Pediatric neurosurgery during the COVID-19 pandemic: update and recommendations from the Brazilian Society of Pediatric Neurosurgery

OBJECTIVESCoronavirus disease (COVID-19) is a potentially severe respiratory illness that has threatened humanity globally. The pediatric neurosurgery practice differs from that of adults in that it treats children in various stages of physical and psychological development and contemplates diseases that do not exist in other areas. The aim of this study was to identify the level of knowledge and readiness of the healthcare providers, as well as to evaluate new preventive practices that have been introduced, psychological concerns, and the impact of the COVID-19 pandemic on pediatric neurosurgical units in Brazil.METHODSPediatric neurosurgeons were given an online questionnaire developed by the Brazilian Society of Pediatric Neurosurgery to evaluate the impact of the COVID-19 pandemic on their clinical practice.RESULTSOf a cohort of 110 active members of the Brazilian Society of Pediatric Neurosurgery, 76 completed the survey (69%). Ninety-six percent were aware of the correct use of and indication for the types of personal protective equipment in clinical and surgical practices, but only 73.7% of them had unrestricted access to this equipment. Ninety-eight percent of participants agreed or strongly agreed that the pandemic had affected their pediatric neurosurgical practice. The COVID-19 pandemic interfered with outpatient care in 88% of the centers, it affected neurosurgical activity in 90.7%, and it led to the cancellation of elective neurosurgical procedures in 57.3%. Concerning the impact of COVID-19 on surgical activity, 9.2% of the centers had less than 25% of the clinical practice affected, 46.1% had 26%–50% of their activity reduced, 35.5% had a 51%–75% reduction, and 9.2% had more than 75% of their surgical work cancelled or postponed. Sixty-three percent affirmed that patients had been tested for COVID-19 before surgery. Regarding the impact of the COVID-19 pandemic on the mental health of those interviewed, 3.9% reported fear and anxiety with panic episodes, 7.9% had worsening of previous anxiety symptoms, 60.5% reported occasional fear, 10.5% had sadness and some depressive symptoms, and 2.6% reported depressive symptoms.CONCLUSIONSThe COVID-19 pandemic has posed unprecedented challenges to healthcare services worldwide, including neurosurgical units. Medical workers, pediatric neurosurgeons included, should be aware of safety measures and follow the recommendations of local healthcare organizations, preventing and controlling the disease. Attention should be given to the psychological burden of exposure to SARS-CoV-2 in healthcare workers, which carries a high risk of anxiety and depression.

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Impact of coronavirus pandemic crisis in endoscopic clinical practice: Results from a national survey in Brazil

Endoscopy International Open ◽

10.1055/a-1183-3324 ◽

2020 ◽

Vol 08 (06) ◽

pp. E822-E829 ◽

Cited By ~ 1

Author(s):

Vitor Nunes Arantes ◽

Bruno Costa Martins ◽

Raphael Seqatto ◽

Daniela Medeiros Milhomen-Cardoso ◽

Tomazo Prince Franzini ◽

...

Keyword(s):

Clinical Practice ◽

National Survey ◽

Nationwide Survey ◽

World Health ◽

Disease Spread ◽

Income Loss ◽

Online Questionnaire ◽

Endoscopic Procedures ◽

Internet Link ◽

The Impact

Abstract Background and study aims In March 2020, the World Health Organization declared coronavirus disease of 2019 (COVID-19) as a pandemic, mobilizing all countries to contain the disease spread. Activity in endoscopy centers globally was severely affected. We conducted a national survey aiming to assess the impact of the COVID-19 outbreak on endoscopic clinical practice in Brazil. Methods In April 2020, 3,719 associate members of SOBED (Brazilian Society of Digestive Endoscopy) were invited to respond to an electronic survey. An Internet link was established to provide access to the online questionnaire with 40 questions regarding personal profile, endoscopy unit logistics and schedule, availability and use of personal protective equipment (PPE), financial impact, and exposure to COVID-19. Results A total of 2,131 individuals (67 %) accessed the questionnaire and 1155 responses were received. After review, 980 responses were considered valid. According to almost 90 % of respondents, endoscopy activity was restricted to urgent procedures, in both public and private hospitals. All respondents increased PPE use after the outbreak, however, institutions provided adequate PPE to only 278 responders (28.7 %). Significant income loss was universally reported. A total of 10 practitioners (1 %) reported COVID-19 infection and attributed the contamination to endoscopic procedures. Conclusions Based on this nationwide survey with almost 1,000 respondents, the COVID-19 pandemic substantially reduced the activity of endoscopy units in private and public settings. The pandemic increased awareness of PPE use, but its availability was not universal and 1 % of the respondents became infected with COVID-19, allegedly due to exposure during endoscopic procedures.

