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3.
PLoS One ; 17(2): e0245182, 2022.
Article in English | MEDLINE | ID: covidwho-1674002

ABSTRACT

BACKGROUND: Working under pandemic conditions exposes health care workers (HCWs) to infection risk and psychological strain. A better understanding of HCWs' experiences of following local infection prevention and control (IPC) procedures during COVID-19 is urgently needed to inform strategies for protecting the psychical and psychological health of HCWs. The objective of this study was therefore to capture the perceptions of hospital HCWs on local IPC procedures and the impact on their emotional wellbeing during the first wave of the COVID-19 pandemic in Europe. METHODS: Participants were recruited in two sampling rounds of an international cross-sectional survey. Sampling took place between 31 March and 17 April 2020 via existing research networks and between 14 May and 31 August 2020 via online convenience sampling. Main outcome measures were behavioural determinants of HCWs' adherence to IPC guidelines and the WHO-5 Well-Being Index, a validated scale of 0-100 reflecting emotional wellbeing. The WHO-5 was interpreted as a score below or above 50 points, a cut-off score used in previous literature to screen for depression. RESULTS: 2289 HCWs from 40 countries in Europe participated. Mean age was 42 (±11) years, 66% were female, 47% and 39% were medical doctors and nurses, respectively. 74% (n = 1699) of HCWs were directly treating patients with COVID-19, of which 32% (n = 527) reported they were fearful of caring for these patients. HCWs reported high levels of concern about COVID-19 infection risk to themselves (71%) and their family (82%) as a result of their job. 40% of HCWs considered that getting infected with COVID-19 was not within their control. This feeling was more common among junior than senior HCWs (46% versus 38%, P value < .01). Sufficient COVID-19-specific IPC training, confidence in PPE use and institutional trust were positively associated with the feeling that becoming infected with COVID-19 was within their control. Female HCWs were more likely than males to report a WHO-5 score below 50 points (aOR 1.5 (95% confidence interval (CI) 1.2-1.8). CONCLUSIONS: In Europe, the COVID-19 pandemic has had a differential impact on those providing direct COVID-19 patient care, junior staff and women. Health facilities must be aware of these differential impacts, build trust and provide tailored support for this vital workforce during the current COVID-19 pandemic.


Subject(s)
COVID-19/prevention & control , Guidelines as Topic/standards , Health Personnel/psychology , Hospitals/standards , Infection Control/statistics & numerical data , Personal Protective Equipment/statistics & numerical data , SARS-CoV-2/isolation & purification , Adult , COVID-19/epidemiology , COVID-19/psychology , COVID-19/virology , Cross-Sectional Studies , Europe/epidemiology , Female , Humans , Male , Patient Care/methods , Patient Care/standards
5.
BMJ Health Care Inform ; 28(1)2021 Jul.
Article in English | MEDLINE | ID: covidwho-1503762

ABSTRACT

OBJECTIVES: Digital systems have long been used to improve the quality and safety of care when managing acute kidney injury (AKI). The availability of digitised clinical data can also turn organisations and their networks into learning healthcare systems (LHSs) if used across all levels of health and care. This review explores the impact of digital systems i.e. on patients with AKI care, to gauge progress towards establishing LHSs and to identify existing gaps in the research. METHODS: Embase, PubMed, MEDLINE, Cochrane, Scopus and Web of Science databases were searched. Studies of real-time or near real-time digital AKI management systems which reported process and outcome measures were included. RESULTS: Thematic analysis of 43 studies showed that most interventions used real-time serum creatinine levels to trigger responses to enable risk prediction, early recognition of AKI or harm prevention by individual clinicians (micro level) or specialist teams (meso level). Interventions at system (macro level) were rare. There was limited evidence of change in outcomes. DISCUSSION: While the benefits of real-time digital clinical data at micro level for AKI management have been evident for some time, their application at meso and macro levels is emergent therefore limiting progress towards establishing LHSs. Lack of progress is due to digital maturity, system design, human factors and policy levers. CONCLUSION: Future approaches need to harness the potential of interoperability, data analytical advances and include multiple stakeholder perspectives to develop effective digital LHSs in order to gain benefits across the system.


Subject(s)
Acute Kidney Injury , Learning Health System , Patient Care , Acute Kidney Injury/diagnosis , Acute Kidney Injury/therapy , Humans , Outcome Assessment, Health Care , Patient Care/instrumentation , Patient Care/methods
6.
Med Oncol ; 38(11): 137, 2021 Sep 28.
Article in English | MEDLINE | ID: covidwho-1439757

