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COVID-19 时代口腔颌面外科医生的考量:我们能否持续保持让患者和医护人员安全的解决方案?

Considerations for Oral and Maxillofacial Surgeons in COVID-19 Era: Can We Sustain the Solutions to Keep Our Patients and Healthcare Personnel Safe?

作者信息

Chigurupati Radhika, Panchal Neeraj, Henry Andrew M, Batal Hussam, Sethi Amit, D'innocenzo Richard, Mehra Pushkar, Krishnan Deepak G, Roser Steven M

机构信息

Associate Professor, Department of Oral and Maxillofacial Surgery, Boston University Medical Center, and Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA.

Assistant Professor and Section Chief, Department of Oral and Maxillofacial Surgery, Philadelphia Veterans Affairs Medical Center, Penn Presbyterian Medical Center, University of Pennsylvania School of Dental Medicine, Philadelphia, PA.

出版信息

J Oral Maxillofac Surg. 2020 Aug;78(8):1241-1256. doi: 10.1016/j.joms.2020.05.027. Epub 2020 May 24.

Abstract

Several uncertainties exist regarding how we will conduct our clinical, didactic, business, and social activities as the coronavirus disease 2019 (COVID-19) global pandemic abates and social distancing guidelines are relaxed. We anticipate changes in how we interact with our patients and other providers, how patient workflow is designed, the methods used to conduct our teaching sessions, and how we perform procedures in different clinical settings. The objective of the present report is to review some of the changes to consider in the clinical and academic oral and maxillofacial surgery workflow and, allow for a smoother transition, with less risk to our patients and healthcare personnel. New infection control policies should be strictly enforced and monitored in all clinical and nonclinical settings, with an overall goal to decrease the risk of exposure and transmission. Screening for COVID-19 symptoms, testing when indicated, and establishing the epidemiologic linkage will be crucial to containing and preventing new COVID-19 cases until a vaccine or an alternate solution is available. Additionally, the shortage of essential supplies such as drugs and personal protective equipment, the design and ventilation of workspaces and waiting areas, the increase in overhead costs, and the possible absence of staff, if quarantine is necessary, must be considered. This shift in our workflow and patient care paths will likely continue in the short-term at least through 2021 or the next 12 to 24 months. Thus, we must prioritize surgery, balancing patient preferences and healthcare personnel risks. We have an opportunity now to make changes and embrace telemedicine and other collaborative virtual platforms for teaching and clinical care. It is crucial that we maintain COVID-19 awareness, proper surveillance in our microenvironments, good clinical judgment, and ethical values to continue to deliver high-quality, economical, and accessible patient care.

摘要

随着2019冠状病毒病(COVID-19)全球大流行趋缓以及社交距离指导方针放宽,我们在如何开展临床、教学、业务和社交活动方面存在诸多不确定性。我们预计在与患者及其他医疗服务提供者的互动方式、患者工作流程的设计、开展教学课程的方法以及在不同临床环境中进行手术的方式等方面都会发生变化。本报告的目的是回顾一些在临床和学术口腔颌面外科工作流程中需要考虑的变化,以便实现更平稳的过渡,降低对患者和医护人员的风险。在所有临床和非临床环境中都应严格执行和监督新的感染控制政策,总体目标是降低暴露和传播风险。对COVID-19症状进行筛查、在有指征时进行检测以及建立流行病学联系对于控制和预防新的COVID-19病例至关重要,直到有疫苗或其他替代解决方案可用。此外,还必须考虑药品和个人防护设备等基本物资的短缺、工作空间和候诊区的设计与通风、间接费用的增加以及如果需要隔离可能出现的人员缺勤情况。我们工作流程和患者护理路径的这种转变至少在短期内可能会持续到2021年或未来12至24个月。因此,我们必须对手术进行优先级排序,平衡患者的偏好和医护人员的风险。我们现在有机会做出改变,采用远程医疗和其他协作虚拟平台进行教学和临床护理。至关重要的是,我们要保持对COVID-19的警惕、在我们的微环境中进行适当监测、具备良好的临床判断力和道德价值观,以继续提供高质量、经济且可及的患者护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4fe5/7246053/ee3574ddcb74/gr1_lrg.jpg

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