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1.
Psychiatr Danub ; 32(3-4): 536-548, 2020.
Article in English | MEDLINE | ID: covidwho-2100776

ABSTRACT

BACKGROUND: Many research has indicated that, during the COVID-19 pandemic, health care workers are under greatly increased pressure and at increased risk for the development of mental health problems. Furthermore, previous research has indicated that psychiatrists are exposed to a number of unique stressors that may increase their risk for poor mental health. The aims of the present study were to assess the level of COVID-19 related concerns, psychological distress and life satisfaction among psychiatrists and other physicians during the first period of the pandemic and to examine whether individual differences in COVID-19 concerns, psychological flexibility, psychological resilience and coping behaviors account for differences in mental health indicators. SUBJECTS AND METHODS: The sample consisted of N=725 physicians, among whom 22.8% were psychiatrists. This study was conducted online during the first lockdown in Croatia and collected data regarding COVID-19 related concerns, coping behaviors and mental health indicators (Psychological Distress and Life Satisfaction). RESULTS: Physicians of other specialties had higher scores on a measure of COVID-19 anxiety than psychiatrists (p=0.012). In addition, a number of differences in coping behaviors are evident. Specifically, psychiatrists were less likely than physicians of other specializations to believe that being informed about COVID-19 is an effective coping strategy (p=0.013), but more prone to using sedatives and drugs as a coping strategy (p=0.002; p=0.037). CONCLUSIONS: Psychiatrists are at special risk for substance abuse. Younger age, psychological inflexibility, low resilience and greater COVID-19 concerns might act as specific risk factors for distress. Our findings highlight the need for promoting a healthy lifestyle and psychological flexibility as universal protective factors.


Subject(s)
COVID-19 , Physicians , Psychiatry , Communicable Disease Control , Croatia , Humans , Mental Health , Pandemics , Protective Factors , SARS-CoV-2
2.
Psychiatr Danub ; 32(2): 287-293, 2020.
Article in English | MEDLINE | ID: covidwho-2100760

ABSTRACT

BACKGROUND: Since the declaration of the coronavirus 2019 (COVID-19) outbreak as pandemic, health workers have shown an incredible commitment to their patients, sometimes in apocalyptic conditions. We explored ways to deal with the coronavirus stressor and psychological outcomes among physicians and nurses. SUBJECTS AND METHODS: 124 healthcare workers in General Hospital Nasice (Croatia) were invited to participate in a study by performing within the period of March 26 to April 6 2020 questionnaire collected information on socio-demographic characteristics and living conditions that may be risk factors for covid-19 concern, Short form health survey-36, Depression Anxiety Stress Scales (DASS-21) and Ways of Coping Questionnaire (WOC; consisting of 8 subscales: Confrontive Coping, Distancing, Self-Controlling, Seeking Social Support, Accepting Responsibility, Escape-Avoidance, Planful Problem Solving, Positive Reappraisal). RESULTS: 11% healthworkers reports moderate to very-severe depression, 17% moderate to extremely-severe anxiety and 10% for moderate to extremely-severe stress. 67% of medical staff are worried. No statistically significant differences in the scales of depression, anxiety, and stress were found between nurses and physicians, but differences were found on Escape-Avoidance and Positive Reappraisal subscales. Nurses use significantly more avoiding coping style and positive reappraisal than doctors. Seeking social support is more pronounced in those over 40 years old, while those under 40 use more avoidable stress management techniques. CONCLUSIONS: Monitoring and ensuring the mental health of coronavirus care staff is crucial for global health. The education of medical staff in the field of stress management is a conditio sine qua non of the issue of an adequate relationship with the COVID-19 pandemic.


Subject(s)
Adaptation, Psychological , Coronavirus Infections/psychology , Health Surveys , Mental Health/statistics & numerical data , Nurses/psychology , Physicians/psychology , Pneumonia, Viral/psychology , Stress, Psychological , Adult , COVID-19 , Child , Coronavirus Infections/epidemiology , Croatia/epidemiology , Humans , Middle Aged , Pandemics , Pneumonia, Viral/epidemiology
3.
J Med Ethics ; 48(7): 430-433, 2022 07.
Article in English | MEDLINE | ID: covidwho-1909808

ABSTRACT

Physicians expressing opinions on medical matters that run contrary to the consensus of experts pose a challenge to licensing bodies and regulatory authorities. While the right to express contrarian views feeds a robust marketplace of ideas that is essential for scientific progress, physicians advocating ineffective or dangerous cures, or actively opposing public health measures, pose a grave threat to societal welfare. Increasingly, a distinction has been made between professional speech that occurs during the physician-patient encounter and public speech that transpires beyond the clinical setting, with physicians being afforded wide latitude to voice empirically false claims outside the context of patient care. This paper argues that such a bifurcated model does not sufficiently address the challenges of an age when mass communications and social media allow dissenting physicians to offer misleading medical advice to the general public on a mass scale. Instead, a three-tiered model that distinguishes between citizen speech, physician speech and clinical speech would best serve authorities when regulating physician expression.


