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1.
Hepatol Commun ; 6(4): 920-930, 2022 04.
Article in English | MEDLINE | ID: covidwho-1756574

ABSTRACT

Palliative care (PC) benefits patients with serious illness including end-stage liver disease (ESLD). As part of a cluster randomized trial, hepatologists were trained to deliver primary palliative care to patients with ESLD using an online course, Palliative Care Always: Hepatology (PCA:Hep). Here we present a multimethod formative evaluation (feasibility, knowledge acquisition, self-efficacy, and practice patterns) of PCA:Hep. Feasibility was measured by completion of coursework and achieving a course grade of >80%. Knowledge acquisition was measured through assessments before and throughout the course. Pre/post-course surveys were conducted to determine self-efficacy and practice patterns. The hepatologists (n = 39) enrolled in a 12-week online course and spent 1-3 hours on the course weekly. The course was determined to be feasible as 97% successfully completed the course and 100% passed. The course was acceptable to participants; 91.7 % reported a positive course experience and satisfaction with knowledge gained (91.6%). The pre/post knowledge assessment showed an improvement of 6.0% (pre 85.9% to post 91.9%, 95% CI [2.8, 9.2], P = 0.001). Self-efficacy increased significantly (P < 0.001) in psychological symptom management, hospice, and psychosocial support. A year after training, over 80% of the hepatologists reported integrating a variety of PC skills into routine patient care. Conclusion: PCA:Hep is feasible, acceptable, and improves learner knowledge and confidence in palliative care skills. This is a viable method to teach primary PC skills to specialists caring for patients with ESLD.


Subject(s)
End Stage Liver Disease , Gastroenterologists , Gastroenterology , Hospice and Palliative Care Nursing , End Stage Liver Disease/psychology , Humans , Palliative Care/methods
2.
Inflamm Bowel Dis ; 27(10): 1703-1705, 2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1740876

ABSTRACT

The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients' concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19 , Gastroenterologists , Inflammatory Bowel Diseases , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/psychology , Patient Participation/methods , Patient Participation/psychology , Physician's Role , Preventive Health Services , Risk Assessment , SARS-CoV-2 , Vaccination/methods , Vaccination/psychology , Vaccination Coverage/methods
3.
Am J Gastroenterol ; 117(1): 3-6, 2022 01 01.
Article in English | MEDLINE | ID: covidwho-1605109
5.
Medicine (Baltimore) ; 100(30): e26781, 2021 Jul 30.
Article in English | MEDLINE | ID: covidwho-1345780

ABSTRACT

ABSTRACT: Coronavirus disease 2019 (COVID-19) pandemic has impacted our clinical practice. Many gastroenterologists have changed their attitudes toward various gastroenterological clinical settings. The aim of the present study is to explore the gastroenterologist's attitudes in several clinical settings encountered in the clinical practice.An online based survey was completed by 101 of 250 Israeli gastroenterologists (40.5%).Most of the participants were males (76.2%), and most of them were in the age range of 40 to 50 (37.6%). For all questionnaire components, the 2 most common chosen options were "I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without preendoscopy severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) testing" and "Tend to postpone endoscopy until SARS-CoV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite." Notably, 12 (11.9%) gastroenterologists were infected by Coronavirus disease 2019 during their work. Classifying the clinical settings to either elective and non-elective, most gastroenterologists (77.4%) chose the attitude of "I perform endoscopy with N95 mask, gloves and gown protection in a standard endoscopy room without SARS-COV-2 testing" in the nonelective settings as compared to 54.2% for the elective settings, (P < .00001), whereas 32.9% of the responders chose the attitude of "Tend to postpone endoscopy until SARS-COV-2 test is performed because of fear from being infected, or virus spreading in the endoscopy suite" in the elective settings (P < .00001).Gastroenterologists' attitude in various gastroenterological settings was based on the clinical indication. Further studies are needed to assess the long-term consequences of the different attitudes.


Subject(s)
Attitude of Health Personnel , COVID-19/epidemiology , Gastroenterologists/statistics & numerical data , Adult , COVID-19/prevention & control , Endoscopy, Digestive System/adverse effects , Endoscopy, Digestive System/psychology , Female , Gastroenterologists/psychology , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Israel , Male , Middle Aged , Surveys and Questionnaires
7.
J Gastroenterol ; 56(8): 788-789, 2021 08.
Article in English | MEDLINE | ID: covidwho-1305154
8.
J Gastroenterol ; 56(8): 786-787, 2021 08.
Article in English | MEDLINE | ID: covidwho-1293377
10.
Postgrad Med ; 133(6): 592-598, 2021 Aug.
Article in English | MEDLINE | ID: covidwho-1281769

