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1.
Can J Anaesth ; 67(10): 1417-1423, 2020 10.
Article in English | MEDLINE | ID: covidwho-1777840

ABSTRACT

Symptom management and end-of-life care are core skills for all physicians, although in ordinary times many anesthesiologists have fewer occasions to use these skills. The current coronavirus disease (COVID-19) pandemic has caused significant mortality over a short time and has necessitated an increase in provision of both critical care and palliative care. For anesthesiologists deployed to units caring for patients with COVID-19, this narrative review provides guidance on conducting goals of care discussions, withdrawing life-sustaining measures, and managing distressing symptoms.


RéSUMé: La prise en charge des symptômes et les soins de fin de vie sont des compétences de base pour tous les médecins, bien qu'en temps ordinaire, de nombreux anesthésiologistes n'ont que peu d'occasions de mettre en pratique ces compétences. La pandémie actuelle de coronavirus 2019 (COVID-19) a provoqué un taux de mortalité significatif dans un court intervalle et a nécessité une augmentation des besoins en soins intensifs et en soins palliatifs. Destiné aux anesthésiologistes déployés dans les unités prenant soin de patients atteints de la COVID-19, ce compte rendu narratif offre des recommandations quant à la façon de mener les discussions à propos des objectifs de soins, du retrait des thérapies de soutien vital, et de la prise en charge de symptômes de détresse.


Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Pneumonia, Viral/therapy , Terminal Care/organization & administration , Anesthesiologists/organization & administration , Anesthesiologists/standards , COVID-19 , Clinical Competence , Coronavirus Infections/mortality , Critical Care/standards , Humans , Palliative Care/organization & administration , Pandemics , Physicians/organization & administration , Physicians/standards , Pneumonia, Viral/mortality , Terminal Care/standards , Withholding Treatment
3.
J Occup Environ Med ; 63(3): 199-220, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1307591

ABSTRACT

OBJECTIVE: Higher probability of developing severe COVID-19 has been associated with health risk factors and medical conditions which are common among workers globally. For at risk workers, return to work may require additional protective policies and procedures. METHODS: A review of the medical literature was conducted on health risk factors and medical conditions associated with increased COVID-19 morbidity and mortality, standardized measures for community COVID transmission, and occupation-specific risk. RESULTS: The relative risk of acquiring and the severity of COVID-19 for workers is associated with three pillars: individual risk, workplace risk, and community risk. Matrices were developed to determine a worker's individual risk based on these three pillars. CONCLUSIONS: A practical decision tool is proposed for physicians evaluating and managing individual worker COVID-19 risk in the context of returning to work.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Physicians/standards , Return to Work , COVID-19/prevention & control , COVID-19/transmission , Communicable Disease Control/methods , Guidelines as Topic , Humans , Occupational Health , Review Literature as Topic , Risk Assessment , Risk Factors , SARS-CoV-2 , Workplace/standards
5.
Muscle Nerve ; 64(3): 270-276, 2021 09.
Article in English | MEDLINE | ID: covidwho-1219308

ABSTRACT

INTRODUCTION/AIMS: Telemedicine may be particularly well-suited for myasthenia gravis (MG) due to the disorder's need for specialized care, its hallmark fluctuating muscle weakness, and the potential for increased risk of virus exposure among patients with MG during the coronavirus disease 2019 (COVID-19) pandemic during in-person clinical visits. A disease-specific telemedicine physical examination to reflect myasthenic weakness does not currently exist. METHODS: This paper outlines step-by-step guidance on the fundamentals of a telemedicine assessment for MG. The Myasthenia Gravis Core Exam (MG-CE) is introduced as a MG-specific, telemedicine, physical examination, which contains eight components (ptosis, diplopia, facial strength, bulbar strength, dysarthria, single breath count, arm strength, and sit to stand) and takes approximately 10 minutes to complete. RESULTS: Pre-visit preparation, remote ascertainment of patient-reported outcome scales and visit documentation are also addressed. DISCUSSION: Additional knowledge gaps in telemedicine specific to MG care are identified for future investigation.


