Lessons for the Next Global Health Crisis: A Qualitative Systematic Review of Women's Experiences of the Perinatal Period During the COVID-19 Pandemic in Australia.

Quo Vadis, COVID-19?

Letter: The Risk of COVID-19 Infection During Neurosurgical Procedures: A Review of Severe Acute Respiratory Distress Syndrome Coronavirus 2 (SARS-CoV-2) Modes of Transmission and Proposed Neurosurgery-Specific Measures for Mitigation.

The coronavirus disease of 2019 (COVID-19) pandemic has dramatically impacted the plastic surgery community across the globe, and it has been the center of discussion in public and private discourse throughout the year.1 Given this deep interest in the COVID-19 pandemic, we hypothesized that articles related to the COVID-19 pandemic in the plastic surgery literature would garner higher levels of attention than other articles. Using the Journal Citation Reports, 15 plastic surgery journals with the highest impact factor in 2019 were selected and all articles published in these journals in 2020 were extracted.2 For the 6815 articles identified, number of citations accrued and Altmetric score, which is a weighted calculation of the attention an article receives online, were recorded.3 COVID-19–related articles were identified by searching titles for “COVID,” “SARS,” “pandemic,” “corona,” “COVID-19,” or “SARS-CoV-2,” resulting in a total of 220 articles (3.2 percent). The Kruskal-Wallis test was used to assess Altmetric score and citations for COVID-19–related versus non–COVID-19 articles. For the COVID-19–related articles, we also assessed whether Altmetric score and citations varied by the type of article (commentary, original article, or guidelines), subspecialty of plastic surgery to which the article pertained, and the quarter of the year in which it was published. Despite the pandemic being a hot topic of discussion, the majority (n = 137, 62 percent) of COVID-19–related articles had an Almetric score of zero, meaning they were not disseminated at all on social media, news outlets, or other electronic forms of media. When compared to non–COVID-19 articles, however, COVID-19–related articles had a higher average Altmetric score (2.1 versus 1.4, p < 0.001, Fig. 1). Of the COVID-19–related articles, original articles had higher Altmetric scores as compared to editorials and guidelines (3.8 versus 1.3 and 1.5, respectively, p < 0.001). There was no association between Altmetric score and specialty (p = 0.24) or quarter of publication (p = 0.40).Fig. 1.: Altmetric score by article type. COVID-19–related articles had higher Altmetric scores than non–COVID-19 articles.COVID-19–related articles accrued a total of 247 citations, with an average of 1.1 citations per article, which is higher than the 0.2 citations non–COVID-19 articles accrued (p < 0.001) (Fig. 2). Among the COVID-19–related articles, over 65 percent of articles had zero citations and four articles alone accounted for 24 percent of all citations. Articles published earlier in the year had more citations than those published later (p < 0.001), which is expected as it takes time for articles to accrue citations. There was no association between number of citations and specialty (p = 0.16) or article type (p = 0.27).Fig. 2.: Number of citations by article type. COVID-19–related articles accrued more citations than non–COVID-19 articles.The high levels of interest in the COVID-19 pandemic were reflected in the plastic surgery literature. Altmetric score, a surrogate for interest and influence, was higher for COVID-19–related articles and highest for studies that analyzed original data.1 Impact, as measured by citations, was also higher for COVID-19–related articles, suggesting there was increased discussion among academics about the pandemic and its ramifications on plastic surgery. The impact and influence of the COVID-19 pandemic were felt by the plastic surgery community worldwide and also depicted in the literature. DISCLOSURE The authors have no financial interest to declare in relation to the content of this article.

Endothelial dysfunction in COVID-19: A potential predictor of long-COVID?

BackgroundThe coronavirus disease of 2019 (COVID-19) pandemic has challenged the existing healthcare delivery systems worldwide and overwhelmed the globally short healthcare workforce, particularly nurses. Nurses are recognized as front-line responders to the COVID-19 pandemic and are crucial healthcare members to win the fight against the evolving COVID-19. Considering the long-lasting shortage of national nurses, and turnover of the current nursing workforce, it is essential to consider unconventional strategies aiming at expanding the national nursing workforce in order to embrace the impact of COVID-19.ObjectiveThis study aimed to measure senior nursing students and intern’s willingness to treat patients with COVID-19. Further, this study investigated their feelings, knowledge, and concerns regarding treating patients with COVID-19.MethodsThis quantitative, cross-sectional study utilized self-reported survey gathered from a convenience sample of 178 senior nursing students and interns. A 7-item scale was used to measure the participants’ willingness to treat patients with COVID-19. The data were collected between March 2020 and April 2020.ResultsOut of 178 participants, 50.56% were at Level 8, 89.33% were single, and 53.37% had a very satisfactory grade point average. The highest proportion of the respondents (38.20%) felt neutral about treating patient with COVID-19, while 53.93% had good knowledge about COVID-19. The perceived willingness to treat of participants had an overall mean score of 20.19, which indicated neutral willingness to treat patients with COVID-19. Participants’ feelings about treating patients with COVID-19 predicted their willingness to treat patients with COVID-19 (P<0.001).Conclusion/RecommendationThere is a clear need for educational and training programs both in clinical practice and academia for the improvement among nursing students and interns who reported paucity of knowledge about COVID-19. Furthermore, hospital institutions should provide additional incentives or hazard protections to maintain and even increase the number of staff at the frontline who are willing to care for patients amid the deadly pandemic of COVID-19.

