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1.
The Lancet Regional Health - Southeast Asia ; : 100131, 2022.
Article in English | ScienceDirect | ID: covidwho-2165669

ABSTRACT

Background COVID-19 pandemic imposed a devastating effect on the psychological health of health professionals as they worked nonstop to withstand the hardship of the pandemic. The present study intended to determine the post-traumatic stress disorders (PTSD) and coping strategies among health professionals during the COVID-19 pandemic in Bangladesh. Methods This country-wide cross-sectional study was conducted from July to December 2021 among 1394 health professionals (596 physicians, 713 nurses, 85 medical technologists) who served COVID-19 patients at the secondary, tertiary, and specialized government healthcare facilities in Bangladesh and completed at least one month after exposure to COVID-19 patient-care. Data were collected through face-to-face interviews using a semi-structured questionnaire and analyzed by SPSS software. All the ethical issues were maintained strictly. Findings Most of the participants, 877(62∙9%) [95% CI: 60∙3-65∙5], were female, and 327(23∙5%) [95% CI: 21∙3-25∙8] developed PTSD. Females (AOR:1∙42 [95% CI: 1∙083-1∙868] p=0∙011), having an elderly family member (AOR:1∙515 [95% CI: 1∙173-1∙956] p=0∙0014), working in specialized hospitals (AOR:2∙685 [95% CI: 1∙928-3∙739] p<0∙001), and working ≥8 hours/day (AOR:1∙897 [95% CI: 1∙350-2∙666] p=0∙0002) had higher odds of developing PTSD. Most of the participants adopted spiritual approaches 96(29∙4%) [24∙5-34∙6] and distraction by watching TV/YouTube 59(18∙0%) [14∙0-22∙6] as coping strategies. Interpretation The study findings would be helpful for health policymakers and managers to develop comprehensive measures for restoring the mental well-being of health professionals by alleviating PTSD induced by a pandemic like COVID-19. Funding The study got funding from the Directorate General of Medical Education under the Ministry of Health and Family Welfare, Bangladesh.

2.
NeuroQuantology ; 20(19):652-658, 2022.
Article in English | EMBASE | ID: covidwho-2164846

ABSTRACT

One of the important measures to prevent the speed o which Covid-19 was spreading was hand washing, it was a simple and main preventive measure that can be done by any person independently. Hand wash using soap or sanitizer was the primary defense to stop the spreading covid-19 disease. In this research paper, we have assessed the actual hand washing/ hand sanitizer practice among the various age group during a pandemic and also after the pandemic. Observational and demonstration was conducted among graduate, undergraduate, government employee, and school children. A total of 300 participants were done in our study. We collected this data using a checklist and questionnaire through observation. Both types of logistic regressions: Bi-variate & Multivariate were used to show the relationship between test and target variables. As per our observation, there was a significant change in practicing WASH (water, sanitation, and hygiene) after the covid-19. Local government and social activities have played an important role in this significant change as per our study. Sanitation and Hygiene were of important practices even before the pandemic among health care workers but it was not as effectively practiced by the common citizens. WHO has started project WASH (water sanitation and hygiene) strategy 2018-2025 as it is crucial for human health and well-being. WASH can be the most important preventive measure for most diseases. This was very much evident and practiced by most people during the pandemic. Copyright © 2022, Anka Publishers. All rights reserved.

3.
Cardiovascular Therapy and Prevention (Russian Federation) ; 21(9):40-49, 2022.
Article in Russian | EMBASE | ID: covidwho-2164350