ABSTRACT

OBJECTIVES: COVID19 pandemic has forced physicians from different specialties to assist cases overload. Our aim is to assess gastroenterologist's assistance in COVID-19 by assessing mortality, ICU admission, and length of stay, and seek for risk factors for in-hospital mortality and longer hospital stay. METHODS: A total of 41 COVID-19 patients assisted by gastroenterologist (GI cohort) and 137 assisted by pulmonologist, internal medicine practitioners, and infectious disease specialists (COVID expert cohort) during October-November 2020 were prospectively collected. Clinical, demographic, imaging, and laboratory markers were collected and compared between both cohorts. Bivariate analysis and logistic regression were performed to search for risk factors of mortality and longer hospital stays. RESULTS: A total of 27 patients died (15.1%), 11 were admitted to ICU (6.1%). There were no differences between cohorts in mortality (14.6% vs 15.4%;p = 0.90), ICU admission (12.1% vs 4%;p = 0.13), and length of stay (6.67 ± 4 vs 7.15 ± 4.5 days; p = 0.58). PaO2/FiO2 on admission (OR 0.991;CI95% 0.984-0.998) and age > 70 (OR 17.54;CI95% 3.93-78.22) were independently related to mortality. Age > 70, history of malignancy, diabetes, and cardiovascular disease were related to longer hospital stays (p < 0.001, p = 0.03, p = 0.04, p = 0.02 respectively). CONCLUSIONS: COVID-19 assistance was similar between gastroenterologist and COVID experts when assessing mortality, ICU admission, and length of stay. Age>70 and decreased PaO2/FiO2 on admission were independent risk factors of mortality. Age and several comorbidities were related to longer hospital stay.


Subject(s)
COVID-19 , Expert Testimony , Gastroenterologists/statistics & numerical data , Length of Stay/statistics & numerical data , Age Factors , Aged , COVID-19/diagnosis , COVID-19/mortality , COVID-19/physiopathology , Comorbidity , Expert Testimony/methods , Expert Testimony/statistics & numerical data , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Interdisciplinary Communication , Male , Prognosis , Risk Assessment/methods , Risk Assessment/statistics & numerical data , Risk Factors , SARS-CoV-2/isolation & purification , Spain/epidemiology
11.
J Gastroenterol Hepatol ; 36(11): 3056-3068, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1280344

ABSTRACT

BACKGROUND AND AIM: The coronavirus disease 2019 pandemic has impacted gastroenterology practices worldwide; however, its protracted effects within Southeast Asia were unknown. The primary aim of the study was to determine the impact of the pandemic on clinical demands including burnout among gastroenterologists within the region. The secondary aim was to identify risk factors for burnout and determine regional stressors. METHODS: This was a mixed-methods study. Gastroenterologists were surveyed electronically between September 1 and December 7, 2020, via gastroenterology and endoscopy societies of Brunei, Indonesia, Malaysia, Philippines, Singapore, and Thailand. Quantitative and qualitative data were collected. The 22-item Maslach Burnout Inventory-Human Services Survey (MBI-HSS) was used to detect burnout. Quantitative data were non-parametric; non-parametric methods were used for statistical comparisons. Logistic regression was used to determine risk factors for burnout. Content analysis method was used to analyze qualitative data. Ethical approval was obtained. RESULTS: A total of 73.0% reported that they were still significantly affected by the pandemic. Of these, 40.5% reported increased workload and 59.5% decreased workload. Statistically significant differences in weekly working hours, endoscopy, and inpatient volumes were present. No differences were observed in outpatient volumes, likely because of telemedicine. Burnout was common; however, 50.1% of gastroenterologists were unaware of or did not have access to mental health support. This, as well as depression, being a trainee, and public sector work, increased burnout risk significantly. CONCLUSION: The effects of the pandemic are multifaceted, and burnout is common among Southeast Asian gastroenterologists. Safeguards for mental health are suboptimal, and improvements are urgently needed.


Subject(s)
Burnout, Professional/psychology , COVID-19/psychology , Gastroenterologists/psychology , Adult , Asia, Southeastern/epidemiology , Burnout, Professional/epidemiology , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
12.
Inflamm Bowel Dis ; 27(10): 1703-1705, 2021 Oct 18.
Article in English | MEDLINE | ID: covidwho-1236236

ABSTRACT

The recent emergency use authorization of a third COVID-19 vaccine means that most patients with inflammatory bowel disease (IBD) will soon be eligible to be vaccinated. Gastroenterology clinicians should be prepared to address patients' concerns regarding safety and efficacy of vaccines. They should also strongly recommend that all their patients be vaccinated with a COVID-19 vaccine. Additionally, they should be prepared to educate patients about logistics that will result in successful vaccination completion. All these measures will be crucial to ensure high uptake among their patients with IBD.


