Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 989
Filter
1.
J Interprof Educ Pract ; 29: 100524, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1967225

ABSTRACT

Telemedicine may provide equitable, accessible, and affordable healthcare to individuals globally. Recently tele-medicine has emerged as a vital resource for interdisciplinary healthcare professionals to provide critical medical care on the frontlines during the combined COVID-19 pandemic and the drug and opioid crisis. With the recent 2020 expansion of insurance coverage of telemedicine services by the United States Centers for Medicare & Medicaid Services, there has been an uptick in the need to understand how to comprehensively train physicians and health care professionals on telemedicine during a public health crisis. This study gathered 98 survey responses from interdisciplinary healthcare professionals regarding their telemedicine experience, focusing on trends of use with the drug and opioid crisis during the COVID-19 pandemic. The results demonstrate that during the COVID-19 pandemic, telemedicine provided a novel, innovative way to address an unmet need in healthcare and may aid to improve safe medication stewardship (SaMS) practice guidelines. Further expanded population-based research and randomized clinical trials are necessary to confirm these preliminary recommendations and form best practices for use in digital health and telemedicine. In addition, further studies will confirm the benefits of interdisciplinary healthcare professionals' engagement in harm reduction strategies via telemedicine to address improving safe medication use.

2.
Anaesth Crit Care Pain Med ; : 101137, 2022 Jul 29.
Article in English | MEDLINE | ID: covidwho-1966260

ABSTRACT

BACKGROUND: The management of obstetric patients with coronavirus disease 2019 (COVID-19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires unique considerations. Many aspects of labour and delivery practice required adaptation in response to the global pandemic and were supported by guidelines from the Royal College of Obstetrics and Gynaecologists. The adoption and adherence to these guidelines is unknown. METHODS: Participating centres in "Quality of Recovery in Obstetric Anaesthesia study - a multicentre study" (ObsQoR) completed an electronic survey based on the provision of services and care related to COVID-19 in October 2021. The survey was designed against the Royal College of Obstetricians and Gynaecologists COVID-19 guidelines. RESULTS: One hundred and five of the 107 participating centres completed the survey (98% response rate representing 54% of all UK obstetric units). The median [IQR] annual number of deliveries among the included sites was 4389 [3000-5325]. Ninety-nine of the 103 (94.3%) sites had guidelines for the management of peripartum women with COVID-19. Sixty-one of 105 (58.1%) had specific guidance for venous thromboembolism (VTE) prophylaxis. Thirty-seven of 104 (35.6%) centres restricted parturient birthing plans if a positive diagnosis of COVID-19 was made. A COVID-19 vaccination referral pathway encouraging full vaccination for all pregnant women was present in 63/103 centres (61.2%). CONCLUSION: We found variability in care delivered and adherence to guidelines related to COVID-19. The clinical implications for this related to quality of peripartum care is unclear, however there remains scope to improve pathways for immunisation, birth plans and VTE prophylaxis.

3.
Ginekol Pol ; 92(2): 165-173, 2021.
Article in English | MEDLINE | ID: covidwho-1964413

ABSTRACT

The Polish Society of Colposcopy and Cervical Pathophysiology (PTKiPSM) together with the Polish Society of Gynecologists and Obstetricians (PTGiP) issued a final summary of interim guidelines for secondary cervical cancer prevention during the SARS-CoV-2 pandemic based on the analysis of the latest directional publications and the authors' own experiences. The aim of the summary is to facilitate the implementation of the most effective possible screening of cervical precancerous lesions and cervical cancer due to temporary significant limitation of screening as a consequence of the ongoing epidemiological threat. These final guidelines are taking into account the 2020 call of the World Health Organization (WHO) for global epidemiological elimination of cervical cancer. The guidelines supplement the interim guidelines of PTKiPSM and PTGiP announced in March 2020 on the possible deferral of diagnostic and therapeutic procedures in patients with abnormal screening tests results in secondary prevention of cervical cancer in current pandemic.