Subject(s)
Ducks , Physicians , Animals , Communication , Freedom , Humans , Physician-Patient Relations
4.
Front Psychol ; 11: 1501, 2020.
Article in English | MEDLINE | ID: covidwho-1903116

ABSTRACT

Objective: Our aim was to explore the presumed infection routes and psychological impact of COVID-19 on staff in administrative and logistics departments (ALDs). Methods: We gathered data from all 18 staff members with COVID-19 in ALDs in Zhongnan Hospital of Wuhan University, China. The baseline, job before diagnosis, presumed infection environment, use of protective equipment, and psychological status before and after diagnosis were collected and analyzed. A total of 18 uninfected staff members working alongside them in the same environment and 18 random matched infected doctors and nurses formed two control groups; the psychological impact of these three groups was then compared. Results: Of the 18 members of staff, 88.89% were infected due to the working environment (hospital), and nine had face-to-face conversations with doctors and nurses in their daily work. Many staff members did not take any protective measures in their routine work. Before they were diagnosed, 12 staff members were aware of the seriousness of the epidemic, and most of the staff maintained a neutral attitude to the COVID-19 outbreak. A total of 77.78% of the staff experienced psychological stress or emotional changes after diagnosis, which were mainly caused by family health and disease related issues. Most of them managed their emotions by self-control and video calls with their families. There was no significant difference in psychological impact among the three groups, but uninfected staff members were fully aware of the seriousness of the epidemic. Conclusions: Effective protective measures should be taken for staff members in ALDs. Psychological interventions are very important to help infected staff members in ALDs cope with psychological distress.

5.
Int Ophthalmol ; 41(4): 1261-1269, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1826668

ABSTRACT

PURPOSE: The coronavirus disease-2019 (COVID-19) has become a difficult pandemic to control worldwide. The high transmission risk and mortality rates of COVID-19 cause serious concerns in ophthalmologists and may cause disruptions in clinical functioning. This study aims to identify changes in the clinical approaches of ophthalmologists, understand their anxiety levels, and exhibit how patients' follow-up processes progress during the pandemic. METHODS: A questionnaire that including demographic information, ophthalmology clinical activity scale, and Beck anxiety scale was sent to ophthalmologists in Turkey. Google Forms was used as a survey platform in this study. RESULTS: A total of 121 ophthalmologists participated in the study. The participants stated that they could not continue routine interventional diagnosis and treatment practices during the outbreak. It was clearly stated that there were changes in their clinical approach and decreased patient examination quality. For this reason, 14.9% of physicians said to missed the diagnosis in this process. Physicians who encounter infected patients state that it is more difficult to provide ophthalmological services and their clinical approaches are affected more negatively. Anxiety levels of physicians who could access personal protective equipment (PPE) and show positive solidarity with their colleagues in the process were found to be lower. CONCLUSION: Our study revealed that ophthalmologists, like other healthcare professionals, were severely affected by the COVID-19 outbreak. Accordingly, healthcare managers should provide adequate PPE for ophthalmologists, organize the clinical operation, and support the mental health of ophthalmologists.


Subject(s)
COVID-19/epidemiology , Ophthalmologists , Ophthalmology/trends , Practice Patterns, Physicians'/trends , Delivery of Health Care , Humans , Pandemics , Surveys and Questionnaires , Turkey/epidemiology
6.
Ecancermedicalscience ; 15: 1213, 2021.
Article in English | MEDLINE | ID: covidwho-1809338

