作的工作人员未发生新型冠状病毒感染。结论全面细致的安排和严格消毒隔离,为大规模新型冠状病毒肺炎患者的安全转运提供了保障。     

传染病专科医院新型冠状病毒肺炎护理应急管理体系构建与实施

目的构建传染病专科医院应对新型冠状病毒肺炎护理应急管理体系,并分析实施效果。方法在新型冠状病毒肺炎疫情暴发期间,迅速构建集管理、培训、调配、救护、感染防控为一体的整体化重大传染病疫情护理应急管理体系,并严格实施。结果从2020年1月21日设置新型冠状病毒肺炎发热门诊和隔离病区,至3月2日发热门诊共接诊发热患者2 330例次;隔离病区收治确诊患者58例,治愈出院56例,转院2例。无医务人员感染。结论护理应急管理体系的建立与有效实施,能够提升传染病专科医院新型冠状病毒肺炎应急救治能力。     

新型冠状病毒肺炎重症隔离病房护理管理策略

目的 探讨新型冠状病毒肺炎重症隔离病房的护理管理方法。方法 通过人员培训、人员配置和排班、建立和实施各项制度与流程、做好医护人员心理疏导和营养保障、加强质控与环节管理5个环节落实新型冠状病毒肺炎病房的护理管理。结果 截至2020年3月10日,收治确诊重症患者130例,治愈出院30例;所有医护人员未发生新型冠状病毒感染。结论 系统的护理管理策略可保障新型冠状病毒肺炎重症隔离病房有序运行,有效完成救治任务,保障医护人员安全。     

新型冠状病毒肺炎疫情期间泌尿外科非新冠肺炎急危重症的治疗建议

新型冠状病毒肺炎(novel coronavirus pneumonia,NCP),简称新冠肺炎,是一种由世界卫生组织(World Health Organization,WHO)命名为2019-nCoV的具有强烈传染性的新型冠状病毒感染引起的肺炎[1]。2019-nCoV除了攻击肺部外,还可引起包括心脏、肾脏等多个器官受损,WHO将该病毒引起的疾病统称为2019年冠状病毒疾病(corona virus disease-19,COVID-19)[2]。新冠肺炎从2019年12月在湖北省武汉市散在发生,逐步蔓延至全国多个省、自治区和直辖市。     

新型冠状病毒对心血管系统影响的研究进展

新型冠状病毒肺炎(COVID-19)患者存在心血管系统受损的临床表现,且此类患者进展为重症或死亡的风险较高.目前尚不清楚新型冠状病毒对心血管系统的影响机制.本文重点介绍新型冠状病毒与心血管系统疾病的相互关系,总结新型冠状病毒损伤心血管系统可能的机制,包括病毒直接损害心肌细胞及其传导系统,细胞因子风暴,氧供需失衡,药物影...     

健脾益肾疏风利湿论治糖尿病肾病合并新型冠状病毒肺炎患者1例

<正>近两年来，新型冠状病毒肺炎于全球范围内广泛流行，导致感染人群病重及病死率显著上升。我们在上海市新型冠状病毒肺炎定点医院利用健脾益肾疏风利湿方成功治愈糖尿病肾病(diabetic nephropathy, DN)合并新型冠状病毒肺炎患者1例，现报道如下。临 床 资 料患者顾某，男，66岁，上海市嘉定区安亭镇人，2022年5月4日因“干咳5 d, 检测新型冠状病毒核酸阳性1 d”入院，入院时干咳，低热，无咽痛、咳痰，无呼吸困难，     

新型冠状病毒肺炎疫情期间对4岁儿童右示指末节两截离断显微再植成功一例

报道1例对4岁儿童右示指末节两截完全离断,离体两截断面挫伤严重,按照新型冠状病毒肺炎(COVID-19)防护需要进行核酸检查和排除诊断后,在严格的防护措施下,进行断指再植术,术后随访2周,再植指体成活良好.     

显微外科预防新型冠状病毒肺炎的应急护理管理措施

目的 探讨手足显微外科在新型冠状病毒肺炎(COVID-19)期间的应急护理管理方法,并评价效果. 方法 2020年1月20日至2月20日,采取应急护理管理措施:做好急诊患者的体温及肺部CT筛查,对所有在院患者及家属进行体温及指脉氧监测,高热或肺部CT异常患者的隔离与确诊,疑似及确诊患者病房的消毒与终末处理,医护人员的个人防护与培训,防护用具的规范使用与管理,病房人力资源的调配与管理,加强住院患者COVID-19的知识宣教以缓解焦虑等,确保患者及医务人员的安全.结果 本科室持续发热患者4例,2例排除COVID-19;1例确诊后转诊;1例高度疑似,已居家隔离.医护人员培训完成率100%,合格率100%.支援一线医护人员共48人,后备人员17人.疫情初期1例医生感染,应急管理措施落实之后无人感染;科室防护用具使用得当;在院患者无过激情绪反应,口罩佩戴依从性100%.结论 科室疫情期间所采取应急管理办法有效避免了院内交叉感染的发生,保障了医务人员及患者的安全,科学及时有效.     