Subject(s)
Colposcopy , Early Detection of Cancer/methods , Mass Screening/methods , Secondary Prevention , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/prevention & control , Algorithms , COVID-19/epidemiology , Female , Humans , Pandemics , Poland , Precancerous Conditions/diagnosis , Precancerous Conditions/prevention & control , Precancerous Conditions/surgery , SARS-CoV-2 , Uterine Cervical Neoplasms/surgery
5.
Antibiotics (Basel) ; 11(7)2022 Jul 06.
Article in English | MEDLINE | ID: covidwho-1963670

ABSTRACT

A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using data from patients with these infections at individual hospitals. Relevant CPG data pre- and post-implementation were collected and compared. Of the 1644 patients enrolled in the study, 808 and 836 were in the pre- and post-implementation periods, respectively, and patient outcomes were compared. Significant reductions in the mean durations of intensive care unit stay (3.44 ± 9.08 vs. 2.55 ± 7.89 days; p = 0.035), ventilator use (5.73 ± 12.14 vs. 4.22 ± 10.23 days; p = 0.007), piperacillin/tazobactam administration (0.954 ± 3.159 vs. 0.660 ± 2.217 days, p = 0.029), and cefoperazone/sulbactam administration (0.058 ± 0.737 vs. 0.331 ± 1.803 days, p = 0.0001) occurred. Multivariate analysis demonstrated that CPG-implementation was associated with favorable clinical outcomes (adjusted odds ratio 1.286, 95% confidence interval: 1.004-1.647, p = 0.046). Among patients who provided follow-up cultures (n = 284), favorable microbiological responses were significantly less frequent during the pre-implementation period than the post-implementation period (80.35% vs. 91.89%; p = 0.01). In conclusion, the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing ATB consumption. Hospital antimicrobial stewardship teams should be able to facilitate CPG development and implementation for antimicrobial therapy for common infections.

6.
Int J Risk Saf Med ; 2022 Jul 20.
Article in English | MEDLINE | ID: covidwho-1963364

ABSTRACT

BACKGROUND: During the COVID-19 pandemic, the Hillingdon Hospitals NHS Foundation Trust produced trust guidelines for the initial blood investigation of COVID-19 inpatients. However, insufficient education meant inconsistent adherence to this guidance. OBJECTIVE: To examine whether the implementation of a COVID-19 blood request panel improves adherence to local trust guidelines. METHOD: Between March and April 2020, initial blood investigations performed for positive COVID-19 cases were compared to guidelines. Results were presented locally and a COVID-19 panel was added to the electronic system that provided prompts for appropriate investigations. A re-audit between May and June 2020 was conducted to assess adherence post-intervention. RESULTS: 383 patients were identified in the initial audit cohort and a sample of 20 patients were re-audited. Adherence to Full Blood Count, Urea and Electrolytes, C-reactive Protein and Liver Function Tests increased to 100% from 99.7% (p = 0.8), 99.2% (p = 0.69), 98.7% (p = 0.61), and 96.6% (p = 0.4) respectively. Coagulation screen adherence increased to 90% from 72.8% (p = 0.09). Appropriate requesting of D dimers increased to 50% from 19.9% (p = 0.001). Inappropriate troponin requesting decreased to 26.3% from 38.9% (p = 0.23). CONCLUSION: A user-friendly COVID-19 panel of investigations resulted in improved adherence to guidelines. Clear communication and education are essential to help alleviate uncertainty during a pandemic.

7.
Exploration of Targeted Anti-tumor Therapy ; 3(3):321-336, 2022.
Article in English | Scopus | ID: covidwho-1965167

ABSTRACT

Aim: During the coronavirus disease 2019 (COVID-19) pandemic two needs have overlapped: on one hand continuing to provide the best care for patients with lung cancer and preventing the spread of the virus between patients and healthcare professionals on the other hand. Due to the pandemic's unpredictable duration, physicians had to evaluate the risk/benefit ratio of anti-cancer therapeutic strategy to do the best for their patients and to protect patients themselves, as well as healthcare workers. Methods: Systematic literature research was performed with the aim to assess the available guidelines for the management of lung cancer patients during the COVID-19 pandemic. Thirteen potentially relevant articles were selected and recommendations have been divided into three main categories: dos, don'ts and don't knows. Results: All guidelines and recommendations highlighted the relevance of being able to delay, if possible and based on risk stratification, and curative interventions. The selected recommendations should be considered adaptable and flexible because they might be contextualized on the basis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection prevalence and the availability of diagnostic-therapeutic resources. Conclusions: It remains of fundamental importance to discuss each diagnostic and therapeutic decision with the patient taking into account risks and benefits that might vary from case to case. © The Author(s) 2022.