ABSTRACT

The covid-19 pandemic has impacted the management of non-covid-19 illnesses. Epithelial ovarian cancer (EOC) requires long-duration multidisciplinary treatment. Teleconsultation and shared care are suggested solutions to mitigate the consequences of the pandemic. However, these may be challenging to implement among patients who come from the lower economic strata. We report the disastrous impact of the pandemic on the care of EOC by comparing patients who were treated during the pandemic with those treated in the previous year. We collected the following data from newly diagnosed patients with EOC: time from diagnosis to treatment, time for completion of planned chemotherapy, and proportion of patients completing various components of therapy (surgery and chemotherapy). Patients treated between January 2019 and September 2019 (Group 1: Pre-covid) were compared with those treated between January 2020 and December 2020 (Group 2: During covid pandemic). A total of 82 patients were registered [Group 1: 43(51%) Group 2: 39(49)]. The median time from diagnosis to start of treatment was longer in group 2 when compared to group 1 [31(23-58) days versus 17(11-30) days (p = 0.03)]. The proportion of patients who had surgery in group 2 was lower in comparison to group 1 [33(77%) versus 21(54%) (p = 0.02)]. Proportion of patients who underwent neoadjuvant (NACT) and surgery were fewer in group 2 in comparison to group 1 [9(33%) versus 18(64%) p = 0.002]. Among patients planned for adjuvant chemotherapy, the median time from diagnosis to treatment was longer in group 2 [28(17-45) days, group 1 versus 49(26-78) days, group 2 (p = 0.04)]. The treatment of patients with EOC was adversely impacted due to the COVID-19 pandemic. There was a compromise in the proportion of patients completing planned therapy. Even among those who completed the treatment, there were considerable delays when compared with the pre-covid period. The impact of these compromises on the outcomes will be known with longer follow-up.


Subject(s)
COVID-19/prevention & control , Carcinoma, Ovarian Epithelial/therapy , Neoadjuvant Therapy/methods , Ovarian Neoplasms/therapy , Patient Care/methods , Time-to-Treatment , Aged , COVID-19/epidemiology , Carcinoma, Ovarian Epithelial/diagnosis , Carcinoma, Ovarian Epithelial/epidemiology , Female , Humans , Middle Aged , Neoadjuvant Therapy/trends , Ovarian Neoplasms/diagnosis , Ovarian Neoplasms/epidemiology , Pandemics , Patient Care/trends , Retrospective Studies , Time-to-Treatment/trends
9.
PLoS Biol ; 19(8): e3001373, 2021 08.
Article in English | MEDLINE | ID: covidwho-1346324

ABSTRACT

Challenges in using cytokine data are limiting Coronavirus Disease 2019 (COVID-19) patient management and comparison among different disease contexts. We suggest mitigation strategies to improve the accuracy of cytokine data, as we learn from experience gained during the COVID-19 pandemic.


Subject(s)
COVID-19/immunology , COVID-19/therapy , COVID-19/epidemiology , Cytokines/immunology , Humans , Pandemics , Patient Care/methods , SARS-CoV-2/immunology
10.
Nurse Educ ; 46(4): E50-E54, 2021.
Article in English | MEDLINE | ID: covidwho-1331618

ABSTRACT

BACKGROUND: Health care professionals need to recognize trauma exposure and provide trauma-informed care. There is a concomitant need to develop resilience when working in this context. PROBLEM: We recognized the need to educate future health care professionals to provide trauma-informed care, develop resilience skills, and collaborate with other disciplines to provide this care. APPROACH: We used a systematic instructional design process and an interprofessional approach to design and deliver the course. We utilized a range of resources and approached the course from micro, meso, and macro perspectives. OUTCOMES: Through purposeful design, we developed a course that was well-aligned with our objectives. Assessments provided documentation that students achieved the learning outcomes. CONCLUSIONS: The course educated future health care professionals on trauma-informed care. Students gained valuable experience that will help them contribute to interprofessional teams in the future. Students also practiced resilience techniques essential for health care professionals.


Subject(s)
Health Personnel , Interprofessional Relations , Patient Care , Teaching , Wounds and Injuries , Attitude of Health Personnel , Health Personnel/education , Humans , Patient Care/methods , Patient Care/psychology , Patient Care Team , Wounds and Injuries/psychology
16.
Am J Med ; 134(8): 945-951, 2021 08.
Article in English | MEDLINE | ID: covidwho-1179206

ABSTRACT

Before the coronavirus disease 2019 (COVID-19) pandemic, use of telehealth services had been limited in cardiovascular care. Potential benefits of telehealth include improved access to care, more efficient care management, reduced costs, the ability to assess patients within their homes while involving key caretakers in medical decisions, maintaining social distance, and increased patient satisfaction. Challenges include changes in payment models, issues with data security and privacy, potential depersonalization of the patient-clinician relationship, limitations in the use of digital health technologies, and the potential impact on disparities, including socioeconomic, gender, and age-related issues and access to technology and broadband. Implementation and expansion of telehealth from a policy and reimbursement practice standpoint are filled with difficult decisions, yet addressing these are critical to the future of health care.


