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1.
Rev. enferm. UERJ ; 28: e50721, jan.-dez. 2020.
Article in English, Portuguese | LILACS (Americas) | ID: covidwho-828134

ABSTRACT

Objetivo: apresentar atualizações para a ressuscitação cardiopulmonar em pacientes suspeitos e confirmados com COVID-19. Método: revisão compreensiva da literatura, com síntese narrativa das evidências de diretrizes e recomendações da Organização Mundial de Saúde, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma e National Association of Emergency Medical Technicians. Resultados: as principais atualizações trazem informações sobre especificidades das manobras de ressuscitação cardiopulmonar; preparação do ambiente, recursos humanos e materiais, reconhecimento da parada cardiorrespiratória e ações iniciais; estratégias de ventilação e acesso invasivo da via aérea; ajustes do ventilador mecânico e manobras de ressuscitação cardiopulmonar em pacientes pronados. Considerações finais: profissionais de saúde envolvidos no atendimento à parada cardiorrespiratória de pacientes suspeitos e/ou confirmados com COVID-19 podem encontrar inúmeros desafios, portanto devem seguir com rigor o protocolo estabelecido para maximizar a efetividade das manobras de ressuscitação e minimizar o risco de contágio pelo vírus e sua disseminação.


Objective: to present updates for cardiopulmonary resuscitation in suspected and confirmed patients with COVID-19. Method: comprehensive literature review with narrative synthesis of the evidence of guidelines and recommendations from World Health Organization, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Results: the main updates bring information about the specifics of cardiopulmonary resuscitation maneuvers; preparation of the environment and human and material resources, recognition of cardiorespiratory arrest and initial actions; ventilation and invasive airway access strategies; mechanical ventilator adjustments and cardiopulmonary resuscitation maneuvers in patients in the prone position. Final considerations: health professionals involved in the care of cardiorespiratory arrest of suspected and/or confirmed patients with COVID-19 can face numerous challenges, so they must strictly follow the protocol established to maximize the effectiveness of resuscitation maneuvers and minimize the risk of contagion by the virus and its spread.


Objetivo: apresentar actualizaciones para la reanimación cardiopulmonar en pacientes sospechos os y confirmados con COVID-19. Método: revisión exhaustiva de la literatura con síntesis narrativa de la evidencia de guías y recomendaciones de la Organización Mundial de la Salud, Associação de Medicina Intensiva Brasileira, American Heart Association, Resuscitation Council UK, American College of Surgions Committee on Trauma and National Association of Emergency Medical Technicians. Resultados: las principales actualizaciones aportan información sobre los detalles de las maniobras de reanimación cardiopulmonar; preparación del medio ambiente y recursos humanos y materiales, reconocimiento de paro cardiorrespiratorio y acciones iniciales; estrategias de ventilación y acceso invasivo a las vías aéreas; ajustes del ventilador mecánico y maniobras de reanimación cardiopulmonar en pacientes en decúbito prono. Consideraciones finales: los profesionales de la salud involucrados en la atención del paro cardiorrespiratorio de pacientes sospechosos y/o confirmados con COVID-19 pueden enfrentar numerosos desafíos, por lo que deben seguir estrictamente el protocolo establecido para maximizar la efectividad de las maniobras de reanimación y minimizar el riesgo de contagio por el virus y supropagación.


Subject(s)
Humans , Male , Female , Cardiopulmonary Resuscitation/standards , Coronavirus Infections/complications , Betacoronavirus , Heart Arrest/etiology , Respiration, Artificial/methods , Clinical Protocols/standards , Cardiopulmonary Resuscitation/methods , Containment of Biohazards/standards , Heart Arrest/rehabilitation , Heart Massage/methods , Nursing, Team/standards
2.
J Formos Med Assoc ; 120(1 Pt 1): 83-92, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-716805

ABSTRACT

The COronaVIrus Disease 2019 (COVID-19), which developed into a pandemic in 2020, has become a major healthcare challenge for governments and healthcare workers worldwide. Despite several medical treatment protocols having been established, a comprehensive rehabilitation program that can promote functional recovery is still frequently ignored. An online consensus meeting of an expert panel comprising members of the Taiwan Academy of Cardiovascular and Pulmonary Rehabilitation was held to provide recommendations for rehabilitation protocols in each of the five COVID-19 stages, namely (1) outpatients with mild disease and no risk factors, (2) outpatients with mild disease and epidemiological risk factors, (3) hospitalized patients with moderate to severe disease, (4) ventilator-supported patients with clear cognitive function, and (5) ventilator-supported patients with impaired cognitive function. Apart from medications and life support care, a proper rehabilitation protocol that facilitates recovery from COVID-19 needs to be established and emphasized in clinical practice.


