Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 26
Filter
1.
Am J Respir Crit Care Med ; 205(12): 1382-1390, 2022 06 15.
Article in English | MEDLINE | ID: covidwho-1892012

ABSTRACT

The role of extracorporeal membrane oxygenation (ECMO) in the management of severe acute respiratory failure, including acute respiratory distress syndrome, has become better defined in recent years in light of emerging high-quality evidence and technological advances. Use of ECMO has consequently increased throughout many parts of the world. The coronavirus disease (COVID-19) pandemic, however, has highlighted deficiencies in organizational capacity, research capability, knowledge sharing, and resource use. Although governments, medical societies, hospital systems, and clinicians were collectively unprepared for the scope of this pandemic, the use of ECMO, a highly resource-intensive and specialized form of life support, presented specific logistical and ethical challenges. As the pandemic has evolved, there has been greater collaboration in the use of ECMO across centers and regions, together with more robust data reporting through international registries and observational studies. Nevertheless, centralization of ECMO capacity is lacking in many regions of the world, and equitable use of ECMO resources remains uneven. There are no widely available mechanisms to conduct large-scale, rigorous clinical trials in real time. In this critical care review, we outline lessons learned during COVID-19 and prior respiratory pandemics in which ECMO was used, and we describe how we might apply these lessons going forward, both during the ongoing COVID-19 pandemic and in the future.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Respiratory Distress Syndrome , COVID-19/therapy , Humans , Pandemics , SARS-CoV-2
2.
Am J Physiol Lung Cell Mol Physiol ; 323(1): L14-L26, 2022 07 01.
Article in English | MEDLINE | ID: covidwho-1861686

ABSTRACT

Critically ill patients manifest many of the same immune features seen in coronavirus disease 2019 (COVID-19), including both "cytokine storm" and "immune suppression." However, direct comparisons of molecular and cellular profiles between contemporaneously enrolled critically ill patients with and without severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are limited. We sought to identify immune signatures specifically enriched in critically ill patients with COVID-19 compared with patients without COVID-19. We enrolled a multisite prospective cohort of patients admitted under suspicion for COVID-19, who were then determined to be SARS-CoV-2-positive (n = 204) or -negative (n = 122). SARS-CoV-2-positive patients had higher plasma levels of CXCL10, sPD-L1, IFN-γ, CCL26, C-reactive protein (CRP), and TNF-α relative to SARS-CoV-2-negative patients adjusting for demographics and severity of illness (Bonferroni P value < 0.05). In contrast, the levels of IL-6, IL-8, IL-10, and IL-17A were not significantly different between the two groups. In SARS-CoV-2-positive patients, higher plasma levels of sPD-L1 and TNF-α were associated with fewer ventilator-free days (VFDs) and higher mortality rates (Bonferroni P value < 0.05). Lymphocyte chemoattractants such as CCL17 were associated with more severe respiratory failure in SARS-CoV-2-positive patients, but less severe respiratory failure in SARS-CoV-2-negative patients (P value for interaction < 0.01). Circulating T cells and monocytes from SARS-CoV-2-positive subjects were hyporesponsive to in vitro stimulation compared with SARS-CoV-2-negative subjects. Critically ill SARS-CoV-2-positive patients exhibit an immune signature of high interferon-induced lymphocyte chemoattractants (e.g., CXCL10 and CCL17) and immune cell hyporesponsiveness when directly compared with SARS-CoV-2-negative patients. This suggests a specific role for T-cell migration coupled with an immune-checkpoint regulatory response in COVID-19-related critical illness.


Subject(s)
COVID-19 , Respiratory Insufficiency , B7-H1 Antigen , Chemokines , Critical Illness , Humans , Prospective Studies , SARS-CoV-2 , Tumor Necrosis Factor-alpha
3.
Health Secur ; 20(S1): S39-S48, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1852865

ABSTRACT

Infectious disease outbreaks and pandemics have repeatedly threatened public health and have severely strained healthcare delivery systems throughout the past century. Pathogens causing respiratory illness, such as influenza viruses and coronaviruses, as well as the highly communicable viral hemorrhagic fevers, pose a large threat to the healthcare delivery system in the United States and worldwide. Through the Hospital Preparedness Program, within the US Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response, a nationwide Regional Ebola Treatment Network (RETN) was developed, building upon a state- and jurisdiction-based tiered hospital approach. This network, spearheaded by the National Emerging Special Pathogens Training and Education Center, developed a conceptual framework and plan for the evolution of the RETN into the National Special Pathogen System of Care (NSPS). Building the NSPS strategy involved reviewing the literature and the initial framework used in forming the RETN and conducting an extensive stakeholder engagement process to identify gaps and develop solutions. From this, the NSPS strategy and implementation plan were formed. The resulting NSPS strategy is an ambitious but critical effort that will have impacts on the mitigation efforts of special pathogen threats for years to come.