ABSTRACT

Aim. To assess the prevalence of non-alcoholic fatty liver disease (NAFLD) using the liver obesity index - FLI (Fatty Liver Index), and to study its associations with socio-demographic indicators and behavioral risk factors for NAFLD. Material and methods. The data from the multicenter ESSE-RF study (Epidemiology of cardiovascular diseases in the regions of the Russian Federation) - samples from the unorganized male and female population aged 25-64 years were used. 5,161 respondents were included, of which 2,275 (44,1%) were men. To assess the prevalence of NAFLD, the liver obesity index FLI was used, calculated according to the formula by Bedogni G, et al. (2006). A high FLI index =60 was considered a predictor of liver steatosis. Results. High FLI =60 was detected in 38,5% of men and 26,6% of women. Multivariate analysis of associations of high FLI index in men and women showed a strong relationship with age: men - odds ratio (OR) 5,01, 95% confidence interval (CI): 3,82-6,59 (p<0,0001) and women - OR 8,58, 95% CI: 6,39-11,64 (p<0,0001), living in rural areas: men - OR 1,32, 95% CI: 1,06-1,63 (p=0,011) and women - OR 1,4, 95% CI: 1,15-1,71 (p=0,001). The FLI index >=60 was significantly associated with low physical activity (p=0,001) in men and current smoking in women (p=0,013). Conclusion. A high FLI index >=60 is most common among men, significantly associated with age, living in rural areas, currently smoking women, and low physical activity men. Higher education, in relation to FLI >=60, had a protective effect on women. Copyright © 2022 Vserossiiskoe Obshchestvo Kardiologov. All rights reserved.

4.
Palliative Medicine in Practice ; 16(3):150-155, 2022.
Article in English | EMBASE | ID: covidwho-2164107

ABSTRACT

Background: The perspective of palliative care has changed dynamically over the years, and palliative medicine, which was originally concerned with patients with advanced oncology diseases, has become an interdisciplinary area. Many societies have published guidelines for the use of palliative medicine in intensive care units. Method(s): This article presents indications and methods for implementing the principles of palliative medicine in intensive care units. Particular attention is devoted to the consultations of palliative medicine for current medical trends - COVID-19 infection, oncological diseases, fragility syndrome, and end-stage circulatory failure. Conclusion(s): Elements of palliative medicine are necessary for everyday practices in the intensive care unit. The most important task in cooperation is to present classifications that can help in the objective identification of patients requiring palliative care. It seems that creating a checklist of the qualifications for a palliative medicine consultation can be the next step towards making decisions about this form of therapy. Copyright © Via Medica.

5.
Canadian Pharmacists Journal. ; 2022.
Article in English | EMBASE | ID: covidwho-2162239

ABSTRACT

Introduction: CARD (Comfort Ask Relax Distract) is a vaccine delivery program demonstrated to reduce pain, fear and associated immunization stress-related responses (ISRR) in children undergoing vaccinations at school. This study evaluated CARD's clinical impact when integrated into community pharmacy-based pediatric vaccinations. Method(s): This was a before-and-after CARD implementation study in 5 independent pharmacies offering COVID-19 vaccinations to children aged 5-11 years. No changes were made to practices in the "before" phase. CARD interventions were integrated in the "after" phase (e.g., children prepared a coping plan using a checklist, distraction toolkits were placed in waiting and vaccination spaces, vaccinations were performed with privacy, needles were obscured). Children self-reported ISRR, including fear, pain and dizziness during vaccination, and both children and parents/caregivers (herein, parents) compared the child's experience to their last needle (better, same, worse). In the "after" phase, parents and children reported how much CARD helped (not at all, a little bit, a moderate amount, a lot). Result(s): The study was conducted between January 16 and March 20, 2022. Altogether, 152 children participated (71 before and 81 after CARD);demographic characteristics did not differ. Children's self-reported fear was lower after CARD, when assessed continuously (2.5 vs 3.7 out of 10;p = 0.02) or dichotomously, using a cut-off of 0 vs >0 (58% vs 80%;p = 0.01). Pain was lower when assessed dichotomously (<2 vs >=2;p = 0.03). There was no difference in dizziness. After CARD, children and parents reported more positive experiences compared to the child's last needle (p = 0.01, both analyses) and more children and parents reported that distraction and child participation in the process were helpful (p < 0.001, both analyses). Overall, 92% of children and 91% of parents said CARD helped. Conclusion(s): CARD reduced children's fear and improved vaccination experiences for children and parents when integrated in community pharmacy-based vaccinations. Copyright © The Author(s) 2022.