Evaluating the Effectiveness of COVID-19 Vaccines in Adults with Sickle Cell Disease during the Omicron Period of COVID-19 Pandemic

Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. To characterize inpatient adaptations to care for non-ICU COVID-19 patients. Cross-sectional survey. A network of 72 hospital medicine groups at US academic centers. COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spreads rapidly, causing outbreaks that grow exponentially within a short period before interventions are sought and effectively implemented. Testing is part of the first line of defense against Corona Virus Disease of 2019 (COVID-19), playing a critical role in the early identification and isolation of cases to slow transmission, provision of targeted care to those affected, and protection of health system operations. Laboratory tests for COVID-19 based on nucleic acid amplification techniques were rapidly developed in the early days of the pandemic, but such tests typically require sophisticated laboratory infrastructure and skilled staff. In March 2020, Zimbabwe confirmed its first case of COVID-19; this was followed by an increase in infection rates as the pandemic spread across the country, thus increasing the demand for testing. One national laboratory was set to test all the country's COVID-19 suspect cases, building pressure on human and financial resources. Staff burnout and longer turnaround times of more than 48 h were experienced, and results were released late for clinical relevance. Leveraging on existing PCR testing platforms, including GeneXpert machines, eased the pressure for a short period before facing the stockout of SARs-CoV-2 cartridges for a long time, leading to work overload at a few testing sites contributing to long turnaround times. On September 11, WHO released the interim guidance to use antigen rapid diagnostic test as a diagnostic tool. The Zimbabwe laboratory pillar quickly adopted it and made plans for its implementation. The National Microbiology Reference Laboratory verified the two emergency-listed kits, the Panbio Abbott and the Standard Q, Biosensor, and they met the WHO minimum performance of ≥97% specificity and ≥80% sensitivity. Decentralizing diagnostic testing leveraging existing human resources became a game-changer in improving COVID-19 containment measures. Task shifting through training on Antigen rapid diagnostic tests (Ag-RDT) commenced, and testing was decentralized to all the ten provinces, from 1 central testing laboratory to more than 1,000 testing centers. WhatsApp platforms made it easier for data to be reported from remote areas. Result turnaround times were improved to the same day, and accessibility to testing was enhanced.

We read the article entitled “The COVID-19 Pandemic: Implications for Medical Students and Plastic Surgery Residency Applicants,” by Raj et al.,1 with great interest. Their article brings to light the ubiquitous effects the coronavirus disease of 2019 (COVID-19) has had on prospective plastic surgery resident applicants in the United States. Specifically, the authors note the lost opportunities prospective plastic surgery applicants experienced because of the pandemic and the challenges prospective applicants will face with plastic surgery residency programs.1 As current plastic surgery trainees in the United Kingdom, we cannot help but draw parallels to the authors and their concerns with regard to the impact COVID-19 has had on selection to plastic surgery residency programs in the United Kingdom. With an international readership and with many previous articles in Plastic and Reconstructive Surgery and PRS Global Open comparing the status and differences in plastic surgery residency programs and selection worldwide,2,3 we wanted to provide insight to the Journal’s readership about some of the effects COVID-19 has had in plastic surgery residency recruitment in the United Kingdom. Unlike in the United States, recruitment into all specific plastic surgery residency positions occurs at a national level via a standardized interview at single location in London.2 The 2020 national selection process for plastic surgery was set to occur in April of 2020. Unfortunately, this was during the height of the pandemic in the United Kingdom (April and May of 2020). Due to countrywide regulations that transport be limited to all but essential travel and concerns that there would be a shortage of medical staff due to increasing medical need, the plastic surgery national residency interviews (as per many other medical interviews) were cancelled and replaced with a modified recruitment process. In plastic surgery, this modified recruitment process involved a review of candidates’ current operative ability, additional qualifications, experience with quality improvement projects, publications, presentations, and teaching experience, which candidates had to declare during submission of their application. Normally, this portfolio of experience contributes approximately 25 percent to the plastic surgery selection process, but in the modified 2020 application process, it became the sole means of ranking applicants. There remained great ambivalence about the validity of such a recruitment process, with some candidates benefiting from these modified arrangements while others were disadvantaged. Notably, there remains great uncertainty as to the state of recruitment to plastic surgery residency programs in the United Kingdom given the unprecedented effects of COVID-19, and we envisage that plastic surgery recruiters and prospective plastic surgery residents share the same uncertainty. One solution may be the introduction of a teleconferencing interview for all applicants. The advent of teleconferencing and telemedicine has been rife in plastic surgery and medicine as a whole during the COVID-19 pandemic.4,5 Backing a teleconferencing interview may enable plastic surgery recruiters to provide a safe and effective interview process that enables the best and most-qualified candidates to be selected while mitigating against the effect of COVID-19 should further waves of the virus present. Ultimately, whatever accommodations are made, the ripples of COVID-19 will undoubtably be felt on the global plastic surgery community for some time to come. DISCLOSURE The authors have no financial interest to declare in relation to the content of this communication. Yasser Al Omran, B.Sc.(Hons.), M.B.B.S., M.Sc.(Dist.)Department of Burns and Plastic SurgeryChelsea and Westminster NHS Foundation TrustLondon, United Kingdom Sarvnaz Sepehripour, M.B.B.S.Catherine Leng, M.B.B.S.Department of Burns and Plastic SurgeryUniversity Hospital Birmingham NHS Foundation TrustBirmingham, United Kingdom