Subject(s)
Coronavirus Infections , Hemorrhagic Fever, Ebola , Coronavirus Infections/epidemiology , Disease Outbreaks/prevention & control , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/prevention & control , Humans , Pandemics , Public Health , United States
4.
Development Policy Review ; n/a(n/a):e12619, 2022.
Article in English | Wiley | ID: covidwho-1626783

ABSTRACT

Summary Motivation This article discusses the use of educational technology (EdTech) in girls? education at PEAS schools (?Promoting Education in African Schools?) in rural Uganda during the COVID-19-related school closures. Purpose This article addresses a research gap surrounding the potential use of EdTech to support girls? education, focusing on the barriers to girls? EdTech use and how technology might be used to enhance girls? education in disadvantaged rural areas ? specifically their academic learning and their social and emotional learning. Methods and approach A sequential, explanatory mixed-methods case study approach was used. Quantitative exploration of a dataset of 483 Ugandan students, from 28 PEAS schools, was first conducted, followed by interviews with PEAS staff to elucidate the reasons and context behind the findings. Findings Findings show female students are less likely than male students to have access to their caregivers? phones for learning. The form of EdTech that appeared most beneficial for girls? academic learning was radio;girls also had significantly more interest in tuning into radio broadcasts than boys did. Also, poorer boys were more likely to be inspired by SMS messages than wealthier boys. Apart from gender-based differences, students with more highly educated parents found SMS messages more helpful, and phone calls from teachers appeared to help boost younger students? self-confidence. Policy implications The findings suggest that policymakers need to: carefully consider provision of education through multiple modes of EdTech in order to ensure that it reaches all students;ensure that caregivers are involved in the strategies developed for girls? education;make EdTech interventions interactive;and consider language in EdTech interventions. Given the gender differences which emerged, the findings are of relevance both to supporting the continuation of educational provision during periods of school closure, and also in terms of finding additional ways to support girls? education alongside formal schooling.

5.
Crit Care Clin ; 38(3): 623-637, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1616400

ABSTRACT

Hospitals and health care systems with active critical care organizations (CCOs) that unified ICU units before the onset of the COVID-19 Pandemic were better positioned to adapt to the demands of the pandemic, due to their established standardization of care and integration of critical care within the larger structure of the hospital or health care system. CCOs should continue to make changes, based on the real experience of COVID-19 that would lead to improved care during the ongoing pandemic, and beyond.


Subject(s)
COVID-19 , Critical Care , Humans , Intensive Care Units , Pandemics , SARS-CoV-2 , Surge Capacity
6.
Critical Care Medicine ; 50:42-42, 2022.
Article in English | Academic Search Complete | ID: covidwho-1591248

ABSTRACT

The survey assessed hospital stress ordinally and also assessed ED and ICU stress and deviations from standard operating procedures. During one December 2020 week, hospital stress, ICU stress, and care deviations were all present at 100% of reporting sites. B Introduction: b Hospitals experienced substantial stress during the COVID-19 pandemic - threats to standard operations - but it is not well known how this stress manifested at individual hospitals. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

