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1.
Journal of Emergency Nursing ; 2022.
Article in English | ScienceDirect | ID: covidwho-1799851

ABSTRACT

Objective Emergency department (ED) healthcare professionals (HCP) are at the frontline of evaluation and management of patients with acute, and often undifferentiated, illness. During the initial phase of the SARS-CoV-2 outbreak, there were concerns that ED HCPs may have been at increased risk of exposure to SARS-CoV-2 due to difficulty in early identification and isolation of patients. This study assessed the seroprevalence of SARS-CoV-2 antibodies among ED HCPs including attending physicians, residents, advanced practice providers, and nurses without prior confirmed history of COVID-19 infection at a quaternary academic medical center. Methods This study was a prospective, cross-sectional study. An ED healthcare professional was deemed eligible if they had worked at least four shifts in the adult ED from April 1, 2020, through May 31, 2020, were asymptomatic on the day of blood draw, and were not known to have had prior documented COVID-19 infection. The study period was December 17, 2020, to January 27, 2021. Eligible participants completed a questionnaire and had a blood sample drawn. Samples were run on the Roche Cobas Elecsys Anti-SARS-CoV-2 antibody assay. Results A total of 103 healthcare professionals (16 attending physicians, 4 emergency residents, 16 advanced practice professionals, and 67 full-time emergency nurses) completed the survey and had their blood drawn. While 17 healthcare professionals reported suspecting they had a prior undiagnosed COVID-19 infection, only three (1 attending physician, 1 advanced practice provider, 1 nurse) of the 103 (2.9%, exact 95% Confidence Interval [0.6%, 8.3%]) were seropositive for SARS-CoV-2 antibodies. Conclusion At this quaternary academic medical center among those who volunteered to take an antibody test, there was a low seroprevalence of SARS-CoV-2 antibodies among ED clinicians who were asymptomatic at the time of blood draw and not known to have had prior COVID-19 infection. Despite many unknowns early in the pandemic, the rate of asymptomatic infections appears to be low.

2.
Postgrad Med J ; 2022 Feb 07.
Article in English | MEDLINE | ID: covidwho-1673479
3.
American journal of physical medicine & rehabilitation ; 101(2):164-169, 2021.
Article in English | EuropePMC | ID: covidwho-1615242

ABSTRACT

A growing number of studies have documented a wide variety of neurological manifestations associated with the novel SARS-CoV-2 (COVID-19). Of the available literature, cranial neuropathies and central nervous system disorders, such as encephalopathy and ischemic strokes, remain the predominant discussion. Limited investigations exist examining peripheral neuropathies of those with COVID-19. This case series discusses eight patients who tested positive for COVID-19 and presented with localized weakness after a prolonged course of mechanical ventilation (>21 days). We retrospectively reviewed all patients’ charts who received electrodiagnostic evaluation between March and November 2020 in the outpatient clinic or in the acute care hospital at the JFK Medical Center/JFK Johnson Rehabilitation Institute and Saint Peter's University Hospital of New Jersey. A total of eight COVID-19–positive patients were identified to have a clinical presentation of localized weakness after a prolonged course of mechanical ventilation. All patients were subsequently found to have a focal peripheral neuropathy of varying severity that was confirmed by electrodiagnostic testing. Patient demographics, clinical, and electrodiagnostic findings were documented. The findings of local weakness and focal peripheral neuropathies after diagnosis of COVID-19 raise significant questions regarding underlying pathophysiology and overall prognosis associated with COVID-19.