8.
Atmosphere ; 13(7):1134, 2022.
Article in English | ProQuest Central | ID: covidwho-1963695

ABSTRACT

Few air pollution studies have been applied in the State of Palestine and all showed an increase in particulate matter concentrations above WHO guidelines. However, there is no clear methodology for selecting monitoring locations. In this study, a methodology based on GIS and locally calibrated low-cost sensors was tested. A GIS-based weighted overlay summation process for the potential sources of air pollution (factories, quarries, and traffic), taking into account the influence of altitude and climate, was used to obtain an air pollution hazard map for Nablus, Palestine. To test the methodology, eight locally calibrated PM sensors (AirUs) were deployed to measure PM2.5 concentrations for 55 days from 7 January to 2 March 2022. The results of the hazard map showed that 82% of Nablus is exposed to a high and medium risk of PM pollution. Sensors’ readings showed a good match between the hazard intensity and PM concentrations. It also shows an elevated PM2.5 concentrations above WHO guidelines in all areas. In summary, the overall average for PM2.5 in the Nablus was 48 µg/m3. This may indicate the effectiveness of mapping methodology and the use of low-cost, locally calibrated sensors in characterizing air quality status to identify the potential remediation options.

9.
BMJ Open ; 12(7): e052411, 2022 07 26.
Article in English | MEDLINE | ID: covidwho-1962187

ABSTRACT

INTRODUCTION: Significant changes in routine maternity care have been introduced globally in response to the COVID-19 pandemic to reduce infection risk, but also due to lack of medical facilities, staff shortages and the unpredictable nature of the disease. However, it is yet to be established if specialised perinatal mental health (PMH) services have been similarly affected. As a Task Force in PMH and COVID-19 pandemic within Riseup-PPD COST Action, this study aims to identify changes in PMH practices, policies and protocols during the COVID-19 pandemic in Europe. METHODS AND ANALYSIS: An online survey of experts in the PMH who are members of the COST Action 'Riseup-PPD' and the COST Action ''DEVOTION" across 36 European countries will be conducted. A questionnaire on changes in PMH care practices during the COVID-19 Pandemic will be administered. It consists of open-ended questions, checklists and ratings on a 7-point scale addressing seven domains of interest in terms of PMH: (1) policies, guidelines and protocols; (2) PMH care practices at a national level; (3) evidence of best practice; (4) barriers to usual care; (5) resources invested; (6) benefits of investment in the policies and (7) short-term and long-term expectations of the policies. Data will be collected using Qualtrics. Descriptive statistics will be reported and differences between countries will be examined using the χ2 statistic or Student's t-test. ETHICS AND DISSEMINATION: Ethical approval was obtained from The Ethics Committee for Research in Life and Health Sciences of the University of Minho (Portugal) to undertake an anonymous online survey. The findings will be disseminated to professional audience through peer-review publication and presentations and shared widely with stakeholders, policy-makers and service user groups. A position paper will be developed to influence policy-making at a European level to alleviate the adversities caused by COVID-19. TRIAL REGISTRATION NUMBER: NCT04779775.


Subject(s)
COVID-19 , Maternal Health Services , Mental Health Services , COVID-19/epidemiology , Female , Humans , Pandemics , Pregnancy
10.
(2021) Understanding the biological basis of behavior: Developing evidence-based interventions for clinical, counseling and school psychologists xvii, 519 pp Cham, Switzerland: Springer Nature Switzerland AG|Switzerland ; 2021.
Article in English | APA PsycInfo | ID: covidwho-1958868

