FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W3025903336> ?p ?o ?g. }

• W3025903336 endingPage "255" @default.
• W3025903336 startingPage "252" @default.
• W3025903336 abstract "In order to restrain the uncontrolled spread of the 2019 coronavirus, COVID-19, and to provide sufficient intensive care unit (ICU) capacity, medical specializations needed to develop new routines and risk strategy protocols. Those restrictions have also impacted the urological community. Several medical organizations have developed specific information hubs, blogs and resource centres focused on how to tackle the COVID-19 situation [1-3]. Although the German Society of Urology (Deutsche Gesellschaft für Urologie) published a recommendation to evaluate the need for timely therapy in patients with prostate cancer (PCa) according to D’Amico risk groups on 2 April 2020, to date there have been no compulsory directives regarding omitting radical prostatectomy during the COVID-19 pandemic. The Martini-Klinik Prostate Cancer Centre (MK) at the University Hospital Hamburg-Eppendorf (UHH) continued to perform surgery for PCa with risk-adjusted special precautions. In the present study, we share our initial experiences, routines and results of treating patients in the early phase of the COVID-19 pandemic. After approval of the study by our institutional review board, we performed a retrospective analysis of patient and preoperative tumour characteristics, and short-term complications of patients with PCa undergoing radical prostatectomy at our institution before and during the early phase of the COVID-19 pandemic in Germany. One group represented a consecutive cohort of patients with PCa treated in the period after the first COVID-19 case at UHH was detected (27 February 2020 to 17 April 2020), while the second group represented consecutive patients treated in the period before the first COVID-19 case (1 January to 26 February 2020). We evaluated the possible short-term postoperative complications and circumstances that occurred in relation to COVID-19. Putative factors that would predispose patients to a potentially worse outcome in case of infection or that increased the probability of being dependent on postoperative ICU care (focusing on patient age, cardiovascular disease and hypertension, obstructive sleep apnoea syndrome, diabetes mellitus, chronic lung, kidney or liver disease, and severe obesity) were assessed by evaluation of patient history. All analysed patients gave their informed consent for data analysis. All clinical and patient data were stored in a secured and pseudonymized database in the MK. In close communication with the official German public health institute, the Robert-Koch Institute (RKI) [4], a task force defined the procedures and safety measures required for all sections of the UHH, thus including the MK, since the first COVID-19 patient was identified in Germany. In addition to being physically ‘disconnected’ from the main complex of the UHH and offering only one- and two-bed rooms, thus benefiting from certain advantages in terms of infection control, further measures were established in the MK in concordance with the task force. No COVID-19 testing was routinely performed prior to surgery; however, before hospital admission and again prior to surgery, patients were repeatedly asked about COVID-19 exposure or symptoms (see Appendix S1). Patients with potential COVID-19 exposure were only admitted after a symptom-free period of >14 days and negative testing. Further COVID-19 measures undertaken by the UHH task force and the MK are shown in Fig. 1. Descriptive statistics of categorical variables are given as frequencies and proportions. Medians and interquartile ranges (IQR) are reported for continuously coded variables. For all statistical analyses, R software environment for statistical computing (version 3.4.3) was used. All tests were two-sided, with a level of statistical significance set at P < 0.05. We compared the results of 447 patients treated prior to the COVID-19 pandemic with those of 337 patients treated during the early phase of COVID-19. Patient characteristics, including preoperative tumour characteristics, were comparable. Further results are depicted in Table 1. Age, years Median (IQR) BMI, kg/m2 Median (IQR) PSA, ng/mL Median (IQR) LOS (days) Median (IQR) Twenty-six planned surgeries have been postponed or cancelled as a result of the COVID-19 situation. The first COVID-19-related prophylactic cancellations of surgeries in the MK occurred on 12 March. Two planned patients were confirmed to be COVID-19-positive (by their general practitioners) before admission to the MK. Surgery for 13 patients was postponed due to a high risk of inheriting a COVID-19 infection and a total of 11 patients chose to cancel because of fear of the COVID-19 situation in general. No patient with confirmed COVID-19 has been present within the MK to date. Of 230 clinic staff members, 31 have been tested for COVID-19, mainly after returning from RKI-declared COVID-19 risk regions after holidays or business travel. One MK ward nurse was confirmed as COVID-19-positive on 21 April without evidence of the origin of infection. After having created contact lists, all staff members and patients who have been in contact with the nurse have been tested and their results were negative. We have noted a slight decrease in the number of ICU transfers during the early COVID-19 phase (n = 19; median [IQR] 2 [0–2.25] per week) compared to the pre-COVID-19 phase (n = 26; median [IQR] 3 [2.75–3.25] per week). The main reason