Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 159
Filter
1.
Open Access Macedonian Journal of Medical Sciences ; 10:1272-1275, 2022.
Article in English | EMBASE | ID: covidwho-2066704

ABSTRACT

BACKGROUND: Mechanical chest compression devices play an important role in assisting patients undergoing cardiac arrest. However, this equipment induces an aerosol-generating procedure that could contaminate hospital staff. The development of a remote control system for mechanical chest compression devices may solve the problem;however, there are currently no studies regarding the efficacy of this system. AIM: This study aims to analyze efficacy of remote control systems for mechanical chest compression devices and compare it with non-remote control systems. METHODS: This was an analytical cross-sectional study at Srinagarind Hospital, Thailand. Data were collected in two periods of the study. The first period was between January and December 2021 using a non-remote control system to operate the mechanical chest compression device. The second period was from January to April 2022 and collected data on the use of a remote control system. RESULTS: Sixty-four participants were examined over the 16-month period of the study. A total of 53.1% (n = 34) of participants were male and the mean age of the patients was 52.4 ± 5.1 years old. The number of emergency medical service members (EMS) needed for resuscitation in the remote control group was less than the non-remote control group (3 vs. 5;p = 0.040). The number of emergency department (ED) members needed for resuscitation in the remote control group was four compared with eight in the non-remote control group. CONCLUSIONS: The remote controlled mechanical chest compression device can effectively reduce the number of staff working both in the EMS and in the ED of the hospital, thus reducing exposure and contamination from aerosol-generating procedure. It was also proven accurate in terms of rate and depth of chest compression according to resuscitation guidelines.

2.
CMAJ. Canadian Medical Association Journal ; 64(5 Supplement 1):S59-S60, 2021.
Article in English | EMBASE | ID: covidwho-2065172

ABSTRACT

Background: Injured adolescents may go to pediatric (PTC) or adult (ATC) trauma centres. Although there appears to be little difference in mortality when adolescents are managed in PTCs versus ATCs, evidence suggests differences in clinical processes (e.g., computed tomographic scanning, operative intervention). Moreover, there is little information on nonclinical outcome variation. We aimed to examine differences in nonclinical outcomes of injured adolescents admitted to the lead PTC or ATC within a regional Canadian trauma system. Method(s): After injury-related hospital admission at the PTC or ATC, adolescents (15-17 yr, inclusive) and parents completed the following: the Quality of Trauma Acute Care Patient-Reported (or Parent- Reported) Experience Measure (QTAC-PREM), examining clinical care, information delivery, education and social supports, and opioid exposure;the Pediatric Quality of Life Inventory;and the Brief Symptom Inventory, a psychological distress measure. Data were collected on clinical outcomes and processes. Descriptive bivariate analyses compared outcomes by trauma centre type. Result(s): Twenty-six ATC and 32 PTC patients have been enrolled to date. Survey response rates were 69% (patients) and 75% (parents) at the PTC and 58% (patients) and 54% (parents) at the ATC. There was a similar age and sex distribution between the 2 centres. Injury severity was higher at the ATC, reflected by greater mean lengths of stay (PTC 2.3 d [standard deviation (SD) 2.1 d], ATC 13.3 d [SD 23.7 d]), and lower mean Glasgow Coma Scale scores (PTC 15.0, ATC 13.8) at the ATC. There were also 3 critical care admissions at the ATC and none at the PTC among recruited patients. No differences were observed in patient- or parent-reported clinical care and follow-up experiences. There was also no difference in patient- or parent-reported social and educational support, although subscales were limited by visitor restrictions because of the COVID-19 pandemic, and the majority of injuries occurring during summer months when students were out of school. Parents at the ATC reported fewer opportunities to stay with or near their child compared with those at the PTC (100% v. 69.2%). Parents reported better information provision at the PTC (mean 17.3 [SD 1.3] v. 13.9 [SD 5.2], out of 18 as measured by the QTAC-PREM). Patients and parents were more likely to report receiving opioid prescriptions on discharge at the ATC (55.6% v. 14.3%). There was no difference in quality of life or psychological distress between the PTC and ATC. Conclusion(s): Injured adolescents and their parents indicated similar clinical and follow-up experiences, although parents felt better informed at the PTC and reported better opportunities to stay near their child. Parents and patients reported higher opioid exposures at the ATC. Sharing of communication, accommodation and opioid prescribing practices may allow for improved experiences and reduced opioid exposures in injured adolescents presenting to ATCs. Multivariable analyses are necessary in the future to adjust for injury severity differences..