ABSTRACT

This book is an introduction to the biological basis of behavior, broadly defined, with practical applications for higher education programs that focus on advances in neuroscience. It has a special focus on training practitioners based on American Psychological Association (APA) health service psychology guidelines. It reviews and digests information for clinical, counseling, and school psychologists serving clients of all ages in a variety of settings, such as schools, hospitals, and clinics. Content for all developmental stages, including birth to geriatric practices are highlighted. This book will help health service psychologists and counselors to meet the needs of an increasingly diverse population by providing cutting-edge, evidence-based, ecologically valid neuropsychological interventions currently lacking within the field. Cultural considerations are provided within each chapter, which is especially important given societal inequity that continues to persist within our world. Implications for the COVID-19 pandemic are also discussed in light of neuroscientific advances in medicine. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

11.
Enfermería Intensiva ; 2022.
Article in Spanish | ScienceDirect | ID: covidwho-1956136

ABSTRACT

Resumen El impacto negativo de la pandemia sobre las tasas de infecciones controladas ha evidenciado la necesidad de reanudar la aplicación de las recomendaciones de los Proyectos Zero (PZ). En este artículo, en primer lugar, se realiza un análisis de la situación de las unidades de cuidados intensivos de España durante la pandemia. A continuación se presenta la adaptación de las recomendaciones de cada uno de los cuatro PZ y su grado de cumplimiento y riesgo de que existan infecciones relacionadas con dispositivos invasivos y/o bacteriemias multirresistentes. Para ello, se han tenido en cuenta: 1)el documento publicado en octubre de 2020 por el Consejo Asesor del Programa de Seguridad de pacientes críticos, y 2)el estudio exploratorio realizado, un año después, por el Consejo Asesor de los PZ, junto con los líderes de los proyectos de las unidades participantes del registro ENVIN. Por último, y en base a los hallazgos encontrados, se formulan cinco recomendaciones tentativas y prioritarias. The negative impact of the pandemic on infection control rates has highlighted the need to resume the implementation of Project Zero (PZ) recommendations. This article first analyses the situation of intensive care units in Spain during the pandemic. Subsequently, it presents the adaptation of the recommendations of each of the four PZs and their degree of compliance and the risk of invasive device-related infections and/or multidrug-resistant bacteraemias. For this purpose, we have taken into account: (i)the document published in October 2020 by the Advisory Board of the Critical Patient Safety Programme, and (ii)the exploratory study conducted, one year later, by the Advisory Board of the PZs, on the leaders of the Projects of the units participating in the ENVIN registry. Finally, based on the findings, five tentative and priority recommendations are formulated.

12.
Front Med (Lausanne) ; 9: 928542, 2022.
Article in English | MEDLINE | ID: covidwho-1957187

ABSTRACT

Kidney transplant recipients (KTR) show significantly lower seroconversion rates after SARS-CoV-2 mRNA vaccination compared to dialysis patients (DP). Mycophenolate mofetil or mycophenolic acid (MMF/MPA) in particular has been identified as a risk factor for seroconversion failure. While the majority of all KTR worldwide receive MMF/MPA for immunosuppressive therapy, its impact on antibody decline in seroconverted KTR still remains unclear. In an observational study (NCT04799808), we investigated whether 132 seroconverted KTR (anti-spike S1 IgG or IgA positive after 2 vaccinations) show a more rapid antibody decline with MMF/MPA than those without this medication. A total of 2 months after mRNA vaccination, average anti-spike S1 IgG levels of KTR with MMF/MPA were lower than without (p = 0.001), while no differences between these two groups were observed after 6 months (p = 0.366). Similar results were obtained for anti-RBD IgG antibodies (T2 p = 0.003 and T3 p = 0.135). The probability of severe IgG decline with MMF/MPA was three times lower than without (p = 0.003, OR 0.236, 95% CI 0.091-0.609). In the multivariate analysis, neither immunosuppressants, such as calcineurin inhibitors, mTOR inhibitors (mTOR-I; mechanistic target of rapamycin), glucocorticoids, nor vaccine type, sex, or age showed a significant influence on IgG titer decline between 2 and 6 months. For the decision on additional booster vaccinations, we consider immunosurveillance to be needed as an integral part of renal transplant follow-up after SARS-CoV-2 mRNA vaccination. Not only the lack of seroconversion but also the peak and titer decline of the specific IgG and RBD IgG antibody formation after two mRNA vaccinations is significantly influenced by MMF/MPA.