ABSTRACT

Burnout (BO) syndrome is a condition that results in physical and mental distress. The current COVID-19 pandemic is strongly affecting the mental health of the general population. We aimed to assess the incidence of BO among medical oncologists and determine factors associated with burnout levels during the current pandemic. METHODS: A digital survey was created for this study. The Spanish-validated version of Maslach BO Inventory was incorporated to define BO. Social and demographic information was analysed to remove duplicated answers. RESULTS: A total of 188 Argentinian medical oncologists from 16 cities participated in the survey. The median age of the participants was 43 years (IQR 38-50) and a similar distribution between male and female was observed. At the time of the survey, Argentina was in the third month of strict lockdown. Most of the participants practiced in both public and private practice facilities (55.3%) and the majority reported more than 10 years of experience (53.2%). Twenty-five percent (43) of subjects reported high levels of DP, 39.9% (75) reported high levels of EE and 53.7% (101) reported low levels of PA. BO Maslach criteria were fulfilled by 14.9% (28). We compared this result with other burnout assessment tools. Using the Gil-Monte and Neira tool, BO-associated domains were altered in 77.1%, 42% and 42% for EE, DP, and PA domains, respectively. Concomitantly, under Neira assessment a domain impairment was appreciated in 77.1%, 76% and 54% respectively. BO criteria were met by 30.3% (57) according to Gil-Monte and 47.9% (90) to Neira. CONCLUSION: BO is a multifaceted issue with a negative impact on physicians, patients, and institutions. During the COVID-19 pandemic, BO criteria was met in a considerable proportion of survey respondents using MBI, and Peiro and Neiro tools and younger age, use of antidepressants and psychological medications and income reduction arose as statistically significant factors after multivariate analysis.

7.
Am J Health Promot ; 34(8): 929-941, 2020 11.
Article in English | MEDLINE | ID: covidwho-1794234

ABSTRACT

OBJECTIVE: This systematic review focused on randomized controlled trials (RCTs) with physicians and nurses that tested interventions designed to improve their mental health, well-being, physical health, and lifestyle behaviors. DATA SOURCE: A systematic search of electronic databases from 2008 to May 2018 included PubMed, CINAHL, PsycINFO, SPORTDiscus, and the Cochrane Library. STUDY INCLUSION AND EXCLUSION CRITERIA: Inclusion criteria included an RCT design, samples of physicians and/or nurses, and publication year 2008 or later with outcomes targeting mental health, well-being/resiliency, healthy lifestyle behaviors, and/or physical health. Exclusion criteria included studies with a focus on burnout without measures of mood, resiliency, mindfulness, or stress; primary focus on an area other than health promotion; and non-English papers. DATA EXTRACTION: Quantitative and qualitative data were extracted from each study by 2 independent researchers using a standardized template created in Covidence. DATA SYNTHESIS: Although meta-analytic pooling across all studies was desired, a wide array of outcome measures made quantitative pooling unsuitable. Therefore, effect sizes were calculated and a mini meta-analysis was completed. RESULTS: Twenty-nine studies (N = 2708 participants) met the inclusion criteria. Results indicated that mindfulness and cognitive-behavioral therapy-based interventions are effective in reducing stress, anxiety, and depression. Brief interventions that incorporate deep breathing and gratitude may be beneficial. Visual triggers, pedometers, and health coaching with texting increased physical activity. CONCLUSION: Healthcare systems must promote the health and well-being of physicians and nurses with evidence-based interventions to improve population health and enhance the quality and safety of the care that is delivered.


Subject(s)
Mindfulness , Nurses , Physicians , Humans , Life Style , Mental Health
8.
J Healthc Leadersh ; 12: 85-94, 2020.
Article in English | MEDLINE | ID: covidwho-1793328

ABSTRACT

PURPOSE: The aim of the study is to evaluate the prevalence and extent of burnout among physicians and investigate the factors related with burnout and the influence of the fight against coronavirus (COVID-19) on the burnout syndrome. METHODS: A cross-sectional survey design was adopted and conducted on 200 actively working physicians in Izmir/Turkey. Personal Information Form and Maslach Burnout Inventory were used in the survey. RESULTS: The findings showed that the emotional exhaustion level of the physicians was medium, the levels of depersonalization and personal accomplishment were low, and the level of total burnout was low. It was observed that the burnout levels of males and females, and married and single physicians were similar. The emotional exhaustion level of 18-23-year-old physicians was lower than the rest of the physicians. Physicians' level of satisfaction with their income is not effective on burnout. The burnout level of physicians who did not choose their profession willingly was determined to be higher than the burnout level of the physicians who chose their profession willingly. One important finding showed that the burnout level of physicians who actively involved in the fight against COVID-19 was lower than the burnout level of the physicians who did not actively involve in the fight against COVID-19. CONCLUSION: Although the impact of some demographic variables, such as gender, marital status and satisfaction of income on burnout, was similar among the groups, total burnout level was lower in physicians who actively fought with the virus. This result may suggest that those physicians who were actively involved in the fight against COVID-19 had a high sense of meaningfulness of work which will result in high satisfaction with the work itself and, thus, creating less burnout. Also, they had a stronger feeling of personal accomplishment as they faced the immediate outcomes of their care for people infected by COVID-19.