: This combined American Neurotology Society, American Otological Society, and American Academy of Otolaryngology - Head and Neck Surgery Foundation document aims to provide guidance during the coronavirus disease of 2019 (COVID-19) on 1) "priority" of care for otologic and neurotologic patients in the office and operating room, and 2) optimal utilization of personal protective equipment. Given the paucity of evidence to inform otologic and neurotologic best practices during COVID-19, the recommendations herein are based on relevant peer-reviewed articles, the Centers for Disease Control and Prevention COVID-19 guidelines, United States and international hospital policies, and expert opinion. The suggestions presented here are not meant to be definitive, and best practices will undoubtedly change with increasing knowledge and high-quality data related to COVID-19. Interpretation of this guidance document is dependent on local factors including prevalence of COVID-19 in the surgeons' local community. This is not intended to set a standard of care, and should not supersede the clinician's best judgement when managing specific clinical concerns and/or regional conditions.Access to otologic and neurotologic care during and after the COVID-19 pandemic is dependent upon adequate protection of physicians, audiologists, and ancillary support staff. Otolaryngologists and associated staff are at high risk for COVID-19 disease transmission based on close contact with mucosal surfaces of the upper aerodigestive tract during diagnostic evaluation and therapeutic procedures. While many otologic and neurotologic conditions are not imminently life threatening, they have a major impact on communication, daily functioning, and quality of life. In addition, progression of disease and delay in treatment can result in cranial nerve deficits, intracranial and life-threatening complications, and/or irreversible consequences. In this regard, many otologic and neurotologic conditions should rightfully be considered "urgent," and almost all require timely attention to permit optimal outcomes. It is reasonable to proceed with otologic and neurotologic clinic visits and operative cases based on input from expert opinion of otologic care providers, clinic/hospital administration, infection prevention and control specialists, and local and state public health leaders. Significant regional variations in COVID-19 prevalence exist; therefore, physicians working with local municipalities are best suited to make determinations on the appropriateness and timing of otologic and neurotologic care.

Determining Urgent/Emergent Status of Gastrointestinal Endoscopic Procedures in an Ambulatory Care Setting During the COVID-19 Pandemic: Additional Factors That Need To Be Considered.

Video Conferencing Impact on Facial Appearance: Looking Beyond the COVID-19 Pandemic.

While the ongoing COVID-19 (Coronavirus disease of 2019) pandemic has destabilized the health system worldwide, its psychological and social impact on those affected by the virus cannot be undermined. This study aimed to assess compliance to following general pre-ventive measures, risk, and stigma associated with COVID-19 among the study population. The present study was a cross-sectional study, and it was conducted among 300 patients from a dental hospital in Bhubaneswar through interviewing patients in the hospital based on a 22-item questionnaire collecting socio-demographic data and consisting of questions concerning patients' perception of risk and social stigma regarding COVID-19. The statistical analysis was performed using the Chi-square test using SPSS version 23 at a 5% significant level. Fe-males were found to be apprehensive about buying fruits and vegetables from vendors and going to their place of work due to the risk of COVID infection. Socioeconomic status (SES) was significantly associated with compliance, risk, fear, and stigma. Risk of infection was seen among 41.6%, and 10% agreed to treat those who had symptoms, tested positive, or re-covered from COVID-19 infection differently. Even though the risk for infection and com-pliance to follow preventive measures in the study population was low, stigma towards those who had symptoms or recovered from COVID was observed. Hence, steps should be taken to highlight the importance of following preventive measures and addressing the stigma asso-ciated with the infection.