13.
BMC Public Health ; 22(1): 898, 2022 05 05.
Article in English | MEDLINE | ID: covidwho-1951137

ABSTRACT

BACKGROUND: COVID-19 public health measures like handwashing and social distancing can help stem the spread of the virus. Adherence to guidelines varies between individuals. This study aims to identify predictors of non-adherence to social distancing and handwashing guidelines. METHODS: A cross-sectional weekly telephone survey was conducted over eight weeks (11/06/2020-05/08/2020). The sample included adults resident on the island of Ireland (75:25 split between ROI and NI). Data were collected on demographics, threat perceptions, fear of COVID-19, response efficacy and self-efficacy, response cost and social norms, COVID-19 behaviours, mood, loneliness, and self-reported health. RESULTS: 3011 participants were surveyed. Handwashing non-adherers were more likely to be male (OR: 5.2, 95% CI: 2.4 - 11.3), to have higher levels of loneliness (OR: 1.86, 95% CI: 1.1 - 3.1), and higher perceptions of handwashing costs (OR: 3.4, 95% CI: 2.2 - 5.2). Those reporting rarely engaging in social distancing were more likely to be members of lower socioeconomic groups, to be younger (OR: 0.97, 95% CI: 0.96 - 0.98), male (OR: 1.67, 95% CI: 1.1 - 2.5), healthcare workers (OR: 1.98, 95% CI: 1.1 - 3.4), to report lower mood (OR: 1.72, 95% CI: 1.3 - 2.2), were less likely to live in households with people aged under-18 (OR: 0.75, 95% CI: 0.6 - 0.9), and to have lower fear of COVID-19 (OR: 0.79, 95% CI: 0.6 - 0.9). CONCLUSIONS: Non-adherers to handwashing differ to social distancing non-adherers. Public health messages should target specific demographic groups and different messages are necessary to improve adherence to each behaviour.


Subject(s)
COVID-19 , Adult , Aged , COVID-19/prevention & control , Cross-Sectional Studies , Female , Humans , Ireland/epidemiology , Male , Physical Distancing , Telephone
14.
J Clin Med ; 11(11)2022 May 24.
Article in English | MEDLINE | ID: covidwho-1953590

ABSTRACT

Background: Significant concern emerged at the beginning of the SARS-CoV-2 pandemic regarding the safety and practicality of robotic-assisted surgery (RAS). We aimed to review reported surgical practice and peer-reviewed published review recommendations and guidelines relating to RAS during the pandemic. Methods: A systematic review was performed in keeping with PRISMA guidelines. This study was registered on Open Science Framework. Databases were searched using the following search terms: 'robotic surgery', 'robotics', 'COVID-19', and 'SARS-CoV-2'. Firstly, articles describing any outcome from or reference to robotic surgery during the COVID-19/SARS-CoV-2 pandemic were considered for inclusion. Guidelines or review articles that outlined recommendations were included if published in a peer-reviewed journal and incorporating direct reference to RAS practice during the pandemic. The ROBINS-I (Risk of Bias in Non-Randomised Studies of Intervention) tool was used to assess the quality of surgical practice articles and guidelines and recommendation publications were assessed using the AGREE-II reporting tool. Publication trends, median time from submission to acceptance were reported along with clinical outcomes and practice recommendations. Results: Twenty-nine articles were included: 15 reporting RAS practice and 14 comprising peer-reviewed guidelines or review recommendations related to RAS during the pandemic, with multiple specialities (i.e., urology, colorectal, digestive surgery, and general minimally invasive surgery) covered. Included articles were published April 2020-December 2021, and the median interval from first submission to acceptance was 92 days. All surgical practice studies scored 'low' or 'moderate' risk of bias on the ROBINS-I assessment. All guidelines and recommendations scored 'moderately well' on the AGREE-II assessment; however, all underperformed in the domain of public and patient involvement. Overall, there were no increases in perioperative complication rates or mortalities in patients who underwent RAS compared to that expected in non-COVID practice. RAS was deemed safe, with recommendations for mitigation of risk of viral transmission. Conclusions: Continuation of RAS was feasible and safe during the SARS-CoV-2 pandemic where resources permitted. Post-pandemic reflections upon published robotic data and publication patterns allows us to better prepare for future events and to enhance urgent guideline design processes.