9.
Indian J Palliat Care ; 26(Suppl 1): S76-S80, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1792220

ABSTRACT

INTRODUCTION: COVID-19, the new pandemic faced by the world, is a novel betacoronavirus causing severe respiratory coronavirus syndrome. Elderly patients, people with underlying chronic illnesses, cancer patients, and those who are immunocompromised are at higher risk and account for higher mortality rate. Unfortunately, there is no approved medication for treatment, till date, thereby supporting triage management and difficult decision-making. Thus, there should be a substantial increase in the palliative care in times of pandemic. There should be an increase in the availability of palliative care services in different care settings. Due to a surge in the number of cases of COVID-19, it has been reported on how palliative care is being delayed, discontinued, or deprioritized. AIM: The aim of this study is to evaluate the barriers occurring in providing the palliative care to the patients with nonmalignant illness. METHODOLOGY: A questionnaire was designed after studying previous work over palliative care and pandemic crisis and was distributed among the physicians, surgeons, and the residents; a total of 95 health-care workers were involved. The survey was done through mails. The response then was evaluated and analyzed. RESULTS: As seen by the responses we got from the health-care workers, the main issue is the nonavailability of the personal protective equipment during this pandemic. Keeping the current scenario in mind, regarding COVID-19, the patients are at fear of coming to the hospital at first place, and even if they come then the fear of being alone haunts them. One of the biggest fears of the patient is dying alone, without being in contact with their loved ones. CONCLUSION: Palliative care should be an essential part of any health-care service in any humanitarian crisis, including the COVID-19 pandemic. Thus, effort should be made to remove the barriers and provide palliative care to the patient.

10.
Pak J Med Sci ; 36(COVID19-S4): S37-S42, 2020 May.
Article in English | MEDLINE | ID: covidwho-1726820

ABSTRACT

OBJECTIVES: The aim of this study was to explore the expectations and fears faced by doctors during Covid-19 Pandemic. METHODS: This is a mixed method exploratory survey. A questionnaire exploring expectations of doctors from administration and seniors as well as their fears while working during pandemic, was developed on Google survey Forms. It included eight closed ended questions and four open ended questions. Data was collected through online Google survey Forms during month of March and April 2020. Doctors were approached through email and WhatsApp group. RESULTS: The mean age of participants was 33.58±4.21 years. Female 150(67.5%) and Male 72(32.4%) participated. 29(13.1%) Associate Professor, 34(15.3%) Assistant Professor, 56(25.2%) Senior Residents and 103(46.3%) residents, medical officers and house officers responded to the survey. 134(60.3%) doctors were working in hospitals which were not dealing with Covid-19. Fear included, infecting family members 177(79.7%), rapid spread of disease 140(63%), complications of disease 134(60.3%), becoming a carrier in 64(28.8%) and 62(27.9%) feared missing the diagnosis. More than 80% expected from seniors and administration, of providing PPE, facilitation, continue chain of supply of essential items, ensuring doctor safety, avoiding exposure of all doctors and keeping reserve workforce, limiting routine checkups, avoid panic and 20% had no expectations. CONCLUSION: It was concluded that doctors had their fears and perceptions regarding pandemic which need to be addressed while policy making. They fear wellbeing of their families and contacting Covid-19, if not provided proper PPE. Our study provides insight of expectations, fears and perceptions of our frontline which invariably gives insight of the views of healthcare workers.