Subject(s)
COVID-19/prevention & control , Myasthenia Gravis/diagnosis , Patient Education as Topic/methods , Physical Examination/methods , Physicians , Telemedicine/methods , Female , Humans , Male , Myasthenia Gravis/therapy , Patient Education as Topic/standards , Physical Examination/standards , Physicians/standards , Telemedicine/standards
8.
11.
Cancer Rep (Hoboken) ; 4(1): e1309, 2021 02.
Article in English | MEDLINE | ID: covidwho-1025074

ABSTRACT

BACKGROUND: The COVID-19 pandemic has created a need to prioritize care because of limitation of resources. Owing to the heterogeneity and high prevalence of breast cancers, the need to prioritize care in this vulnerable population is essential. While various medical societies have published recommendations to manage breast disease during the COVID-19 pandemic, most are focused on the Western world and do not necessarily address the challenges of a resource-limited setting. AIM: In this article, we describe our institutional approach for prioritizing care for patients presenting with breast disease. METHODS AND RESULTS: The breast disease management guidelines were developed and approved with the expertise of the Multidisciplinary Breast Program Leadership Committee (BPLC) of the Aga Khan University, Karachi, Pakistan. These guidelines were inspired, adapted, and modified keeping in view the needs of our resource-limited healthcare system. These recommendations are also congruent with the ethical guidelines developed by the Center of Biomedical Ethics and Culture (CBEC) at the Sindh Institute of Urology and Transplantation (SIUT), Karachi. Our institutional recommendations outline a framework to triage patients based on the urgency of care, scheduling conflicts, and tumor board recommendations, optimizing healthcare workers' schedules, operating room reallocation, and protocols. We also describe the "Virtual Blended Clinics", a resource-friendly means of conducting virtual clinics and a comprehensive plan for transitioning back into the post-COVID routine. CONCLUSION: Our institutional experience may be considered as a guide during the COVID-19 pandemic, particularly for triaging care in a resource-limited setting; however, these are not meant to be universally applicable, and individual cases must be tailored based on physicians' clinical judgment to provide the best quality care.


Subject(s)
Breast Diseases/therapy , COVID-19/complications , Interdisciplinary Communication , Physicians/standards , Practice Guidelines as Topic/standards , SARS-CoV-2/isolation & purification , Triage/statistics & numerical data , Breast Diseases/virology , COVID-19/transmission , COVID-19/virology , Developing Countries , Female , Humans , Tertiary Care Centers
14.
Intern Med J ; 50(12): 1578-1583, 2020 12.
Article in English | MEDLINE | ID: covidwho-991431

ABSTRACT

The COVID-19 pandemic has led to many physicians working from home whenever possible. Although the concept of 'remote' patient care has been around for decades, present circumstances have provided a grand impetus in that direction with a view to protecting both patient and caregiver. In this article, we discuss some of the various challenges to moving forward with telemedicine, drawing in part on our own experiences in dealing with the COVID-19 pandemic. Clinical, technical, financial and cultural barriers to telemedicine are identified, along with a discussion concerning anticipated benefits. We conclude that the COVID-19 pandemic will likely forever change how healthcare is conducted as telemedicine figures increasingly prominently in the clinical landscape.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Physicians/trends , Telemedicine/methods , Telemedicine/trends , Humans , Physicians/standards , Smartphone/standards , Smartphone/trends , Telemedicine/standards , Wearable Electronic Devices/standards , Wearable Electronic Devices/trends
15.
J Occup Environ Med ; 63(3): 199-220, 2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-990903

ABSTRACT

OBJECTIVE: Higher probability of developing severe COVID-19 has been associated with health risk factors and medical conditions which are common among workers globally. For at risk workers, return to work may require additional protective policies and procedures. METHODS: A review of the medical literature was conducted on health risk factors and medical conditions associated with increased COVID-19 morbidity and mortality, standardized measures for community COVID transmission, and occupation-specific risk. RESULTS: The relative risk of acquiring and the severity of COVID-19 for workers is associated with three pillars: individual risk, workplace risk, and community risk. Matrices were developed to determine a worker's individual risk based on these three pillars. CONCLUSIONS: A practical decision tool is proposed for physicians evaluating and managing individual worker COVID-19 risk in the context of returning to work.


