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1.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Article in English | MEDLINE | ID: covidwho-1777840

ABSTRACT

Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.


RéSUMé: La prise en charge des symptômes et les soins de fin de vie sont des compétences de base pour tous les médecins, bien qu'en temps ordinaire, de nombreux anesthésiologistes n'ont que peu d'occasions de mettre en pratique ces compétences. La pandémie actuelle de coronavirus 2019 (COVID-19) a provoqué un taux de mortalité significatif dans un court intervalle et a nécessité une augmentation des besoins en soins intensifs et en soins palliatifs. Destiné aux anesthésiologistes déployés dans les unités prenant soin de patients atteints de la COVID-19, ce compte rendu narratif offre des recommandations quant à la façon de mener les discussions à propos des objectifs de soins, du retrait des thérapies de soutien vital, et de la prise en charge de symptômes de détresse.


Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Pneumonia, Viral/therapy , Terminal Care/organization & administration , Anesthesiologists/organization & administration , Anesthesiologists/standards , COVID-19 , Clinical Competence , Coronavirus Infections/mortality , Critical Care/standards , Humans , Palliative Care/organization & administration , Pandemics , Physicians/organization & administration , Physicians/standards , Pneumonia, Viral/mortality , Terminal Care/standards , Withholding Treatment
2.
Anesth Prog ; 69(1): 59-60, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1775598
3.
Paediatr Anaesth ; 32(2): 181-190, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1666336

ABSTRACT

Neonatal and childhood infectious diseases continue to be a global health problem. Acute respiratory tract infections are typically classified as upper respiratory tract infection and lower respiratory tract infections. The most common lower respiratory infections in childhood are pneumonia and bronchiolitis. Vaccination against measles, diphtheria, pertussis, Haemophilus influenzae, pneumococcus, and influenza resulted in a significant reduction in the incidence of acute respiratory tract infection globally. Though the global burden of the disease has decreased, the mortality rates still are higher in developing countries. Patients with severe lower respiratory tract infections and their complications are often evaluated for elective or emergency procedures. In this review article, the authors aim to discuss the etiology, pathogenesis, preoperative evaluation of lower respiratory tract infections, and the anesthesia implications pertinent to the practice of anesthesia.


Subject(s)
Pneumonia , Respiratory Tract Infections , Anesthesiologists , Child , Humans , Incidence , Infant, Newborn , Respiratory Tract Infections/prevention & control , Vaccination
4.
Anesth Analg ; 134(2): 348-356, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1635164

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has affected the personal and professional lives of all health care workers. Anesthesiologists frequently perform virus-aerosolizing procedures (eg, intubation and extubation) that place them at increased risk of infection. We sought to determine how the initial COVID-19 outbreak affected members of the Society for Pediatric Anesthesia (SPA) on both personal and professional levels. Specifically, we examined the potential effects of gender and age on personal stress, burnout, sleep deprivation, anxiety, depression, assessed job satisfaction, and explored financial impact. METHODS: After receiving approval from the SPA Committees for Research and Quality and Safety and the Colorado Multiple Institutional Review Board, we e-mailed a questionnaire to all 3245 SPA members. The survey included 22 questions related to well-being and 13 questions related to effects of COVID-19 on current and future practice, finances, retirement planning, academic time and productivity, and clinical and home responsibilities. To address low initial response rates and quantify nonresponse bias, we sent a shortened follow-up survey to a randomly selected subsample (n = 100) of SPA members who did not respond to the initial survey. Response differences between the 2 cohorts were determined. RESULTS: A total of 561 (17%) members responded to the initial questionnaire. Because of COVID-19, 21.7% of respondents said they would change their clinical responsibilities, and 10.6% would decrease their professional working time. Women were more likely than men to anticipate a future COVID-19-related job change (odds ratio [OR] = 1.92, 95% confidence interval [CI], 1.12-2.63; P = .011), perhaps because of increased home responsibilities (OR = 2.63, 95% CI, 1.74-4.00; P < .001). Additionally, 14.2% of respondents planned to retire early, and 11.9% planned to retire later. Women and non-White respondents had higher likelihoods of burnout on univariate analysis (OR = 1.75, 95% CI, 1.06-2.94, P = .026 and OR = 1.82, 95% CI, 1.08-3.04, P = .017, respectively), and 25.1% of all respondents felt socially isolated. In addition, both changes in retirement planning and future occupational planning were strongly associated with total job satisfaction scores (both P < .001). CONCLUSIONS: The COVID-19 pandemic has affected the personal and professional lives of pediatric anesthesiologists, albeit not equally, as women and non-Whites have been disproportionately impacted. The pandemic has significantly affected personal finances, home responsibilities, and retirement planning; reduced clinical and academic practice time and responsibilities; and increased feelings of social isolation, stress, burnout, and depression/anxiety.


