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1.
Anesth Analg ; 131(2): 351-364, 2020 08.
Article in English | MEDLINE | ID: covidwho-665311

ABSTRACT

Health care systems are belligerently responding to the new coronavirus disease 2019 (COVID-19). The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a specific condition, whose distinctive features are severe hypoxemia associated with (>50% of cases) normal respiratory system compliance. When a patient requires intubation and invasive ventilation, the outcome is poor, and the length of stay in the intensive care unit (ICU) is usually 2 or 3 weeks. In this article, the authors review several technological devices, which could support health care providers at the bedside to optimize the care for COVID-19 patients who are sedated, paralyzed, and ventilated. Particular attention is provided to the use of videolaryngoscopes (VL) because these can assist anesthetists to perform a successful intubation outside the ICU while protecting health care providers from this viral infection. Authors will also review processed electroencephalographic (EEG) monitors which are used to better titrate sedation and the train-of-four monitors which are utilized to better administer neuromuscular blocking agents in the view of sparing limited pharmacological resources. COVID-19 can rapidly exhaust human and technological resources too within the ICU. This review features a series of technological advancements that can significantly improve the care of patients requiring isolation. The working conditions in isolation could cause gaps or barriers in communication, fatigue, and poor documentation of provided care. The available technology has several advantages including (a) facilitating appropriate paperless documentation and communication between all health care givers working in isolation rooms or large isolation areas; (b) testing patients and staff at the bedside using smart point-of-care diagnostics (SPOCD) to confirm COVID-19 infection; (c) allowing diagnostics and treatment at the bedside through point-of-care ultrasound (POCUS) and thromboelastography (TEG); (d) adapting the use of anesthetic machines and the use of volatile anesthetics. Implementing technologies for safeguarding health care providers as well as monitoring the limited pharmacological resources are paramount. Only by leveraging new technologies, it will be possible to sustain and support health care systems during the expected long course of this pandemic.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/therapy , Critical Care/organization & administration , Delivery of Health Care, Integrated/organization & administration , Health Resources/organization & administration , Health Services Accessibility/organization & administration , Infection Control/organization & administration , Pneumonia, Viral/therapy , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Health Services Needs and Demand/organization & administration , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Needs Assessment/organization & administration , Occupational Exposure/adverse effects , Occupational Exposure/prevention & control , Occupational Health , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Point-of-Care Systems/organization & administration , Point-of-Care Testing/organization & administration , Risk Factors , Severity of Illness Index
3.
Am Surg ; 86(6): 567-571, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-656872

ABSTRACT

A surgeon was among the teams caring for critically-ill patients with COVID-19 infection during the height of the pandemic in March and April 2020 in Brooklyn. He recorded his experiences and thoughts as events unfolded, a chronicle of the landmark public health event of the century. Working to exhaustion alongside his colleagues from Mount Sinai Hospital, he encountered tragedy and inspiration.


Subject(s)
Coronavirus Infections/therapy , Pandemics , Patient Care Team , Physician's Role/psychology , Pneumonia, Viral/therapy , Surgeons/psychology , Betacoronavirus , Coronavirus Infections/epidemiology , Critical Care , Humans , New York City/epidemiology , Physician-Patient Relations , Pneumonia, Viral/epidemiology , Social Support
6.
Am J Pharm Educ ; 84(6): ajpe8158, 2020 06.
Article in English | MEDLINE | ID: covidwho-646817

ABSTRACT

The novel coronavirus identified in 2019 (COVID-19) pandemic has impacted pharmacy graduate and postgraduate education. This crisis has resulted in a cosmic shift in the administration of these programs to ensure core values are sustained. Adjustments may be needed at a minimum to ensure that postgraduate trainees complete program requirements while maintaining safety. Moving forward, additional issues may arise that will need to be addressed such as admissions and program onboarding, acclimating students to new training environments, and managing inadequate resources for distance education, distance practice, and remote versus in-person research opportunities.