6.
Tehran University Medical Journal ; 80(8):477-484, 2022.
Article in Persian | EMBASE | ID: covidwho-2157091

ABSTRACT

Background: Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables. Method(s): This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0.05. Result(s): In this study, the overall mortality rate among mechanically ventilated patients was 62.5%. The mean age of patients was 69.99+/-17.87 years and the mean duration of hospitalization in surviving patients was 15.47+/-11.73 days and for deceased ones was 55.21+/-69.14 days. The mean age of the deceased group (65.71+/-16.59) was significantly higher than the surviving group 53+/-21.17 was (P=0.0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0.005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0.001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0.05). Conclusion(s): Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality. Copyright © 2022 Shetabi et al. Published by Tehran University of Medical Sciences.

7.
Tehran University Medical Journal ; 80(8):485-492, 2022.
Article in Persian | EMBASE | ID: covidwho-2156790

ABSTRACT

Background: The prevalence of emerging and re-emerging diseases has made the need for basic preparations for all health care organizations more crucial. Strengthening preparedness and formulating crisis strategies will have a great impact on reducing casualties. Given the importance of preparing hospitals to deal with such an outbreak and reduce the resulting mortality, the present study was conducted to assess their readiness against Covid-19. Method(s): The present study is a quantitative and descriptive cross-sectional research conducted from October to March 2019. Data collection used the standard checklists prepared by the European Center for the Prevention and Control of Coronavirus and the Centers for Disease Control and Prevention, consisting of eight domains and 21 components. The minimum score that each hospital could get in this checklist was 143 and the maximum was 429. The sampling method in the present study was a census, and nine reference hospitals for Corona were included in the study. All hospitals' directors, managers, quality officers and crisis secretaries and others related to hospital readiness during Covid-19 were recruited by the census. Result(s): On average, the hospitals scored 391 out of 429, indicating a fairly "high readiness" in dealing with Covid-19. The highest score obtained by the hospitals was 425 and the lowest score was 349. In terms of preparation areas, the hospitals' readiness was higher than 80% in all areas. The highest readiness of hospitals was in the fifth domain, i.e. Hand hygiene, personal protective equipment and hospital waste management. The 7th domain namely, patient placement and relocation, and patient visitor access was of the lowest preparation. Conclusion(s): The hospitals were of fairly appropriate readiness to deal with Covid-19. This level of preparedness, despite being desirable, might not reflect the real capacity of hospitals to deal with this disease. Regular evaluation of the Covid referral hospitals could help make these hospitals more prepared. Also, the experiences of hospitals that were more prepared should be used to improve the condition of other hospitals. Copyright © 2022 Jaafaripooyan et al. Published by Tehran University of Medical Sciences.

8.
European Psychiatry ; 65(Supplement 1):S305, 2022.
Article in English | EMBASE | ID: covidwho-2153888

ABSTRACT

Introduction: Despite the large amount of research concerning the impact of COVID-19 on health care workers, to date few targeted MHWs. Moreover, none has investigated the vulnerability due to exposure to previous traumatic events among health care workers. Objective(s): This study aimed to investigate the psychological distress in MHWs after the first lockdown imposed by the COVID-19 pandemic in the more impacted regions of the North of Italy, to understand which COVID-19, sociodemographic and professional variables as well as previous stressful life experiences, could have had greater negative effects. Method(s): The online survey occurred from 28-June to 10-August 2020. This included questions regarding sociodemographic factors, professional information, COVID-19 exposure. Moreover, three validated self-report questionnaires were administered: Life Events Checklist for DSM-5 (LEC-5), Impact of Event Scale-Revised (IESR), Depression Anxiety Stress Scales-21 (DASS-21). Result(s): 271 MHWs completed the survey. At least 20% had elevated levels of psychological distress with post-traumatic symptoms. Stratifying for professional roles, the nurses resulted the most affected, with significantly higher scores in terms of intrusive thoughts, hyperarousal and avoidance behaviors. Several variables affected psychological distress in MHWs, but stronger effects were done by age, professional roles, increased workload and worst working environment during COVID-19 pandemic, to had experienced the separation of family members, but also had experienced during their life of a severe human suffering (physical and/or psychological) on oneself or on a loved one. Conclusion(s): Our data underlying the importance of recent but also previous severe stressful events as risk factors to develop post-traumatic symptoms reducing the resilience of the subjects investigated.