Subject(s)
COVID-19/epidemiology , Communicable Disease Control/standards , Physicians/standards , Return to Work , COVID-19/prevention & control , COVID-19/transmission , Communicable Disease Control/methods , Guidelines as Topic , Humans , Occupational Health , Review Literature as Topic , Risk Assessment , Risk Factors , SARS-CoV-2 , Workplace/standards
16.
Postgrad Med J ; 96(1141): 711-717, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-901414

ABSTRACT

Facing an investigation into performance concerns can be one of the most traumatic events in a doctor's career, and badly handled investigations can lead to severe distress. Yet there is no systematic way for National Health Service (NHS) Trusts to record the frequency of investigations, and extremely little data on the long-term outcomes of such action for the doctors. The document-Maintaining High Professional Standards in the Modern NHS (a framework for the initial investigation of concerns about doctors and dentists in the NHS)-should protect doctors from facing unfair or mismanaged performance management procedures, which include conduct, capability and health. Equally, it provides NHS Trusts with a framework that must be adhered to when managing performance concerns regarding doctors. Yet, very few doctors have even heard of it or know about the provisions it contains for their protection, and the implementation of the framework appears to be very variable across NHS Trusts. By empowering all doctors with the knowledge of what performance management procedures exist and how best practice should be implemented, we aim to ensure that they are informed participants in any investigation should it occur.


Subject(s)
Clinical Competence/standards , Physicians , Professional Practice , Professionalism , Work Performance/standards , Humans , Liability, Legal , Medical Errors/legislation & jurisprudence , Medical Errors/prevention & control , Personnel Management/methods , Physicians/psychology , Physicians/standards , Professional Practice/organization & administration , Professional Practice/standards , Professionalism/ethics , Professionalism/legislation & jurisprudence , Professionalism/standards , State Medicine/standards , United Kingdom , Workforce/organization & administration
18.
J Epidemiol Glob Health ; 11(1): 60-68, 2021 03.
Article in English | MEDLINE | ID: covidwho-789171

ABSTRACT

BACKGROUND AND OBJECTIVES: Corona Virus Disease 2019 (COVID-19) pandemic is a global health emergency. Health Care Workers (HCWs) with sound knowledge and practices can help curb the pandemic. This study aimed to assess the knowledge, attitude and practices of HCWs about COVID-19 and compare physicians and non-physicians in Saudi Arabia. METHODS: An online survey was conducted among HCWs in Saudi Arabia in March and April 2020. Data were collected using a structured questionnaire having four sections including; socio-demographic and professional profile, knowledge, attitude and practices regarding COVID-19. Questionnaire link was sent through social media. Descriptive analysis was used for assessment of knowledge, attitude and practice and Chi-square test was used for comparing physicians and non-physicians. Data were analyzed using SPSS version 21.0. RESULTS: A total of 398 HCWs completed the questionnaire. Only 45% of the participants had correct knowledge about the agent while about 97% knew that close contact with infected person is the most important risk factor. Only 63% had correct knowledge about the role of antibiotics in COVID-19 treatment. Majority of the HCWs were worried and most frequently reported worry was risk to family. Carrying infection to home was most commonly reported fear, 92%. Cleaning hands often or always was 11.5% and 87% respectively. About 71% wore mask during work. Knowledge was better among physicians compared to non-physicians while attitude and practices were comparable between the two groups. CONCLUSION: We found that there was poor knowledge about causative agent and role of antibiotics for COVID-19 but for mode of transmission and prevention there was good knowledge. There were widely prevalent worries and fears among the participants. Overall, there were good infection control practices among the HCWs. Interventions are needed to improve knowledge and address worries and fears of HCW.