Outcomes of orthopaedic trauma patients undergoing surgery during the peak period of COVID-19 infection at a UK major trauma centre

BackgroundTo review the clinical outcomes of all patients undergoing emergency orthopaedic trauma surgery at a UK major trauma centre during the first 6 weeks of the COVID-19 related lockdown.MethodsA retrospective review was performed of all patients who underwent emergency orthopaedic trauma surgery at a single urban major trauma centre over the first six-week period of national lockdown. Demographics, co-morbidities, injuries, injury severity scores, surgery, COVID-19 status, complications and mortalities were analysed.ResultsA total of 76 patients were included for review who underwent multiple procedures. Significant co-morbidity was present in 72%. The overall COVID-19 infection rate of the study population at any time was 22%. Sub-group analysis indicated 13% had active COVID-19 at the time of surgery. Only 4% of patients developed COVID-19 post surgery with no mortalities in this sub-group. The overall mortality rate was 4%. The overall complication rate was 14%. However mortality and complications rates were higher if the patients had active COVID-19 at surgery, if they were over 70 years and had sustained life-threatening injuries.ConclusionThe overall survival rate for patients undergoing emergency orthopaedic trauma surgery during the COVID-19 peak was 96%. The rate of any complication was more significant in those presenting with active COVID-19 infections who had sustained potentially life threatening injuries and were over 70 years of age. Conversely those without active COVID-19 infection and who lacked significant co-morbidities experienced a lower complication and mortality rate.     

How COVID-19 Patients Were Moved to Speak: A Rehabilitation Interdisciplinary Case Series

Background

Up to 36% of patients admitted to the ICU for COVID-19 require tracheostomy. While the literature recommends the use of multidisciplinary teams in the management of patients with tracheostomy for other diseases, little is known on the collaborative administration of physical therapy and speech language pathology services in the COVID-19 population.

Purpose

We sought to determine the outcomes of a collaboration between physical therapy (PT) and speech language pathology (SLP) in the treatment of patients who underwent tracheostomy placement as part of their treatment for COVID-19 at our facility.

Methods

We conducted a retrospective case series on patients with COVID-19 who had a tracheostomy. We included patients who had undergone mechanical ventilation for 14 days or longer, had a surgical tracheostomy, been discharged from intensive care to a medical unit, and received PT and SLP referrals. We compiled retrospective data from electronic medical records, analyzing days from tracheostomy to achievement of PT and SLP functional milestones, including mobility, communication, and swallowing. Of six critically ill patients with COVID-19 who had tracheostomy placement at our facility, three met inclusion criteria: patient 1, a 33-year-old woman; patient 2, an 84-year-old man; and patient 3, an 81-year-old man. For all patients, PT interventions focused on breathing mechanics, secretion clearance, posture, sitting balance, and upper and lower extremity strengthening. SLP interventions focused on cognitive reorganization, verbal and nonverbal communication, secretion management, and swallowing function. Intensity and duration of the sessions were adapted according to patient response and level of fatigue.

Results

We found that time to tracheostomy from intubation for the three patients was 23 days, 20 days, and 24 days, respectively. Time from tracheostomy insertion to weaning from ventilator was 9 days for patient 1, and 5 days for patient 2 and patient 3. Regarding time to achieve functional PT and SLP milestones, all patients achieved upright sitting with PT prior to achieving initial SLP milestone of voicing with finger occlusion. Variations in progression to swallowing trials were patient specific and due to respiratory instability, cognitive deficits, and limitations in production of an effortful swallow. Patient participation in therapy sessions improved following establishment of oral verbal communication.

Conclusion

Interdisciplinary cooperation and synchronized implementation of PT and SLP interventions in three COVID-19 patients following prolonged intubation facilitated participation in treatment and achievement of functional milestones. Further study is warranted.