15.
Eur J Investig Health Psychol Educ ; 12(5): 494-515, 2022 May 23.
Article in English | MEDLINE | ID: covidwho-1953153

ABSTRACT

As the COVID-19 pandemic continues, university education and feedback guidance have inevitably moved to online platforms, becoming a global trend. This study focuses on a case of Sookmyung Women's University in South Korea, which has operated an online discussion clinic for university general education for more than a year as a case study. There are two main research methods. A frequency analysis was conducted to confirm what kind of counseling the students preferred at the discussion clinic based on the answers written in the students' applications. The students whose applications were used for the analysis were divided into 57 teams, and there were two to six members per team. The results were as follows: In the survey results, students wanted help with the preparation process necessary for the discussion and the practical strategies for facilitating discussions. They wanted personalized counseling, demonstrating that discussion education provided in the foundational curriculum is insufficient. Second, the educational model of the discussion clinic and educational examples were examined. The findings confirmed that online discussion education is effective if the system is technically supplemented. Instructors and researchers are prepared to meet students' demands for feedback and individual counseling, even if these are not provided through face-to-face discussions. Additionally, face-to-face guidance can be operated more effectively by taking advantage of online systems. The findings also demonstrate that further research on designing and operating online discussion centers is required. This study is a preceding study on developing online systems and educational guidelines for higher educational institutions to present new insights into smart learning. This paper also includes suggestions for educational and scientific discussions. The online discussion instructional model shown in this paper explores methods of scientific communication through a debate on scientific issues.

16.
BMJ Open ; 12(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1950155

ABSTRACT

IntroductionThe prevalence of dementia among the elderly population in South Korea was 9.94% in 2017, and the number of people living with dementia is estimated to increase up to one million by 2024. Considering that approximately 55%–85% of people with dementia are taken care of by family members in South Korea, the phenomenon of resilience for family caregivers with patients with dementia should be understood within a Korean cultural context. The purpose of this paper is to describe the protocol of a scoping review addressing the resilience of family caregivers for Koreans with dementia.Methods and analysisArksey and O'Malley’s scoping review framework and Joanna Briggs Institute’s manual for scoping reviews will guide the review methods. Multiple databases, including Ovid-MEDLINE, Ovid-EMBASE, PsycINFO, Cumulative Index for Nursing and Allied Health Literature and Korean databases will be identified using controlled vocabulary and text words. Two review authors will independently screen and select studies based on predefined eligible criteria. The extracted data will undergo descriptive analysis of the contextual data and a quantitative analysis using the appropriate descriptive statistics.Ethics and disseminationBecause the scoping review methodology consists of reviewing and collecting data from the published literature, this study does not require ethics approval. This scoping review will serve to highlight existing gaps within the literature to guide further research and to develop future strategies to measure and improve the resilience of family caregivers for patients with dementia in South Korea.

17.
Journal of Chemical Education ; 99(7):2439, 2022.
Article in English | ProQuest Central | ID: covidwho-1947176

ABSTRACT

Many chemistry educators have taken to heart design guidelines proposed for teaching during the SARS-CoV-2 pandemic. Often these guidelines incorporate suggestions for helping students encounter more flexible demands for their learning of course material. As educational settings return to modalities that more closely resemble prepandemic ones, the question has emerged as to the potential value of maintaining enhanced levels of flexibility for students. Such a choice can certainly be considered from the perspective of pedagogical theories, but it remains equally important to incorporate the idea that teachers and instructors require flexibility as well in the new paradigms that may emerge for formal learning. Keeping both desirable facets of educational flexibility in mind represents a core concept that merits consideration as future plans for teaching and learning are discussed.

