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3.
Reumatol Clin (Engl Ed) ; 17(9): 491-493, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1510266

ABSTRACT

SARS-COV-2 infection has spread worldwide since it originated in December 2019, in Wuhan, China. The pandemic has largely demonstrated the resilience of the world's health systems and is the greatest health emergency since World War II. There is no single therapeutic approach to the treatment of COVID-19 and the associated immune disorder. The lack of randomised clinical trials (RCTs) has led different countries to tackle the disease based on case series, or from results of observational studies with off-label drugs. We as rheumatologists in general, and specifically rheumatology fellows, have been on the front line of the pandemic, modifying our activities and altering our training itinerary. We have attended patients, we have learned about the management of the disease and from our previous experience with drugs for arthritis and giant cell arteritis, we have used these drugs to treat COVID-19.


Subject(s)
Antiviral Agents/therapeutic use , Biological Factors/therapeutic use , COVID-19/drug therapy , Immunosuppressive Agents/therapeutic use , Physician's Role , Rheumatologists , Autoimmune Diseases/complications , Autoimmune Diseases/drug therapy , Autoimmune Diseases/immunology , COVID-19/complications , COVID-19/epidemiology , COVID-19/immunology , Drug Therapy, Combination , Education, Medical, Graduate , Fellowships and Scholarships , Global Health , Humans , Immunocompromised Host , Opportunistic Infections/complications , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Patient Care Team/organization & administration , Practice Patterns, Physicians' , Rheumatic Diseases/complications , Rheumatic Diseases/drug therapy , Rheumatic Diseases/immunology , Rheumatologists/education , Rheumatologists/organization & administration , Rheumatology/education , Rheumatology/methods , Rheumatology/organization & administration , Spain/epidemiology
4.
Nutr Hosp ; 38(Spec No1): 41-45, 2021 Apr 12.
Article in English | MEDLINE | ID: covidwho-1503007

ABSTRACT

Introduction: The debate from the course preceding the SENPE (Spanish Society of Clinical Nutrition and Metabolism) 2020 Conference gathered together well-known professionals who form part of nutritional support teams (NSTs), as well as other specialists from departments whose patients benefit from the services offered by these NSTs. In this article, relevant points from the round table, including strengths and weaknesses detected in the implementation of nutrition support teams, are summarized.


El debate del curso previo al congreso de la Sociedad Española de Nutrición Clínica y Metabolismo (SENPE) 2020 reunió en una mesa redonda a profesionales de prestigio que forman parte de unidades de nutrición y dietética, y a otros especialistas de servicios cuyos pacientes se benefician de los servicios de estas unidades. En este artículo se muestran los puntos relevantes que se trataron en el mismo y se muestran algunas fortalezas y debilidades que se han detectado en la implementación de las unidades de nutrición.


Subject(s)
Food Service, Hospital , Health Personnel/organization & administration , Nutritional Support , Patient Care Team/organization & administration , COVID-19/epidemiology , Humans , Pandemics
5.
Pan Afr Med J ; 39: 173, 2021.
Article in English | MEDLINE | ID: covidwho-1468745

ABSTRACT

The coronavirus disease-19 (COVID-19), first appearing in Wuhan, China, and later declared as a pandemic, has caused serious morbidity and mortality worldwide. Severe cases usually present with acute respiratory distress syndrome (ARDS), pneumonia, acute kidney injury (AKI), liver damage, or septic shock. However, with recent advances in severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) research, the virus´s effect on cardiac tissues has become evident. Reportedly, an increased number of COVID-19 patients manifested serious cardiac complications such as heart failure, increased troponin, and N-terminal pro-B-type natriuretic peptide levels (NT-proBNP), cardiomyopathies, and myocarditis. These cardiac complications initially present as chest tightness, chest pain, and heart palpitations. Diagnostic investigations such as telemetry, electrocardiogram (ECG), cardiac biomarkers (troponin, NT-proBNP), and inflammatory markers (D-dimer, fibrinogen, PT, PTT), must be performed according to the patient´s condition. The best available options for treatment are the provision of supportive care, anti-viral therapy, hemodynamic monitoring, IL-6 blockers, statins, thrombolytic, and anti-hypertensive drugs. Cardiovascular disease (CVD) healthcare workers should be well-informed about the evolving research regarding COVID-19 and approach as a multi-disciplinary team to devise effective strategies for challenging situations to reduce cardiac complications.