4.
Microbiol Spectr ; 10(1): e0078621, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1605388

ABSTRACT

Seroepidemiological studies to monitor antibody kinetics are important for assessing the extent and spread of SARS-CoV-2 in a population. Noninvasive sampling methods are advantageous for reducing the need for venipuncture, which may be a barrier to investigations, particularly in pediatric populations. Oral fluids are obtained by gingiva-crevicular sampling from children and adults and are very well accepted. Enzyme immunoassays (EIAs) based on these samples have acceptable sensitivity and specificity compared to conventional serum-based antibody EIAs and are suitable for population-based surveillance. We describe the development and evaluation of SARS-CoV-2 IgG EIAs using SARS-CoV-2 viral nucleoprotein (NP) and spike (S) proteins in IgG isotype capture format and an indirect receptor-binding-domain (RBD) IgG EIA, intended for use in children as a primary endpoint. All three assays were assessed using a panel of 1,999 paired serum and oral fluids from children and adults participating in school SARS-CoV-2 surveillance studies during and after the first and second pandemic wave in the United Kingdom. The anti-NP IgG capture assay was the best candidate, with an overall sensitivity of 75% (95% confidence interval [CI]: 71 to 79%) and specificity of 99% (95% CI: 78 to 99%) compared with paired serum antibodies. Sensitivity observed in children (80%, 95% CI: 71 to 88%) was higher than that in adults (67%, CI: 60% to 74%). Oral fluid assays (OF) using spike protein and RBD antigens were also 99% specific and achieved reasonable but lower sensitivity in the target population (78%, 95% CI [68% to 86%] and 53%, 95% CI [43% to 64%], respectively). IMPORTANCE We report on the first large-scale assessment of the suitability of oral fluids for detection of SARS-CoV-2 antibody obtained from healthy children attending school. The sample type (gingiva-crevicular fluid, which is a transudate of blood but is not saliva) can be self collected. Although detection of antibodies in oral fluids is less sensitive than that in blood, our study suggests an optimal format for operational use. The laboratory methods we have developed can reliably measure antibodies in children, who are able to take their own samples. Our findings are of immediate practical relevance for use in large-scale seroprevalence studies designed to measure exposure to infection, as they typically require venipuncture. Overall, our data indicate that OF assays based on the detection of SARS-CoV-2 antibodies are a tool suitable for population-based seroepidemiology studies in children and highly acceptable in children and adults, as venipuncture is no longer necessary.


Subject(s)
Antibodies, Viral/analysis , COVID-19/diagnosis , Gingival Crevicular Fluid/immunology , Immunoglobulin G/analysis , SARS-CoV-2/immunology , Adolescent , Child , Child, Preschool , Humans , Immunoenzyme Techniques , Infant , Sensitivity and Specificity , Seroepidemiologic Studies
5.
Accid Anal Prev ; 163: 106428, 2021 Dec.
Article in English | MEDLINE | ID: covidwho-1458510

ABSTRACT

With the rising number of cases and deaths from the COVID-19 pandemic, nations and local governments, including many across the U.S., imposed travel restrictions on their citizens. This travel restriction order led to a significant reduction in traffic volumes and a generally lower exposure to crashes. However, recent preliminary statistics in the US suggest an increase in fatal crashes over the period of lockdown in comparison to the same period in previous years. This study sought to investigate how the pandemic affected road crashes and crash outcomes in Alabama. Daily vehicle miles traveled and crashes were obtained and explored. To understand the factors associated with crash outcomes, four crash-severity models were developed: (1) Single-vehicle (SV) crashes prior to lockdown order (Normal times SV); (2) multi-vehicle (MV) crashes prior to lockdown order (Normal times MV); (3) Single-vehicle crashes after lockdown order (COVID times SV); and (4) Multi-vehicle crashes after lockdown order (COVID times MV). The models were developed using the first 28 weeks of crashes recorded in 2020. The findings of the study reveal that although traffic volumes and vehicle miles traveled had significantly dropped during the lockdown, there was an increase in the total number of crashes and major injury crashes compared to the period prior to the lockdown order, with speeding, DUI, and weekends accounting for a significant proportion of these crashes. These observations provide useful lessons for road safety improvements during extreme events that may require statewide lockdown, as has been done with the COVID-19 pandemic. Traffic management around shopping areas and other areas that may experience increased traffic volumes provide opportunities for road safety stakeholders to reduce the occurrence of crashes in the weeks leading to an announcement of any future statewide or local lockdowns. Additionally, increased law enforcement efforts can help to reduce risky driving activities as traffic volumes decrease.