3.
CMAJ. Canadian Medical Association Journal ; 64(5 Supplement 1):S44, 2021.
Article in English | EMBASE | ID: covidwho-2065171

ABSTRACT

Background: The COVID-19 pandemic has been linked to increased mental health issues and interpersonal violence. Both psychiatric diagnoses and young males are overrepresented in the trauma population. Our objective was to characterize injury characteristics and their relationship to psychiatric diagnoses after the COVID-19 lockdown at a trauma centre in Edmonton, Alberta. Specifically, we queried relationships between gender, age, length of stay and intentionally violent injuries, and we reviewed access to inpatient and outpatient mental health and addiction resources. Method(s): We performed a retrospective chart audit for trauma patients aged 18-64 years admitted to the University of Alberta Hospital Trauma Service from June 1 to Aug. 31, 2020. Variables included demographics, injury characteristics, psychiatric history, substance use disorder history and presence of psychiatry and addictions consultations. Treatment plans and follow-up were assessed. Frequencies and basic descriptives were calculated. Univariate analyses were performed to identify relationships between psychiatric or addiction diagnosis (or both) and injury patterns. Result(s): A total of 176 patients met the inclusion criteria. Patients were young (mean age 39.7 yr) and male (73%), and blunt injury was most common (82%). Sixty-three patients (36%) had a psychiatric (29 patients) or addiction (59 patients) history. Twenty-eight patients (15%) received consults to the psychiatry service. At discharge, follow-up included mental health team (10 patients, 36%), family physician (2 patients, 7%) or self-referral resources (8 patients, 29%). Eight patients were not provided follow-up. Fifty-nine patients (34%) had 1 or more addictions history. Nineteen patients (32%) received consultations to psychiatry (18 patients) or addictions (1 patient). Otherwise, 6 patients (10%) were provided community resources at tertiary survey, 6 patients (10%) declined offered resources and 6 patients (10%) had traumatic brain injury (addiction resources deferred). Twenty-five patients (42%) either were not offered resources or documentation was unclear. On univariate analysis of patients with psychiatry consult, age was similar, but females were more likely to be represented (42% v. 24%, p = 0.06). Average length of stay was 17 days versus 9.7 days (p = 0.05). Having a psychiatric consultation or addictions history (or both) was associated with a violent mechanism of injury (35% v. 18%, p < 0.02). Conclusion(s): Over one-third of trauma patients aged 18-64 years had a psychiatric or addiction history (or both) and were significantly more likely to have a violent injury mechanism. Psychiatric consultation was common, more so in female patients, and linked to increased length of stay. Community follow-up was suboptimal, especially for patients with addiction history. Resource access and provision must be optimized to improve care, reduce recidivism and target interpersonal violence during this time of increased individual and system stress..

4.
CMAJ. Canadian Medical Association Journal ; 64(5 Supplement 1):S43-S44, 2021.
Article in English | EMBASE | ID: covidwho-2065168

ABSTRACT

Background: Alcohol is a major factor in traumatic injuries. Accreditation bodies recommend alcohol screening and intervention programs as trauma quality indicators. Previous research in Alberta reported increasing alcohol use prevalence in major trauma. The COVID-19 pandemic has also been linked to increased alcohol consumption. Our objective was to characterize injury characteristics and their relationship to alcohol use during the summer trauma season after the COVID-19 lockdown, and compliance with alcohol misuse screening, at a level 1 trauma centre in Edmonton, Alberta. Method(s): We conducted a retrospective chart audit for trauma patients aged 18-64 years who were admitted to the University of Alberta Hospital Trauma Service from June 1 to Aug. 31, 2020. Variables included demographics, injury characteristics, ethanol level on presentation, history of substance use and screening or intervention. Tertiary surveys as well as psychiatry and addictions consultations were reviewed to assess compliance with screening and intervention. Frequencies and basic descriptives were calculated. Logistic regression was performed to identify relationships between alcohol use and injury patterns. Result(s): A total of 176 patients met the inclusion criteria. The mean age was 40 (standard deviation [SD] 13.8) years, and 128 (72.7%) were male. Blunt injuries were most common (144 patients [81.8%] had a blunt injury, 27 [15.3%] had a penetrating injury and 3 [1.7%] had a burn), with average Injury Severity Score 13 (1-45) and average length of stay 10.6 (SD 14.6) days. Motor vehicle crashes (MVCs) predominated (66 patients, 37.5%) followed by falls (33 patients, 18.8%), sport-related injuries (30 patients, 17.1%) and stabbings (17 patients, 9.7%). A total of 156 patients (88.6%) had an ethanol level drawn on presentation;50 (32%) were positive, and 33 of these (66%) were legally intoxicated. Forty-five patients (25.6%) had a documented addiction history with alcohol use disorder, 29 of whom presented with a positive ethanol level. Of the 50 patients with elevated ethanol level on presentation, the average age was 36 (SD 12.1) years and the mean ethanol level was 36.9 (SD 23.3) mmol/L. MVCs were the most common mechanism (18 patients, 36%). Screening for alcohol use disorder was performed in 39 (78%) of these 50 patients who presented with a positive ethanol level (unclear documentation in the remainder). Addiction services were offered to 10 of 50 patients (20%). Positive ethanol level was associated with younger age (36 v. 41 yr, p = 0.02). Logistic regression revealed that positive ethanol level was significantly associated with stab mechanism of injury (odds ratio [OR] 3.75, 96% confidence interval [CI] 1.1-11.6, p < 0.05);intoxication further increased association with stab injury (OR 4.4, 95% CI 1.4-15, p < 0.01). Conclusion(s): The prevalence of positive ethanol level in trauma patients is rising: 32% currently, compared with 24% from Alberta 2010 data. Over one-quarter of MVC patients had a positive ethanol level, and intoxication increased the odds of stab injury. Compliance with alcohol misuse screening was 78% with only 20% of patients offered intervention, despite 58% having alcohol use disorder. Interventions to reduce preventable injuries and alcohol misuse at the population and hospital levels are needed..