11.
Int J Environ Res Public Health ; 17(9)2020 05 02.
Article in English | MEDLINE | ID: covidwho-1725600

ABSTRACT

The number of COVID-19 (Coronavirus Disease of 2019) cases in Jordan is rising rapidly. A serious threat to the healthcare system appears on the horizon. Our study aims to evaluate preparedness of Jordanian frontline doctors to the worsening scenario. It has a questionnaire-based cross-sectional structure. The questionnaire was designed to evaluate preparedness according to knowledge about virus transmission and protective measures, adherence to protection guidelines, and psychological impacts affecting doctors. Institutional factors affecting doctors' readiness like adopting approach protocols and making protection equipment available were investigated; 308 doctors from different healthcare facilities participated (response rate: 53.9%). Approximately 25% of doctors (n = 77) previously took care of COVID-19 patients, and 173 (56.2%) have institutional COVID-19 approach protocols. Only 57 doctors (18.5%) reported all PPE (Personal Protective Equipment) available. The self-reported score of preparedness to deal with COVID-19 patients was 4.9 ± 2.4. Doctors having institutional protocols for dealing with COVID-19 cases and those with sustained availability of PPE reported higher scores of preparedness (5.5 ± 2.3 and 6.2 ± 2.1 with p < 0.001, respectively). Correlations with knowledge score, adherence to PPE score, and psychological impacts were investigated. The study revealed multiple challenges and insufficiencies that can affect frontline doctors' preparedness. Policy makers are urged to take these findings into consideration and to act promptly.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Disease Outbreaks , Health Knowledge, Attitudes, Practice , Physicians/psychology , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Adult , COVID-19 , Cross-Sectional Studies , Female , Health Facilities , Humans , Jordan/epidemiology , Male , Pandemics , Personal Protective Equipment/supply & distribution , Physicians/statistics & numerical data , Surveys and Questionnaires
12.
Brain Behav Immun ; 87: 40-48, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719336

ABSTRACT

In addition to being a public physical health emergency, Coronavirus disease 2019 (COVID-19) affected global mental health, as evidenced by panic-buying worldwide as cases soared. Little is known about changes in levels of psychological impact, stress, anxiety and depression during this pandemic. This longitudinal study surveyed the general population twice - during the initial outbreak, and the epidemic's peak four weeks later, surveying demographics, symptoms, knowledge, concerns, and precautionary measures against COVID-19. There were 1738 respondents from 190 Chinese cities (1210 first-survey respondents, 861 s-survey respondents; 333 respondents participated in both). Psychological impact and mental health status were assessed by the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale (DASS-21), respectively. IES-R measures PTSD symptoms in survivorship after an event. DASS -21 is based on tripartite model of psychopathology that comprise a general distress construct with distinct characteristics. This study found that there was a statistically significant longitudinal reduction in mean IES-R scores (from 32.98 to 30.76, p < 0.01) after 4 weeks. Nevertheless, the mean IES-R score of the first- and second-survey respondents were above the cut-off scores (>24) for PTSD symptoms, suggesting that the reduction in scores was not clinically significant. During the initial evaluation, moderate-to-severe stress, anxiety and depression were noted in 8.1%, 28.8% and 16.5%, respectively and there were no significant longitudinal changes in stress, anxiety and depression levels (p > 0.05). Protective factors included high level of confidence in doctors, perceived survival likelihood and low risk of contracting COVID-19, satisfaction with health information, personal precautionary measures. As countries around the world brace for an escalation in cases, Governments should focus on effective methods of disseminating unbiased COVID-19 knowledge, teaching correct containment methods, ensuring availability of essential services/commodities, and providing sufficient financial support.


Subject(s)
Anxiety/epidemiology , Coronavirus Infections/epidemiology , Depression/epidemiology , Pneumonia, Viral/epidemiology , Stress Disorders, Post-Traumatic/epidemiology , Stress, Psychological/epidemiology , Adolescent , Adult , Anxiety/psychology , Anxiety/therapy , Betacoronavirus , COVID-19 , Child , China/epidemiology , Coronavirus Infections/prevention & control , Depression/psychology , Depression/therapy , Epidemics , Female , Hand Hygiene , Health Behavior , Humans , Internet-Based Intervention , Longitudinal Studies , Male , Masks , Mental Health , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Psychotherapy , SARS-CoV-2 , Stress Disorders, Post-Traumatic/psychology , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/psychology , Stress, Psychological/therapy , Young Adult
13.
Infect Control Hosp Epidemiol ; 43(5): 609-615, 2022 05.
Article in English | MEDLINE | ID: covidwho-1586123