Subject(s)
Coronavirus Infections/epidemiology , Education, Graduate/organization & administration , Education, Pharmacy/organization & administration , Pneumonia, Viral/epidemiology , Betacoronavirus , Education, Distance , Education, Graduate/standards , Education, Pharmacy/standards , Humans , Interprofessional Relations , Pandemics , Patient Care Team/organization & administration , Pharmacy Residencies/organization & administration , Research/organization & administration , School Admission Criteria , Teaching/organization & administration , Telemedicine/organization & administration
7.
Recenti Prog Med ; 111(7): 402-403, 2020.
Article in Italian | MEDLINE | ID: covidwho-644446

ABSTRACT

The CoViD-19 pandemic has changed the concept of clinic and doctor-patient relationship. Due to the risk of mutual contagion, patients in many cases were managed without direct physical contact. This resulted in a forced acceleration towards e-health and remote consultation. The onset of a new professional figure is ever closer, the virtualist, the doctor who can treat patients without direct physical contact. For this reason, new skills and organizational methods are needed to create a care approach capable of integrating technology opportunities with the traditional clinical method.


Subject(s)
Betacoronavirus , Coronavirus Infections , Medicine , Pandemics , Physician-Patient Relations , Pneumonia, Viral , Telemedicine/trends , Virtual Reality , Coronavirus Infections/prevention & control , Health Services Accessibility , Humans , Internet , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/prevention & control , Social Determinants of Health , Social Isolation , Telemedicine/methods , User-Computer Interface
8.
Ger Med Sci ; 18: Doc05, 2020.
Article in English | MEDLINE | ID: covidwho-643792

ABSTRACT

Objective: The outbreak of COVID-19 was declared a pandemic by the WHO in March 2020. Studies from China, where the virus first spread, have reported increased psychological strain in healthcare professionals. The aim of this study was to investigate the psychosocial burden of physicians and nurses depending on their degree of contact with COVID-19 patients. In addition, we explored which supportive resources they used and which supportive needs they experienced during the crisis. Methods: Data were collected between March and April 2020 at the University Hospital Augsburg. A total of 75 nurses and 35 physicians, working either in a special COVID-19 ward or in a regular ward, took part in the survey. The participants filled in two standardized questionnaires (the Patient Health Questionnaire, PHQ; and the Maslach Burnout Inventory, MBI), and reported their fear of a COVID-19 infection and stress at work on a 10-point Likert scale. Finally, they answered three open-ended questions about causes of burden, supportive resources and needs during the crisis. Results: Nurses working in the COVID-19 wards reported higher levels of stress, exhaustion, and depressive mood, as well as lower levels of work-related fulfilment compared to their colleagues in the regular wards. Physicians reported similar scores independent of their contact with COVID-19 patients. The most common causes for burden were job strain and uncertainty about the future. Psychosocial support as well as leisure time were listed as important resources, and a better infrastructure adjustment to COVID-19 at the hospital (e.g. sufficient staff, keeping teams and working schedules stable) as suggestion for improvement. Conclusions: Our findings indicate that especially nurses working in COVID-19 wards are affected psychologically by the consequences of the pandemic. This might be due to a higher workload and longer time in direct contact with COVID-19 patients, compared to physicians.


Subject(s)
Burnout, Professional/psychology , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Health Personnel/psychology , Occupational Stress/epidemiology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Workload/psychology , Adult , Betacoronavirus , Female , Germany , Hospitals, University , Humans , Incidence , Male , Middle Aged , Nurses/psychology , Occupational Health , Occupational Stress/psychology , Pandemics/statistics & numerical data , Patient Care Team , Physicians/psychology , Psychology , Surveys and Questionnaires , World Health Organization
9.
J Perioper Pract ; 30(7-8): 210-220, 2020 07.
Article in English | MEDLINE | ID: covidwho-636523

ABSTRACT

This article aims to describe the early experience of a large major trauma operating theatres department in the East of England during the outbreak of the coronavirus disease 2019 (COVID-19) pandemic. To date and to our knowledge, a small amount of reports describing a surgical department's response to this unprecedented pandemic have been published, but a well-documented account from within the United Kingdom (UK) has not yet been reported in the literature. We describe our preparation and response, including: operating theatres management during the COVID-19 pandemic, operational aspects and communication, leadership and support. The process review of measures presented covers approximately the two-month period between March and May 2020 and emphasises the fluidity of procedures needed. We discuss how significant challenges were overcome to secure implementation and reliable oversight. The visible presence of clinical leads well sighted on every aspect of the response guaranteed standardisation of procedures, while sustaining a vital feedback loop. Finally, we conclude that an effective response requires rapid analysis of the complex problem that is of providing care for patients intraoperatively during the COVID-19 pandemic, and that retrospective sense-making is essential to maintain adaptability.