Subject(s)
COVID-19/complications , Heart Diseases/virology , SARS-CoV-2/isolation & purification , Biomarkers/metabolism , COVID-19/diagnosis , COVID-19 Testing , Heart Diseases/diagnosis , Heart Diseases/physiopathology , Humans , Patient Care Team/organization & administration
6.
BMC Health Serv Res ; 20(1): 101, 2020 Feb 10.
Article in English | MEDLINE | ID: covidwho-1455959

ABSTRACT

BACKGROUND: Having psychologically safe teams can improve learning, creativity and performance within organisations. Within a healthcare context, psychological safety supports patient safety by enabling engagement in quality improvement and encouraging staff to speak up about errors. Despite the low levels of psychological safety in healthcare teams and the important role it plays in supporting patient safety, there is a dearth of research on interventions that can be used to improve psychological safety or its related constructs. This review synthesises the content, theoretical underpinnings and outcomes of interventions which have targeted psychological safety, speaking up, and voice behaviour within a healthcare setting. It aims to identify successful interventions and inform the development of more effective interventions. METHODS: A key word search strategy was developed and used to search electronic databases (PsycINFO, ABI/Inform, Academic search complete and PubMed) and grey literature databases (OpenGrey, OCLC WorldCat, Espace). Covidence, an online specialised systematic review website, was used to screen records. Data extraction, quality appraisal and narrative synthesis were conducted on identified papers. RESULTS: Fourteen interventions were reviewed. These interventions fell into five categories. Educational interventions used simulation, video presentations, case studies and workshops while interventions which did not include an educational component used holistic facilitation, forum play and action research meetings. Mixed results were found for the efficacy or effectiveness of these interventions. While some interventions showed improvement in outcomes related to psychological safety, speaking up and voice, this was not consistently demonstrated across interventions. Included interventions' ability to demonstrate improvements in these outcomes were limited by a lack of objective outcome measures and the ability of educational interventions alone to change deeply rooted speaking up behaviours. CONCLUSION: To improve our understanding of the efficacy or effectiveness of interventions targeting psychological safety, speaking up and voice behaviour, longitudinal and multifaceted interventions are needed. In order to understand whether these interventions are successful, more objective measures should be developed. It is recommended that future research involves end users in the design phase of interventions, target both group and organisational levels, ensure visible leader support and work across and within interdisciplinary teams. PROSPERO REGISTRATION NUMBER: CRD42018100659.


Subject(s)
Health Personnel/psychology , Interprofessional Relations , Patient Care Team/organization & administration , Safety , Humans , Patient Safety
8.
Plast Reconstr Surg ; 148(4): 899-906, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1398200

ABSTRACT

SUMMARY: In the wake of the death toll resulting from coronavirus disease of 2019 (COVID-19), in addition to the economic turmoil and strain on our health care systems, plastic surgeons are taking a hard look at their role in crisis preparedness and how they can contribute to crisis response policies in their own health care teams. Leaders in the specialty are charged with developing new clinical policies, identifying weaknesses in crisis preparation, and ensuring survival of private practices that face untenable financial challenges. It is critical that plastic surgery builds on the lessons learned over the past tumultuous year to emerge stronger and more prepared for subsequent waves of COVID-19. In addition, this global health crisis presents a timely opportunity to reexamine how plastic surgeons can display effective leadership during times of uncertainty and stress. Some may choose to emulate the traits and policies of leaders who are navigating the COVID-19 crisis effectively. Specifically, the national leaders who offer empathy, transparent communication, and decisive action have maintained high public approval throughout the COVID-19 crisis, while aggressively controlling viral spread. Crises are an inevitable aspect of modern society and medicine. Plastic surgeons can learn from this pandemic to better prepare for future turmoil.