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An International Patient Centred Study Of Retroperitoneal Fibrosis

QJM ◽

10.1093/qjmed/hcaa327 ◽

2020 ◽

Author(s):

Dattani R ◽

Barwick TD ◽

El Wardany G ◽

Gibbons N ◽

Mason JC ◽

...

Keyword(s):

Retroperitoneal Fibrosis ◽

Interventional Procedure ◽

Healthcare Providers ◽

Psychological Aspects ◽

Free Text ◽

Online Questionnaire ◽

Psychological Burden ◽

Chronic Disorders ◽

Patient Related Outcome ◽

The Impact

Abstract Background The impact that rare chronic disorders such as Retroperitoneal Fibrosis (RPF) can have on the physical and psychological aspects of a patient’s health is poorly understood. Patient related outcome measures and experiences provide a unique opportunity to understand the impact rare chronic disorders have on a patient’s life as well as allowing healthcare providers to compare and improve performance. Aim To understand the physical and psychosocial impact that RPF has upon peoples’ lives Design An international online questionnaire was therefore created to gain insights into how patients with RPF, a rare fibro-inflammatory condition, viewed their health and experiences. Methods An international online questionnaire comprising 62 questions/free text options, was designed in collaboration with two patient advocates and the multi-disciplinary Renal Association Rare Disease Registry (RaDaR) RPF Groupthe questionnaire was anonymous and freely accessible on a GOOGLE Form online platform for 6 months. Results 229 patients from 30 countries across 5 continents responded. Four key issues were identified; (1) pain; (2) therapy related side effects; (3) lack of informed doctors/information about their condition and its management; (4) psychological burden. Variations in diagnosis and management are highlighted with 55% undergoing a biopsy to reach a diagnosis of RPF; 75% of patients underwent a further interventional procedure with 60% concurrently treated medically. Conclusion This study will guide further development of clinical and academic multi-disciplinary activity and shows the importance of trying to understand the impact of rare chronic disorders on the physical and psychological aspects of a patient’s health.

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Assessing Knowledge, Preventive Practices, and Depression among Chinese University Students in Korea and China during the COVID-19 Pandemic: An Online Cross-Sectional Study

Healthcare ◽

10.3390/healthcare9040433 ◽

2021 ◽

Vol 9 (4) ◽

pp. 433

Author(s):

Bo Zhao ◽

Fanlei Kong ◽

Eun Woo Nam

Keyword(s):

Depressive Symptoms ◽

University Students ◽

South Korea ◽

Mainland China ◽

Severe Depression ◽

Online Questionnaire ◽

Cross Sectional ◽

Preventive Practices ◽

Chinese University ◽

Chinese University Students

To investigate the knowledge, preventive practices, and depression of Chinese university students living in South Korea and Mainland China during the COVID-19 outbreak and explore the determinants of depression among these students, an online cross-sectional questionnaire survey was conducted from 23 March to 12 April 2020. The online questionnaire included questions on knowledge and preventive practices related to COVID-19, and the Patient Health Questionnaire-9 was used to diagnose depressive symptoms. A total of 420 Chinese university students were finally included in the study (171 students from South Korea and 249 students from Mainland China). The majority of these students had a good level of knowledge of COVID-19. Students living in South Korea displayed better preventive practices than those living in Mainland China; however, the proportion of students (28.7%) with moderate-to-severe depression in this group was relatively higher than that (18.9%) of the Mainland Group (χ2 = 5.50, p < 0.05). More severe depression was related to high levels of concern about family members and contracting COVID-19 as well as suspecting themselves of having come into contact with patients. Displaying more preventive behaviors decreased the depressive symptoms in both groups. These data could be used as a reference for further studies in different regions to take measures (e.g., psychological counseling and encouragement for physical activities) to reduce depressive symptoms in university students.

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The Impact of the COVID-19 Pandemic on Vulnerable People Suffering from Depression: Two Studies on Adults in France

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063250 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3250

Author(s):

Natalia Martinelli ◽

Sandrine Gil ◽

Johann Chevalère ◽

Clément Belletier ◽

Guillaume Dezecache ◽

...

