Category: Medicine

Posted on

Rapid Advice for COVID-19 Clinical Practice Guidelines (2020)

Rapid advice clinical practice guidelines for COVID-19 were released in February 2020 by the Zhongnan Hospital of Wuhan University Novel Coronavirus Management and Research Team and the Evidence-Based Medicine Chapter of China International Exchange and Promotive Association for Medical and Health Care (CPAM).

Close Contacts and Possible Exposure Guidance

Strictly adhere to the 14-day observation period.

Should symptoms such as fever or cough develop, go to the hospital for diagnosis and treatment. If possible, notify the hospital in advance and have it arrange transportation to the hospital.

Wearing of N95 masks is the priority strategy, with the alternate strategy being a disposable surgical mask.

Public transportation should be avoided as a method of transport to the hospital; priority methods are an ambulance or a private vehicle; vehicle windows should be open to provide ventilation.

While in public (eg, walking on the road, waiting in the hospital), wear a mask and attempt to stay at least 1 meter away from other people.

Family members who accompany people going to the hospital for examination should immediately adhere to the monitoring recommendations for close contacts; additionally, they should practice proper respiratory hygiene and wash their hands properly.

The local or community hospital must be notified before arrival of the suspected contact at the hospital. The vehicle used to transport the suspected close contact should be disinfected with chlorine-containing solution (500 mg/L) and the vehicle windows should be opened for ventilation.

Isolation & Home Care Guidance for Those With Mild Symptoms

The preferred strategy is a well-ventilated, single-occupancy room; alternatively, attempt to stay at least 1 meter away from the patient.

Household articles should be cleaned and disinfected with a chlorine-containing solution (500 mg/L) frequently every day.

Visits from relatives and friends should be limited.

The caregiver should be a healthy family member who does not have any underlying diseases.

The patient’s activity should be restricted.

Windows in shared, communal areas (eg, bathrooms, kitchens) should be opened to provide ventilation.

Do not share household items (eg, toothbrush, towel, tableware, bedsheets) with patients. The items used by the patient for daily necessities should be for single use only; they should be stored separately from those used by family members.

When the patient coughs or sneezes, he or she should be wearing a medical mask or should cover the mouth with a paper towel and bent elbow; his or her hands should be cleaned immediately after coughing and sneezing.

The preferred strategy is that caregivers wear an N95 mask when in the same room with the patient; alternatively, a disposable surgical mask can be worn.

The mask should be used with strict adherence to the instruction manual.

After washing hands, the preferred strategy is to dry them with a paper towel; alternatively, a towel can be used but should be washed and disinfected daily.

Continue reading
Posted on

COVID-19 Interim Guidelines by ISUOG

The guideline on coronavirus disease (COVID-19) infection control during pregnancy and puerperium was released on March 11, 2020 by the International Society of Ultrasound in Obstetrics and Gynecology.

Screening

During the COVID-19 epidemic period, a detailed history regarding recent travel, occupation, significant contact and cluster (TOCC) and clinical manifestations should be acquired routinely from all pregnant women attending for routine care.

On presentation to triage areas, pregnant patients with TOCC risk factors should be placed in an isolation room for further assessment.

Pregnant patients with known TOCC risk factors and those with mild or asymptomatic COVID-19 infection should delay antenatal visit and routine ultrasound assessment by 14 days.

In units in which routine group B streptococcus (GBS) screening is practiced, acquisition of vaginal and/or anal swabs should be delayed by 14 days in pregnant women with TOCC risk factors or should be performed only after a suspected/probable case tests negative or after recovery in a confirmed case. Intrapartum prophylactic antibiotic cover for women with ante- or intrapartum risk factors for GBS is an alternative.

Chest Radiography during Pregnancy

In a pregnant woman with suspected COVID-19 infection, a chest CT scan may be considered as a primary tool for the detection of COVID-19 in epidemic areas. Informed consent should be acquired (shared decision-making) and a radiation shield be applied over the gravid uterus.

Treatment during Pregnancy

Management of COVID-19-infected pregnant women should be undertaken by a multidisciplinary team (obstetricians, maternal–fetal-medicine subspecialists, intensivists, obstetric anesthetists, midwives, virologists, microbiologists, neonatologists, infectious disease specialists).

Suspected, probable, and confirmed cases of COVID-19 infection should be managed initially by designated tertiary hospitals with effective isolation facilities and protection equipment.