     

新型冠状病毒肺炎疫情下急诊创伤骨科诊疗行为的建议和策略

目的探讨新型冠状病毒肺炎(COVID-19)疫情下急诊创伤骨科诊疗行为的建议和策略。方法回顾性分析2020年1月21日至2月15日期间武汉大学人民医院骨外科收治的128例急诊创伤骨科患者资料,男71例,女57例;年龄为5~88岁,平均48.7岁。门诊处置107例;住院手术21例,其中急诊手术4例,择期手术17例。记录患者和医务人员感染COVID-19的情况,总结疫情暴发以来实施的一些措施和经验。结果107例接受门诊处置的患者中,3例确诊COVID-19,3例疑似COVID-19。4例接受急诊手术的患者中,1例疑似COVID-19;17例接受择期手术的患者中,1例确诊COVID-19,2例疑似COVID-19。医务人员感染COVID-19的情况:2名护士确诊COVID-19,但均为轻症患者;1名医生和1名护士均疑似COVID-19。医务人员感染COVID-19均发生在疫情防控措施执行之前,不排除社区感染的可能。结论各级医疗机构在做好COVID-19防控的同时,保证安全、有效的医疗行为正常运转尤为重要。在COVID-19疫情期间,参与急诊创伤骨科的一线医务人员的接诊过程均面临诸多挑战。通过健全急诊创伤分诊流程、住院患者分类管理、住院病房优化管理、围手术期标准预防、完善落实医护防护制度、患者及陪护宣教配合等措施,可降低院内COVID-19感染发生率,在疫情期间依然可以为急诊创伤骨科患者提供优质、安全的医疗服务。     

Challenges of Egyptian patients with systemic lupus erythematosus during the COVID-19 pandemic

ObjectivesThe coronavirus disease 2019 (COVID-19) pandemic in Egypt is part of the worldwide COVID-19 pandemic that has contributed to substantial deterioration of healthcare systems. The aim of this study was to assess the challenges faced by Egyptian systemic lupus erythematosus (SLE) patients during the COVID-19 pandemic.Material and methodsThis questionnaire-based study was carried out on 200 patients with SLE from Egypt. The questionnaire provided covered socioeconomic status, lupus disease data, information about COVID-19 infection, and medical and family history of COVID-19 infection.ResultsThe mean age of the participants was 30.1 ±8.4 years. 140/200 (70%) of the participants reported difficulty in obtaining medications during the COVID-19 pandemic, particularly antimalarials (60%). The lupus disease condition became worse because of the drug shortage in half of the participants. Wearing protective masks (74%) and using disinfectants of the hands several times per day (67%) were the most reported used measures. Forty patients (20%) had to stop or reduce taking nonsteroidal anti-inflammatory drugs while 10 patients (5%) had to start taking antimalarials as a prophylaxis against COVID-19 infection. Among those who needed hospitalization, the main cause was lupus activity, and most of them (71%) experienced difficulty in hospital admission. Thirty-two patients (16%) had confirmed COVID-19 infection. About half of them had lupus flare and had to change the medications used for treatment of lupus.ConclusionsThe current COVID-19 pandemic has a negative impact on the healthcare provided to SLE patients in Egypt. Patients with SLE faced a shortage of their medications, especially antimalarials, and difficulty in hospital admission.     

Coronavirus Disease 2019 Positivity Immediately After Lung Transplantation: A Case Report

Management of COVID-19 in lung transplant recipients is challenging. We report a case of a 71-year-old male who underwent bilateral lung transplantation with an unexpected case of COVID-19. The patient had been fully vaccinated. The patient and donor tested negative for pretransplant COVID-19. On routine bronchoscopy on day 1 after transplant, the COVID-19 test was positive. Mycophenolic mofetil and the second dose of basiliximab were skipped, but tacrolimus and prednisone were continued. He was treated with casirivimab/imdevimab and remdesivir. He was discharged on day 14 and has had no episodes of acute rejection during the 3 months.     

Elective Joint Arthroplasty Should be Delayed by One Month After COVID-19 Infection to Prevent Postoperative Complications

BackgroundIt remains unclear whether a history of recent COVID-19 infection affects the outcomes and risks of complications of total joint arthroplasty (TJA). The purpose of this study was to compare the outcomes of TJA in patients who have and have not had a recent COVID-19 infection.MethodsA large national database was queried for patients undergoing total hip and total knee arthroplasty. Patients who had a diagnosis of COVID-19 within 90-days preoperatively were matched to patients who did not have a history of COVID-19 based on age, sex, Charlson Comorbidity Index, and procedure. A total of 31,453 patients undergoing TJA were identified, of which 616 (2.0%) had a preoperative diagnosis of COVID-19. Of these, 281 COVID-19 positive patients were matched with 281 patients who did not have COVID-19. The 90-day complications were compared between patients who did and did not have a diagnosis of COVID-19 at 1, 2, and 3 months preoperatively. Multivariate analyses were used to further control for potential confounders.ResultsMultivariate analysis of the matched cohorts showed that COVID-19 infection within 1 month prior to TJA was associated with an increased rate of postoperative deep vein thrombosis (odds ratio [OR]: 6.50, 95% confidence interval: 1.48-28.45, P = .010) and venous thromboembolic events (odds ratio: 8.32, confidence interval: 2.12-34.84, P = .002). COVID-19 infection within 2 and 3 months prior to TJA did not significantly affect outcomes.ConclusionCOVID-19 infection within 1 month prior to TJA significantly increases the risk of postoperative thromboembolic events; however, complication rates returned to baseline after that time point. Surgeons should consider delaying elective total hip arthroplasty and total knee arthroplasty until 1 month after a COVID-19 infection.     