Subject(s)
Clinical Protocols/standards , Infection Control , Rehabilitation , /epidemiology , /rehabilitation , Consensus , Humans , Infection Control/methods , Infection Control/organization & administration , Recovery of Function , Rehabilitation/methods , Rehabilitation/standards , Taiwan
3.
Buenos Aires; ANMAT; mar. 20, 2020.
Non-conventional in Spanish | LILACS (Americas) | ID: covidwho-709716

ABSTRACT

En el marco de la actual situación de emergencia sanitaria, la Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), establece las siguientes medidas y recomendaciones con el objeto de preservar las actividades de los estudios de farmacología clínica (EFC) protegiendo la seguridad y bienestar de los participantes del estudio. Los patrocinadores de los EFC deberán confeccionar un plan de mitigación de riesgo para extremar las medidas tendientes a evitar el contagio y diseminación de COVID-19 así como la saturación del sistema sanitario del país. Este plan deberá quedar debidamente documentado en el archivo de cada estudio y será notificado a los investigadores, centros de investigación, comités de Ética y a la ANMAT. Su aplicación no requiere aprobación previa como modificación sustancial por esta Administración. Algunos estudios podrán requerir modificaciones particulares que no se encuentren reflejadas en el plan de mitigación. Estas deberán ser consensuadas con el equipo de investigación y plasmarse en un documento. Este plan deberá ser presentado por cada patrocinador por única vez ante la ANMAT en un trámite caratulado como "comunicación a DERM" por la plataforma de trámites a distancia (TAD) y esta Administración Nacional tomará conocimiento del mismo. No será necesario esperar a una respuesta de esta Administración para su implementación.


Subject(s)
Pharmacology, Clinical/methods , Pharmacology, Clinical/standards , Pneumonia, Viral/drug therapy , Clinical Protocols/standards , Coronavirus Infections/drug therapy , Betacoronavirus/drug effects , Argentina/epidemiology
5.
Surg Infect (Larchmt) ; 21(8): 671-676, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-656029

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has become an increasingly challenging problem throughout the world. Because of the numerous potential modes of transmission, surgeons and all procedural staff represent a unique population that requires standardized procedures to protect themselves and their patients. Although several protocols have been implemented during other infectious disease outbreaks, such as Ebola virus, no standardized protocol has been published in regard to the COVID-19 pandemic. Methods: A multidisciplinary team of two surgeons, an anesthesiologist, and an infection preventionist was assembled to create a process with sterile attire adapted from the National Emerging Special Pathogen Training and Education Center (NETEC) donning and doffing process. After editing, a donning procedure and doffing procedure was created and made into checklists. The procedures were simulated in an empty operating room (OR) with simulation of all personnel roles. A "dofficer" role was established to ensure real-time adherence to the procedures. Results: The donning and doffing procedures were printed as one-page documents for easy posting in ORs and procedural areas. Pictures from the simulation were also obtained and made into flow chart-style diagrams that were also posted in the ORs. Conclusions: Coronavirus disease 2019 (COVID-19) is a quickly evolving pandemic that has spread all over the globe. With the rapid increase of infections and the increasing number of severely ill individuals, healthcare providers need easy-to-follow guidelines to keep themselves and patients as safe as possible. The processes for donning and doffing personal protective equipment (PPE) presented here provide an added measure of safety to surgeons and support staff to provide quality surgical care to positive and suspected COVID-19-positive patients.


Subject(s)
Clinical Protocols/standards , Coronavirus Infections/prevention & control , Infection Control/methods , Operating Rooms/organization & administration , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Betacoronavirus , Coronavirus Infections/surgery , Humans , Infection Control/standards , Operating Rooms/standards , Patient Care Team , Pneumonia, Viral/surgery , Program Evaluation
6.
Psychother Psychosom ; 89(5): 314-319, 2020.
Article in English | MEDLINE | ID: covidwho-607232

ABSTRACT

INTRODUCTION: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.