Subject(s)
COVID-19 , Health Personnel , Infection Control/methods , Physicians , SARS-CoV-2/pathogenicity , Universal Precautions/methods , Adult , COVID-19/drug therapy , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , Cross-Sectional Studies , Demography , Female , Health Knowledge, Attitudes, Practice , Health Personnel/education , Health Personnel/psychology , Humans , Male , Needs Assessment , Physicians/psychology , Physicians/standards , Saudi Arabia/epidemiology , Sociological Factors , Surveys and Questionnaires
19.
Postgrad Med ; 133(2): 237-241, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-707268

ABSTRACT

OBJECTIVES: Given the many medications used to treat novel coronavirus disease (COVID-19) and its comorbidities and complications, the risk of drug-drug interactions (DDIs) and resulting patient harm is concerning. This study aimed to shed light on physicians' knowledge of potential DDIs related to COVID-19 treatment, to determine the effect of an information brief about these DDIs on their correct response rates, and to identify factors associated with higher levels of knowledge about these DDIs. METHODS: The knowledge of physicians regarding the clinical significance and intervention of 7 common potential DDIs during COVID-19 treatment was evaluated via an online survey. Using a pretest-posttest design, the physicians completed a multiple-choice questionnaire first using their existing knowledge, then received an information brief about the DDIs and completed the same questionnaire again. Pretest and posttest scores were evaluated and factors affecting correct response rates were determined using correlation, regression, and post-hoc analyzes. RESULTS: A total of 244 physicians participated in the survey, 147 (60.2%) of whom were involved in the treatment of COVID-19 patients. After the information brief, there were significant increases in the number of correct responses for both clinical significance and interventions (p < 0.0001). In comparisons of pretest knowledge, physicians involved in the treatment of COVID-19 patients showed significantly higher correct response rate for interventions compared to physicians who had not treated COVID-19 patients (p = 0.003). Post-hoc analysis to compare pretest correct intervention responses among all medical specialties revealed significant differences between infectious diseases and family practice (mean difference: 1.059; p = 0.005) and between internal medicine and family practice (mean difference: 1.771; p < 0.0001). CONCLUSION: Physicians involved in the treatment of COVID-19 patients had more knowledge regarding clinical significance and appropriate management of potential DDIs than those not involved. Therefore, it may be beneficial to organize trainings and issue guidelines about potential DDIs for physicians during the COVID-19 pandemic.


Subject(s)
COVID-19/drug therapy , Drug Interactions , Health Knowledge, Attitudes, Practice , Pandemics , Physicians/standards , Adult , COVID-19/epidemiology , Comorbidity , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , Surveys and Questionnaires
20.
PM R ; 12(9): 926-932, 2020 09.
Article in English | MEDLINE | ID: covidwho-647024

ABSTRACT

INTRODUCTION: The global pandemic due to SARS-CoV-2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. OBJECTIVE: To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. DESIGN: Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020-17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. PRIMARY OUTCOME MEASURES: Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. RESULTS: Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow-up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as "excellent" or "very good" across measures (91.6%-95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no-show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. CONCLUSIONS: In summary, rapid expansion of telemedicine during the COVID-19 pandemic was well-received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.


Subject(s)
Betacoronavirus , Coronavirus Infections/rehabilitation , Pandemics , Patient Satisfaction/statistics & numerical data , Physical and Rehabilitation Medicine/methods , Physicians/standards , Pneumonia, Viral/rehabilitation , Telemedicine/methods , Adolescent , Adult , Aged , COVID-19 , Child , Coronavirus Infections/epidemiology , Female , Humans , Male , Middle Aged , Outpatients , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Young Adult
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