7.
Infect Control Hosp Epidemiol ; 42(11): 1307-1312, 2021 11.
Article in English | MEDLINE | ID: covidwho-1574178

ABSTRACT

OBJECTIVE: In response to the 2013-2016 Ebola virus disease outbreak, the US government designated certain healthcare institutions as Ebola treatment centers (ETCs) to better prepare for future emerging infectious disease outbreaks. This study investigated ETC experiences and critical care policies for patients with viral hemorrhagic fever (VHF). DESIGN: A 58-item questionnaire elicited information on policies for 9 critical care interventions, factors that limited care provision, and innovations developed to deliver care. SETTING AND PARTICIPANTS: The questionnaire was sent to 82 ETCs. METHODS: We analyzed ordinal and categorical data pertaining to the ETC characteristics and descriptive data about their policies and perceived challenges. Statistical analyses assessed whether ETCs with experience caring for VHF patients were more likely to have critical care policies than those that did not. RESULTS: Of the 27 ETCs who responded, 17 (63%) were included. Among them, 8 (47%) reported experience caring for persons under investigation or confirmed cases of VHF. Most felt ready to provide intubation, chest compressions, and renal replacement therapy to these patients. The factors most cited for limiting care were staff safety and clinical futility. Innovations developed to better provide care included increased simulation training and alternative technologies for procedures and communication. CONCLUSIONS: There were broad similarities in critical care policies and limitations among institutions. There were several interventions, namely ECMO and cricothyrotomy, which few institutions felt ready to provide. Future studies could identify obstacles to providing these interventions and explore policy changes after increased experience with novel infectious diseases, such as COVID-19.


Subject(s)
COVID-19 , Hemorrhagic Fever, Ebola , Critical Illness , Disease Outbreaks , Hemorrhagic Fever, Ebola/epidemiology , Hemorrhagic Fever, Ebola/therapy , Humans , Organizational Policy , SARS-CoV-2
8.
Journal of Museum Education ; 46(4):454-466, 2021.
Article in English | Academic Search Complete | ID: covidwho-1553713

ABSTRACT

The COVID-19 pandemic is a global, collective, traumatic experience. Trauma-aware museum educators can play a therapeutic role in helping visitors reengage with life as the world reopens. This article explores the dynamics of what a trauma-aware approach to engaging with art may be, specifically detailing methods that can create new cognitive, emotional, and sensory experiences that contradict the experiences of trauma by replacing them with sensations rooted in agency and connection. Through their experiences working at different museums, the authors outline the main principles of trauma-aware art museum education (T-AAME) as it relates to visitors: orientation (setting a supportive tone);being with one another (regulation, attunement, and responsive pacing);choice and voice;and connection. The article also discusses museum-based art therapy as it compares to art museum education to highlight the overlaps and distinctions between the two and to show that museum experiences can be therapeutic without being therapy. [ FROM AUTHOR] Copyright of Journal of Museum Education is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

9.
Lancet Infect Dis ; 22(3): e74-e87, 2022 03.
Article in English | MEDLINE | ID: covidwho-1510480

ABSTRACT

During the current COVID-19 pandemic, health-care workers and uninfected patients in intensive care units (ICUs) are at risk of being infected with SARS-CoV-2 as a result of transmission from infected patients and health-care workers. In the absence of high-quality evidence on the transmission of SARS-CoV-2, clinical practice of infection control and prevention in ICUs varies widely. Using a Delphi process, international experts in intensive care, infectious diseases, and infection control developed consensus statements on infection control for SARS-CoV-2 in an ICU. Consensus was achieved for 31 (94%) of 33 statements, from which 25 clinical practice statements were issued. These statements include guidance on ICU design and engineering, health-care worker safety, visiting policy, personal protective equipment, patients and procedures, disinfection, and sterilisation. Consensus was not reached on optimal return to work criteria for health-care workers who were infected with SARS-CoV-2 or the acceptable disinfection strategy for heat-sensitive instruments used for airway management of patients with SARS-CoV-2 infection. Well designed studies are needed to assess the effects of these practice statements and address the remaining uncertainties.


Subject(s)
COVID-19 , Consensus , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intensive Care Units/standards , SARS-CoV-2/isolation & purification , COVID-19 Vaccines/administration & dosage , Delphi Technique , Health Personnel/standards , Humans , Personal Protective Equipment/standards
10.
Ann Intern Med ; 174(8): 1151-1158, 2021 08.
Article in English | MEDLINE | ID: covidwho-1481184