5.
Archives of Disease in Childhood ; 107(Supplement 2):A21, 2022.
Article in English | EMBASE | ID: covidwho-2064011

ABSTRACT

Aims A recent RCPCH publication shared the struggles across Paediatric Emergency Departments (PEDs) with meeting the 'Facing the Future' standards for children and young people (CYP) with mental health (MH) concerns, with few units studied being able to adequately meet the needs of CYP in MH crisis (1). We work in a central London teaching hospital and major trauma centre: our aim was to understand the experience of CYP aged 13-17 presenting to the PED with MH concerns, as compared with those presenting with physical complaints. Methods Collection of quantitative data surrounding CYP in the ED with MH presentations (n=271), including time to be seen, time to see Child and Adolescent Mental Health Services (CAMHS), time to admission or discharge, and total time spent in ED (all as compared with physical health presentations n=7551). Use of independent samples t-tests to analyse differences between groups across outcomes. Two time periods (1 July-30 Oct 2019 and 1 July-30 Oct 2021, n= 3913 and 3909 respectively) were examined to encapsulate pre and post COVID. Qualitative inquiry with 22 CYP presenting to the ED to co-produce experience maps to visualise their healthcare journeys and identify opportunities to improve their care. Results CYP with MH presentations spent a mean time of 747.6 minutes in the ED, compared with physical health patients who spent 195.76 minutes (p=<0.001). Mean time to be seen by CAMHS was 225.0 minutes, whereas patients with physical health complaints who are referred to specialties waited 196.52 minutes to be seen (a difference that was not significant). More CYP with MH presentations than those with physical health presentations spent >4 hours but <12 hours in the ED (76.4% vs 18.4%, p<0.001) and almost 1/3 spent more than 12 hours in the ED (32.8% vs 1.0%, p<0.001). Experience mapping captured that CYP and families acknowledged the wait but would benefit from signposting of the physical environment (e.g. 'you are here' maps), the presence of age-appropriate entertainment, and the input of volunteers or staff to support basic needs (e.g. food, water, pillows): we are implementing each. Conclusion CYP with MH presentations have a worse experience of the ED than their counterparts with physical health complaints, spending longer in the department, being more likely to surpass 4 or 12 hours in the ED. CYP have indicated to us some simple changes to their environment and the management of their stay which could improve their experience. It is widely acknowledged that most areas need to grow our provision of CAMHS to meet the need, but we also need to further utilise other MH services available beyond hospital walls (e.g. crisis lines, wellbeing practitioners, school counselling, youth support services). (1) John Criddle, Virginia Davies, RCPCH Website https:// www.rcpch.ac.uk/news-events/news/time-raise-standard-childrenpresenting- emergency-departments-mental-health-crisis.

6.
Journal of Pediatric Gastroenterology and Nutrition ; 75(Supplement 1):S170-S171, 2022.
Article in English | EMBASE | ID: covidwho-2058503

ABSTRACT

Background: Foreign body ingestions (FBI) are most commonly seen in children aged 6 months to 4 years and occur at home. Most foreign bodies pass through the gastrointestinal tract without causing any injury. However, 10-20% of cases require endoscopic intervention and <1% require surgery. On March 4th, 2020, a state of emergency in California was announced in response to the evolving COVID-19 pandemic, including closure of all county public schools on March 13th, 2020, and a shelter-in-place order ceasing all non-essential business and travel on March 16th, 2020. Despite the breadth of data on FBIs prior to the pandemic, and others outlining findings from surgical perspectives or in other countries during the pandemic, there is limited data on FBIs and the COVID-19 pandemic in a US pediatric Level 1 Trauma Center in a state with extended and strict mandated shutdowns. Method(s): We used the National Electronic Injury Surveillance System (NEISS) data set for a single large tertiary center, retrospective analysis of FBI, patient demographics, and patient disposition between 3/16/2019-3/15/2021 to better characterize FBI prior to and during the COVID-19 pandemic. Our primary outcome measure was the number of patients presenting to our emergency department (ED) and admitted to our hospital for FBI. High Risk FBI were events involving button batteries, magnets, lead-based objects, or sharp objects (broken glass, needles, nails). We also conducted a secondary chart review to collect demographic data on FBI patients who required admission. All automatically collected data was qualitatively screened and systematically categorized for more effective data presentation. Result(s): While the overall number of presentations to the ED remained similar (279 to 268), there was a higher rate of admissions (8.9% vs 12.3%) during the pandemic. The average age of patients with an ingestion was 42.5 months pre-pandemic, 52.7 months during pandemic;the average age of patients admitted for an FBI was 35.4 months pre-pandemic, 50.9 months during pandemic. The number of high-risk ingestions during the pandemic (10.8% vs 14.2%) was higher. Of children who needed to be admitted, a greater number required endoscopic procedures during the pandemic (29.9% vs 38.5%). There was also a larger proportion of patients belonging to ethnic minorities (Black, Asian, Hispanic/Latino) that were admitted during the pandemic (45.5% vs 63.0%). Conclusion(s): Both ED and hospital admission data reflect the disruption to the home and work environments that the general population experienced in the pandemic. The increased average age of a FBI-presenting and FBI-admitted patient could reflect the increased incidence in older, possibly school-aged children, in light of the state-wide shutdown of schools and children being at home full-time. The increase in high risk and admission rates in the pandemic also suggests that mandates placing children in the home increase their exposure to harmful materials and increased risk of serious injury requiring invasive procedures. We serve a particularly vulnerable population;the majority of our patients are insured by Medicaid and of lower socioeconomic status (SES), and we would expect that the increase in FBI is correlated to SES. Moving forward, we would like to further investigate how the COVID-19 pandemic may have further exacerbated pediatric health disparities by analyzing health outcomes based on patients' preferred language (English or other) and home zip code and corresponding census info (median household income, percent living below the poverty line). In our at-risk population, based on the above data, we propose implementing proactive counseling by primary care providers (PCP) on safety around FBI. Education provided to families at PCP visits on securing dangerous objects in the home may help decrease FBI especially during times when children are required to be at home more often, like during a pandemic.