Subject(s)
Civil Defense/organization & administration , Coronavirus Infections/epidemiology , Infection Control/organization & administration , Operating Rooms/organization & administration , Pneumonia, Viral/epidemiology , Trauma Centers/organization & administration , Betacoronavirus/isolation & purification , Coronavirus Infections/prevention & control , Disease Outbreaks/prevention & control , Female , Humans , Male , Pandemics/prevention & control , Patient Care Team/organization & administration , Pneumonia, Viral/prevention & control , Safety Management , United Kingdom/epidemiology
10.
Mayo Clin Proc ; 95(7): 1467-1481, 2020 07.
Article in English | MEDLINE | ID: covidwho-634722

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which presents an unprecedented challenge to medical providers worldwide. Although most SARS-CoV-2-infected individuals manifest with a self-limited mild disease that resolves with supportive care in the outpatient setting, patients with moderate to severe COVID-19 will require a multidisciplinary collaborative management approach for optimal care in the hospital setting. Laboratory and radiologic studies provide critical information on disease severity, management options, and overall prognosis. Medical management is mostly supportive with antipyretics, hydration, oxygen supplementation, and other measures as dictated by clinical need. Among its medical complications is a characteristic proinflammatory cytokine storm often associated with end-organ dysfunction, including respiratory failure, liver and renal insufficiency, cardiac injury, and coagulopathy. Specific recommendations for the management of these medical complications are discussed. Despite the issuance of emergency use authorization for remdesivir, there are still no proven effective antiviral and immunomodulatory therapies, and their use in COVID-19 management should be guided by clinical trial protocols or treatment registries. The medical care of patients with COVID-19 extends beyond their hospitalization. Postdischarge follow-up and monitoring should be performed, preferably using telemedicine, until the patients have fully recovered from their illness and are released from home quarantine protocols.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/therapy , Hospitalization , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Coronavirus Infections/diagnosis , Humans , Pandemics , Patient Care Team , Pneumonia, Viral/diagnosis
11.
Encephale ; 46(3S): S3-S13, 2020 Jun.
Article in French | MEDLINE | ID: covidwho-634328

ABSTRACT

OBJECTIVE: The lack of ressources and coordination to face the epidemic of coronavirus raises concerns for the health of patients with mental disorders in a country where we keep in memory the dramatic experience of famine in psychiatric hospitals during the Second World War. This article aims at proposing guidance to ensure mental health care during the SARS-CoV epidemy in France. METHODS: Authors performed a narrative review identifying relevant results in the scientific and medical literature and local initiatives in France. RESULTS: We identified four types of major vulnerabilities in patients suffering from mental disorders during this pandemic: (1) medical comorbidities that are more frequently found in patients suffering from mental disorders (cardiovascular and pulmonary pathologies, diabetes, obesity, etc.) which represent risk factors for severe infections with Covid-19; (2) age (the elderly constituting the population most vulnerable to coronavirus); (3) cognitive and behavioral troubles which can hamper compliance with confinement and hygiene measures and finally and (4) psychosocial vulnerability due to stigmatization and/or socio-economic difficulties. Furthermore, the mental health healthcare system is more vulnerable than other healthcare systems. Current government plans are poorly adapted to psychiatric establishments in a context of major shortage of organizational, material and human resources. In addition, a certain number of structural aspects make the psychiatric institution particularly vulnerable: many beds are closed, wards have a high density of patients, mental health community facilities are closed, medical teams are understaffed and poorly trained to face infectious diseases. We could also face major issues in referring patients with acute mental disorders to intensive care units. To maintain continuity of psychiatric care in this pandemic situation, several directions can be considered, in particular with the creation of Covid+ units. These units are under the dual supervision of a psychiatrist and of an internist/infectious disease specialist; all new entrants should be placed in quarantine for 14 days; the nurse staff should benefit from specific training, from daily medical check-ups and from close psychological support. Family visits would be prohibited and replaced by videoconference. At the end of hospitalization, in particular for the population of patients in compulsory ambulatory care situations, specific case-management should be organized with the possibility of home visits, in order to support them when they get back home and to help them to cope with the experience of confinement, which is at risk to induce recurrences of mental disorders. The total or partial closure of mental health community facilities is particularly disturbing for patients but a regular follow-up is possible with telemedicine and should include the monitoring of the suicide risk and psychoeducation strategies; developing support platforms could also be very helpful in this context. Private psychiatrists have also a crucial role of information with their patients on confinement and barrier measures, but also on measures to prevent the psychological risks inherent to confinement: maintenance of sleep regularity, physical exercise, social interactions, stress management and coping strategies, prevention of addictions, etc. They should also be trained to prevent, detect and treat early warning symptoms of post-traumatic stress disorder, because their prevalence was high in the regions of China most affected by the pandemic. DISCUSSION: French mental healthcare is now in a great and urgent need for reorganization and must also prepare in the coming days and weeks to face an epidemic of emotional disorders due to the containment of the general population.