The Coronavirus disease of 2019 (COVID-19) pandemic undoubtedly ranks among the most health-impacting pandemics throughout medical history.Although the COVID-19 global public health emergency has ended, lessons need to be learned to be more ready to facesimilar pandemics in the future. Few studies in Saudi Arabia discuss the impact of the COVID-19 pandemic on autoimmune rheumatic disease (AIRD) patients. Thus, this study was conducted to elaborate on the effects of the COVID-19 pandemic on AIRDpatients and rheumatology practices in Saudi Arabia. Methods: This observational cross-sectional study was conducted among patients aged over 14with AIRD using a pre-designed validated survey questionnaire. Data were collected from AIRD patients who were following up between November 2021 to April 2022 at the Rheumatology Clinicof King Fahad General Hospital in Madinah City, Saudi Arabia. This center was chosen as being the main hospital in the city following patients of AIRD. A total of 324 patients were included in our study, with the majority (n=264, 81.5%) being females. The mean age was 44.42±14.4 years. Clinical data revealed that 115(35.5%) of our patients experienced mild COVID-19 infection, 19 (5.9%) suffered from respiratory insufficiency, and seven (2.2%) required admission to the intensive care unit (ICU). Non-compliance to medication was recorded at 25.2%. There were 115 (35.5%) patients who had an AIRD flare that was significantly higher among those who were not adherent to the medications (p<0.001). Disease flare was also significantly seen among patients who were not on prednisone or were on low doses of prednisone (p<0.001). The majority (n=33, 97.1%) of the 34 infected patients who had an AIRD flarehad their flare-up at the same time as their COVID-19 infection (p<0.001). COVID-19 vaccination rate was 87.7% (n=284).The most common reason for non-vaccination in 40 (12.3%) patients was the patients' concern about disease flare-ups by the vaccine or interference of the vaccine with their medication (n=16, 4.9%). Our study showed a 35.5% (n=115) COVID-19 infection rate. The majority of our AIRDpatients sustainedminor infections that did not require hospitalization or ICU admission. The majority of the patients who underwent a severe COVID-19 infection coursewere not on prednisolone or were on low-dose prednisone. Due to COVID-19 restrictions and drug shortages, one in four patients (25.3%) stopped taking their medications and was significantly found to have a high prevalence of underlying AIRD flare. Despite the high vaccination rate, disease flare was the biggest concern for those who were not immunized. Although the COVID-19 pandemic has ended, doctors should be aware of risk factors associated with severe AIRD outcomes that should be balanced based on the infection severity, underlying disease flares, and patient-centered education about medication adherence and vaccination.

Overlapping commonalities between coronavirus disease of 2019 (COVID-19) and cardio-oncology regarding cardiovascular toxicities (CVT), pathophysiology, and pharmacology are special topics emerging during the pandemic. In this perspective, we consider an array of CVT common to both COVID-19 and cardio-oncology, including cardiomyopathy, ischemia, conduction abnormalities, myopericarditis, and right ventricular (RV) failure. We also emphasize the higher risk of severe COVID-19 illness in patients with cardiovascular disease (CVD) or its risk factors or cancer. We explore commonalities in the underlying pathophysiology observed in COVID-19 and cardio-oncology, including inflammation, cytokine release, the renin-angiotensin-aldosterone-system, coagulopathy, microthrombosis, and endothelial dysfunction. In addition, we examine common pharmacologic management strategies that have been elucidated for CVT from COVID-19 and various cancer therapies. The use of corticosteroids, as well as antibodies and inhibitors of various molecules mediating inflammation and cytokine release syndrome, are discussed. The impact of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) is also addressed, since these drugs are used in cardio-oncology and have received considerable attention during the COVID-19 pandemic, since the culprit virus enters human cells via the angiotensin converting enzyme 2 (ACE2) receptor. There are therefore several areas of overlap, similarity, and interaction in the toxicity, pathophysiology, and pharmacology profiles in COVID-19 and cardio-oncology syndromes. Learning more about either will likely provide some level of insight into both. We discuss each of these topics in this viewpoint, as well as what we foresee as evolving future directions to consider in cardio-oncology during the pandemic and beyond. Finally, we highlight commonalities in health disparities in COVID-19 and cardio-oncology and encourage continued development and implementation of innovative solutions to improve equity in health and healing.