Subject(s)
COVID-19 Vaccines/pharmacology , COVID-19 , Gastroenterologists , Inflammatory Bowel Diseases , Vaccination , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/immunology , Inflammatory Bowel Diseases/psychology , Patient Participation/methods , Patient Participation/psychology , Physician's Role , Preventive Health Services , Risk Assessment , SARS-CoV-2 , Vaccination/methods , Vaccination/psychology , Vaccination Coverage/methods
13.
Gastrointest Endosc ; 94(1): 160-168.e3, 2021 07.
Article in English | MEDLINE | ID: covidwho-1230498

ABSTRACT

BACKGROUND AND AIMS: During the severe acute respiratory syndrome coronavirus 2 pandemic, N95 filtering facepiece respirator (FFR) use was required while performing aerosol-generating procedures. We studied the physiologic effects of N95 FFR use in a cohort of gastroenterologists performing simulated colonoscopies. METHODS: Data collection and comparisons included (1) symptoms and change in vital signs in 12 gastroenterologists performing simulated colonoscopy for 60 minutes while wearing a surgical mask (SM) and faceshield (FS); N95 FFR, SM, and FS; and powered air-purifying respirator (PAPR) and (2) respiratory belt plethysmography and continuous electrocardiographic frequency-based heart rate (HR) variability indices including very low frequency power (measures intracardiac sympathetic tone) and low frequency to high frequency ratios (intracardiac sympathetic to vagal ratio) in 11 gastroenterologists performing simulated colonoscopy while wearing an SM (15 minutes), N95 FFR and SM (60 minutes), and SM (15 minutes) in rapid sequence. RESULTS: Ten of 12 gastroenterologists (83%) reported symptoms with N95 FFR use, most commonly breathing difficulty, frustration, fatigue, and headache. Nine of these gastroenterologists (75%) had associated significant HR elevation. Respiratory peak to trough measurement showed a significant increase (F(2) = 7.543, P = .004) during the N95 FFR stage, which resolved after removal of the N95 FFR. Although not statistically different, all gastroenterologists showed a decrease in sympathetic to vagal ratios and an increase in intracardiac sympathetic effects in the N95 FFR stage. PAPR use was better tolerated but was associated with headache and elevated HR in 4 gastroenterologists (33%). CONCLUSIONS: N95 FFR use by gastroenterologists is associated with development of acute physiologic changes and symptoms.


Subject(s)
COVID-19 , Gastroenterologists , N95 Respirators , Occupational Exposure , Colonoscopy , Electrocardiography , Heart Rate , Humans , Occupational Exposure/prevention & control
19.
Clin Gastroenterol Hepatol ; 19(4): 836-838.e3, 2021 04.
Article in English | MEDLINE | ID: covidwho-956085

ABSTRACT

The COVID-19 pandemic poses unprecedented and unique challenges to gastroenterologists eager to maintain clinical practice, patients' health, and their own physical/mental well-being. We aimed to estimate the prevalence and critical determinants of psychological distress in gastroenterologists during the COVID-19 pandemic.


Subject(s)
COVID-19/epidemiology , Gastroenterologists/psychology , Mental Health , Stress, Psychological/epidemiology , COVID-19/complications , COVID-19/psychology , Cross-Sectional Studies , Humans , Pandemics , Prevalence , Retrospective Studies , Stress, Psychological/etiology , Stress, Psychological/psychology , Surveys and Questionnaires , United States/epidemiology
20.
Gastroenterol Hepatol ; 44(9): 637-643, 2021 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-935614

ABSTRACT

INTRODUCTION: In the midst of the SARS-CoV-2 virus (COVID-19) pandemic, health professionals, specifically gastroenterologists, have had to use personal protective equipment (PPE) to reduce contact with droplets and aerosols generated during gastrointestinal endoscopy. OBJECTIVE: To evaluate the impact of the use of two types of PPE on quality of vision during gastrointestinal endoscopy. METHODS: A cross-sectional observational pilot study in gastroenterologists who undergo an ophthalmological examination of visual acuity and quality of vision when using two types of PPE. Type #1: 3M N95 1860 green respirator + 3M mono safety glasses + protective screen. Type #2: 3M 6800 full facepiece + 3M NIOSH 7093C HF/P100 filters. RESULTS: Visual acuity and quality of vison parameters while using the PPE that is routinely used when performing gastrointestinal endoscopy during the pandemic were evaluated. It was found that Modality #1 was associated with decreases of up to 37% in visual acuity, 25% in colour visualisation and 75% in contrast sensitivity among digestive endoscopists within minutes of placement. These figures worsened over the course of the procedure, rising to 75%, 60% and 100%, respectively. Modality #2 was not associated with any deterioration in quality of vision. CONCLUSIONS: The different PPE modalities used during gastrointestinal endoscopy could have an impact on the quality of endoscopy studies performed during the SARS-CoV-2 (COVID-19) pandemic.


Subject(s)
COVID-19/prevention & control , Endoscopy, Gastrointestinal/standards , Gastroenterologists , Pandemics , Personal Protective Equipment/adverse effects , Visual Acuity , Color Perception , Contrast Sensitivity , Cross-Sectional Studies , Eye Protective Devices/adverse effects , Filtration/instrumentation , Humans , Masks , N95 Respirators , Pilot Projects , Respiratory Protective Devices/adverse effects , Time Factors
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