553 Quality Improvement: The Implementation of Routine Tertiary Trauma Survey in all Trauma Patients Aged Over 60 Years in a Busy District General Hospital

Introduction Missed injury (MI) in trauma-patients is a widely reported phenomenon, with rates varying from 1.9-39%. Methods exist to reduce the incidence of MI’s such as the tertiary-trauma-survey (TTS). Robust primary and secondary surveys should indeed identify all injuries and facilitate management. However, for trauma patients, there remains an unwanted prevalence of MI. We hypothesized the addition of TTS may reduce the incidence of MI in a District General Hospital (DGH) and reduce associated morbidity and mortality; in particular in those aged >60. Method Patient notes for 18 consecutive trauma admissions in those >60 years were audited for admission demographics, timing and outcome of primary, secondary, and tertiary surveys, and occult injury. The TTS bundle was subsequently implemented in all trauma inpatients >60. Results In the primary round, 11% (n = 2) had evidence of TTS within 36hr of admission, reflective of exceeding the TARN criterion. TTS is now being utilised and we expect to see >98% compliance. Conclusions TTS is now incorporated as routine patient care for all trauma admissions >60. Compliance will be re-audited; aiming to reduce the opportunity for missed injury morbidity.

Guidelines for oral, pharyngeal and laryngopharyngeal surgery during COVID-19 pandemic

<p class="abstract">The pandemic due to the new respiratory infection known as coronavirus 2019 disease (COVID-19), caused by the SARS-CoV-2 virus, has triggered an unprecedented disruption in the normal activity of ENT, oral, and pharyngeal surgery departments worldwide, delaying routine patient care and elective surgical interventions. ENT, oral, and pharyngeal surgeons are one of the healthcare groups with the highest risk of nosocomial infection because of the close contact that occurs with asymptomatic and symptomatic patients with SARS-CoV-2 infection through the oral cavity and laryngopharynx. The purpose of this document has been to update the available evidence for the safe and effective management and treatment in elective and emergency surgeries, and hospitalization, while minimizing as much as possible the risk of infection for the ENT, oral, and laryngopharyngeal surgeon, health workers and patients. This document aims to clarify the most significant aspects and develop a common protocol for the surgical management of patients with COVID-19 in ENT, oral, and maxillofacial surgery during the acute stage of spread and subsequent control of the pandemic in our country.</p>

Histopathological variant types diagnosed in prostate surgery

Rare pathological variants may only be diagnosed after the surgical treatments applied. We aimed to determine the rare variant pathologies and their frequencies diagnosed in prostate surgeries performed in routine patient care. We retrospectively analyzed hospital pathology records for all prostate surgeries performed namely TUR-P, open prostatectomy, and radical prostatectomy between October 2014 and October 2019. A total of 1345 patients’ clinical data together with relevant prostate surgery pathologic diagnoses were evaluated from the database. Their mean age was 67.63±8.09. The most common comorbid diseases were hypertension (46%), diabetes mellitus (21%) and cerebrovascular disease (23%). Surgeries indicated and performed for prostate diseases were TUR-P (72%), open prostatectomy (9.7%) and radical prostatectomy (18.4%). The respective median PSA values for above mentioned surgery groups were 3.21, 7.34 and 8.13 ng/ml. Ninety-three patients (6.9%) had variant pathology associated with their primary pathologies including either BPH or prostate adenocarcinoma. 8.6% of patients with variant pathology had more than one variant types. Histopathological variant types generally considered rare can be seen up to 20% in oncological cases according to our database and their clinical importance and treatment differs for each variant type.

A New Method to Detect Gastro-esophageal Reflux in Critically Ill Mechanically Ventilated Patients: A Clinical Proof of Concept Study