for ICU transfers was a precautionary relocation, prompted by institutional standards of the anaesthesiology department, in order to ensure monitoring for patients who were not assumed fit enough for the ward. Those relocations lasted only for the first postoperative night and retransfer to the MK was arranged on the first postoperative day. Two patients, however, were relocated to the ICU because of Clavien IV complications (pulmonary embolism and haemorrhagic shock) during the COVID-19 phase. As no COVID-19 case occurred in our clinic during the early phase of the pandemic, we were unable to identify COVID-19-related complications in our patients. Moreover, we did not identify any association with potentially concealed COVID-19 infections. Further short-term surgical complications are shown in Table 1. Our data demonstrate the feasibility of continuing surgery for PCa in a prepared setting. However, we acknowledge that the precautions and measures we have implemented within the MK might differ in other institutions or countries. Our experience was mainly possible because the German health system, and specifically the UHH, has an extraordinary hospital bed and ICU capacity, which provided some leeway, especially in this early phase of the COVID-19 pandemic. Furthermore, the MK is in the special position of not being physically connected to the main UHH complex of buildings and, therefore, we were able to treat our patients in reasonably protected surroundings. As we usually do not discharge patients before monitoring them for at least 3 days after surgery, we were able to recognize potential early COVID-19-related complications. If any signs of overstretching the UHH capacity had occurred, we would have taken action to drastically decrease our activity. If necessary, the MK would have given over its bed capacity (and will do so) to prevent the emergence of a potentially uncontrollable situation. Notably, we did not perform COVID-19 screening routinely but, instead, trusted in thorough and repeated assessment of patient history prior to admission to the clinic. With regard to the general population, the RKI initially recommended testing only for patients with explicit symptoms and those with a very high risk of harbouring COVID-19 (e.g. people in close contact with a confirmed case), while in later days, because of the increased availability of tests, the recommendation has been to additionally test mildly symptomatic persons. Very recently we decided to perform in-house reverse real-time RT-PCR for all patients admitted to MK prior to surgery. We are aware that this virus is unpredictable and, therefore, further adjustments of our actions will most likely have to be considered in the future in order to decrease the probability of further spread and of potentially avoidable complications or deaths. Although it is indisputable that cancer surgery cannot be postponed indefinitely, a certain delay in the treatment of PCa because of the COVID-19 pandemic might not influence oncological outomes [3, 5]. Nevertheless, mainly as a result of the rapid roll of events and in some extent inconsistent official information and guidelines on COVID-19 related restrictions during the early phase of the virus in Germany, we continued to perform surgeries for all risk groups as most of these patients had already received a diagnosis and had been enrolled on a waiting list for a long period. We decided, therefore, to continue to also treat low-risk cancer in very fit patients with a life expectancy far beyond 10 years. However, reserving surgery for patients with more aggressive tumour features will most likely reach the biggest consensus in future, as this has also been advocated recently by the European Association of Urology (EAU) [3]. Further surgical measures will be taken into consideration, such as the latest EAU Robotic Urology Section guidelines, advocating the reduction of potentially contagious airborne viral particles within the operating room [6]. In conclusion, during the early phase of the COVID-19 pandemic, we experienced favourable outcomes for our patients, without having performed rigorous screening, apart from taking a thorough patient history, and by applying strict protective hygiene standards. Nevertheless, we would like to distance ourselves from a general recommendation to commence surgery in other institutions or countries despite our favourable data. We hope, however, that our data contribute to a constructive discussion on possible future strategies within the medical community. We would like to thank all institutions involved which have enabled the MK to provide the necessary care to our cancer patients during the COVID-19 pandemic. None declared. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
• W3025903336 created "2020-05-21" @default.
• W3025903336 creator A5014466137 @default.
• W3025903336 creator A5014573705 @default.
• W3025903336 creator A5021872588 @default.
• W3025903336 creator A5027594836 @default.
• W3025903336 creator A5043714631 @default.
• W3025903336 creator A5058023068 @default.
• W3025903336 creator A5065439229 @default.
• W3025903336 creator A5065598615 @default.
• W3025903336 creator A5089661293 @default.
• W3025903336 date "2020-08-01" @default.
• W3025903336 modified "2023-10-01" @default.
• W3025903336 title "Martini‐Klinik experience of prostate cancer surgery during the early phase of the COVID‐19 pandemic" @default.
• W3025903336 cites W2121836977 @default.
• W3025903336 cites W3019631904 @default.
• W3025903336 doi "https://doi.org/10.1111/bju.15115" @default.