Subject(s)
Aerosols , Anesthesia/standards , Clinical Protocols/standards , Coronavirus Infections/prevention & control , Electroconvulsive Therapy/standards , Oxygen Inhalation Therapy/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Process Assessment, Health Care , Respiration, Artificial/standards , Adult , Body Mass Index , Female , Humans , Male , Retrospective Studies
7.
Hastings Cent Rep ; 50(3): 50-53, 2020 May.
Article in English | MEDLINE | ID: covidwho-619245

ABSTRACT

When confronted by the novel ethical challenges posed by a pandemic, it is helpful to turn to history for guidance and direction. In this essay, the author revisits Thucydides's description of the Plague of Athens from The Peloponnesian War as he considers the New York State Task Force on Life and the Law's 2015 guidelines on ventilator allocation. Confronted by the exigencies of the Covid-19 surge that struck New York, he questions the task force's decision not to give any degree of preference to health care workers who might become ill. He posits that they are due a compensatory ethic and some deference given the risks they have assumed, often with inadequate protective gear. Reflecting on his ambivalence, he asks if his change of heart reflects the impact of experiential learning or the erosion of nomos-or governing norms-described by Thucydides when the plague struck Athens.


Subject(s)
Bioethical Issues , Clinical Protocols/standards , Coronavirus Infections/epidemiology , Health Personnel , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/epidemiology , Betacoronavirus , Greece/epidemiology , Humans , New York City/epidemiology , Pandemics , Plague/epidemiology
8.
Int J Environ Res Public Health ; 17(11)2020 May 27.
Article in English | MEDLINE | ID: covidwho-381788

ABSTRACT

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant'Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes.


Subject(s)
Clinical Protocols/standards , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Hospital Administration , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Betacoronavirus , Humans , Italy/epidemiology , Patient Care Team/organization & administration , Pilot Projects , Quality of Health Care/organization & administration , Workflow
9.
J Pediatr Gastroenterol Nutr ; 70(6): 751-754, 2020 06.
Article in English | MEDLINE | ID: covidwho-326162

ABSTRACT

SARS-CoV-2, the novel coronavirus causing coronavirus disease 2019 (COVID-19), is now a global pandemic. Human-to-human transmission has been documented to occur through respiratory secretions, feces, aerosols, and contaminated environmental surfaces. Pediatric patients present a unique challenge as they may have minimal symptoms and yet transmit disease. Endoscopists face risk for infection with viruses like SARS-CoV-2, as the aerosol generating nature of endoscopy diffuses respiratory disease that can be spread via an airborne and droplet route. We describe our center's methodology for pediatric patient risk stratification to facilitate responsible use of endoscopic resources during this crisis. We also describe our recommendations for use of personal protective equipment by endoscopists, with the goal of ensuring the safety of ourselves, our anesthesiology and endoscopy staff, and our patients.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Betacoronavirus , Child , Clinical Protocols/standards , Coronavirus Infections/transmission , Endoscopy, Gastrointestinal/standards , Humans , Pneumonia, Viral/transmission , Risk Assessment
10.
J Med Ethics ; 46(7): 455-458, 2020 07.
Article in English | MEDLINE | ID: covidwho-306141

ABSTRACT

The COVID-19 pandemic has generated an imbalance between the clinical needs of the population and the effective availability of advanced life support (ALS) resources. Triage protocols have thus become necessary. Triage decisions in situations of scarce resources were not extraordinary in the pre-COVID-19 era; these protocols abounded in the context of organ transplantation. However, this prior experience was not considered during the COVID-19 outbreak in Spain. Lacking national guidance or public coordination, each hospital has been forced to put forth independent and autonomous triage protocols, most of which were, nonetheless, based on common ethical principles and clinical criteria. However, controversial, non-clinical criteria have also been defended by Spanish scientific societies and public institutions, including setting an age cut-off value for unilaterally withholding ALS, using 'social utility' criteria, prioritising healthcare professionals or using 'first come, first served' policies. This paper describes the most common triage criteria used in the Spanish context during the COVID-19 epidemic. We will highlight our missed opportunities by comparing these criteria to those used in organ transplantation protocols. The problems posed by subjective, non-clinical criteria will also be discussed. We hope that this critical review might be of use to countries at earlier stages of the epidemic while we learn from our mistakes.


Subject(s)
Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Pneumonia, Viral/epidemiology , Triage/ethics , Betacoronavirus , Clinical Protocols/standards , Humans , Intensive Care Units , Organ Transplantation/ethics , Organ Transplantation/standards , Pandemics , Spain
12.
J Laparoendosc Adv Surg Tech A ; 30(5): 481-484, 2020 May.
Article in English | MEDLINE | ID: covidwho-125506

ABSTRACT

The novel coronavirus SARS-CoV-2 (COVID-19) strain has caused a pandemic that affects everyday clinical practice. Care of patients with acute surgical problems is adjusted to minimize exposing health care providers to this highly contagious virus. Our goal is to describe a specific and reproducible perioperative protocol aiming to keep health care providers safe and, simultaneously, not compromise standard of care for surgical patients.