ABSTRACT

The development of the National Institutes of Health (NIH) COVID-19 Treatment Guidelines began in March 2020 in response to a request from the White House Coronavirus Task Force. Within 4 days of the request, the NIH COVID-19 Treatment Guidelines Panel was established and the first meeting took place (virtually-as did subsequent meetings). The Panel comprises 57 individuals representing 6 governmental agencies, 11 professional societies, and 33 medical centers, plus 2 community members, who have worked together to create and frequently update the guidelines on the basis of evidence from the most recent clinical studies available. The initial version of the guidelines was completed within 2 weeks and posted online on 21 April 2020. Initially, sparse evidence was available to guide COVID-19 treatment recommendations. However, treatment data rapidly accrued based on results from clinical studies that used various study designs and evaluated different therapeutic agents and approaches. Data have continued to evolve at a rapid pace, leading to 24 revisions and updates of the guidelines in the first year. This process has provided important lessons for responding to an unprecedented public health emergency: Providers and stakeholders are eager to access credible, current treatment guidelines; governmental agencies, professional societies, and health care leaders can work together effectively and expeditiously; panelists from various disciplines, including biostatistics, are important for quickly developing well-informed recommendations; well-powered randomized clinical trials continue to provide the most compelling evidence to guide treatment recommendations; treatment recommendations need to be developed in a confidential setting free from external pressures; development of a user-friendly, web-based format for communicating with health care providers requires substantial administrative support; and frequent updates are necessary as clinical evidence rapidly emerges.


Subject(s)
COVID-19/therapy , Pandemics , Practice Guidelines as Topic , Advisory Committees , COVID-19/drug therapy , COVID-19/epidemiology , Child , Data Interpretation, Statistical , Drug Approval , Evidence-Based Medicine , Female , Humans , Interprofessional Relations , National Institutes of Health (U.S.) , Pregnancy , SARS-CoV-2 , Stakeholder Participation , United States
11.
Crit Care Med ; 49(11): 1974-1982, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1475880
12.
Psychology Teaching Review ; 27(1):26-41, 2021.
Article in English | ProQuest Central | ID: covidwho-1459812

ABSTRACT

Research methods and statistics are cornerstones of undergraduate psychology degrees. However, many students find the subject uninteresting and anxiety provoking, while educators find it challenging to teach. This multi-method action research project explored how e-learning activities within a blended learning context affected students' experience of learning statistics. Data were gathered with first year undergraduate students via a survey (N=89), two focus groups (N=12), and interviews with educators (N=2). The e-learning activities were valued by students and staff, owing to the interactive, flexible approach to learning they afforded. The blended strategy provided an opportunity for students to develop intrinsic motivation to learn statistics, completing a range of activities to develop competence with autonomy. Social support from peer-networks and tutor feedback during face-to-face sessions facilitated deeper learning. These findings are timely, given increases in online teaching resulting from changing higher education landscapes and the COVID-19 pandemic.

13.
Nat Microbiol ; 6(10): 1245-1258, 2021 10.
Article in English | MEDLINE | ID: covidwho-1380902

ABSTRACT

Respiratory failure is associated with increased mortality in COVID-19 patients. There are no validated lower airway biomarkers to predict clinical outcome. We investigated whether bacterial respiratory infections were associated with poor clinical outcome of COVID-19 in a prospective, observational cohort of 589 critically ill adults, all of whom required mechanical ventilation. For a subset of 142 patients who underwent bronchoscopy, we quantified SARS-CoV-2 viral load, analysed the lower respiratory tract microbiome using metagenomics and metatranscriptomics and profiled the host immune response. Acquisition of a hospital-acquired respiratory pathogen was not associated with fatal outcome. Poor clinical outcome was associated with lower airway enrichment with an oral commensal (Mycoplasma salivarium). Increased SARS-CoV-2 abundance, low anti-SARS-CoV-2 antibody response and a distinct host transcriptome profile of the lower airways were most predictive of mortality. Our data provide evidence that secondary respiratory infections do not drive mortality in COVID-19 and clinical management strategies should prioritize reducing viral replication and maximizing host responses to SARS-CoV-2.


Subject(s)
Bronchoalveolar Lavage Fluid/microbiology , COVID-19/therapy , Respiration, Artificial , SARS-CoV-2/pathogenicity , Adaptive Immunity , Adult , Aged , Bacteria/classification , Bacteria/genetics , Bacteria/isolation & purification , Bacterial Load , Bronchoalveolar Lavage Fluid/immunology , Bronchoalveolar Lavage Fluid/virology , COVID-19/immunology , COVID-19/microbiology , COVID-19/mortality , Critical Illness , Female , Hospitalization , Humans , Immunity, Innate , Male , Microbiota , Middle Aged , Odds Ratio , Prognosis , Prospective Studies , Respiratory System/immunology , Respiratory System/microbiology , Respiratory System/virology , SARS-CoV-2/immunology , Viral Load
14.
Crit Care ; 25(1): 148, 2021 04 19.
Article in English | MEDLINE | ID: covidwho-1191483