Subject(s)
Betacoronavirus , Continuity of Patient Care/organization & administration , Coronavirus Infections/epidemiology , Mental Disorders/therapy , Mental Health Services/organization & administration , Pandemics , Pneumonia, Viral/epidemiology , Aftercare , Age Factors , Aged, 80 and over , Antiviral Agents/pharmacokinetics , Antiviral Agents/therapeutic use , Child , Cognition Disorders/epidemiology , Cognition Disorders/therapy , Comorbidity , Coronavirus Infections/psychology , Drug Interactions , France/epidemiology , Hospital Units/organization & administration , Hospitals, Psychiatric/organization & administration , Humans , Infection Control/methods , Mental Disorders/epidemiology , Mental Disorders/etiology , Mental Health Services/supply & distribution , Patient Care Team , Patient Compliance , Pneumonia, Viral/psychology , Prisoners/psychology , Stress Disorders, Post-Traumatic/etiology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/etiology , Stress, Psychological/therapy , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Suicide/prevention & control , Vulnerable Populations
12.
J Am Med Inform Assoc ; 27(6): 853-859, 2020 06 01.
Article in English | MEDLINE | ID: covidwho-631869

ABSTRACT

OBJECTIVE: To describe the implementation of technological support important for optimizing clinical management of the COVID-19 pandemic. MATERIALS AND METHODS: Our health system has confirmed prior and current cases of COVID-19. An Incident Command Center was established early in the crisis and helped identify electronic health record (EHR)-based tools to support clinical care. RESULTS: We outline the design and implementation of EHR-based rapid screening processes, laboratory testing, clinical decision support, reporting tools, and patient-facing technology related to COVID-19. DISCUSSION: The EHR is a useful tool to enable rapid deployment of standardized processes. UC San Diego Health built multiple COVID-19-specific tools to support outbreak management, including scripted triaging, electronic check-in, standard ordering and documentation, secure messaging, real-time data analytics, and telemedicine capabilities. Challenges included the need to frequently adjust build to meet rapidly evolving requirements, communication, and adoption, and to coordinate the needs of multiple stakeholders while maintaining high-quality, prepandemic medical care. CONCLUSION: The EHR is an essential tool in supporting the clinical needs of a health system managing the COVID-19 pandemic.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Electronic Health Records , Medical Records Systems, Computerized , Pandemics/prevention & control , Pneumonia, Viral/epidemiology , Telemedicine , User-Computer Interface , Academic Medical Centers/organization & administration , California/epidemiology , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Databases, Factual , Decision Support Systems, Clinical , Humans , Medical Informatics , Patient Care Team/organization & administration , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy
13.
Eur Arch Otorhinolaryngol ; 277(7): 2133-2135, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-628611

ABSTRACT

PURPOSE: The role of tracheostomy in COVID-19-related ARDS is unknown. Nowadays, there is no clear indication regarding the timing of tracheostomy in these patients. METHODS: We describe our synergic experience between ENT and ICU Departments at University Hospital of Modena underlining some controversial aspects that would be worth discussing tracheostomies in these patients. During the last 2 weeks, we performed 28 tracheostomies on patients with ARDS due to COVID-19 infection who were treated with IMV. RESULTS: No differences between percutaneous and surgical tracheostomy in terms of timing and no case of team virus infection. CONCLUSION: In our experience, tracheostomy should be performed only in selected patients within 7- and 14-day orotracheal intubation.