Subject(s)
COVID-19/prevention & control , Leadership , Professional Role , Surgery, Plastic/organization & administration , COVID-19/economics , COVID-19/epidemiology , COVID-19/transmission , Communicable Disease Control/standards , Global Health , Humans , Pandemics/economics , Pandemics/prevention & control , Patient Care Team/economics , Patient Care Team/organization & administration , SARS-CoV-2/pathogenicity , Surgeons/organization & administration , Surgery, Plastic/economics , Uncertainty
9.
Nursing ; 51(7): 44-47, 2021 Jul 01.
Article in English | MEDLINE | ID: covidwho-1393335

ABSTRACT

ABSTRACT: Prone positioning is a recommended therapy for patients with COVID-19 who develop acute respiratory distress syndrome. This article describes the creation, operation, and evolution of the pronation therapy team at the author's Veterans Affairs facility.


Subject(s)
COVID-19/complications , Hospitals, Veterans/organization & administration , Patient Care Team/organization & administration , Patient Positioning/methods , Respiratory Distress Syndrome/therapy , COVID-19/epidemiology , Humans , New Jersey/epidemiology , Prone Position , Respiratory Distress Syndrome/virology
12.
BMC Pregnancy Childbirth ; 21(1): 587, 2021 Aug 26.
Article in English | MEDLINE | ID: covidwho-1371956

ABSTRACT

BACKGROUND: The coronavirus disease (COVID-19) pandemic has caused ongoing challenges in health services worldwide. Despite the growing body of literature on COVID-19, reports on perinatal care in COVID-19 cases are limited. CASE PRESENTATION: We describe a case of severe acute respiratory distress syndrome (ARDS) in a 36-year-old G5/P2 pregnant woman with morbid obesity, confirmed severe acute respiratory syndrome coronavirus 2 infection, and fulminant respiratory failure. At 28+ 1 gestational weeks, the patient delivered an uninfected newborn. Using ImmunoCAP ISAC® technology, we found no immunoglobulin (Ig) M antibodies, suggesting that no mother-to-child viral transmission occurred during pregnancy or delivery. The maternal respiratory state improved rapidly after delivery; both maternal and neonatal outcomes were encouraging given the early gestational age and fulminant course of respiratory failure in our patient. CONCLUSIONS: The management of ARDS in pregnant women with COVID-19 is complex and requires an individualized, multidisciplinary approach, while considering maternal and fetal outcomes.


Subject(s)
COVID-19 , Cesarean Section/methods , Pneumonia, Viral , Pregnancy Complications, Infectious , Premature Birth , Respiratory Distress Syndrome , SARS-CoV-2/isolation & purification , Adult , COVID-19/complications , COVID-19/diagnosis , Female , Fetal Monitoring/methods , Gestational Age , Humans , Obesity, Morbid/diagnosis , Obesity, Morbid/physiopathology , Patient Care Team/organization & administration , Perinatal Care/methods , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/etiology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Pregnancy Complications, Infectious/virology , Pregnancy Outcome , Premature Birth/etiology , Premature Birth/therapy , Respiration, Artificial/methods , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/physiopathology , Respiratory Distress Syndrome/therapy , Treatment Outcome
16.
J Immunother Cancer ; 9(7)2021 07.
Article in English | MEDLINE | ID: covidwho-1318086