7.
Journal of the Intensive Care Society ; 23(1):150, 2022.
Article in English | EMBASE | ID: covidwho-2042963

ABSTRACT

Introduction: The aim of the audit was to assess the frequency of Emergency Department (ED) attendances before and after Intensive care and correlate this with functional decline and worsening comorbidities. Though the Covid 19 pandemic has highlighted this more starkly1 the implications of prolonged ICU care and increased long term care needs is well established.2 Objectives: A well-structured, comprehensive, multidisciplinary rehabilitation program during and after discharge from the hospital could improve outcomes and prevent further hospital/ED visits. Method: Data was collected using the ITU admission data base for all > 72 hour ITU patient stays over a two year period of 2017-2018 and 2018-2019 in a district general hospital in the UK. Each individual patient's number of same hospital ED attendances for twelve months before and after their ITU admission were reviewed and the causes for them assessed, in addition survival data over a two year period was also reviewed. Results: During 2017-2018 and 2018-2019 a total of 414 and 425 patients were admitted respectively to ITU for more than 72 hours (median= 133.5 hours). Of the total 839 ITU admissions 700 (83.4%) survived ICU stay. 165 (23.6%) of the 700 patients died in subsequent 2 years of ITU discharge. The two year survival rate was 65%. The most common ITU admissions reason was postoperative monitoring (20%) followed by Type 1 respiratory failure (18%) and Type 2 respiratory failure (15%). The median ED attendance was 0 (Range 0 to 29, mean 0.985, S.D 3.985) in the 17-18 and 0 (Range 0 to 24, mean 1.153, SD 2.154) in the 18-19 cohort in the 12 months prior to ITU admission while the median ED attendance was 0 (Range 0 to 15, mean 0.980, S.D 4.4) in the 17-18 and 0 (Range 0 to 15, mean 1.19, SD 2.0) in the 18-19 cohort in the 12 months following the ITU admission. 98% for 17-18 and 72% for 18-19 of ED reattendances following prolonged ITU stay were due to reasons similar to ITU care. Of the 445 patients with no prior ED attendance in 1 year, 168 or 38% (range 1 to 14) had at least one ED attendance in the 12 months following ITU discharge. The remaining 394 patients with at least one ED attendance prior to ICU, 185 or 47% (1 to 15 Range) had ED attendance 12 months following their ITU discharge. Conclusion: The results show that ITU admitted patients consume significant health resources before and after their ITU stay. Patients with no prior ED attendances before ITU admission also reattended in substantial numbers. Most of these attendances were related to their initial reason for ITU admission. A comprehensive rehabilitation program both in hospital and following discharge could improve patients' outcomes, reduce stress on emergency services and improve patient experience. A rehab service was implemented. The need for rehab program for Covid 19 patients during the pandemic has grown immense because of evolving evidence of Long Covid.3.