Subject(s)
Anesthesia/psychology , Anesthesiologists/psychology , Burnout, Professional/psychology , COVID-19/psychology , Pediatrics , Surveys and Questionnaires , Adult , Anesthesia/trends , Anesthesiologists/trends , Burnout, Professional/epidemiology , COVID-19/epidemiology , Female , Humans , Job Satisfaction , Male , Middle Aged , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Pediatrics/trends , Retirement/trends , Societies, Medical/trends
6.
Anesth Analg ; 133(6): 1497-1509, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1607763

ABSTRACT

Research has shown that women have leadership ability equal to or better than that of their male counterparts, yet proportionally fewer women than men achieve leadership positions and promotion in medicine. The Women's Empowerment and Leadership Initiative (WELI) was founded within the Society for Pediatric Anesthesia (SPA) in 2018 as a multidimensional program to help address the significant career development, leadership, and promotion gender gap between men and women in anesthesiology. Herein, we describe WELI's development and implementation with an early assessment of effectiveness at 2 years. Members received an anonymous, voluntary survey by e-mail to assess whether they believed WELI was beneficial in several broad domains: career development, networking, project implementation and completion, goal setting, mentorship, well-being, and promotion and leadership. The response rate was 60.5% (92 of 152). The majority ranked several aspects of WELI to be very or extremely valuable, including the protégé-advisor dyads, workshops, nomination to join WELI, and virtual facilitated networking. For most members, WELI helped to improve optimism about their professional future. Most also reported that WELI somewhat or absolutely contributed to project improvement or completion, finding new collaborators, and obtaining invitations to be visiting speakers. Among those who applied for promotion or leadership positions, 51% found WELI to be somewhat or absolutely valuable to their application process, and 42% found the same in applying for leadership positions. Qualitative analysis of free-text survey responses identified 5 main themes: (1) feelings of empowerment and confidence, (2) acquisition of new skills in mentoring, coaching, career development, and project implementation, (3) clarification and focus on goal setting, (4) creating meaningful connections through networking, and (5) challenges from coronavirus disease 2019 (COVID-19) and the inability to sustain the advisor-protégé connection. We conclude that after 2 years, the WELI program has successfully supported career development for the majority of protégés and advisors. Continued assessment of whether WELI can meaningfully contribute to attainment of promotion and leadership positions will require study across a longer period. WELI could serve as a programmatic example to support women's career development in other subspecialties.


Subject(s)
Anesthesiologists , Empowerment , Gender Equity , Leadership , Pediatricians , Physicians, Women , Sexism , Women, Working , Attitude of Health Personnel , COVID-19 , Career Mobility , Female , Humans , Male , Mentors , Program Evaluation , Staff Development , Surveys and Questionnaires
8.
Anaesthesist ; 70(Suppl 1): 1-10, 2021 12.
Article in English | MEDLINE | ID: covidwho-1575759

ABSTRACT

The current outbreak of coronavirus disease (COVID-19) has reached Germany. The majority of people infected present with mild disease, but there are severe cases that need intensive care. Unlike other acute infectious diseases progressing to sepsis, the severe courses of COVID19 seemingly show prolonged progression from onset of first symptoms to life-threatening deterioration of (primarily) lung function. Diagnosis relies on PCR using specimens from the respiratory tract. Severe ARDS reflects the hallmark of a critical course of the disease. Preventing nosocomial infections (primarily by correct use of personal protective equipment) and maintenance of hospitals' operational capability are of utmost importance. Departments of Anaesthesia, Intensive Care and emergency medicine will envisage major challenges.


Subject(s)
COVID-19 , Anesthesiologists , Germany/epidemiology , Humans , SARS-CoV-2
9.
Anesth Prog ; 68(4): 245-247, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1575523
10.
J Neurosurg Anesthesiol ; 34(1): 158-162, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1555946

ABSTRACT

Dr. Emanuel Martin Papper was a Professor and Department Chair at Columbia University whose top passion was training the next generation of anesthesiologists. As such, a fitting topic for discussion at Columbia University Department of Anesthesiology's Papper Symposium was the "The Impact of the COVID-19 Pandemic on Trainees: Lessons Learned and Unanticipated Opportunities," presented by Dr. Roberta L. Hines, Nicholas M. Greene Professor of Anesthesiology and Department Chair and Chief of Anesthesiology at Yale-New Haven Hospital. The pandemic led to abrupt changes at the national, hospital, and training program levels, all of which impacted trainees in anesthesiology and other disciplines. Nationally, there were sweeping regulatory changes that helped to shape the coronavirus disease-2019 response by medical front line workers. At each individual hospital, coronavirus disease-2019 units were created and teams were restructured to keep up with patient care demands. Educational programs adapted their curricula and trainees lost valuable clinical and academic opportunities. The innovative educational responses, including a pivot to virtual learning and virtual recruitment, provided a silver lining to the health care crisis. Another bright spot was that anesthesiology as a specialty rose to the forefront of patient care. Anesthesiologists displayed impactful leadership during the pandemic, paving the way for future growth and broadened reach of our specialty.