Keyword(s):

Depressive Symptoms ◽

Risk Behaviors ◽

Health Risk Behaviors ◽

Psychological Effects ◽

Daily Routine ◽

Online Questionnaire ◽

Perceived Vulnerability ◽

Large Samples ◽

Health Related ◽

The Impact

This study investigated the difficulties experienced by people suffering from depression in coping with the stressful context of the COVID-19 pandemic and the lockdown. Two large samples of the French population were classified on the basis of their depressive symptoms and completed an online questionnaire on their emotions and their behaviors during the lockdown. Results showed that, compared to participants with no or mild mental health-related symptoms, participants with moderate to severe depressive symptoms suffered from greater psychological effects of the pandemic and the lockdown (fear, anxiety, sadness, sleep quality, loss of daily routine). However, health risk behaviors (smoking, drinking, non-compliance with lockdown and barrier gestures) and perceived vulnerability did not differ between the participant groups, although more severely depressed participants tended to be less respectful of health guidelines. In addition, the most heightened effects on the depressed participants were boredom and the feeling of social isolation, which was not compensated by the search for social affiliation. Supporting people with depression should be a public health priority because they suffer psychologically more than others from the pandemic and the lockdown.

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The effect of weekend and after-hours surgery on morbidity and mortality rates in pediatric neurosurgery patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2015.6.peds15184 ◽

2015 ◽

Vol 16 (6) ◽

pp. 726-731 ◽

Cited By ~ 20

Author(s):

Virendra Desai ◽

David Gonda ◽

Sheila L. Ryan ◽

Valentina Briceño ◽

Sandi K. Lam ◽

...

Keyword(s):

Pediatric Neurosurgery ◽

Weekend Effect ◽

Morbidity And Mortality ◽

Neurosurgical Procedures ◽

Ulcer Disease ◽

Logistic Regression Models ◽

After Hours ◽

American Society ◽

American Society Of Anesthesiologists ◽

The Impact

OBJECT Several studies have indicated that the 30-day morbidity and mortality risks are higher among pediatric and adult patients who are admitted on the weekends. This “weekend effect” has been observed among patients admitted with and fora variety of diagnoses and procedures, including myocardial infarction, pulmonary embolism, ruptured abdominal aortic aneurysm, stroke, peptic ulcer disease, and pediatric surgery. In this study, morbidity and mortality outcomes for emergency pediatric neurosurgical procedures carried out on the weekend or after hours are compared with emergency surgical procedures performed during regular weekday business hours. METHODS A retrospective analysis of operative data was conducted. Between December 1, 2011, and August 20, 2014, a total of 710 urgent or emergency neurosurgical procedures were performed at Texas Children’s Hospital in children younger than than 18 years of age. These procedures were then stratified into 3 groups: weekday regular hours, weekday after hours, and weekend hours. By cross-referencing these events with a prospectively collected morbidity and mortality database, the impact of the day and time on complication incidence was examined. Outcome metrics were compared using logistic regression models. RESULTS The weekday regular hours and after-hours (weekday after hours and weekends) surgery groups consisted of 341 and 239 patients and 434 and 276 procedures, respectively. There were no significant differences in the types of cases performed (p = 0.629) or baseline preoperative health status as determined by American Society of Anesthesiologists classifications (p = 0.220) between the 2 cohorts. After multivariate adjustment and regression, children undergoing emergency neurosurgical procedures during weekday after hours or weekends were more likely to experience complications (p = 0.0227). CONCLUSIONS Weekday after-hours and weekend emergency pediatric neurosurgical procedures are associated with significantly increased 30-day morbidity and mortality risk compared with procedures performed during weekday regular hours.

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The Impact of Childhood Trauma and Depressive Symptoms on Body Mass Index

Global Psychiatry ◽

10.2478/gp-2019-0008 ◽

2019 ◽

Vol 2 (1) ◽

pp. 97-106

Author(s):

Lara N. Schulze ◽

Sandra Van der Auwera ◽

Deborah Janowitz ◽

Johannes Hertel ◽

Katharina Wittfeld ◽

...

Keyword(s):