ABSTRACT

Expanding the US Food and Drug Administration-approved indications for immune checkpoint inhibitors in patients with cancer has resulted in therapeutic success and immune-related adverse events (irAEs). Neurologic irAEs (irAE-Ns) have an incidence of 1%-12% and a high fatality rate relative to other irAEs. Lack of standardized disease definitions and accurate phenotyping leads to syndrome misclassification and impedes development of evidence-based treatments and translational research. The objective of this study was to develop consensus guidance for an approach to irAE-Ns including disease definitions and severity grading. A working group of four neurologists drafted irAE-N consensus guidance and definitions, which were reviewed by the multidisciplinary Neuro irAE Disease Definition Panel including oncologists and irAE experts. A modified Delphi consensus process was used, with two rounds of anonymous ratings by panelists and two meetings to discuss areas of controversy. Panelists rated content for usability, appropriateness and accuracy on 9-point scales in electronic surveys and provided free text comments. Aggregated survey responses were incorporated into revised definitions. Consensus was based on numeric ratings using the RAND/University of California Los Angeles (UCLA) Appropriateness Method with prespecified definitions. 27 panelists from 15 academic medical centers voted on a total of 53 rating scales (6 general guidance, 24 central and 18 peripheral nervous system disease definition components, 3 severity criteria and 2 clinical trial adjudication statements); of these, 77% (41/53) received first round consensus. After revisions, all items received second round consensus. Consensus definitions were achieved for seven core disorders: irMeningitis, irEncephalitis, irDemyelinating disease, irVasculitis, irNeuropathy, irNeuromuscular junction disorders and irMyopathy. For each disorder, six descriptors of diagnostic components are used: disease subtype, diagnostic certainty, severity, autoantibody association, exacerbation of pre-existing disease or de novo presentation, and presence or absence of concurrent irAE(s). These disease definitions standardize irAE-N classification. Diagnostic certainty is not always directly linked to certainty to treat as an irAE-N (ie, one might treat events in the probable or possible category). Given consensus on accuracy and usability from a representative panel group, we anticipate that the definitions will be used broadly across clinical and research settings.


Subject(s)
Drug-Related Side Effects and Adverse Reactions/diagnosis , Immune Checkpoint Inhibitors/adverse effects , Immunotherapy/adverse effects , Nervous System Diseases/diagnosis , Practice Guidelines as Topic , Consensus , Humans , Nervous System Diseases/chemically induced , Nervous System Diseases/immunology , Neurologists/statistics & numerical data , Oncologists/statistics & numerical data , Patient Care Team/organization & administration , Patient Care Team/statistics & numerical data
17.
Am J Health Syst Pharm ; 77(18): 1510-1515, 2020 09 04.
Article in English | MEDLINE | ID: covidwho-1317902

ABSTRACT

PURPOSE: To describe our hospital pharmacy department's preparation for an influx of critically ill patients during the coronavirus disease 2019 (COVID-19) pandemic and offer guidance on clinical pharmacy services preparedness for similar crisis situations. SUMMARY: Personnel within the department of pharmacy at a medical center at the US epicenter of the COVID-19 pandemic proactively prepared a staffing and pharmacotherapeutic action plan in anticipation of an expected surge in admissions of critically ill patients with COVID-19 and expansion of acute care and intensive care unit (ICU) capacity. Guidance documents focusing on supportive care and pharmacotherapeutic treatment options were developed. Repurposing of non-ICU-trained clinical pharmacotherapy specialists to work collaboratively with clinician teams in ICUs was quickly implemented; staff were prepared for these duties through use of shared tools to facilitate education and practice standardization. CONCLUSION: As challenges were encountered at the initial peak of the pandemic, interdisciplinary collaboration and teamwork was crucial to ensure that all patients were proactively assessed and that their respective pharmacotherapeutic regimens were optimized.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , COVID-19/epidemiology , Critical Care/organization & administration , Critical Care/standards , Critical Illness , Disaster Planning/organization & administration , Disaster Planning/standards , Emergencies , Humans , Intensive Care Units/organization & administration , Intensive Care Units/standards , Medication Therapy Management/organization & administration , Pandemics/prevention & control , Patient Care Team/organization & administration , Patient Care Team/standards , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Professional Role , Workforce/organization & administration , Workforce/standards
18.
Pediatr Surg Int ; 37(10): 1409-1414, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1310561