ABSTRACT

BACKGROUND: Analyses of blood biomarkers involved in the host response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral infection can reveal distinct biological pathways and inform development and testing of therapeutics for COVID-19. Our objective was to evaluate host endothelial, epithelial and inflammatory biomarkers in COVID-19. METHODS: We prospectively enrolled 171 ICU patients, including 78 (46%) patients positive and 93 (54%) negative for SARS-CoV-2 infection from April to September, 2020. We compared 22 plasma biomarkers in blood collected within 24 h and 3 days after ICU admission. RESULTS: In critically ill COVID-19 and non-COVID-19 patients, the most common ICU admission diagnoses were respiratory failure or pneumonia, followed by sepsis and other diagnoses. Similar proportions of patients in both groups received invasive mechanical ventilation at the time of study enrollment. COVID-19 and non-COVID-19 patients had similar rates of acute respiratory distress syndrome, severe acute kidney injury, and in-hospital mortality. While concentrations of interleukin 6 and 8 were not different between groups, markers of epithelial cell injury (soluble receptor for advanced glycation end products, sRAGE) and acute phase proteins (serum amyloid A, SAA) were significantly higher in COVID-19 compared to non-COVID-19, adjusting for demographics and APACHE III scores. In contrast, angiopoietin 2:1 (Ang-2:1 ratio) and soluble tumor necrosis factor receptor 1 (sTNFR-1), markers of endothelial dysfunction and inflammation, were significantly lower in COVID-19 (p < 0.002). Ang-2:1 ratio and SAA were associated with mortality only in non-COVID-19 patients. CONCLUSIONS: These studies demonstrate that, unlike other well-studied causes of critical illness, endothelial dysfunction may not be characteristic of severe COVID-19 early after ICU admission. Pathways resulting in elaboration of acute phase proteins and inducing epithelial cell injury may be promising targets for therapeutics in COVID-19.


Subject(s)
COVID-19/blood , Endothelial Cells/virology , Epithelial Cells/virology , Host Microbial Interactions , Inflammation/virology , Adult , Aged , Biomarkers/blood , COVID-19/epidemiology , COVID-19/therapy , Case-Control Studies , Female , Humans , Inflammation/blood , Intensive Care Units , Male , Middle Aged , Prospective Studies
16.
Crit Care Med ; 49(4): 598-622, 2021 04 01.
Article in English | MEDLINE | ID: covidwho-1085323

ABSTRACT

OBJECTIVES: To identify research priorities in the management, pathophysiology, and host response of coronavirus disease 2019 in critically ill patients. DESIGN: The Surviving Sepsis Research Committee, a multiprofessional group of 17 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine, was virtually convened during the coronavirus disease 2019 pandemic. The committee iteratively developed the recommendations and subsequent document. METHODS: Each committee member submitted a list of what they believed were the most important priorities for coronavirus disease 2019 research. The entire committee voted on 58 submitted questions to determine top priorities for coronavirus disease 2019 research. RESULTS: The Surviving Sepsis Research Committee provides 13 priorities for coronavirus disease 2019. Of these, the top six priorities were identified and include the following questions: 1) Should the approach to ventilator management differ from the standard approach in patients with acute hypoxic respiratory failure?, 2) Can the host response be modulated for therapeutic benefit?, 3) What specific cells are directly targeted by severe acute respiratory syndrome coronavirus 2, and how do these cells respond?, 4) Can early data be used to predict outcomes of coronavirus disease 2019 and, by extension, to guide therapies?, 5) What is the role of prone positioning and noninvasive ventilation in nonventilated patients with coronavirus disease?, and 6) Which interventions are best to use for viral load modulation and when should they be given? CONCLUSIONS: Although knowledge of both biology and treatment has increased exponentially in the first year of the coronavirus disease 2019 pandemic, significant knowledge gaps remain. The research priorities identified represent a roadmap for investigation in coronavirus disease 2019.


Subject(s)
COVID-19 , Critical Care , Research , Sepsis/therapy , Humans
17.
Crit Care Med ; 49(3): e219-e234, 2021 03 01.
Article in English | MEDLINE | ID: covidwho-1069322

ABSTRACT

BACKGROUND: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU. METHODS: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning. CONCLUSION: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.