ABSTRACT

OBJECTIVE: To examine the associations between factors based on the social cognitive theory (SCT) and behavioral intention among doctors and nurses in China toward free and self-paid (600 RMB or US$91) severe acute respiratory coronavirus virus 2 (SARS-CoV-2) vaccination given 80% effectiveness and rare mild side effects. DESIGN: Cross-sectional study. SETTING: Public hospitals. PARTICIPANTS: The study included 362 doctors and 1,702 nurses in major departments of 5 hospitals of 3 Chinese provinces. METHODS: An anonymous online survey was conducted from October to November 2020, facilitated by hospital administrators through online WeChat/QQ working groups. Data on outcome expectations, self-efficacy, norms, and COVID-19-related work experiences were collected. Multivariate logistic regression models were used for data analyses. RESULTS: The logistic regression analysis showed that physical (eg, protective effect of vaccination) and self-evaluative outcome expectations (eg, anticipated regret), self-efficacy, norms (eg, descriptive norm, subjective norm, professional norm, and moral norm), and job satisfaction were significantly and positively associated with the free and self-paid SARS-CoV-2 vaccination intention outcomes among doctors and nurses, adjusted for background variables. Doctors who had engaged in COVID-19-related work reported higher self-paid vaccination intention. CONCLUSIONS: Health promotion is needed to improve the uptake of SARS-CoV-2 vaccination among healthcare workers. Such interventions may consider modifying the identified factors of vaccination intention, including strengthening perceived efficacy, positive feelings about vaccination, the need to avoid future regret, self-efficacy, and social norms. Future studies should examine the actual behavior patterns of SARS-CoV-2 vaccination, and the efficacy of promotion intervention should be tested in randomized controlled studies.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19/prevention & control , COVID-19 Vaccines , China , Cross-Sectional Studies , Humans , Intention , Psychological Theory , Vaccination/psychology
14.
J Hum Hypertens ; 35(10): 828-836, 2021 10.
Article in English | MEDLINE | ID: covidwho-1575511

ABSTRACT

Concern has arisen about the role played in coronavirus disease 2019 (COVID-19) infection by angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs). This study was designed to assess the practice behaviors of physicians toward hypertension treatment with ACE-i or ARBs during the COVID-19 pandemic. A self-administered survey questionnaire consisting of 26 questions about current hypertension treatment with ACE-i/ ARBs was applied to cardiologists, internists, and family physicians in central and western Turkey, between 01 and 19 May 2020. A total of 460 physicians were approached, and 220 (47.8%) participated in the study. Of the total respondents, 78.7% reported that they had not changed their antihypertensive medication prescribing pattern, 8.6% of clinicians had changed ACE-i/ ARBs medicine of patients during the COVID-19 pandemic and 12.7% of them were undecided. The median (±interquartile range) score indicating general reliance level of physicians in ACE-i/ARBs therapy was 8 ± 4 (range, 1-10). In multiple comparison analyses, the general reliance level in ACE-i/ARBs, reliance level when starting a new ACEi/ARBs and changing behavior in heart failure patients were significantly different with regard to the specialties (p:0.02, p:0.009, p:0.005 respectively). Although most of the physicians found the publications about ACE-i/ ARBs during the COVID-19 pandemic untrustworthy, there were variable levels of knowledge and reliance among different physicians and specialty groups. In general, the ACE-i/ ARBs prescribing habits were not affected by safety concerns during the COVID-19 pandemic in Turkey.


Subject(s)
COVID-19 , Hypertension , Angiotensin Receptor Antagonists , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Attitude , Humans , Hypertension/drug therapy , Hypertension/epidemiology , Pandemics , Renin-Angiotensin System , SARS-CoV-2
15.
J Med Internet Res ; 23(2): e23658, 2021 02 25.
Article in English | MEDLINE | ID: covidwho-1575249

ABSTRACT

BACKGROUND: Lockdowns and shelter-in-place orders during COVID-19 have accelerated the adoption of remote and virtual care (RVC) models, potentially including telehealth, telemedicine, and internet-based electronic physician visits (e-visits) for remote consultation, diagnosis, and care, deterring small health care businesses including clinics, physician offices, and pharmacies from aligning resources and operations to new RVC realities. Current perceptions of small health care businesses toward remote care, particularly perceptions of whether RVC adoption will synergistically improve business sustainability, would highlight the pros and cons of rapidly adopting RVC technology among policy makers. OBJECTIVE: This study aimed to assess the perceptions of small health care businesses regarding the impact of RVC on their business sustainability during COVID-19, gauge their perceptions of their current levels of adoption of and satisfaction with RVC models and analyze how well that aligns with their perceptions of the current business scenario (SCBS), and determine whether these perceptions influence their view of their midterm sustainability (SUST). METHODS: We randomly sampled small clinics, physician offices, and pharmacies across Colorado and sought assistance from a consulting firm to collect survey data in July 2020. Focal estimated study effects were compared across the three groups of small businesses to draw several insights. RESULTS: In total, 270 respondents, including 82 clinics, 99 small physician offices, and 89 pharmacies, across Colorado were included. SRVC and SCBS had direct, significant, and positive effects on SUST. However, we investigated the effect of the interaction between SRVC and SCBS to determine whether RVC adoption aligns with their perceptions of the current business scenario and whether this interaction impacts their perception of business sustainability. Effects differed among the three groups. The interaction term SRVC×SCBS was significant and positive for clinics (P=.02), significant and negative for physician offices (P=.05), and not significant for pharmacies (P=.76). These variations indicate that while clinics positively perceived RVC alignment with the current business scenario, the opposite held true for small physician offices. CONCLUSIONS: As COVID-19 continues to spread worldwide and RVC adoption progresses rapidly, it is critical to understand the impact of RVC on small health care businesses and their perceptions of long-term survival. Small physician practices cannot harness RVC developments and, in contrast with clinics, consider it incompatible with business survival during and after COVID-19. If small health care firms cannot compete with RVC (or synergistically integrate RVC platforms into their current business practices) and eventually become nonoperational, the resulting damage to traditional health care services may be severe, particularly for critical care delivery and other important services that RVC cannot effectively replace. Our results have implications for public policy decisions such as incentive-aligned models, policy-initiated incentives, and payer-based strategies for improved alignment between RVC and existing models.