Patients With Previous COVID-19 Infection Can Safely Undergo Primary Total Joint Arthroplasty

BackgroundThe COVID-19 virus is believed to increase the risk of diffusing intravascular coagulation. Total joint arthroplasty (TJA) is one of the most common elective surgeries and is also associated with a temporarily increased risk of venous thromboembolism (VTE). However, the influence of a history of COVID-19 infection on perioperative outcomes following TJA remains unknown. Therefore, this study sought to determine what effect a history of COVID-19 infection had on outcomes following primary TJA.MethodsA retrospective case-control study using the national database was performed to identify all patients who had a history of COVID-19 and had undergone TJA, between 2019 and 2020. Patients who had a history of both were 1:1 matched to those who did not have a history of COVID-19, and 90-day outcomes were compared. A total of 661 TKA and 635 THA patients who had a history of COVID-19 were 1:1 matched to controls. There were no differences in demographics and comorbidities between the propensity-matched pairs in both TKAs and THAs studied. Previous COVID-19 diagnosis was noted in 28.3% of patients 5 days within TJA and in 78.6%, 90 days before TJA.ResultsPatients who had a previous diagnosis of COVID-19 had a higher risk of pneumonia during the postoperative period for both THA and TKA (6.9% versus 3.5%, P < .001 and 2.27% versus 1.21%, P = .04, respectively). Mean lengths of stay were also greater for those with a previous COVID-19 infection in both cohorts (TKA: 3.12 versus 2.57, P = .027, THA: 4.52 versus 3.62, P < .001). Other postoperative outcomes were similar between the 2 groups.ConclusionCOVID-19 infection history does not appear to increase the risk of VTE following primary TJA, but appears to increase the risk of pneumonia in addition to lengths of stay postoperatively. Individual risk factors should be discussed with patients, to set reasonable expectations regarding perioperative outcomes.     

Recent COVID-19 infection is associated with increased mortality in the ambulatory surgery population

BackgroundThe effect of COVID-19 infection on post-operative mortality and the optimal timing to perform ambulatory surgery from diagnosis date remains unclear in this population. Our study was to determine whether a history of COVID-19 diagnosis leads to a higher risk of all-cause mortality following ambulatory surgery.MethodsThis cohort constitutes retrospective data obtained from the Optum dataset containing 44,976 US adults who were tested for COVID-19 up to 6 months before surgery and underwent ambulatory surgery between March 2020 to March 2021. The primary outcome was the risk of all-cause mortality between the COVID-19 positive and negative patients grouped according to the time interval from COVID-19 testing to ambulatory surgery, called the Testing to Surgery Interval Mortality (TSIM) of up to 6 months. Secondary outcome included determining all-cause mortality (TSIM) in time intervals of 0–15 days, 16–30 days, 31–45 days, and 46–180 days in COVID-19 positive and negative patients.Results44,934 patients (4297 COVID-19 positive, 40,637 COVID-19 negative) were included in our analysis. COVID-19 positive patients undergoing ambulatory surgery had higher risk of all-cause mortality compared to COVID-19 negative patients (OR = 2.51, p < 0.001). The increased risk of mortality in COVID-19 positive patients remained high amongst patients who had surgery 0–45 days from date of COVID-19 testing. In addition, COVID-19 positive patients who underwent colonoscopy (OR = 0.21, p = 0.01) and plastic and orthopedic surgery (OR = 0.27, p = 0.01) had lower mortality than those underwent other surgeries.ConclusionsA COVID-19 positive diagnosis is associated with significantly higher risk of all-cause mortality following ambulatory surgery. This mortality risk is greatest in patients that undergo ambulatory surgery within 45 days of testing positive for COVID-19. Postponing elective ambulatory surgeries in patients that test positive for COVID-19 infection within 45 days of surgery date should be considered, although prospective studies are needed to assess this.