Suspected/probable cases should be treated in isolation and confirmed cases should be managed in a negative-pressure isolation room. A patient with a confirmed case who is critically ill should be admitted to a negative-pressure isolation room in an ICU.

Designated hospitals should set up a dedicated negative-pressure operating room and a neonatal isolation ward. All attending medical staff should don personal protective equipment (PPE; respirator, goggle, face protective shield, surgical gown, and gloves) when providing care for patients with confirmed cases of COVID-19 infection. However, in areas with widespread local transmission of the disease, health services may be unable to provide such levels of care to all suspected, probable, or confirmed cases.

Pregnant women with a mild clinical presentation may not initially require hospital admission and home confinement can be considered, provided that this is possible logistically and that monitoring of the woman’s condition can be ensured.

If negative-pressure isolation rooms are not available, patients should be isolated in single rooms, or grouped together once COVID-19 infection has been confirmed.

For transfer of confirmed cases, the attending medical team should don PPE and keep themselves and their patient a minimum distance of 1–2 meters from any individuals without PPE.

Continue reading
Posted on

Traditional Hernia Repair Better Than Robotic Approach

For primary inguinal hernia repair, there is no apparent benefit to the robotic approach over the traditional laparoscopic approach, according to a randomized controlled trial.

On the contrary, robotic-assisted surgery was pricier, took longer, led to more surgeon frustration and had no ergonomic benefit for surgeons, researchers report in JAMA Surgery.

The robotic platform for inguinal hernia repair has been “rapidly” adopted in the United States, Dr. Ajita Prabhu of the Cleveland Clinic Center in Ohio and colleagues note in their report. But no level-I trials have compared robotic inguinal hernia repair to laparoscopic repair until now.

With funding from Intuitive Surgical, which makes the robots used in the study, the team compared robotic transabdominal preperitoneal repair to standard laparoscopic transabdominal preperitoneal repair in 102 patients (48 in the robotic group and 54 in the control arm).

There were no significant between-group differences in operative outcomes at 30 days in terms of postoperative pain, health-related quality of life, mobility, wound morbidity, or cosmetic outcome.

Robotic hernia repair took longer to perform (median 75.5 min vs. 40.5 min; P<0.001), cost more (median $3,258 vs $1,421; P<0.001), and was associated with greater surgeon frustration on the NASA Task Load Index Scale (32.7 vs. 20.1 on a 1-100 scale with lower scores indicating lower cognitive workload; P=0.004), “without discernible ergonomic benefit for surgeons.”

In their report, Dr. Prabhu and colleagues write, “Our study is to date the only prospective randomized head- to-head comparison of robotic vs. laparoscopic minimally invasive inguinal hernia repair. Despite the pilot nature of our study, our outcomes are notable, particularly given the frequency with which inguinal hernia repair is performed in the United States, and suggest that the use of the robotic platform for unilateral uncomplicated inguinal hernia repair is not justified for surgeons able to perform this operation laparoscopically.”

They note that their study was not designed to address “potential benefits of the robotic platform for open surgeons attempting to adopt minimally invasive techniques, or in more complex clinical scenarios of inguinal hernia repair and further study should be devoted to these specific questions.”

The authors of an invited commentary say the use of the robotic platform for primary inguinal hernia repair has been “controversial.” While this study suggests it does not have any benefits over traditional laparoscopy for primary inguinal hernia repairs, “we cannot assume that there is no role for robotic approaches in the field of hernia surgery,” write Dr. Jacob Greenberg and Dr. Natalie Liu of the University of Wisconsin School of Medicine in Madison.

“The benefits of 3-dimensional visualization and improved dexterity may prove beneficial in the treatment of recurrent inguinal hernias or postoperative inguinodynia,” they point out. “Studies have also shown that robotic surgery is associated with a shorter learning curve and may help transition from open to minimally invasive techniques for surgeons without substantial laparoscopic training.”

“While cost still remains a barrier, it may be mitigated with increased competition in the market as new robotic platforms are introduced. Although robotic surgery and laparoscopy may currently be viewed as rivals, the 2 techniques should more accurately be considered as different approaches to facilitate minimally invasive surgery. Surgeons should be mindful of the different costs, risks, and benefits of both techniques and be encouraged to use the approach that provides patients with the best outcomes,” the editorial writers conclude.

Source : Medscape