• W3025903336 hasPubMedCentralId "https://www.ncbi.nlm.nih.gov/pmc/articles/7276763" @default.
• W3025903336 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/32424990" @default.
• W3025903336 hasPublicationYear "2020" @default.
• W3025903336 type Work @default.
• W3025903336 sameAs 3025903336 @default.
• W3025903336 citedByCount "11" @default.
• W3025903336 countsByYear W30259033362020 @default.
• W3025903336 countsByYear W30259033362021 @default.
• W3025903336 countsByYear W30259033362022 @default.
• W3025903336 crossrefType "journal-article" @default.
• W3025903336 hasAuthorship W3025903336A5014466137 @default.
• W3025903336 hasAuthorship W3025903336A5014573705 @default.
• W3025903336 hasAuthorship W3025903336A5021872588 @default.
• W3025903336 hasAuthorship W3025903336A5027594836 @default.
• W3025903336 hasAuthorship W3025903336A5043714631 @default.
• W3025903336 hasAuthorship W3025903336A5058023068 @default.
• W3025903336 hasAuthorship W3025903336A5065439229 @default.
• W3025903336 hasAuthorship W3025903336A5065598615 @default.
• W3025903336 hasAuthorship W3025903336A5089661293 @default.
• W3025903336 hasBestOaLocation W30259033361 @default.
• W3025903336 hasConcept C116675565 @default.
• W3025903336 hasConcept C121608353 @default.
• W3025903336 hasConcept C126322002 @default.
• W3025903336 hasConcept C141071460 @default.
• W3025903336 hasConcept C159047783 @default.
• W3025903336 hasConcept C2778137277 @default.
• W3025903336 hasConcept C2779134260 @default.
• W3025903336 hasConcept C2780192828 @default.
• W3025903336 hasConcept C2909376813 @default.
• W3025903336 hasConcept C3006700255 @default.
• W3025903336 hasConcept C3007834351 @default.
• W3025903336 hasConcept C3008058167 @default.
• W3025903336 hasConcept C524204448 @default.
• W3025903336 hasConcept C61434518 @default.
• W3025903336 hasConcept C71924100 @default.
• W3025903336 hasConcept C89623803 @default.
• W3025903336 hasConceptScore W3025903336C116675565 @default.
• W3025903336 hasConceptScore W3025903336C121608353 @default.
• W3025903336 hasConceptScore W3025903336C126322002 @default.
• W3025903336 hasConceptScore W3025903336C141071460 @default.
• W3025903336 hasConceptScore W3025903336C159047783 @default.
• W3025903336 hasConceptScore W3025903336C2778137277 @default.
• W3025903336 hasConceptScore W3025903336C2779134260 @default.
• W3025903336 hasConceptScore W3025903336C2780192828 @default.
• W3025903336 hasConceptScore W3025903336C2909376813 @default.
• W3025903336 hasConceptScore W3025903336C3006700255 @default.
• W3025903336 hasConceptScore W3025903336C3007834351 @default.
• W3025903336 hasConceptScore W3025903336C3008058167 @default.
• W3025903336 hasConceptScore W3025903336C524204448 @default.
• W3025903336 hasConceptScore W3025903336C61434518 @default.
• W3025903336 hasConceptScore W3025903336C71924100 @default.
• W3025903336 hasConceptScore W3025903336C89623803 @default.
• W3025903336 hasIssue "2" @default.
• W3025903336 hasLocation W30259033361 @default.
• W3025903336 hasLocation W30259033362 @default.
• W3025903336 hasLocation W30259033363 @default.
• W3025903336 hasLocation W30259033364 @default.
• W3025903336 hasOpenAccess W3025903336 @default.
• W3025903336 hasPrimaryLocation W30259033361 @default.
• W3025903336 hasRelatedWork W3034139802 @default.
• W3025903336 hasRelatedWork W3036899716 @default.
• W3025903336 hasRelatedWork W3042427510 @default.
• W3025903336 hasRelatedWork W3045573749 @default.
• W3025903336 hasRelatedWork W3127941442 @default.
• W3025903336 hasRelatedWork W3128585611 @default.
• W3025903336 hasRelatedWork W3199363150 @default.
• W3025903336 hasRelatedWork W4280491013 @default.
• W3025903336 hasRelatedWork W4310828482 @default.
• W3025903336 hasRelatedWork W3107152225 @default.
• W3025903336 hasVolume "126" @default.
• W3025903336 isParatext "false" @default.
• W3025903336 isRetracted "false" @default.
• W3025903336 magId "3025903336" @default.
• W3025903336 workType "article" @default.