Subject(s)
COVID-19/epidemiology , Pharmacies/economics , Physicians' Offices/economics , Small Business/economics , Telemedicine/methods , Adult , Colorado/epidemiology , Female , Humans , Male , Middle Aged , Referral and Consultation , SARS-CoV-2/isolation & purification , Surveys and Questionnaires
16.
Telemed J E Health ; 27(12): 1344-1345, 2021 12.
Article in English | MEDLINE | ID: covidwho-1575137

ABSTRACT

Higher rates of burnout among female physicians as compared with male physicians remain a troubling phenomenon. Achieving gender equity in academic advancement is a critical component of addressing this gap. During the timeframe of childbearing and rearing, enhanced control and flexibility are desired workplace changes and offered by telehealth work modalities. This viewpoint explores the role of telehealth and the remote work environment in optimizing control and flexibility, which can increase participation in academic advancement opportunities and improve female physician burnout. Widespread promotion of remote clinical practice and participation in scholarly activities beyond the duration of the COVID-19 pandemic may be a component of the long-term solution to female physician burnout.


Subject(s)
COVID-19 , Telemedicine , Female , Humans , Male , Pandemics , SARS-CoV-2 , Workplace
17.
J Med Internet Res ; 23(2): e20812, 2021 02 25.
Article in English | MEDLINE | ID: covidwho-1574241

ABSTRACT

BACKGROUND: Since the onset of the COVID-19 pandemic, several health care programs intended to provide telemedicine services have been introduced in Libya. Many physicians have used these services to provide care and advice to their patients remotely. OBJECTIVE: This study aimed to provide an overview of physicians' awareness, knowledge, attitude, and skill in using telehealth services in Libya. METHODS: In this cross-sectional study, we administered a web-based survey to health care workers in Libya in May 2020. The questionnaire collected information on physicians' general demographic characteristics, ability to use a computer, and telemedicine awareness, knowledge, attitude, and skills. RESULTS: Among 673 health care workers who responded to the survey, 377 (56%) and 248 (36.8%) reported high awareness and high computer skill scores, respectively, for telemedicine. Furthermore, 582 (86.5%) and 566 (82.6%) health care workers reported high knowledge and high attitude scores, respectively. We observed no significant differences in awareness, knowledge, attitude, and skill scores among physicians employed at public, private, or both types of hospitals. We observed significant differences in the mean awareness (P<.001), attitude (P=.001), and computer skill scores (P<.001) , where the score distribution of the groups based on the ability to use computers was not similar. Knowledge scores did not significantly differ among the three groups (P=.37). Respondents with professional computer skills had significantly higher awareness (χ23=14.5; P<.001) and attitude (χ23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (χ23=199.6; P<.001). CONCLUSIONS: The consequences of the COVID-19 pandemic are expected to persist for a long time. Hence, policy programs such as telemedicine services, which aim to address the obstacles to medical treatment owing to physical distancing measures, will likely continue for a long time. Therefore, there is a need to train and support health care workers and initiate government programs that provide adequate and supportive health care services to patients in transitional countries.