Subject(s)
Anesthesiology , COVID-19 , Anesthesiologists , Humans , Pandemics , SARS-CoV-2
11.
J Neurosurg Anesthesiol ; 34(1): 113-115, 2022 Jan 01.
Article in English | MEDLINE | ID: covidwho-1555456

ABSTRACT

Translational science seeks to accelerate the multi-step process by which scientific discoveries are transformed into therapies that can improve the health of individuals and their communities. To facilitate crossing the traditional boundaries between basic and clinical research for instance, a systematic understanding of the scientific and operational principles that underlie each step of the translational cycle is developed to identify and address barriers to translation. Skills required by translational scientists, such as being systems thinkers and process innovators, overlap with those of anesthesiologists, and therefore, it is no surprise that anesthesiologists have contributed to this field. Indeed, the safety and efficacy of anesthesia care has greatly evolved over many decades because anesthesiologists have recognized the importance of readily incorporating physiological and pharmacological basic research findings into clinical practice. This article highlights the characteristics that make anesthesiologists well suited to be translational scientists. We also discuss one example of anesthesiology contributing to the field of translational science during the COVID-19 pandemic. We show that anesthesiologists, regardless of their specific clinical or research interests, have the skill set to become effective and critical players in the field of translational science and emphasize the importance of continued leadership in this field to academic anesthesiology.


Subject(s)
Anesthesiology , COVID-19 , Anesthesiologists , Humans , Pandemics , SARS-CoV-2
12.
Asian J Anesthesiol ; 59(3): 111-114, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1518746
14.
Semin Cardiothorac Vasc Anesth ; 26(1): 27-31, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1506118

ABSTRACT

Anesthesiologists are important components of volunteer teams which perform congenital cardiac surgery in low-resource settings throughout the world, but limited data exist to characterize the nature and breadth of their work. A survey of Congenital Cardiac Anesthesia Society (CCAS) members was conducted with the objective of understanding the type of voluntary care being provided, its geographic reach, the frequency of volunteer activities, and factors which may encourage or limit anesthesiologists' involvement in this work. The survey was completed by 108 participants. Respondents reported a total of 115 volunteer trips during the study period, including work in 41 countries on 5 continents. Frequent motivating factors to begin volunteering included invitations from charitable groups, encouragement from senior colleagues, and direct connections to individual locations. Discouraging factors included familial responsibilities, the need to use vacation time, and a lack of support from home institutions. The year 2020 saw a marked decrease in reported volunteer activity, and respondents reported multiple pandemic-related factors which might discourage future volunteer activities. The results of this study demonstrate the global reach of anesthesiologists in providing care for children having cardiac surgery. It also offers insights into the challenges faced by interested individuals, many of which are related to a lack of institutional support. These challenges have only mounted under the COVID-pandemic, leading to a dramatic downturn in volunteer activities. Finally, the survey reinforces the need for better coordination of volunteer activities to optimize clinical impact.


Subject(s)
Anesthesia, Cardiac Procedures , COVID-19 , Cardiac Surgical Procedures , Anesthesiologists , Child , Humans , Surveys and Questionnaires
16.
J Occup Environ Med ; 63(6): 521-527, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1494064

ABSTRACT

OBJECTIVE: We measured the seroprevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) immunoglobulin G (IgG) antibodies among surgeons and anesthesiologists and associated antibody status with coronavirus disease 2019 (COVID-19) clinical illness. METHODS: A cross-sectional study of SARS-CoV-2 IgG seroprevalence with a survey assessing demographics, SARS-CoV-2 exposure risk, and COVID-19 illness. The primary outcome was the period prevalence of SARS-CoV-2 IgG antibodies associated with COVID-19 illness. RESULTS: One hundred forty three surgeons and anesthesiologists completed both serology and survey testing. We found no significant relationships between antibody status and clinical role (anesthesiologist, surgeon), mode of commuting to work, other practice settings, or place of residence. SARS-CoV-2 IgG seroprevalence was 9.8%. Positive IgG status was highly correlated with presence of symptoms of COVID-19 illness. CONCLUSIONS: These results suggest the relative safety of surgeons and anesthesiologists where personal protective equipment (PPE) is available and infection control protocols are implemented.


Subject(s)
Anesthesiologists/statistics & numerical data , COVID-19/epidemiology , Surgeons/statistics & numerical data , Adult , Antibodies, Viral/blood , COVID-19/diagnosis , Cross-Sectional Studies , Female , Hospitals , Humans , Immunoglobulin G/blood , Infection Control , Male , Middle Aged , New York City/epidemiology , Personal Protective Equipment , Prevalence , SARS-CoV-2/immunology , SARS-CoV-2/isolation & purification , Seroepidemiologic Studies
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