BackgroundTracheal aspiration of gastric content among mechanically ventilated and tube-fed critically ill patients is of great concern. The mechanism leading to bacterial colonization of the lower respiratory tract in mechanically ventilated patients is tracheal aspiration of oral or gastric contents leading to Ventilator Associated Pneumonia (VAP). VAP is the most common nosocomial infection in the Intensive Care Unit (ICU). ICU-VAP generates about half of the cases of hospital-acquired pneumonia. There are various nursing practices available to reduce the rate of aspiration, but their efficacy is limited and they are not strong enough to prevent aspiration and VAP in practice. In this clinical study we used the smARTrack System, by ART MEDICAL, to assess the frequency of gastro-esophageal reflux in 20 ventilated ICU patients and its' correlation to procedures during routine patient care. MethodsThe smARTrack System is comprised of a novel gastric tube and an electronic monitoring console, which contains the system's software. The tube contains a series of bio-impedance sensors that can detect the presence of fluid around them. We conducted a study on 20 ICU ventilated patients at the Rambam Health Care Campus in Haifa, Israel. Reflux events and their duration were recorded when the tube detected gastric content rising above the sensors located at the lower esophageal sphincterResultsOur main findings shows that gastro-esophageal reflux occurs on average three times per hour of mechanical ventilation. We have also recorded three common clinical scenarios that were associated with a high risk of reflux; patient position-change, enteral fluid bolus, tracheal suction and migration of the feeding tube tip during ongoing use. ConclusionsGasto-esophageal reflux is a common event in the ICU as shown by the smARTrack System and may be related to routine patient care procedures. This study provides an important insight into the consequences of these procedures and might suggest ways to further improve them in reducing the rate of gasto-esophageal reflux and the risk of VAP among mechanicaly ventilated ICU patients.https://clinicaltrials.gov/ct2/show/NCT02705781?term=smARTrack&draw=2&rank=1 registered 11.3.2016

A COVID-19 exposure at a dental clinic where healthcare workers routinely use particulate filtering respirators

Back ground. Asymptomatic/mildly symptomatic coronavirus disease 2019 (COVID-19) patients produce a considerable amount of virus and transmit severe acute respiratory syndrome virus 2 (SARS-CoV-2) through close contact. Preventing in-hospital transmission of SARS-CoV-2 is challenging, since symptom-based screening protocols may miss asymptomatic/mildly symptomatic patients. In particular, dental health workers (HCWs) are at high risk of exposure, as face-to-face contact and exposure to oral secretions is unavoidable. We report exposure of HCWs during dental procedures on a mild symptomatic COVID-19 patient. Methods. A 32-year old male visited a dental clinic at a tertiary care hospital. He experienced mild cough, which started three days before the dental visit, but did not report his symptom during the entrance screening. He underwent several dental procedures and imaging for orthognathic surgery without wearing a mask. Seven HCWs were closely exposed to the patient during dental procedures that could have generated droplets and aerosols. One HCW had close contact with the patient during radiologic exams, and seven HCWs had casual contact. All HCWs wore particulate filtering respirators with 94% filter capacity and gloves, but none wore eye protection or gowns. The next day, the patient experienced dysgeusia and was diagnosed with COVID-19 with high viral load. Results. All HCWs who had close contact with the patient were quarantined for 14 days, and polymerase chain reaction and antibody tests for SARS-CoV-2 were negative. Conclusion. This exposure event suggests the protective effect of particulate filtering respirators in dental clinics. The appropriate personal protective equipment for routine patient care during COVID-19 pandemic should be established. The appropriate personal protective equipment for routine patient care during COVID-19 pandemic should be established.

Describing nearly two decades of Chagas disease in Germany and the lessons learned: a retrospective study on screening, detection, diagnosis, and treatment of Trypanosoma cruzi infection from 2000 – 2018

Background The highly complex and largely neglected Chagas disease (CD) has become a global health problem due to population movements between Latin America and non-endemic countries, as well as non-vectorial transmission routes. Data on CD testing and treatment from routine patient care in Germany of almost two decades was collected and analysed. Methods German laboratories offering diagnostics for chronic Trypanosoma cruzi (T. cruzi) infection in routine patient care were identified. All retrievable data on tests performed during the years of 2000–2018 were analysed. Additional clinical information regarding patients diagnosed with CD was collected through questionnaires. Results Five German laboratories with diagnostics for T. cruzi infection in routine patient care were identified. Centres in Hamburg and Munich offered two independent serological tests to confirm the CD diagnosis, as recommended by WHO during the entire time period 2000–2018. Overall, a total of n = 10,728 independent tests involving n = 5991 individuals were identified with a progressive increase in testing rates over time, only n = 130 (16.0%) of the tested individuals with known nationality came from CD endemic countries. Of all test units conducted at the included institutes, a total of n = 347/10,728 (3.2%) tests on CD were positive, of which n = 200/347 (57.6%) were ELISA, n = 133/347 (38.3%) IFT, n = 10/347 (2.9%) PCR, and n = 4/347 (1.2%) RDT. Of the n = 5991 individuals only n = 81 (1.4%) with chronic infection were identified, n = 52 females and n = 28 males. Additional clinical information could only be collected from n = 47. Conclusion The results of this study give insight into the deployment of screening, detection, diagnosis, and treatment of T. cruzi over the last two decades in Germany and existing deficits therein; the creation of guidelines for Germany could be a step forward to improve the existing gaps.