9.
European Psychiatry ; 65(Supplement 1):S255, 2022.
Article in English | EMBASE | ID: covidwho-2153865

ABSTRACT

Introduction: COVID-19 pandemic leads to high levels of stress. Individuals who have previously sought psychiatric assistance are more sensitive. Objective(s): Analysis of the perception of the pandemic by people who have previously sought psychiatric care. Method(s): An internet-survey (20.03.2020 - 13.01.2021) (N=659;152 - previously sought psychiatric assistance);included SCL-90-R;questions about the levels of anxiety, depression, and fear (assessed on 0-10 scale);question about opinion on COVID-19 pandemic (coded further on the basis of meaning);question about epidemiological situation of COVID-19 in respondents' places of residence and their social circles. Result(s): Individuals who had previously sought psychiatric assistance demonstrated higher levels of anxiety (5,533+/-2,489 versus 4,774+/-2,590), depression (4,945+/-2,926 versus 3,861+/-2,988), and fear (0,195+/-0,397 versus 0,278+/-0,448). They showed roughly equivalent reactions to both anticipated and real danger (z-score GSI of SCL-90-R 0,90 versus 0,90 for anticipated and real danger respectively), the same indicator of the control group (0,53 and 0,65). In statements about the pandemic, they are more often referred to the topic of"positive effects" of pandemic (3,30% versus 0,99%), expressed "curiosity" (5,92% versus 2,37%). They were less drawn to conspiracy (9,87% versus 16,17%), and exploited more readily the topic "about myself" (20,39% versus 13,21%), negative images of "the present" (3,64% versus c 1,58%) and "the future" (15,79% versus 9, 47%), vocabulary of "anger" (5,92% versus 2,17%). Conclusion(s): Individuals who had previously sought psychiatric assistance were ambivalent in their attitudes towards pandemic, and tended to concentrate more on feelings and the negative vision of the future. They perceived anticipated danger roughly equivalent to real danger.

10.
Pakistan Journal of Medical Sciences ; 39(1), 2023.
Article in English | EMBASE | ID: covidwho-2145275

ABSTRACT

The ongoing coronavirus (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare due to highly transmissible and contagious nature. Aerosol generating procedures such as tracheal intubation is of particularly high risk. This mandates some advice on processes and techniques required to protect staff and uniform approach during airway management. We hereby share our experience in development of an emergency response system to deal with COVID airway management at a frontline hospital which particularly consider the local demands and resources. This includes a change in working dynamics with 24/7 consultant coverage for emergent or urgent tracheal intubation of COVID patients at non-operating room locations. Other steps include prepackaging intubation baskets, availability of videolaryngoscope, standard personal protective equipment including powered air purifying respirator, and use of modified intubation checklist. Copyright © 2023, Professional Medical Publications. All rights reserved.

11.
Journal of Applied Hematology ; 13(4):222-227, 2022.
Article in English | EMBASE | ID: covidwho-2144235

ABSTRACT

BACKGROUND: Many systematic reviews (SRs) and meta-analyses (MAs) have been published regarding the incidence of venous thromboembolism (VTE) in coronavirus disease 2019 (COVID-19) patients, which is acknowledged as high. Therefore, we aimed to assess the methodological quality of any SR/MA involving VTE and COVID-19. METHOD(S): This is a meta-epidemiological study evaluating the methodological quality of SR/MA. A structured search in PubMed and Web of Science was done for all SRs/MAs in VTE and COVID-19 from inception till April 29, 2021. We evaluated the methodological quality using A Measurement Tool to Assess SRs-2 (AMSTAR-2) checklist. RESULT(S): We included 29 SRs/MAs where only one SR/MA was rated as high (3.44%), 12 (41.37%) were rated as moderate, and the rest were rated as low/critically low (55.17%). No statistical significance was observed in Spearman's correlation analysis between the rate of methodological quality and the number of authors, searching period, publication month, and publishing journal's impact factor. CONCLUSION(S): The number of published SRs/MAs in the VTE and COVID-19 subject is rising rapidly. The readers should pay attention to the low methodological quality of most published SRs/MAs. Copyright © 2022 Journal of Applied Hematology.