8.
British Journal of Surgery ; 109:vi38, 2022.
Article in English | EMBASE | ID: covidwho-2042549

ABSTRACT

Aim: Trauma encompasses a significant proportion of referrals to Oral Maxillofacial Surgery (OMFS). COVID-19 called for clinicians globally to tailor practice and follow-up patterns. Multiple government-imposed lock downs saw changes in patterns of emergency department (ED) attendances nationally. The aim of this audit was to examine the impact of COVID-19 on Maxillofacial trauma presentations, admissions, and existing practice in University Hospital of Wales (UHW). Method: Data was collected using an electronic patient database Team Talk. Patients filtered by pathology (Soft tissue trauma, fractures) and location (ED). Annual data collected for 2019, 2020 and 2021, to compare pre-pandemic (2019), evolving pandemic (2020) and established pandemic (2021) figures. Results: Trauma made up 74%, 73% and 78% of total OMFS referrals (2019, 2020, 2021). There was an 83% decrease in the number of trauma referrals between 2019 and 2020, despite UHW becoming a major trauma centre. No correlation identified between trauma presentations and lockdown events (2020) but lifting of restrictions (September 2021) showed an increase in presentations. 16.8%, 16.4% and 16.2% (2019, 2020 and 2021, respectively) of ED referrals were offered follow up follow up. Percentage of follow up appointments used for removal of sutures (ROS) decreased by 30% (2019-2020). Conclusions: 1) Overall decrease of trauma presentations during the COVID-19 pandemic, but trauma still comprised >70% of all OMFS referrals from ED. 2) Pandemic pressures did not change follow-up, discharge, or admission decisions for ED referrals. 3) Change to absorbable sutures can be taken forward to reduce percentage of follow up clinic appointments required for ROS.

9.
British Journal of Surgery ; 109:vi39, 2022.
Article in English | EMBASE | ID: covidwho-2042541

ABSTRACT

Aim: To determine the orthopaedic trauma theatre efficiency in two large major trauma centres (MTCs) in Scotland before and after the outbreak of Coronavirus disease (COVID-19) pandemic. Method: All trauma patients presented to the North and East of Scotland's MTCs prior to the outbreak of COVID-19 (7th May to 7th June 2019), during the first peak of COVID-19 (7th May to 7th June 2020), after Aerosol Generating Procedures updates (7th November to 7th December 2020) and the 'new normal' (7th May to 7th June 2021) were retrospectively reviewed. Training opportunities and theatre time were compared. The Kruskall-Wallis test was used. Results: There were no significant differences in the length of hospital stay (p=0.117, 0.065) and time from injuries and surgery within groups in both MTCs (p=0.508, 0.384). The pandemic has negatively affected the anaesthetic and surgical preparation time, time between end of procedure and send for next case, and turnover time, with more profound effect on the North of Scotland's MTC. The trainee's involvement as main surgeon had decreased with the outbreak of the pandemic, with the junior trainees being affected most severely in North of Scotland. The time taken for patient to arrive to theatre after sending and total downtime were twice as long in the North of Scotland. Conclusion: The COVID-19 pandemic has negatively impacted the orthopaedic trauma theatre efficiency and training opportunities. Actions should be taken to improve the turnover time to maximise theatre efficiency while prioritizing training opportunities.

10.
British Journal of Surgery ; 109:vi27, 2022.
Article in English | EMBASE | ID: covidwho-2042537

ABSTRACT

Aim: Ankle fractures constitute approximately 10.2% of all bony injuries. Due to pressures exerted by the COVID-19 pandemic, a series of modifications have evolved within subspecialty fracture management. The aim of our study was to evaluate our adaptations to the COVID-19 pandemic and assess our management of ankle fractures according to the BOAST guidelines. Method: We performed a retrospective review of 30 skeletally mature patients with a closed ankle fracture presenting to a major tertiary centre. Our inclusion criteria comprised of the 'BOAST guidelines for ankle fracture management' published in 2016. Results: Of the 30 patients within our cohort, 40% (n= 12) had stable ankle fractures, whereas 60% (n= 18) were unstable (based on the weber classification and evidence of syndesmotic instability). 63% (n= 10) had fracture manipulations prior to surgery. 50% (n= 5) had a documented re-examination of neurovascular status. All patients had a post reduction image. 88% (n= 16) with unstable fractures underwent operative fixation. 6 patients underwent external fixation prior to definitive management. The average time from injury to definitive fixation was 12 days with a range from 0-22 days. Only 8 patients had clear documentation of intraoperative syndesmotic stability. Conclusions: The BOAST guidelines outline a range of standards that should be utilised when treating ankle fracture patients. We intend to use our study to educate healthcare professionals on the importance of accurate documentation and encourage shorter operative waiting times to improve standard of care and patient outcomes.

11.
Journal Europeen des Urgences et de Reanimation ; 34(2):54-63, 2022.
Article in English | EMBASE | ID: covidwho-2041927

ABSTRACT

To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.

12.
Deutsche Apotheker Zeitung ; 161(48), 2021.
Article in German | EMBASE | ID: covidwho-1647351

ABSTRACT

The pressure on the unvaccinated is growing and with it the number of those who try to get a digital vaccination certificate with fake vaccination certificates. Against this background, the Berlin Chamber of Pharmacists advises pharmacies against digitizing vaccination certificates in the emergency service.