Subject(s)
COVID-19/epidemiology , Health Knowledge, Attitudes, Practice , Telemedicine/methods , Adult , COVID-19/therapy , Cross-Sectional Studies , Developing Countries , Female , Health Personnel , Humans , Male , Pandemics , SARS-CoV-2/isolation & purification
18.
Telemed J E Health ; 27(12): 1355-1362, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574147

ABSTRACT

Introduction: In this study, we aimed to detect anxiety levels of the physicians during the Coronavirus Disease 2019 (COVID-19) pandemic and to assess the knowledge, perspective, and willingness of the physicians about telemedicine. Materials and Methods: This was a survey study of physicians from different specialties who provided patient care during the pandemic in Turkey. A total of 824 physicians responded to questionnaire, which consisted of 5 sections: (1) demographic characteristics; (2) anxiety level; (3) knowledge; (4) perspective; and (5) willingness to use telemedicine. Results: Fifty-six percent of the participants were found to experience mild-to-severe anxiety during the pandemic. It was found that the early career physicians most likely report anxiety about COVID-19 (p = 0.012). Physicians working in training and research hospital settings had higher Beck Anxiety Inventory scores compared to their colleagues working in private health care institutions (p = 0.011). Anxiety levels of physicians were not affected by working experience, existence of comorbidities, or living conditions of the participants (p = 0.138, p = 0.317, and p = 0.123, respectively). The results showed that the participants had a low level of knowledge about telemedicine. Only 61.1% of the physicians stated that they had heard of telemedicine before. The physicians who experienced telemedicine before (N = 76, 9.2% of all the participants) were more likely to find telemedicine beneficial both in pandemic (p < 0.001) and postpandemic period (p = 0.002). Conclusions: About half of our physicians had different levels of anxiety during the pandemic, and this anxiety seemed to be more related to infecting their relatives. Participants thought that providing health care services with telemedicine during the pandemic period would be beneficial and reduce the spread of hospital-acquired COVID-19. However, there was no consensus among the participants regarding the use of telemedicine in the postpandemic period.


Subject(s)
COVID-19 , Physicians , Telemedicine , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Surveys and Questionnaires
19.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 May 07.
Article in English | MEDLINE | ID: covidwho-1561834

ABSTRACT

PURPOSE: Workplace silence impedes productivity, job satisfaction and retention, key issues for the hospital workforce worldwide. It can have a negative effect on patient outcomes and safety and human resources in healthcare organisations. This study aims to examine factors that influence workplace silence among hospital doctors in Ireland. DESIGN/METHODOLOGY/APPROACH: A national, cross-sectional, online survey of hospital doctors in Ireland was conducted in October-November 2019; 1,070 hospital doctors responded. This paper focuses on responses to the question "If you had concerns about your working conditions, would you raise them?". In total, 227 hospital doctor respondents (25%) stated that they would not raise concerns about their working conditions. Qualitative thematic analysis was carried out on free-text responses to explore why these doctors choose to opt for silence regarding their working conditions. FINDINGS: Reputational risk, lack of energy and time, a perceived inability to effect change and cultural norms all discourage doctors from raising concerns about working conditions. Apathy arose as change to working conditions was perceived as highly unlikely. In turn, this had scope to lead to neglect and exit. Voice was seen as risky for some respondents, who feared that complaining could damage their career prospects and workplace relationships. ORIGINALITY/VALUE: This study highlights the systemic, cultural and practical issues that pressure hospital doctors in Ireland to opt for silence around working conditions. It adds to the literature on workplace silence and voice within the medical profession and provides a framework for comparative analysis of doctors' silence and voice in other settings.


Subject(s)
Physicians , Workplace , Attitude of Health Personnel , Cross-Sectional Studies , Hospitals , Humans , Ireland
20.
Arch Dis Child Fetal Neonatal Ed ; 106(6): 627-634, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1503592

ABSTRACT

OBJECTIVE: To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC). DESIGN: Prospective cohort study. SETTING: Two perinatal centres in Melbourne, Australia. PATIENTS: At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s. MAIN OUTCOME MEASURES: Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth. RESULTS: Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%). CONCLUSIONS: We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.


Subject(s)
Critical Pathways/standards , Delivery, Obstetric , Electrocardiography/methods , Oxygen Inhalation Therapy , Umbilical Cord , Australia/epidemiology , Cesarean Section/adverse effects , Cesarean Section/methods , Clinical Decision-Making , Constriction , Continuous Positive Airway Pressure/methods , Delivery, Obstetric/adverse effects , Delivery, Obstetric/methods , Delivery, Obstetric/statistics & numerical data , Female , Gestational Age , Heart Rate , Humans , Infant, Newborn , Male , Monitoring, Physiologic/methods , Oxygen Inhalation Therapy/adverse effects , Oxygen Inhalation Therapy/instrumentation , Oxygen Inhalation Therapy/methods , Risk Assessment/methods , Risk Factors , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data
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