12.
Multiple Sclerosis Journal ; 28(3 Supplement):898, 2022.
Article in English | EMBASE | ID: covidwho-2138779

ABSTRACT

Introduction: Multiple Sclerosis (MS) is a complex disease which affects the central nervous system. The myelin sheath that protects the nerve fibres of the body is damaged by its own immune system (demyelination). Under NICE guidelines CG186, podiatrists are not currently included within the Multiple Sclerosis rehabilitation team, with access to podiatric treatment in secondary care available for those with a specific need. Aim(s): 1. To establish the impact of MS on lower limb health 2. To evaluate the benefit of Podiatric interventions, including foot health education, in the management and rehabilitation of lower limb health for increased mobility and ambulation Objectives: 1. Establish and facilitate a Patient and Public Involvement Advisory Panel 2. Undertake a scoping review under the PRISMA-ScR guidelines Methods: A scoping review of the effects of MS on the lower limb was undertaken to examine the extent, range and nature of any research activity that has already been completed in this area of podiatric medicine, subsequently identifying research gaps in existing literature. A PPI advisory panel was established, comprising of ten members, formed through social media recruitment, utilising Twitter as the primary platform. A search strategy was entered into the PubMed database which yielded the literature for our review in COVIDENCE. Result(s): The COM-B model has been used as a framework for analysis, along with keywords used as discussion strategy. The Guidance for Reporting Involvement of Patients and Public 2-GRIPP2 is the checklist that has been utilised to report the themes and initial findings of the PPI meetings. This guidance resembles the logic model, highlighting that evaluating participation is a complex activity, which provides the fundamental key to ensuring that public involvement and participation activities and programmes generate learning and results, and improve future participation practices. Full data extraction has been performed on the 128 articles with no indication of any podiatric involvement in studies. Discussion(s): The initial findings have identified that there is scope for further research of the utilisation of podiatrists in the management and rehabilitation of lower limb health in patients with MS. The dialogue of the panel is encouraging with a host of examples provided as evidence that podiatric interventions could facilitate meaningful change to the rehabilitation service and have a great impact on both patients and carers.

13.
Asia-Pacific Journal of Clinical Oncology ; 18(Supplement 3):187, 2022.
Article in English | EMBASE | ID: covidwho-2136611

ABSTRACT

Background: AYA with cancer commonly experience sexuality concerns during and post treatment. Evaluation andmanagement of these critical aspects are often neglected by health professionals due to factors such as poor knowledge, confidence and communication, lack of comfort, time and prioritisation of sexuality concerns. It is not known what policy and practice tools are available to bridge this evidence gap. Aim(s): To scope, analyse and map the literature on policy and practice tools, specific to AYA oncosexology education and training programs, for health professionals. Method(s): A scoping review was conducted using the Joanna Briggs Institute methodology. A search strategy was developed using key words initially tested in OVID MEDLINE. The formal search was conducted in July 2022 in Medline, EMCARE, EMBASE and PsychINFO (all on OVID platform) for articles: published after 2012;in English;qualitative, quantitative, mixed method studies, case studies, review articles or grey literature;in patients aged 15-39 years. Articles were excluded if they did not meet these criteria, only examined potential education/training programs or health professionals' knowledge, attitudes or practices, or only focused on patients' perspectives. Retrieved articles were extracted into Covidence and two screening roundswere independently performed by two authors each for the final analysis and evidence synthesis. Result(s): After removing 1140 duplicate records, 1825 records were screened of which 1523 were excluded and 302 full texts assessed for eligibility. The final number of studies included along with other quantitative findings will be reported against the PRISMA-ScR reporting checklist. Results from the basic content analysis to organise qualitative findings into higher level categories will also be presented. Conclusion(s): Evidence gaps, limitations and implications for research will be discussed. We will seek stakeholders' views on whether our findings are locally relevant and how they can inform improvements in health professional oncosexology policy and practice tools.