13.
Anaesthesia ; 77:32, 2022.
Article in English | EMBASE | ID: covidwho-2032348

ABSTRACT

Rapid infusion of warmed blood products is an essential part of the resuscitation of massive haemorrhage [1]. Anaesthetic trainees must therefore be confident and competent in the use of their Trust's chosen device. The aim of this project was to assess and improve trainee confidence in the operation of the newly acquired Belmont Rapid Infuser 2 (RI-2) after informal feedback from trainees that they did not feel proficient in its use. Methods An anonymous online survey was disseminated to anaesthetic trainees at St Mary's Hospital to assess their confidence in the set-up, operation and troubleshooting of the Belmont RI-2. A face-to-face practical teaching session was then delivered by a consultant anaesthetist and experienced operating department practitioner (ODP), where trainees were shown how to use the Belmont RI- 2 and had the opportunity to practise operating and troubleshooting it. Trainees were then asked to complete a follow-up questionnaire to assess their confidence after the teaching session. Results Twenty trainees, ranging from CT1 to ST7, completed the primary questionnaire. Sixteen (80%) had used the Belmont RI-2 less than five times prior to arriving on this rotation and most did not feel confident in the set-up, operation and troubleshooting of the device (Fig. 1). All (100%) respondents felt they would benefit from a practical teaching session. The post-teaching questionnaire demonstrated that trainee confidence in the use of the Belmont RI-2 increased (Fig. 1). (Figure Presented) Discussion Trainee experience in use of the Belmont RI-2 is variable and most did not feel confident in its use, highlighting a need for additional training after induction. Face-to-face practical teaching improved confidence, but the ability to deliver this was hampered due to trainee on-call commitments (13 of the original 20 trainees were absent) and COVID-19 limits on the number of people in a room. In the future, we plan to video the teaching session so that trainees can learn the information at induction in a COVID-19-safe manner and refresh their knowledge as required.

14.
Open Access Macedonian Journal of Medical Sciences ; 10:1252-1256, 2022.
Article in English | EMBASE | ID: covidwho-2010395

ABSTRACT

BACKGROUND: In 2015, approximately 350,000 adults in the United States experienced nontraumatic out-of-hospital cardiac arrest and were treated by the emergency medical services (EMS) personnel. Despite recent increases, <40% of adults receive layman-initiated cardiopulmonary resuscitation (CPR), and <12% apply an automated external defibrillator before EMS personnel. AIM: To know the ability of the Medan city community in handling cardiac arrest for the first time and implementing the 2020 AHA basic life support (BLS). METHODS: This study used a descriptive method with a cross-sectional approach and was conducted in the city of Medan in the period July–October 2021. Sampling used cluster sampling and purposive sampling with inclusion and exclusion criteria. RESULTS: In this study, it was found that the majority of the people of Medan City had less knowledge about CPR in BLS. In this study, only respondents from Medan Marelan District were dominated by good knowledge by 80%. It was found that the people of Medan City have a good level of knowledge about these cardiac events, and the people of Medan City have a low level of knowledge about BLS and CPR. CONCLUSION: The ability of the people of Medan City in implementing BLS and CPR in BLS for cardiac events outside the hospital is still lacking.

15.
Journal of Obstetrics and Gynaecology Canada ; 44(5):626, 2022.
Article in English | EMBASE | ID: covidwho-2004261

ABSTRACT

Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords: telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone

16.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003502

ABSTRACT

Background: Non-accidental trauma (NAT) is a global health issue and is responsible for 50,000 deaths worldwide and 1,800 deaths in the United States annually. Established risk factors for NAT include lower socioeconomic status and ethnic minority status. Memphis, TN has the nation's second poorest metropolitan area, with greater than one-third of children living in poverty and a disproportionate number of those being ethnic minority children. The COVID-19 Pandemic, in addition to direct health effects, has brought with it increased financial and social hardship, possibly exacerbating the factors leading to violence against children. We sought to explore what impact the COVID19 Pandemic had on the incidence of NAT within an already atrisk population. Methods: Retrospective registry data was obtained for patients with suspected and confirmed NAT admitted through the Pediatric Emergency Department at our Level 1 Pediatric Trauma Center from 2011-2020. We compared the NAT rates before and during the COVID-19 Pandemic, designated as year 2020, using risk ratios and Chi-squared test. We conducted interrupted time series analysis to examine the impact of COVID-19 and time on the rate of NAT. A P-value ≤ 0.05 was considered statistically significant. Results: The year 2020 showed an increase risk of NAT compared to prior years since 2011, both individually and as a whole. Interrupted time series analysis revealed a steady rise in NAT admissions over the last decade, but this rise was eight-fold above expected rates in the time of the COVID-19 Pandemic, RR 8.64 (95% CI: 3.3-13.9;p 0.006). There was decrease in emergency department encounters by 35.5% during the COVID-19 Pandemic compared to the average over the prior nine years. Patient demographics of NAT admissions prior to the COVID-19 pandemic and during the Pandemic did not significantly change. Injury Severity Score showed a decrease during the pandemic compared to the decade prior to the pandemic (p 0.002). Total hospital days were unaffected but total ICU days showed a decrease from 5.7 to 1.5 days (p <0.001). Conclusion: Our study found a disproportionate increase in incidence of hospitalized NAT cases despite overall decreased volume of emergency department encounters during the COVID-19 Pandemic. Additionally, there was a decrease in injury severity and ICU length of stay, suggesting the increase in hospitalized NAT cases did not result in more critical injury, but rather increased frequency of mild-to-moderate severity of injury. We hypothesize the added social stress and financial impact of the COVID-19 Pandemic has resulted in heightened external stress on families, therefore increasing the risk of NAT in the pediatric population. Further evaluation on a national level, including non-hospitalized children, will need to be conducted. Our study supports the need for increased community awareness of NAT for at-risk children during times of social disruption and financial crisis.