Subject(s)
COVID-19 , Pandemics , Accidents, Traffic , Alabama/epidemiology , Communicable Disease Control , Humans , SARS-CoV-2
6.
Crit Care Med ; 49(10): 1684-1693, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1452742

ABSTRACT

OBJECTIVES: Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators. DESIGN: A 2-day in-person meeting was held in Washington, DC, on March 28-29, 2019, followed by a three-round, online modified Delphi consensus process. PARTICIPANTS: Thirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process. MEASUREMENTS AND MAIN RESULTS: The final recommendations were iteratively refined based on the survey results, participants' reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization. CONCLUSIONS: These recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.


Subject(s)
Hypnotics and Sedatives/pharmacokinetics , Hypnotics and Sedatives/therapeutic use , Congresses as Topic , Consensus , Delphi Technique , District of Columbia , Humans , Hypnotics and Sedatives/pharmacology , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Time Factors
7.
Viruses ; 13(4)2021 04 01.
Article in English | MEDLINE | ID: covidwho-1389534

ABSTRACT

Sindbis virus (SINV), a positive-sense single stranded RNA virus that causes mild symptoms in humans, is transmitted by mosquito bites. SINV reverse genetics have many implications, not only in understanding alphavirus transmission, replication cycle, and virus-host interactions, but also in biotechnology and biomedical applications. The rescue of SINV infectious particles is usually achieved by transfecting susceptible cells (BHK-21) with SINV-infectious mRNA genomes generated from cDNA constructed via in vitro translation (IVT). That procedure is time consuming, costly, and relies heavily on reagent quality. Here, we constructed a novel infectious SINV cDNA construct that expresses its genomic RNA in yeast cells controlled by galactose induction. Using spheroplasts made from this yeast, we established a robust polyethylene glycol-mediated yeast: BHK-21 fusion protocol to rescue infectious SINV particles. Our approach is timesaving and utilizes common lab reagents for SINV rescue. It could be a useful tool for the rescue of large single strand RNA viruses, such as SARS-CoV-2.


Subject(s)
Alphavirus Infections/virology , Cell Fusion , Host Microbial Interactions/physiology , Sindbis Virus/genetics , Spheroplasts , Yeasts/genetics , Animals , COVID-19 , DNA, Complementary , RNA, Viral/genetics , SARS-CoV-2 , Saccharomyces cerevisiae , Yeasts/virology
8.
BMJ Open ; 11(7): e051823, 2021 07 29.
Article in English | MEDLINE | ID: covidwho-1334584

ABSTRACT

INTRODUCTION: Front-line health workers in remote health facilities are the first contact of the formal health sector and are confronted with life-saving decisions. Health information systems (HIS) support the collection and use of health related data. However, HIS focus on reporting and are unfit to support decisions. Since data tools are paper-based in most primary healthcare settings, we have produced an innovative Paper-based Health Information System in Comprehensive Care (PHISICC) using a human-centred design approach. We are carrying out a cluster randomised controlled trial in three African countries to assess the effects of PHISICC compared with the current systems. METHODS AND ANALYSIS: Study areas are in rural zones of Côte d'Ivoire, Mozambique and Nigeria. Seventy health facilities in each country have been randomly allocated to using PHISICC tools or to continuing to use the regular HIS tools. We have randomly selected households in the catchment areas of each health facility to collect outcomes' data (household surveys have been carried out in two of the three countries and the end-line data collection is planned for mid-2021). Primary outcomes include data quality and use, coverage of health services and health workers satisfaction; secondary outcomes are additional data quality and use parameters, childhood mortality and additional health workers and clients experience with the system. Just prior to the implementation of the trial, we had to relocate the study site in Mozambique due to unforeseen logistical issues. The effects of the intervention will be estimated using regression models and accounting for clustering using random effects. ETHICS AND DISSEMINATION: Ethics committees in Côte d'Ivoire, Mozambique and Nigeria approved the trials. We plan to disseminate our findings, data and research materials among researchers and policy-makers. We aim at having our findings included in systematic reviews on health systems interventions and future guidance development on HIS. TRIAL REGISTRATION NUMBER: PACTR201904664660639; Pre-results.


