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New Crucial Literature: The Science You Need to Know

Protect Health Care Personnel during COVID-19: New Guidelines from Infectious Diseases Society

Lynch JB, Davitkov P, Anderson DJ, et al. Infectious Diseases Society of America Guidelines on Infection Prevention for Health Care Personnel Caring for Patients with Suspected or Known COVID-19. Clin Infect Dis. 2020.

This article provides clearly stated guidelines for protecting health care personnel while they care for patients with actual or suspected COVID-19 infection. The authors acknowledge that strong evidence to support recommendations is not consistently available; consequently, some of the suggestions are based on expert consensus.

The recommendations are divided into two sections that are relevant to situations where essential resources are available; a second category deals with “crisis” situations in which resources may be scarce. Use of impervious gowns, eye protection and N-95 masks or alternatives are recommended. Reuse of masks and use of face shields are recommended for crisis situations. Proper donning, doffing and disposal of used equipment are emphasized. Personal hygiene with hand washing and showering after a care event involving an infected patient also are recommended. Attention to minimizing involved care personnel and aggressive personal protection are recommended for care situations where droplet production risk is elevated. Overall, the guidelines are rational, carefully structured and have significant value for caregivers and administrators.

Increased Use of Antiplatelet Therapy Creates Challenge for Surgeons Who Care for Emergency and Trauma Patients

Godier A, Garrigue DU, Lasne D, et al. Management of antiplatelet therapy for non elective invasive procedures of bleeding complications: Proposals from the French working group on perioperative haemostasis (GIHP), in collaboration with the French Society of Anaesthesia and Intensive Care Medicine (SFAR). Anaesth Crit Care Pain Med. 2019;38(3):289-302.

Stonko DP, Haut ER. Review of the French Working Group on Perioperative Hemostasis, French Study Group on Thrombosis and Hemostasis, and French Society for Anaesthesia and Intensive Care Guidelines on Management of Antiplatelet Therapy for Nonelective Invasive Procedures or Bleeding Complications. JAMA Surg. 2020.

The increasing number of patients who are receiving antiplatelet medications has resulted in challenging problems for surgeons. Patients who require elective or urgent surgical procedures will require careful risk assessment to determine the need for postponing the planned procedure and for determining the necessity of neutralizing agents or platelet transfusion.

Bleeding complications of antiplatelet therapy, especially intracranial hemorrhage and traumatic injuries such as splenic rupture, may require emergent surgical intervention in patients receiving antiplatelet agents. The guidelines outline clear evidence of the mechanisms of action of the various agents as well as data supporting the proper use of neutralizing agents and platelet transfusion.

The editorial comment by Stonko and Haut emphasizes the importance of clear communication between the surgical team and primary care providers, cardiologists and hematologists. The guidelines document provides clear algorithms for management of needed surgical procedures and bleeding complications, which are outlined in two accompanying figures.

Prehabilitation May Have Limited Impact on Outcomes for Non-Bariatric Abdominal Surgery Patients

Lyons N, Bernardi K, Olavaria O, et al. Prehabilitation Among Patients Undergoing Non-Bariatric Abdominal Surgery: A Systematic Review. J Am Coll Surg. 2020.

This systematic review of the literature assesses available evidence on prehabilitation’s effects on mortality, morbidity and surgical site infection rates in patients who require non-bariatric abdominal surgical procedures. The authors note that the benefits of prehabilitation in cardiac surgery and orthopaedic surgery are well recognized. The data analysis includes 14 randomized trials involving nearly 1,000 patients; findings of importance include significant heterogeneity of available studies and relatively poor compliance (greater than 75 percent, range 16 percent−98 percent) with prehabilitation program requirements. The authors found no significant reductions in postoperative complications or rates of surgical site infections in the prehabilitation groups.

They did, however, find a significant improvement in functional status in patients who successfully completed the programs. The authors conclude that although available evidence failed to show a clear benefit additional studies are necessary to evaluate methods for improved compliance and to investigate the potential benefit associated with improved functional status.

Additional Readings

New York Times, How Russia’s COVID-19 Vaccine Could Backfire

New York Times, ‘A Smoking Gun’: Infectious Coronavirus Retrieved From Hospital Air

JAMA, Safety and Efficacy of Apixaban vs Enoxaparin for Preventing Postoperative Venous Thromboembolism in Women Undergoing Surgery for Gynecologic Malignant Neoplasm: A Randomized Clinical Trial

New England Journal of Medicine, The Effect of Advances in Lung-Cancer Treatment on Population Mortality

Politico, Masks, surgical gowns, testing supplies on FDA shortage list