17.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003458

ABSTRACT

Background: The COVID-19 pandemic presented unique challenges to pediatric emergency medicine (PEM) departments nationwide. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care while keeping their workforce safe. Methods: This is a qualitative study based on semi-structured interviews with PEM physicians in leadership positions within their institution's COVID-19 response or emergency/disaster management departments. Participants were identified through convenient purposive sampling. Demographic data was captured in a pre-interview survey. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by two independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member checking was completed to ensure trustworthiness of the results. Results: Fourteen PEM-trained physicians participated in this study. Eleven of the participants received specialized disaster management training, and ten are directors of their institutions' emergency/disaster management departments. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Within these themes, participants discussed challenges and offered examples as to how they overcame them within their department and their larger institution. To improve communication and disseminate new information, departments might consider shift huddles, town hall meetings, limiting the number of daily emails, and highlighting the newest changes. During traumas and resuscitations, “gatekeepers” oversee who goes into the trauma bay, and technology should be utilized to communicate with the team outside. For leadership and planning, the emergency department should appoint leaders to summarize updates and attend incident command meetings. Institutions should consider developing containment units and having multiple vendors for key supplies as part of their pandemic plans. Business continuity plans should be updated regularly as part of pandemic preparedness. Hospitals should be prepared to utilize telehealth and accept adult patients if pediatric volumes drop. Recommendations regarding adjusting clinical practice include having clear guidelines for what constitutes an aerosol-generating procedure, drive-through testing sites to alleviate pressure on emergency centers, and performing triage in the patient's room if possible. Personal protective equipment (PPE) should be safely re-purposed if supplies are insufficient. Staff must be trained on the proper donning and doffing of PPE with regular reminders during prolonged pandemics. Transparency with the workforce regarding supplies, testing, and safety protocols help alleviate fear and anxiety. Medical caregivers can limit their exposure by utilizing cardiac monitors visible from outside patient rooms and providing updates via telephone in patient rooms. For a full list of challenges and recommendations, see Table 1. Conclusion: By sharing COVID-19 experiences and offering solutions to commonly encountered problems nationwide, pediatric emergency centers and their institutions may better prepare both themselves and one another for future pandemics.

18.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003352

ABSTRACT

Background: Awareness of day to day situations that can effect children and families in disasters is an important component to mitigation in the disaster cycle through the development of standardized metrics to evaluate all types of events. Children make up 20% of the US population and are impacted physically and emotionally by disasters. Issues related to social and physical determinants of health emphasize the inequities between preparedness for the segments of the US population in different communities, as evidenced by the COVID pandemic. Tools have been created to assist communities to address hazards, such as the Hazard Vulnerability Analysis (HVA) and the Threat Hazard Identification and Risk Assessment (THIRA), but unique needs of children are not included or highlighted in these tools. The Assistant Secretary for Preparedness and Response (ASPR) created two Pediatric Disaster Centers of Excellence (COE) in 2019, Western Regional Alliance for Pediatric Emergency Management (WRAP- EM) and Eastern Great Lakes Pediatric Consortium for Disaster Response (EGLPCDR) and situational awareness around pediatrics and disasters was a important deliverable. Methods: Along with the two pediatric COE, and Emergency Medical Services for Children (EMSC/EIIC) disaster domain experts, a group of pediatric disaster subject matter experts (SME) identified key infrastructures and support mechanisms that exist and could be important to healthcare coalitions or communities when considering children and families within a region. Through a modified delphi process, nine domains were recommended. The domains consisted of healthcare expertise available within a region, mental health considerations, community resiliency, early education and schools, transportation services, public health jurisdiction, shelters and sheltering in place, supply chain and patient tracking, reunification and evacuation. Results: An extensive literature search was completed to review existing resources that could inform quality measures within the domains identified. Alignment of available measures that could inform the domains was completed and a scorecard was created to pilot among healthcare coalitions to better assess community level awareness for children and families that are important to the entire disaster cycle. This scorecard and preliminary evaluation will be used to create the first regional metrics scorecard for situational awareness to help inform the nine domains within communities or healthcare coalitions that can be important to consider when mitigating for disasters effecting children and families. Conclusion: When used at least annually, this regional metrics scorecard can inform where improvement and where further attention is needed to better prepare for future disasters improving the resilience for children and families and the entire community.