Subject(s)
Health Information Systems , Child , Cote d'Ivoire , Data Accuracy , Humans , Mozambique , Nigeria , Primary Health Care , Randomized Controlled Trials as Topic , Systematic Reviews as Topic
9.
PLoS Med ; 18(7): e1003656, 2021 07.
Article in English | MEDLINE | ID: covidwho-1298076

ABSTRACT

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) antibody neutralization response and its evasion by emerging viral variants and variant of concern (VOC) are unknown, but critical to understand reinfection risk and breakthrough infection following vaccination. Antibody immunoreactivity against SARS-CoV-2 antigens and Spike variants, inhibition of Spike-driven virus-cell fusion, and infectious SARS-CoV-2 neutralization were characterized in 807 serial samples from 233 reverse transcription polymerase chain reaction (RT-PCR)-confirmed Coronavirus Disease 2019 (COVID-19) individuals with detailed demographics and followed up to 7 months. A broad and sustained polyantigenic immunoreactivity against SARS-CoV-2 Spike, Membrane, and Nucleocapsid proteins, along with high viral neutralization, was associated with COVID-19 severity. A subgroup of "high responders" maintained high neutralizing responses over time, representing ideal convalescent plasma donors. Antibodies generated against SARS-CoV-2 during the first COVID-19 wave had reduced immunoreactivity and neutralization potency to emerging Spike variants and VOC. Accurate monitoring of SARS-CoV-2 antibody responses would be essential for selection of optimal responders and vaccine monitoring and design.


Subject(s)
Antibodies, Neutralizing/immunology , SARS-CoV-2/pathogenicity , Adult , Antibodies, Viral/immunology , Female , Humans , Male , Middle Aged , Nucleocapsid Proteins/immunology , SARS-CoV-2/immunology
10.
J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Article in English | MEDLINE | ID: covidwho-1268210

ABSTRACT

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.


Subject(s)
COVID-19/epidemiology , Needs Assessment , Vulnerable Populations , Adolescent , Adult , Aged , Child , Community Health Services , Consumer Health Information , Female , Florida/epidemiology , Food Assistance , Health Services Needs and Demand , Humans , Male , Medically Underserved Area , Middle Aged , Pandemics , Social Determinants of Health , Young Adult
11.
Acad Med ; 96(11): 1518-1523, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1207326

ABSTRACT

Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.


Subject(s)
COVID-19/psychology , Education, Medical/ethics , Racism/ethnology , African Americans , Awareness , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Education, Medical/statistics & numerical data , Female , Healthcare Disparities/ethnology , Humans , Male , Minority Groups , Problem-Based Learning/statistics & numerical data , Public Health/ethics , Public Health/statistics & numerical data , SARS-CoV-2/genetics , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Social Justice/ethics , Stakeholder Participation , Students, Medical/statistics & numerical data , United States/epidemiology
12.
Public Health Rep ; 136(3): 368-374, 2021 05.
Article in English | MEDLINE | ID: covidwho-1138485

ABSTRACT

OBJECTIVE: Understanding the pattern of population risk for coronavirus disease 2019 (COVID-19) is critically important for health systems and policy makers. The objective of this study was to describe the association between neighborhood factors and number of COVID-19 cases. We hypothesized an association between disadvantaged neighborhoods and clusters of COVID-19 cases. METHODS: We analyzed data on patients presenting to a large health care system in Boston during February 5-May 4, 2020. We used a bivariate local join-count procedure to determine colocation between census tracts with high rates of neighborhood demographic characteristics (eg, Hispanic race/ethnicity) and measures of disadvantage (eg, health insurance status) and COVID-19 cases. We used negative binomial models to assess independent associations between neighborhood factors and the incidence of COVID-19. RESULTS: A total of 9898 COVID-19 patients were in the cohort. The overall crude incidence in the study area was 32 cases per 10 000 population, and the adjusted incidence per census tract ranged from 2 to 405 per 10 000 population. We found significant colocation of several neighborhood factors and the top quintile of cases: percentage of population that was Hispanic, non-Hispanic Black, without health insurance, receiving Supplemental Nutrition Assistance Program benefits, and living in poverty. Factors associated with increased incidence of COVID-19 included percentage of population that is Hispanic (incidence rate ratio [IRR] = 1.25; 95% CI, 1.23-1.28) and percentage of households living in poverty (IRR = 1.25; 95% CI, 1.19-1.32). CONCLUSIONS: We found a significant association between neighborhoods with high rates of disadvantage and COVID-19. Policy makers need to consider these health inequities when responding to the pandemic and planning for subsequent health needs.