14.
British Journal of Surgery ; 109(Supplement 5):v7-v8, 2022.
Article in English | EMBASE | ID: covidwho-2134894

ABSTRACT

Introduction: We are faced with long waiting lists coupled with a loss of training opportunities for surgical trainees as a result of CoVID-19. It is imperative to ensure training opportunities are optimised and trainees are encouraged to contribute to The service recovery efforts we are faced with. Method(s): A pilot 'The hernia fest' was undertaken with The aim of training core trainees, supporting senior trainees as independent practitioners coupled with supporting The delivery of high volume, low complexity (HVLC) care. Parallel bespoke theatre lists with The grouping of specific cases (hernias), have been run with a consultant surgeon overseeing 2-3 lists. Each list includes a selected senior trainee who is suitable to train colleagues. Cases were screened prior to booking. All theatre staff were briefed On The purpose of The lists. All patients, trainees and theatre staff completed a questionnaire. Result(s): 50 hernia training cases were carried out over 15 sessions. 100% of patients were confident with their treatment and would recommend The service. 100% of trainees felt they had progressed in their operative competence and skill acquisition. 100%oftrainees were satisfied. Senior trainees enjoyed The responsibility of running an independent list. 100% of theatre staff felt they would participate in future lists. Conclusion(s): This model cultivates a learning environment whilst addressing waiting lists. The grouping of operations together allows for repetitive practice and may encourage rapid skill acquisition. We discuss lessons learnt and a proposed framework & checklist which can be applied to The future planning of such lists.

15.
British Journal of Surgery ; 109(Supplement 5):v135, 2022.
Article in English | EMBASE | ID: covidwho-2134883

ABSTRACT

Aims: The COVID-19 pandemic has resulted in major changes in pre-operative assessment, as consultations became conducted over The telephone, and pre-operative tests carried out a few days before Surgery to coincide with The COVID testing visit. This increased The chances for preoperative tests to be missed. A recent audit in our unit revealed missed investigations just before surgery. A checklist was introduced to identify issues early and help reduce avoidable delays. Method(s): An audit was performed for completeness of preoperative preparations. A pre-operative checklist was created to include pre-operative investigation reports, routine laboratory results, proof of COVID-19 swabs and vaccination records, correct details on The theatre lists, signed consent forms with clearly visible patient marking. The checklist was launched and The team, including doctors and nurses, were educated on its value in improving patient care. Result(s): The implementation of electronic pre-operative checklists resulted in an immediate improvement of care, with preliminary results showing issues with a potential of causing delays being promptly identified and addressed. Late identification of issues could not be entirely avoided;however, this was discussed with team members, further education was provided, and data collection continues, to ensure good practice is sustained. Conclusion(s): COVID-19 has reduced The time for hospital visit and face to face interactions, but this created The opportunity for missed tests and processes leading to delays and cancellation of surgery. The checklist in our case has proven useful in identifying issues early and promptly managing potential delays in patient care.

16.
British Journal of Surgery ; 109(Supplement 4):iv37, 2022.
Article in English | EMBASE | ID: covidwho-2134873

ABSTRACT

Introduction: The SARS-COV-2 pandemic has led to The redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOp) was proposed. An audit was undertaken to evaluate The SOp, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements. Method(s): To ascertain key pre-operative steps to include in The checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once The checklist was established The questionnaire was re-sent additionally asking for feedback On its impact On The service and suggestions for improvement. Using these results, The checklist was incorporated as a smart text to EpIC (electronic patient notes). Result(s): The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt The checklist improved The service in all domains, except bed availability and subsequent surgical delay, likely because this depended On HDU bed availability and need for on-the-day prioritisation. Conclusion(s): The CEA surgery checklist is now an established part of The electronic patient record in The form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of The team including new/temporary staff can follow this, ensuring a safe care pathway. Take-home message: With The move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by The use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.