19.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003161

ABSTRACT

Background: Limited data exist regarding parental acceptance of COVID-19 vaccines for children or likelihood of acceptance in a pediatric emergency department (PED). We sought to determine rates of COVID-19 immunization among eligible children with a minor illness or injury treated in a pediatric emergency department (PED), to ascertain parent willingness for their child to receive COVID-19 vaccine (CV) in general and during future PED visits, and to describe factors associated with vaccine acceptance. Methods: Structured interviews were conducted with caregivers of children aged 6+ months evaluated in a large, urban PED in the summer of 2021 using questions derived from the literature and prior surveys. Exclusion criteria included temperature 103+F, communication barrier, Emergency Services Index (ESI) triage score of 1 or 2, or evaluation for non-accidental trauma or psychiatric complaints. Demographic and visit data, contact information, patient and parent vaccination history, and intent and willingness to receive CV were recorded, along with responses regarding parental concerns about COVID-19 illness or vaccination. Data were analyzed using standard descriptive statistics. Participants will be contacted by phone 6 months after vaccines become available for their age group to assess vaccination status. Results: Of 205 families approached, 17 declined participation, 7 were ineligible, and 181 have been enrolled. The mean patient age was 6.15 (+/- 5) years;43.6% were black. 33 (18.2%) had asthma and 16 (8.8%) had another high-risk condition. 17 (9.4%) had been previously diagnosed with COVID. Only 8/36 eligible patients (22.2%) were vaccinated. Among those previously unvaccinated, 55/173 (31.7%) definitely/probably would vaccinate their child when CV becomes available. 59/181 (32.6%) would definitely/probably accept CV in the PED at a similar future visit. Factors associated with increased overall CV acceptance included caregiver flu vaccine receipt (52.3% vs. 26.5%, p = 0.002), caregiver CV receipt (43.2% vs. 21.2%, p = 0.022), and concern that the child currently has COVID (77.8% vs. 35.6%, p = 0.012). Factors associated with acceptance in the PED included intent to vaccinate against CV (81.8% vs. 17.2%, p < 0.001), caregiver flu vaccine receipt (46.1% vs. 25.2%, p = 0.004), caregiver CV status (40.7% vs. 11.1% %, p < 0.001) and caregiver concern the child has COVID (87.5% vs. 31.9%, p = 0.001). Caregivers who were very/somewhat concerned that the child would become ill from CV were less likely to accept (overall (32.6% vs. 51.4%) and significantly less likely to accept in the PED (26.2% vs. 51.4% accepting, p < 0.001). Conclusion: Caregiver intent to immunize children against COVID is concerningly low, but is associated with caregiver vaccination status and concern for current COVID-19 illness. Those who intend to vaccinate are willing to receive CV while in the PED, indicating potential viability for future COVID-19 vaccine programs in the PED.

20.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003148

ABSTRACT

Background: Our frontline nurses and physicians seemed to have increased anxiety at the beginning of the COVID-19 pandemic and increased depression as the year progressed. Perceptions of anxiety and depression coincided with concern for one's own health, limited knowledge of how to care for patients during a pandemic, limited personal protective equipment (PPE), and/or financial constraints. To date, there are no studies looking at pediatric frontline healthcare providers and their rates of anxiety and depression over the course of a pandemic. Furthermore, nurses and physicians have distinct roles in the emergency setting that affect their perceptions of anxiety and depression. Currently, there are limited studies comparing nurse and physician anxiety and depression rates during a pandemic. The purpose of this study was to determine if there was a difference in perceptions of anxiety and depression among our Pediatric Emergency and Urgent Care frontline providers during the COVID-19 pandemic. Methods: This was a prospective cross-sectional study at a large quaternary level 1 trauma center including 3 emergency departments and 7 urgent care sites. We used the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2), both standardized validated screening tools for identifying anxiety and depressive disorders, respectively. The GAD-7 scores range from 0-21 points, with 0-4 considered minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety. PHQ-2 scores range from 0-6 points with 3-6 considered likely major depressive disorder. We surveyed healthcare providers including physicians and nurses twice with the GAD-7, once at the beginning of the pandemic in Spring 2020 and again after vaccine implementation in Spring 2021. We surveyed healthcare providers once after vaccine implementation with the PHQ-2. Results: 396 surveys were distributed in Spring 2020 and 466 surveys were distributed in Spring 2021, with one-third physician and two-thirds nurse response each time. Table 1 shows the average GAD-7 and PHQ2 scores for healthcare providers by role. The average GAD-7 score decreased for both nurses and physicians from the beginning of the pandemic to after vaccine implementation. Nurses on average had higher anxiety scores with mild score range compared to minimal score range for physicians. Nurses on average had higher depression scores compared to physicians but both roles had scores in the low likelihood range. Conclusion: Many healthcare providers perceived higher anxiety and depression levels during the pandemic. The anxiety levels appeared to decrease after vaccine implementation although hospital-wide pandemic relief efforts may have played a role in improved perceptions. Even though nurses had higher anxiety scores, the difference in the score is unlikely to be clinically significant. Our data supports rigorous mental health infrastructure during pandemic preparedness to support the sudden feelings of anxiety and depression in frontline healthcare providers.

SELECTION OF CITATIONS
SEARCH DETAIL