Subject(s)
Coronavirus Infections , General Surgery/standards , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Perioperative Care/standards , Pneumonia, Viral , Surgical Procedures, Operative/standards , Algorithms , Clinical Protocols/standards , Emergencies , Humans , Massachusetts , Patient Care Team/standards , United States
13.
J Med Ethics ; 46(7): 444-446, 2020 07.
Article in English | MEDLINE | ID: covidwho-46239

ABSTRACT

The novel COVID-19 pandemic has placed medical triage decision-making in the spotlight. As life-saving ventilators become scarce, clinicians are being forced to allocate scarce resources in even the wealthiest countries. The pervasiveness of air travel and high rate of transmission has caused this pandemic to spread swiftly throughout the world. Ethical triage decisions are commonly based on the utilitarian approach of maximising total benefits and life expectancy. We present triage guidelines from Italy, USA and the UK as well as the Jewish ethical prospective on medical triage. The Jewish tradition also recognises the utilitarian approach but there is disagreement between the rabbis whether human discretion has any role in the allocation of scarce resources and triage decision-making.


Subject(s)
Coronavirus Infections/epidemiology , Health Care Rationing/ethics , Jews/psychology , Judaism/psychology , Pneumonia, Viral/epidemiology , Triage/ethics , Betacoronavirus , Clinical Protocols/standards , Humans , Morals , Pandemics , Standard of Care/ethics , Ventilators, Mechanical/supply & distribution
14.
Infez Med ; 28(2): 143-152, 2020.
Article in English | MEDLINE | ID: covidwho-49983

ABSTRACT

The spread of COVID-19 epidemic in Italy, and particularly in Lombardy determined the need to standardize the therapeutic approach in order to offer the same indications for all hospitals in Lombardy. However, no specific drug has been previously approved for the COVID-19 treatment. The Lombardy Section of the Italian Society of Infectious and Tropical Diseases provided this «vademecum¼ with the aim to explore the current evidence about the drugs likely to be efficacious in the treatment of COVID-19. Moreover, a multidisciplinary group including critical care specialists has been created in order to provide indications about supporting measures and the use of steroids. A new grading scale has been proposed to help patients' stratification according to the severity of the respiratory conditions. Lastly, a collaborating group with immunologists and rheumatologists has been built with the aim of providing some guidance about the use of tocilizumab, a promising option for the treatment of the hyperinflammatory state occurring in most patients affected by COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Betacoronavirus/isolation & purification , Coronavirus Infections/drug therapy , Pandemics , Pneumonia, Viral/drug therapy , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Alanine/analogs & derivatives , Alanine/therapeutic use , Antibodies, Monoclonal, Humanized/therapeutic use , Clinical Protocols/standards , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Italy/epidemiology , Patient Care Team , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy
15.
J Pediatr Gastroenterol Nutr ; 70(6): 751-754, 2020 06.
Article in English | MEDLINE | ID: covidwho-23655

ABSTRACT

SARS-CoV-2, the novel coronavirus causing coronavirus disease 2019 (COVID-19), is now a global pandemic. Human-to-human transmission has been documented to occur through respiratory secretions, feces, aerosols, and contaminated environmental surfaces. Pediatric patients present a unique challenge as they may have minimal symptoms and yet transmit disease. Endoscopists face risk for infection with viruses like SARS-CoV-2, as the aerosol generating nature of endoscopy diffuses respiratory disease that can be spread via an airborne and droplet route. We describe our center's methodology for pediatric patient risk stratification to facilitate responsible use of endoscopic resources during this crisis. We also describe our recommendations for use of personal protective equipment by endoscopists, with the goal of ensuring the safety of ourselves, our anesthesiology and endoscopy staff, and our patients.


Subject(s)
Coronavirus Infections/prevention & control , Endoscopy, Gastrointestinal/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/standards , Pneumonia, Viral/prevention & control , Betacoronavirus , Child , Clinical Protocols/standards , Coronavirus Infections/transmission , Endoscopy, Gastrointestinal/standards , Humans , Pneumonia, Viral/transmission , Risk Assessment
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