Subject(s)
Adrenal Cortex Hormones/therapeutic use , COVID-19/therapy , Critical Care , Dexamethasone/therapeutic use , Disease Management , Intensive Care Units , Practice Guidelines as Topic , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Anticoagulants , Evidence-Based Medicine , Hemodynamics , Humans , Hydroxychloroquine , Immunization, Passive , Patient Positioning , Ventilation
18.
BMJ Simulation & Technology Enhanced Learning ; 6(Suppl 1):A68-A69, 2020.
Article in English | ProQuest Central | ID: covidwho-919137

ABSTRACT

PG70 Table 1Summarised results from questionnairesTheme % Change in confidence Pre vs. Post-Course Post-Course vs. Delayed Clinical knowledge +46.4 -14.6 Practicing within own limitations +12.8 -2.3 Raising concerns +19.4 +2.3 Assessing and treating the unwell patient +48.3 0 Communicating to the MDT +69.2 0 Awareness of the impact of human factors +69.2 0 Discussion and ConclusionThis pilot course suggests trainee ACCPs benefit greatly from targeted high fidelity simulation despite limited previous exposure.Confidence in clinical knowledge was not sustained at immediate post-course levels after three months, perhaps due to decay of skills or exposure to more challenging cases in practice. The delayed survey coincided with the start of the COVID-19 pandemic which may have had an impact.Further evaluations could review the longevity of the benefits from simulation to guide how regularly to offer future sessions.The benefits realised from this pilot will lead to further provision of high fidelity simulation for trainee ACCPs.

19.
BMJ Simulation & Technology Enhanced Learning ; 6(Suppl 1):A100-A101, 2020.
Article in English | ProQuest Central | ID: covidwho-919107

ABSTRACT

Background‘The Simulation Training Day’ is designed to provide the students with the opportunity to rehearse the key clinical skills practiced throughout their Critical Illness attachment, and also to consider many of the other factors that can influence the patient’s outcome. Previously, we conducted it as a face to face session. Participants observe, practice and then reflect upon the immediate management of acutely ill patients through facilitated debriefing.In response to the COVID -19 pandemic, we have amended our approach to the delivery of this training for 2020–21. The aim has been to respond to the constraints that have been imposed on scheduling of their modules, student numbers and availability of resources for teaching.Despite modifying the delivery model, we aim to achieve as many of the educational outcomes as possible.Project DescriptionWe offered the students two different hybrid approaches:An online learning package with one half day face to face simulation course for Nottingham University Hospitals based students.An online learning package and one half day remote simulation course for students from outside Nottingham University Hospitals and for those are shielding.The online learning package involves virtual simulation where students will be asked to watch a series of specially filmed scenarios that raise important discussion points. This will enable face to face and remote simulation sessions to be shortened;group sizes reduced and still allow the same number of themes to be covered as the traditional full day simulation course.A half day interactive live streaming simulation, where trainees participate in a simulation from home/base trust, will cover the same scenarios as face to face simulation.We will evaluate the effectiveness of our revised course by collecting feedback from both the learner’s and faculty’s perspectives. We will generate a set of questions in line with previous traditional ones in order to compare the achievement of learning outcomes for last year traditional format group, this year face to face with online package and this year remote sim with online package. We will also explore any challenges/achievements from the faculty and identify technical issues and improvements for future courses.Summary of ResultsThe course will run from October to March and the findings from these questionnaires from some of the groups will be presented on the conference day.Discussion and Conclusions;RecommendationsIn progress and will be presented in the poster.

20.
Crit Care Med ; 48(6): e440-e469, 2020 06.
Article in English | MEDLINE | ID: covidwho-685042

ABSTRACT

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. No recommendation was provided for six questions. The topics were: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines.


Subject(s)
Coronavirus Infections/therapy , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Practice Guidelines as Topic/standards , Betacoronavirus , COVID-19 , Critical Illness , Diagnostic Techniques and Procedures/standards , Humans , Infection Control/methods , Infection Control/standards , Intensive Care Units/standards , Pandemics , Respiration, Artificial/methods , Respiration, Artificial/standards , SARS-CoV-2 , Shock/therapy
SELECTION OF CITATIONS
SEARCH DETAIL