18.
Anaesthesia ; 77(9): 959-970, 2022 09.
Article in English | MEDLINE | ID: covidwho-1948977

ABSTRACT

The evidence base surrounding the transmission risk of 'aerosol-generating procedures' has evolved primarily through quantification of aerosol concentrations during clinical practice. Consequently, infection prevention and control guidelines are undergoing continual reassessment. This mixed-methods study aimed to explore the perceptions of practicing anaesthetists regarding aerosol-generating procedures. An online survey was distributed to the Membership Engagement Group of the Royal College of Anaesthetists during November 2021. The survey included five clinical scenarios to identify the personal approach of respondents to precautions, their hospital's policies and the associated impact on healthcare provision. A purposive sample was selected for interviews to explore the reasoning behind their perceptions and behaviours in greater depth. A total of 333 survey responses were analysed quantitatively. Transcripts from 18 interviews were coded and analysed thematically. The sample was broadly representative of the UK anaesthetic workforce. Most respondents and their hospitals were aware of, supported and adhered to UK guidance. However, there were examples of substantial divergence from these guidelines at both individual and hospital level. For example, 40 (12%) requested respiratory protective equipment and 63 (20%) worked in hospitals that required it to be worn whilst performing tracheal intubation in SARS-CoV-2 negative patients. Additionally, 173 (52%) wore respiratory protective equipment whilst inserting supraglottic airway devices. Regarding the use of respiratory protective equipment and fallow times in the operating theatre: 305 (92%) perceived reduced efficiency; 376 (83%) perceived a negative impact on teamworking; 201 (64%) were worried about environmental impact; and 255 (77%) reported significant problems with communication. However, 269 (63%) felt the negative impacts of respiratory protection equipment were appropriately balanced against the risks of SARS-CoV-2 transmission. Attitudes were polarised about the prospect of moving away from using respiratory protective equipment. Participants' perceived risk from COVID-19 correlated with concern regarding stepdown (Spearman's test, R = 0.36, p < 0.001). Attitudes towards aerosol-generating procedures and the need for respiratory protective equipment are evolving and this information can be used to inform strategies to facilitate successful adoption of revised guidelines.


Subject(s)
COVID-19 , Personal Protective Equipment , Anesthetists , COVID-19/prevention & control , Humans , Respiratory Aerosols and Droplets , SARS-CoV-2
20.
Am J Health Syst Pharm ; 2022 Jul 15.
Article in English | MEDLINE | ID: covidwho-1948156

ABSTRACT

DISCLAIMER: In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE: To assess the quality of critical care clinical practice guidelines (CPGs) involving pharmacotherapy recommendations. METHODS: A systematic electronic search was performed using PubMed, MEDLINE, and Embase for critical care CPGs published between 2012 and 2022 and involving pharmacotherapy recommendations. The Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument was employed to appraise CPG quality through independent assessment by 2 appraisers. RESULTS: Twenty-one CPGs were evaluated. The number of recommendations in each guideline ranged from 2 to 250, with a total of 1,604 recommendations. The number of strong (vs weak) recommendations in each guideline ranged from 0 to 31, with a total of 116 strong recommendations, or 7.23% of the total number of recommendations. There was at least 1 pharmacist author for 9 (43%) of the guidelines. The AGREE II domains for which mean quality scores of evaluated guidelines were highest were scope and purpose (0.88; 95% CI, 0.85-0.92), rigor of development (0.80; 95% CI, 0.77-0.83), clarity of presentation (0.84; 95% CI, 0.81-0.87), and editorial independence (0.86; 95% CI, 0.79-0.94), while those for which mean scores were lowest were stakeholder involvement (0.69; 95% CI, 0.63-0.75) and applicability (0.49; 95% CI, 0.43-0.55). Involvement of a pharmacist in CPG development was associated with significantly higher scoring for stakeholder involvement (P = 0.0356). CONCLUSION: Strong recommendations accounted for less than 10% of the recommendations in the evaluated CPGs. Moreover, there are concerns related to guideline applicability (ie, advice or tools for putting recommendations into practice) and stakeholder involvement (ie, inclusion of individuals from all relevant groups). It is important to involve pharmacists in CPGs with pharmacotherapy recommendations.

SELECTION OF CITATIONS
SEARCH DETAIL