Subject(s)
Coronavirus Infections/diagnosis , Intubation, Intratracheal , Minimally Invasive Surgical Procedures/methods , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome, Adult/therapy , Tracheostomy/methods , Adult , Betacoronavirus , Coronavirus Infections/epidemiology , Humans , Intensive Care Units , Male , Middle Aged , Pandemics/prevention & control , Patient Care Team , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/etiology , Treatment Outcome
16.
Recenti Prog Med ; 111(6): 357-367, 2020 06.
Article in Italian | MEDLINE | ID: covidwho-612961

ABSTRACT

The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD-19 care settings, due to the obligation to maintain complete social isolation. Healthcare workers are isolated from their families, and must manage the consequences of this isolation just like the patients. They and their families perceive the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the healthcare workers during isolation is especially important when a patient dies, and it may influence the process of grief. This document is intended for all healthcare professionals caring for CoViD-19 patients, particularly those in more severe clinical conditions and it is aimed to help the care team to communicate with families distanced from the patient. The document consists of three parts: 1) presentation of the statements for communicating with patients family members during isolation; 2) discussion of key points as a theoretical framework for the statements; 3) instructions for telephone communication, with a checklist and a worksheet. The document was written by authors from different disciplines (doctors, nurses, psychologists, legal experts) and was then reviewed by a group of experts comprising professionals, people who have experienced ICU hospitalization, and their families. Finally, the document was approved by the National Boards of the Italian Society of Anesthesia and Intensive Care (SIAARTI), Italian Association of Critical Care Nurses (Aniarti), Italian Society of Emergency Medicine (SIMEU), and Italian Society of Palliative Care (SICP).


Subject(s)
Betacoronavirus , Communication , Coronavirus Infections , Pandemics , Patient Isolation , Pneumonia, Viral , Professional-Patient Relations , Social Isolation , Attitude of Health Personnel , Checklist , Communication Barriers , Confidentiality , Electronic Mail , Family Relations , Health Personnel/psychology , Humans , Interdisciplinary Communication , Patient Care Team , Patient Preference , Professional-Family Relations , Social Isolation/psychology , Social Support , Telephone , Truth Disclosure
17.
Recenti Prog Med ; 111(6): 357-367, 2020 06.
Article in Italian | MEDLINE | ID: covidwho-612960

ABSTRACT

The global emergency caused by the SARS-CoV-2 pandemic has suddenly changed how we communicate with families in all the CoViD-19 care settings, due to the obligation to maintain complete social isolation. Healthcare workers are isolated from their families, and must manage the consequences of this isolation just like the patients. They and their families perceive the personal attitudes, closeness and psychological support from the care teams. This perception of genuine participation by the healthcare workers during isolation is especially important when a patient dies, and it may influence the process of grief. This document is intended for all healthcare professionals caring for CoViD-19 patients, particularly those in more severe clinical conditions and it is aimed to help the care team to communicate with families distanced from the patient. The document consists of three parts: 1) presentation of the statements for communicating with patients family members during isolation; 2) discussion of key points as a theoretical framework for the statements; 3) instructions for telephone communication, with a checklist and a worksheet. The document was written by authors from different disciplines (doctors, nurses, psychologists, legal experts) and was then reviewed by a group of experts comprising professionals, people who have experienced ICU hospitalization, and their families. Finally, the document was approved by the National Boards of the Italian Society of Anesthesia and Intensive Care (SIAARTI), Italian Association of Critical Care Nurses (Aniarti), Italian Society of Emergency Medicine (SIMEU), and Italian Society of Palliative Care (SICP).


Subject(s)
Betacoronavirus , Communication , Coronavirus Infections , Pandemics , Patient Isolation , Pneumonia, Viral , Professional-Patient Relations , Social Isolation , Attitude of Health Personnel , Checklist , Communication Barriers , Confidentiality , Electronic Mail , Family Relations , Health Personnel/psychology , Humans , Interdisciplinary Communication , Patient Care Team , Patient Preference , Professional-Family Relations , Social Isolation/psychology , Social Support , Telephone , Truth Disclosure
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