ABSTRACT

BACKGROUND: The disruptive effects on society and medical systems due to the coronavirus disease 2019 (COVID-19) pandemic are substantial and far-reaching. The effect of the pandemic on the quantity and quality of pediatric traumas is unclear and has a direct bearing on how scarce hospital resources should be allocated in a pandemic situation. METHODS: A retrospective review of the trauma registry was performed for trauma activations in the years 2018 through 2020 during the months of March, April, and May. Demographic and injury specific datapoints were compared across calendar years. RESULTS: There were 111, 100, and 52 trauma activations during the study interval in 2018, 2019, and 2020, respectively. There were fewer highest severity level activations in 2020 compared to 2018 and 2019 (1 vs 5 and 9; p < 0.01). The median Injury Severity Score was 5 in 2020 compared to 4 in both 2018 and 2019 (p < 0.01). More patients went directly to the operating room in 2020 compared to prior years (21.2% vs 8% and 6.1%; p < 0.01). There were fewer discharges from the emergency department (ED) (12.1% vs 36.6% and 32.7%). No increase in the number of child abuse reports and investigations was noted. There was no difference in the proportion of blunt versus penetrating trauma between years (p = 0.57). No pedestrians were struck by automobiles in 2020 compared to 12 and 14 in 2018 and 2019. However, there were a greater proportion of injuries from falls during 2020 compared to prior years. CONCLUSIONS: There were fewer trauma activations during the peak of the COVID pandemic compared to prior years. Due to the decrease in trauma volume during the peak of the pandemic, hospital resources could potentially be reallocated toward areas of greater need. LEVEL OF EVIDENCE: IV; Retrospective cohort study using historical controls.


Subject(s)
COVID-19/prevention & control , Pandemics/prevention & control , Patient Care Team/organization & administration , Pediatrics , Trauma Centers/organization & administration , Wounds and Injuries/classification , COVID-19/epidemiology , Child , Humans , New York/epidemiology , Retrospective Studies , SARS-CoV-2 , Trauma Centers/statistics & numerical data , Wounds and Injuries/surgery
19.
Br J Community Nurs ; 26(7): 318-323, 2021 Jul 02.
Article in English | MEDLINE | ID: covidwho-1299697

ABSTRACT

The COVID-19 pandemic has required rapid adaptation of the community nursing service, including the introduction of online communication platforms to prevent COVID-19 transmission among staff. Remote working has protected the workforce in the community from being decimated through team sickness, but has resulted in nurses who are feeling anxious and isolated from their colleagues while experiencing increased workloads, with complex and often emotionally challenging situations. The pressures of community nursing and the associated impact on sickness absence relating to mental health are well documented. The resources made available to support staff wellbeing were increased during the pandemic, but there remains some disparity of access to these resources. There is much that can be done by the district nurse as a leader of a team to ensure that the pressures are managed in a way that promotes team cohesion and mutual respect, while ensuring that open communication about wellbeing is encouraged.


Subject(s)
COVID-19/epidemiology , Communication , Community Health Nursing , Nurse's Role , Patient Care Team/organization & administration , State Medicine , COVID-19/therapy , Humans , United Kingdom , Workload
20.
BMC Fam Pract ; 22(1): 143, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1295441

ABSTRACT

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.


Subject(s)
COVID-19 , Delivery of Health Care, Integrated/organization & administration , Mental Health Services , Patient Care Team/organization & administration , Primary Health Care , Telemedicine , Adult , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/psychology , Female , Focus Groups , Health Services Needs and Demand , Humans , Male , Mental Health/trends , Mental Health Services/standards , Mental Health Services/supply & distribution , Ontario/epidemiology , Practice Patterns, Physicians'/trends , Primary Health Care/methods , Primary Health Care/trends , Quality Improvement/organization & administration , SARS-CoV-2 , Telemedicine/methods , Telemedicine/statistics & numerical data
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