Body Mass Index ◽

Depressive Symptoms ◽

Childhood Trauma ◽

Body Mass ◽

Childhood Maltreatment ◽

The Body ◽

Psychotherapeutic Treatment ◽

Childhood Trauma Questionnaire ◽

Psychological Burden ◽

The Impact

AbstractObjectivesObesity is associated with several somatic diseases and increased psychological burden. This study focused on two potential psychological predictors of the body mass index (BMI), childhood trauma and depressive symptoms.MethodsWe used three independent populations: two general population samples (Study of Health in Pomerania, SHIP-2, N = 1,657; SHIP-TREND-0, N = 3,278) and one patient sample (GANI_MED, N = 1,742). Childhood trauma was measured with the childhood trauma questionnaire (CTQ) and depression with the Beck Depression Inventory (BDI-II) in SHIP-2 and the Patient Health Questionnaire (PHQ-9) in SHIP-TREND-0 and GANI_MED. We investigated the impact of childhood trauma and depression on BMI. Furthermore, we used mediation analysis to assess whether depression was a significant mediator on the path from childhood trauma to adult BMI in each of the three samples.ResultsIn all the three populations, depressive symptoms exhibited a significant association towards higher BMI (p < 0.05). Childhood trauma was positively associated with BMI with significant associations in SHIP-TREND-0 (p < 0.001) and GANI_MED (p = 0.005). The relationship between CTQ and BMI was significantly partially mediated (p < 0.05) by depressive symptoms in SHIP-TREND-0 (38.0%) and GANI_MED (16.4%), in SHIP-2 results pointed in the same direction. All the trauma sub-dimensions, except sexual abuse, exhibited at least one significant association towards increased BMI in one of the samples.ConclusionsChildhood trauma and depressive symptoms may be considered as causes of obesity. These results suggest that psychological treatments against obesity should address childhood maltreatment as well as depressive symptoms in their diagnostic assessment and could facilitate psychotherapeutic treatment when necessary.

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High Flow Oxygen Therapy and the Pressure to Feed Infants With Acute Respiratory Illness

Perspectives of the ASHA Special Interest Groups ◽

10.1044/2020_persp-19-00158 ◽

2020 ◽

Vol 5 (4) ◽

pp. 1006-1010

Author(s):

Jennifer Raminick ◽

Hema Desai

Keyword(s):

Clinical Practice ◽

Clinical Practice Guidelines ◽

Practice Guidelines ◽

Oxygen Therapy ◽

Respiratory Illness ◽

High Flow ◽

Oral Feeding ◽

Respiratory Support ◽

Acute Respiratory Illness ◽

High Flow Oxygen

Purpose Infants hospitalized for an acute respiratory illness often require the use of noninvasive respiratory support during the initial stage to improve their breathing. High flow oxygen therapy (HFOT) is becoming a more popular means of noninvasive respiratory support, often used to treat respiratory syncytial virus/bronchiolitis. These infants present with tachypnea and coughing, resulting in difficulties in coordinating sucking and swallowing. However, they are often allowed to feed orally despite having high respiratory rate, increased work of breathing and on HFOT, placing them at risk for aspiration. Feeding therapists who work with these infants have raised concerns that HFOT creates an additional risk factor for swallowing dysfunction, especially with infants who have compromised airways or other comorbidities. There is emerging literature concluding changes in pharyngeal pressures with HFOT, as well as aspiration in preterm neonates who are on nasal continuous positive airway pressure. However, there is no existing research exploring the effect of HFOT on swallowing in infants with acute respiratory illness. This discussion will present findings from literature on HFOT, oral feeding in the acutely ill infant population, and present clinical practice guidelines for safe feeding during critical care admission for acute respiratory illness. Conclusion Guidelines for safety of oral feeds for infants with acute respiratory illness on HFOT do not exist. However, providers and parents continue to want to provide oral feeds despite clinical signs of respiratory distress and coughing. To address this challenge, we initiated a process change to use clinical bedside evaluation and a “cross-systems approach” to provide recommendations for safer oral feeds while on HFOT as the infant is recovering from illness. Use of standardized feeding evaluation and protocol have improved consistency of practice within our department. However, further research is still necessary to develop clinical practice guidelines for safe oral feeding for infants on HFOT.

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Translating Principles of Speech Science to Clinical Practice: Current and Future Trends in Craniofacial Disorders

Perspectives on Speech Science and Orofacial Disorders ◽

10.1044/ssod18.1.31 ◽

2008 ◽

Vol 18 (1) ◽

pp. 31-40 ◽

Cited By ~ 2

Author(s):

David J. Zajac

Keyword(s):

Clinical Practice ◽

Speech Intelligibility ◽

Current Practice ◽

Computer Assisted ◽

Behavioral Management ◽

Single Word ◽

Future Directions ◽

Speech Science ◽

The Impact ◽

Opinion Article

Abstract The purpose of this opinion article is to review the impact of the principles and technology of speech science on clinical practice in the area of craniofacial disorders. Current practice relative to (a) speech aerodynamic assessment, (b) computer-assisted single-word speech intelligibility testing, and (c) behavioral management of hypernasal resonance are reviewed. Future directions and/or refinement of each area are also identified. It is suggested that both challenging and rewarding times are in store for clinical researchers in craniofacial disorders.

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