Subject(s)
COVID-19 , Cardiovascular Diseases , Patient Care , Telemedicine , COVID-19/epidemiology , COVID-19/prevention & control , Cardiology/methods , Cardiology/trends , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/therapy , Humans , Infection Control , Organizational Innovation , Patient Care/economics , Patient Care/methods , Patient Care/trends , SARS-CoV-2 , Telemedicine/methods , Telemedicine/organization & administration
17.
Front Cell Infect Microbiol ; 11: 639579, 2021.
Article in English | MEDLINE | ID: covidwho-1167305

ABSTRACT

A multidisciplinary group, mainly from Bergamo region - the epicenter of the COVID-19 pandemic crisis in Italy on march 2020- has developed concept of creating intermediate care facilities and proposes a three-tier model of community-based care, with the goal of reducing hospital admissions, contagion and mortality related to hospital overloading and optimizing human resources.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Pandemics , COVID-19/prevention & control , Home Care Services , Humans , Italy/epidemiology , Patient Care/classification , Patient Care/methods , SARS-CoV-2 , Severity of Illness Index
18.
PLoS One ; 16(3): e0248286, 2021.
Article in English | MEDLINE | ID: covidwho-1167080

ABSTRACT

BACKGROUND: Today, physicians are at the front lines of a pandemic response. Military physicians are uniquely trained to excel in such large-scale emergency situations. Civilian physicians can harness military know-how, but it will require research into military healthcare responses-specifically, we need to learn lessons from military interprofessional healthcare teams (MIHTs). METHODS: This research answers two questions: What are the characteristics of successful MIHTs? Why are those characteristics important to MIHT success in large-scale emergency situations? Using a Grounded Theory approach, 30 interviews were conducted soliciting perspectives from the broadest range of healthcare professionals who had experiences working in and leading MIHTs. Purposive sampling was used to recruit participants broadly across: contexts where MIHTs work; military branches; ranks; genders; and healthcare professions. Data were iteratively collected and analyzed. RESULTS: 30 participants were interviewed (18 male (60%); 21 officers (70%); 9 enlisted (30%)) who held various healthcare occupations (medic/tech/corpsman (9); nurse (7); physician (7); dentist (2); occupational therapist (2); chaplain (1); physician's assistant (1); and psychiatrist (1)). Six characteristics of successful MIHTs that are directly applicable to large-scale emergency situations were identified thatthat clustered into two themes: own your purposes and responsibilities (through mission focus and ethical bearing) and get it done, safely (via situational awareness, adaptability, and leadership with followership). CONCLUSIONS: This study provides insights, informed by decades of military service and training, to help civilian physicians succeed in large-scale emergency situations. These experiences from the war front can support today's pandemic responses on the home front.


Subject(s)
Delivery of Health Care/methods , Emergency Responders/psychology , Health Personnel/psychology , Military Health Services , Military Personnel/psychology , Patient Care Team , Patient Care/methods , Adaptation, Psychological , Awareness , Female , Goals , Humans , Leadership , Male , Social Responsibility
19.
J Microbiol Immunol Infect ; 54(3): 349-358, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1157513

ABSTRACT

The radiology department was categorized as a "high risk area" during the severe acute respiratory syndrome (SARS) outbreak in 2003 and is similarly considered a "high risk area" during the current coronavirus (COVID-19) pandemic. The purpose of infection control is to isolate patients with suspected or confirmed COVID-19 from uninfected people by utilizing separate equipment, spaces, and healthcare workers. Infection control measures should be prioritized to prevent the nosocomial spread of infection. We established a COVID-19 infection control team in our radiology department. The team's responsibilities include triaging patients with confirmed or suspected COVID-19, performing imaging and reporting, using dedicated equipment, disinfecting the equipment and the immediate environment, and staff scheduling.


Subject(s)
COVID-19/prevention & control , Cross Infection/prevention & control , Infection Control/methods , Practice Guidelines as Topic , Radiology Department, Hospital/organization & administration , Health Personnel , Humans , Patient Care/methods , Patient Care Planning , Patient Safety , Personal Protective Equipment/standards , Personnel Staffing and Scheduling/organization & administration , Program Evaluation
20.
Radiol Imaging Cancer ; 2(6): e200058, 2020 11.
Article in English | MEDLINE | ID: covidwho-1155957

ABSTRACT

Patients with cancer have been negatively impacted during the coronavirus disease 2019 (COVID-19) pandemic, as many of these individuals may be immunosuppressed and of older age. Additionally, cancer follow-up or imaging appointments have been delayed in many clinics around the world. Postponement of routine screening exams will result in delays in new cancer diagnoses. Clinics are continuing to monitor and adapt their appointment schedules based on local outbreaks of COVID-19. Studies on COVID-19 in patients with cancer are limited, but consistently indicate that this population is at risk for more severe COVID-19 illness. Data from recent studies also suggest that pediatric patients with cancer have a lower risk of severe COVID-19 illness compared to adults. Certain features of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection detected by lung, brain, and gastrointestinal imaging may confound radiologists' interpretation of cancer diagnosis, staging, and treatment response. Lastly, as clinics begin to re-open for routine appointments, protocols have been put in place to reduce SARS-CoV-2 exposure to patients during their visits. This review details different perspectives on the impact of the COVID-19 pandemic on patients with cancer and on cancer imaging. Keywords: Abdomen/GI, Cardiac, Infection, Nervous-Peripheral.


Subject(s)
COVID-19/complications , Diagnostic Imaging/methods , Neoplasms/complications , Neoplasms/diagnostic imaging , Patient Care/methods , Humans , Pandemics , SARS-CoV-2
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