Subject(s)
COVID-19/epidemiology , Medically Uninsured/statistics & numerical data , Poverty/statistics & numerical data , Residence Characteristics , Vulnerable Populations/statistics & numerical data , Adult , Aged , Female , Food Assistance/statistics & numerical data , Geographic Mapping , Humans , Incidence , Male , Massachusetts/epidemiology , Middle Aged , Socioeconomic Factors
13.
Mem. Inst. Oswaldo Cruz ; 115:e200232-e200232, 2020.
Article in English | LILACS (Americas), Grey literature | ID: grc-742520

ABSTRACT

Coronavirus disease 2019 (COVID-19) surveillance, in Brazil, initiated shortly after its description, in China. Our aim was to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and additional pathogens in samples from the initial phase of the outbreak in Brazil, from late February to late March. From 707 samples analysed, 29 (4.1%) were SARS-CoV-2 positive. Fever and cough were their most prevalent symptoms. Co-detection of rhinovirus was observed in 2 (6.9%) cases. Additional pathogens were identified in 66.1% of the SARS-CoV-2 negative cases, mainly rhinovirus and influenza A(H1N1)pdm09. Thus, we emphasise the importance of differential diagnosis in COVID-19 suspected cases.

14.
Am J Emerg Med ; 46: 476-481, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-927002

ABSTRACT

OBJECTIVE: Prior data suggest Emergency Department (ED) visits for many emergency conditions decreased during the initial COVID-19 surge. However, the pandemic's impact on the wide range of conditions seen in EDs, and the resources required for treating them, has been less studied. We sought to provide a comprehensive analysis of ED visits and associated resource utilization during the initial COVID-19 surge. METHODS: We performed a retrospective analysis from 5 hospitals in a large health system in Massachusetts, comparing ED encounters from 3/1/2020-4/30/2020 to identical weeks from the prior year. Data collected included demographics, ESI, diagnosis, consultations ordered, bedside procedures, and inpatient procedures within 48 h. We compared raw frequencies between time periods and calculated incidence rate ratios. RESULTS: ED volumes decreased by 30.9% in 2020 compared to 2019. Average acuity of ED presentations increased, while most non-COVID-19 diagnoses decreased. The number and incidence rate of all non-critical care ED procedures decreased, while the occurrence of intubations and central lines increased. Most subspecialty consultations decreased, including to psychiatry, trauma surgery, and cardiology. Most non-elective procedures related to ED encounters also decreased, including craniotomies and appendectomies. CONCLUSION: Our health system experienced decreases in nearly all non-COVID-19 conditions presenting to EDs during the initial phase of the pandemic, including those requiring specialty consultation and urgent inpatient procedures. Findings have implications for both public health and health system planning.


Subject(s)
COVID-19/epidemiology , Disease Management , Emergency Service, Hospital/statistics & numerical data , Pandemics , COVID-19/therapy , Female , Follow-Up Studies , Humans , Male , Massachusetts/epidemiology , Middle Aged , Retrospective Studies , SARS-CoV-2
15.
Prog Pediatr Cardiol ; 60: 101320, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-907176