17.
Radiotherapy and Oncology ; 174(Supplement 1):S49, 2022.
Article in English | EMBASE | ID: covidwho-2132765

ABSTRACT

Purpose: Beyond patient symptom management during treatment, patient reported outcomes (PRO) play a critical role in oncology survivorship. Although considered standard of care, PRO collection and use is challenging for radiotherapy (RT) centres lacking electronic PRO (ePRO) infrastructure. This work outlines facilitators and barriers to the implementation of an ePRO program across a multicentre radiation oncology department. Material(s) and Method(s): Dalhousie University's Department of Radiation Oncology (DRO) is composed of four RT centres across three provinces. Department-wide implementation of ePRO was precipitated by several key events: In 2009, a Canadian Partnership Against Cancer (CPAC) grant enabled 2 centres to begin paper-based PRO using the Canadian Problem Checklist (CPC) and Edmonton Symptom Assessment System (ESASr). In 2015, the Department's research retreat set ePRO as a priority. In 2017, Accreditation Canada mandated routine evaluation of patient outcomes and in 2018, the Canadian Partnership for Quality Radiotherapy (CPQR) identified Dalhousie's DRO as an early adopter within the pan-Canadian PRO initiative. In 2019, three DRO centres were awarded CPAC funding to launch ePROs. The fourth centre now hopes to use lessons learned in order to facilitate their ePRO implementation. Result(s): ePRO was launched in September 2021 with a phased approach across centres and tumour sites so that user feedback can inform the roll out. Clinic workflows now includes ePRO at consultation, first and last RT review as well as follow-up. Within the ePRO application (Noona), CPQR-endorsed PRO tools include CPC, ESASr, and the Brief Pain Inventory (BPI), with use of other tumour-site specific questionnaires planned. Project charter included needs assessments (human resource, staff /patient education) and change management strategies required to obtain buy-in from front line staff. Although coordination of such a large-scale initiative was challenged by COVID restrictions, project priority was escalated with ePRO recognized as a powerful tool to assess patient symptoms in clinic or remotely. Research unit support was invaluable to navigate IT project complexities including vendor/collaborator contracts, processes of Privacy Impact Assessments and IT architectural reviews. From the advisory board to PRO working groups, mullti-stakeholder feedback and collaboration has been key, including representatives of patients, cancer program leadership, project managers/principle investigators, administrative staff, nurses, radiation therapists, radiation oncologists, industry, IT and legal. Conclusion(s): Multi-centre implementation of an ePRO program has been feasible but complex and time intensive. It is hoped that our lessons learned may benefit those RT centres aiming to transition from paper-based to ePRO systems. With critical electronic infrastructure now in place, we await data to analyze ePRO amongst other patient outcomes in ongoing RT Big Data initiatives. Copyright © 2022 Elsevier Ireland Ltd. This is an open access article under the CC-BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

18.
Journal of Vascular Access ; 23(1 Supplement):38, 2022.
Article in English | EMBASE | ID: covidwho-2114897

ABSTRACT

Introduction: Two fundamental supportive invasive interventions in the intensive care unit (ICU) are ventilation and intravenous therapy. Ventilation research has dominated the literature since the pandemic began, with little research on vascular access devices (VADs), despite these interventions existing almost co-dependently. This scoping review aimed to identify the types of evidence available, knowledge gaps and key concepts on vascular access (VA) approaches in patients with Covid-19 in ICU. The main objective was to conduct a systematic search to examine the types of research conducted on VADs during the pandemic. Method(s): Design: scoping review. The Joanna Briggs Institute (JBI) three-step approach was followed to undertake a systematic search using databases and search engines EMBASE, Medline, CINAHL, PubMed and clinical trials registries. Study designs were searched from 2019 to March 2022 limited to the English language. Our data extraction instrument was developed using a template from JBI (Table 1). The PRISMA-ScR checklist was used to report findings. Result(s): A total of 5107 results were identified (Figure 1). From this number data was extracted from 67 papers. Among the study designs were: retrospective studies (20), editorials and commentaries (17), case reports (14), prospective cohort studies;observational studies;cross sectional studies (8), conference s (2), quality improvement initiative (2), one survey (1), study protocol (1). Two clinical guidelines from expert groups were identified. No randomised controlled trials were identified. No clinical trials, registered or ongoing, were identified. Discussion(s): This review identified that Covid-19 patients are requiring more VADs, over longer periods with an increased risk of mortality. These patients are proned for up to 18 hours a day, reducing access for regular VAD assessment. Well-designed VA research is lacking in COVID 19 cohorts. Conclusion(s): The foundation of evidence-based practice depends on the integration of valid research alongside clinical expertise. Despite VA recommendations being in existence, no randomised controlled trials, systematic reviews or meta-analysis exist to support these recommendations. Future research needs to focus on high quality randomised controlled trials. A systematic review and meta-analysis is, at present, unnecessary.

