Papel del personal técnico superior en imagen para el diagnóstico durante la pandemia COVID-19: importancia de la organización y planificación en la primera línea

The COVID-19 pandemic and the consequent declaration of a state of alarm have required changes throughout the entire health system and diagnostic imaging departments are no exception.In our department, these circumstances led to an immediate restructuring of the working dynamics of our group of imaging technologists that had an important role in the front lines of the battle. To ensure that these new needs were met, the staff had to be trained and distributed into different areas and working groups; moreover, new protective measures and protocols had to be adopted in the working environment. We also defined different care circuits for patients with COVID-19 and those without COVID-19, incorporating new technologies, adapting existing resources to the new scenario, and creating a circuit for the rapid diagnosis of COVID-19. This paper also provides detailed recommendations for organizing radiology departments in the case of new outbreaks of COVID-19.     

Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment

Abstract

We highlight the critical roles that pharmacists have related to sustaining and advancing the changes being made in the face of the current COVID-19 pandemic to ensure that patients have more seamless and less complex access to treatment. Discussed herein is how the current COVID-19 pandemic is impacting persons with substance use disorders, barriers that persist, and the opportunities that arise as regulations around treatments for this population are eased.     

Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic

ObjectivesIn the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care.MethodsThese recommendations rely on the authors’ experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020.ResultsThe first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation.ConclusionThe neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.     

The influences of the COVID-19 pandemic on medical service behaviors

The outbreak of the novel coronavirus (COVID-19) has greatly impacted medical services worldwide. In addition to changing the processes used by hospital medical services, it has also changed the behaviors of medical staff, resulting in a completely different appearance. Fear of being infected with COVID-19 makes patients fear entering hospitals, and hospitals must repeatedly screen patients prior to entry in order to confirm that they are not infected. Patients are then separated according to their symptoms and travel, occupation, contact and cluster histories (TOCC), which seriously affects them. In addition, hospitals have invested a lot of money into the whole visiting process and into the equipment required to prevent the spread or lessen the impact of COVID-19.     

Neuro-oncology practice guidelines from a high-volume surgeon at the COVID-19 epicenter

BackgroundDuring the coronavirus 19 (COVID-19) pandemic, physicians have begun adapting their daily practices to prevent transmissions. In this study we aimed to provide surgical neuro-oncologists with practice guidelines during the COVID-19 pandemic based on objective data from a high-volume brain tumor surgeon at the current COVID-19 epicenter.MethodsAll outpatient visits and surgeries performed by the senior author during the COVID-19 pandemic were compared between the initial quarantine (3/23/20–5/4/20), the plateau period following quarantine (5/5/20–6/27/20), and the second peak (6/28/20–7/20/20). In-person and telemedicine visits were evaluated for crossovers. Surgeries were subdivided based on lesion type and evaluated across the same time period.ResultsFrom 3/23/20–7/20/20, 469 clinic visits and 196 surgeries were identified. After quarantine was lifted, face-to-face visits increased (P < 0.01) yet no change in telehealth visits occurred. Of 327 telehealth visits, only 5.8% converted to in-person during the 4-month period with the most cited reason being patient preference (68.4%). Of the 196 surgeries performed during the pandemic, 29.1% occurred during quarantine, 49.0% during the plateau, and 21.9% occurred in the second peak. No COVID negative patients developed symptoms at follow-up. 55.6% were performed on malignant tumors and 31.6% were benign with no difference in case volumes throughout the pandemic.ConclusionsDespite exceptional challenges, we have maintained a high-volume surgical neuro-oncology practice at the epicenter of the COVID-19 pandemic. We provide the protocols implemented at our institution in order to maximize neuro-oncology care while mitigating risk of COVID-19 exposure to both patients and providers.     

Documento de consenso de la Sociedad Española de Medicina Intensiva,Crítica,y Unidades Coronarias (SEMICYUC), la Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello (SEORL-CCC) y la Sociedad Española de Anestesiología y Reanimación (SEDAR) sobre la traqueotomía en pacientes con COVID-19

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.     

Supporting community participation in a pandemic

The invariable governmental approach to the impact of the COVID-19 pandemic has been to effect the White Knight stance of Don Quixote, defending the population from the “Virus Dragon” and dedicating its knight-errantry to the damsel Dulcinea. Though essential, new therapeutics, vaccines, physical distancing, rigorous hygiene standards and efficient health systems are not sufficient to counter the effects of the virus. Individual compliance to public health guidelines also matters, while remaining similarly insufficient to diminish the threat. Earthier, citizen-led, community participation strategies, however, lead to innovative, tailored solutions that better fulfil the needs of diverse neighbourhoods and assures greater virus resistance and increase in population health compared to a top-down, knightly approach or isolated individual efforts. The challenge of COVID-19 offers communities a moment to build more resilient, antifragile communities that not only survive the current crisis, but that thrive after it, and that are better equipped for the next challenge. This is not the time for the singular heroics of the White Knight, or the antics of Don Quixote, tilting at windmills. It is the time of Sancho Panza, which is to say of regular non-credentialed citizens, and their collective efforts, who up to now have largely been considered pawns in this contest. Asset-based community development (ABCD) rejects both the individual as an island and the institutional, knightly emphasis on assessing needs and deficits within communities. It favours identifying and mobilising available and latent assets within a community to forge closer connections among all people, the better to collectivise problem-solving efforts. Community-driven initiatives are assisted in this by localised not-for-profit agencies that practice subsidiarity.     

[Artículo traducido] Manifestaciones cutáneas de la COVID-19: ¿Qué hemos aprendido tras un año de pandemia?

Coronavirus disease-19 (COVID-19) is an emerging health situation caused by the “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). The ongoing COVID-19 pandemic which emerged from the Chinese city of Wuhan in December 2019 has spread to over 188 countries and infected over 100 million people across the globe in over one year. Most common symptoms of COVID-19 include fever and respiratory illness. Among extrapulmonary signs associated with COVID-19, dermatological manifestations have been increasingly reported from different geographical regions. The exact incidence or prevalence of COVID-19 associated skin manifestation remains largely unknown and the pathophysiological mechanisms are still unclear. In this article, we have attempted to give a comprehensive overview of what has been learned a year into the pandemic on the epidemiology, clinical and histopathological features, pathophysiological mechanisms and clinical management of COVID-19 associated cutaneous manifestations.