ABSTRACT

In the setting of the coronavirus disease 2019 (COVID-19) pandemic, an emergency hospital-wide eWork policy was enacted at Boston Children's Hospital on March 16, 2020. The number of clinicians on campus was restricted to only essential personnel, guidelines limited clinical care delivery to solely non-elective patients, and strict maximums were placed on the numbers of people allowed to congregate in the same physical space. With this abrupt transition to social distancing and electronic communication, the established approach to educating graduate medical trainees became obsolete overnight. Anticipating significant impact on trainee and faculty professional and personal lives, the importance of adaptive teaching strategies was evident. This document details one approach to redesigning the clinical learning system including a description of the learners and environment, the pedagogical principles that guided the approach, and technological tools used in implementation. Additionally, available literature pertinent to this topic is explored, assessment of the work to date is presented, and suggestions are provided regarding future directions related to online graduate medical education.

17.
J Pediatr Rehabil Med ; 13(3): 371-376, 2020.
Article in English | MEDLINE | ID: covidwho-890315

ABSTRACT

The COVID-19 pandemic is exacerbating longstanding challenges facing children with tracheostomies and their families. Myriad ethical concerns arising in the long-term care of children with tracheostomies during the COVID-19 pandemic revolve around inadequate access to care, healthcare resources, and rehabilitation services. Marginalized communities such as those from Black and Hispanic origins face disproportionate chronic illness because of racial and other underlying disparities. In this paper, we describe how these disparities also present challenges to children who are technology-dependent, such as those with tracheostomies and discuss the emerging ethical discourse regarding healthcare and resource access for this population during the pandemic.


Subject(s)
COVID-19/epidemiology , Health Status Disparities , Long-Term Care/methods , Pandemics , SARS-CoV-2 , Tracheostomy/ethics , COVID-19/therapy , Child , Humans
18.
West J Emerg Med ; 21(6): 88-92, 2020 Sep 25.
Article in English | MEDLINE | ID: covidwho-869241

ABSTRACT

INTRODUCTION: Emergency clinicians on the frontline of the coronavirus pandemic experience a range of emotions including anxiety, fear, and grief. Debriefing can help clinicians process these emotions, but the coronavirus pandemic makes it difficult to create a physically and psychologically safe space in the emergency department (ED) to perform this intervention. In response, we piloted a video-based debriefing program to support emergency clinician well-being. We report the details of our program and results of our evaluation of its acceptability and perceived value to emergency clinicians during the pandemic. METHODS: ED attending physicians, resident physicians, and non-physician practitioners (NPP) at our quaternary-care academic medical center were invited to participate in role-based, weekly one-hour facilitated debriefings using Zoom. ED attendings with experience in debriefing led each session and used an explorative approach that focused on empathy and normalizing reactions. At the end of the pilot, we distributed to participants an anonymous 10-point survey that included multiple-answer questions and visual analogue scales. RESULTS: We completed 18 debriefings with 68 unique participants (29 attending physicians, 6 resident physicians, and 33 NPPs. A total of 76% of participants responded to our survey and 77% of respondents participated in at least two debriefings. Emergency clinicians reported that the most common reasons to participate in the debriefings were "to enhance my sense of community and connection" (81%) followed by "to support colleagues" (75%). Debriefing with members of the same role group (92%) and the Zoom platform (81%) were considered to be helpful aspects of the debriefing structure. Although emergency clinicians found these sessions to be useful (78.8 +/- 17.6) interquartile range: 73-89), NPPs were less comfortable speaking up (58.5 +/- 23.6) than attending physicians (77.8 +/- 25.0) (p = < 0.008). CONCLUSION: Emergency clinicians participating in a video-based debriefing program during the coronavirus pandemic found it to be an acceptable and useful approach to support emotional well-being. Our program provided participants with a platform to support each other and maintain a sense of community and connection. Other EDs should consider implementing a debriefing program to safeguard the emotional well-being of their emergency clinician workforce.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital , Feedback , Nurse Practitioners/psychology , Occupational Stress/therapy , Physicians/psychology , Videoconferencing , Attitude of Health Personnel , Burnout, Professional/prevention & control , Health Promotion/methods , Humans , Occupational Stress/psychology , Resilience, Psychological , SARS-CoV-2 , Surveys and Questionnaires
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