19.
Tanzania Journal of Health Research ; 23(Supplement 1):203-204, 2022.
Article in English | EMBASE | ID: covidwho-2114881

ABSTRACT

Background: The Coronavirus Virus Disease 2019 (COVID-19) has increased demand for new medicines, vaccines, and diagnostics, and therefore regulatory authorities need to keep a good oversight of the development of these products in the interest of public health. For Tanzania, Tanzania Medicines, and Medical Devices Authority (TMDA) is responsible for regulating clinical trials conducted in the country. In this responsibility, TMDA needs a competent pool of Good Clinical Practice inspectors. Therefore, the present study was aimed at determining the level of competency and training needs of clinical inspectors in Tanzania. Methodology: A descriptive cross-sectional study was conducted from February 2021 to June 2021 using an online survey to gather all required information. Participants with bachelor's degrees and Doctor of Philosophy were almost equal in proportion with 21.1 % and 20.0 %, respectively. Result(s): The results indicated that 69.2% (90/130) of participants responded to the survey. Most of the participants, 58.9% (53/90), were male. On an educational level, more than half of the participants had a master's degree 58.9% (53/90). Participants with bachelor's degrees and Doctor of Philosophy were almost equal in proportion with 21.1 % and 20.0 %, respectively. Only 12.8% (n=10) of the respondents were competent in understanding and using the checklist for inspection of clinical trials. This was identified as gap need to be addressed by training more GCP inspectors to increase the pool. These findings were used to develop 70 hours (7 credits) of a short course curriculum for Good Clinical Practice (GCP) Inspection that was developed jointly and accredited by the Directorate for Continued Professional Development at the Muhimbili University of Health and Allied Sciences (MUHAS). Therefore, a two-week short training was organized and conducted, the analysis of pre and post-test results revealed that the median score significantly increased from 55 in pretext to 65 in post-test (p<0.05) which implied that the training had a positive impact. Conclusion(s): There was a small number of proficient GCP inspectors regarding the use of African Vaccine Regulatory Forum (AVAREF) guidelines for GCP inspection. The training conducted increased the knowledge and competency of GCP inspectors in Tanzania. Similar trainings should be conducted at regular intervals.

20.
Tanzania Journal of Health Research ; 23(Supplement 1):118, 2022.
Article in English | EMBASE | ID: covidwho-2113848

ABSTRACT

Background: The COVID-19 pandemic affected health commodities due to disrupted supply chains, increased demand, and price increases. Jazia Prime Vendor System (Jazia PVS) is a Public Private Partnership for procuring health commodities when not available at Medical Stores Department (MSD). The system has been operational since 2018. Objective(s): This study highlights the resilience and contribution of Jazia PVS during the pandemic in mitigating health supply challenges including price increases. Methodology: Routine data from regional monitoring of the Jazia PVS were analyzed between March 2020 and June 2021. Prices of selected health products were compared with baseline prices. Data were collected using monitoring checklists and secondary information from 7 (27%) regions and 5 (37%) contracted regional vendors. Analysis used Microsoft office excel. Result(s): Despite the spike in demand, PVS managed to supply commodities to public health facilities, complementing MSD during the pandemic. Facilities recorded availability of medicines of 75% and 85% in April 2020 and April 2021, respectively. Initially, Jazia PVS continued supply of health commodities at original contract prices. As stock depleted and demand increased, vendors and their clients (regions) initiated market price reviews and contract negotiation leading to price adaption. Price increase of 244.83% in June 2020 for examination gloves reduced to 201.72% in June 2021. The baseline price increase for surgical gloves of 122.22% reduced to 77.78%. Paracetamol price increase of 51.72% reduced to 37.93%. The price for azithromycin tablets increased by 69.23% up to June 2021. Multivitamins tablets increased by 157.14%. Conclusion(s): The COVID-19 pandemic disrupted health supply chains. The complementary Jazia PVS demonstrated resilience and was able to mitigate supply challenges. Vendors and clients agreed to amend commodities prices as a measure to maintain operations and to sustain supply of health commodities. The system proved flexibility in response to a public health and economic crisis.

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