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1.
JAMA Netw Open ; 4(5): e2111417, 2021 05 03.
Article in English | MEDLINE | ID: covidwho-1242694

ABSTRACT

Importance: Infection with COVID-19 has been associated with long-term symptoms, but the frequency, variety, and severity of these complications are not well understood. Many published commentaries have proposed plans for pandemic control that are primarily based on mortality rates among older individuals without considering long-term morbidity among individuals of all ages. Reliable estimates of such morbidity are important for patient care, prognosis, and development of public health policy. Objective: To conduct a systematic review of studies examining the frequency and variety of persistent symptoms after COVID-19 infection. Evidence Review: A search of PubMed and Web of Science was conducted to identify studies published from January 1, 2020, to March 11, 2021, that examined persistent symptoms after COVID-19 infection. Persistent symptoms were defined as those persisting for at least 60 days after diagnosis, symptom onset, or hospitalization or at least 30 days after recovery from the acute illness or hospital discharge. Search terms included COVID-19, SARS-CoV-2, coronavirus, 2019-nCoV, long-term, after recovery, long-haul, persistent, outcome, symptom, follow-up, and longitudinal. All English-language articles that presented primary data from cohort studies that reported the prevalence of persistent symptoms among individuals with SARS-CoV-2 infection and that had clearly defined and sufficient follow-up were included. Case reports, case series, and studies that described symptoms only at the time of infection and/or hospitalization were excluded. A structured framework was applied to appraise study quality. Findings: A total of 1974 records were identified; of those, 1247 article titles and abstracts were screened. After removal of duplicates and exclusions, 92 full-text articles were assessed for eligibility; 47 studies were deemed eligible, and 45 studies reporting 84 clinical signs or symptoms were included in the systematic review. Of 9751 total participants, 5266 (54.0%) were male; 30 of 45 studies reported mean or median ages younger than 60 years. Among 16 studies, most of which comprised participants who were previously hospitalized, the median proportion of individuals experiencing at least 1 persistent symptom was 72.5% (interquartile range [IQR], 55.0%-80.0%). Individual symptoms occurring most frequently included shortness of breath or dyspnea (26 studies; median frequency, 36.0%; IQR, 27.6%-50.0%), fatigue or exhaustion (25 studies; median frequency, 40.0%; IQR, 31.0%-57.0%), and sleep disorders or insomnia (8 studies; median 29.4%, IQR, 24.4%-33.0%). There were wide variations in the design and quality of the studies, which had implications for interpretation and often limited direct comparability and combinability. Major design differences included patient populations, definitions of time zero (ie, the beginning of the follow-up interval), follow-up lengths, and outcome definitions, including definitions of illness severity. Conclusions and Relevance: This systematic review found that COVID-19 symptoms commonly persisted beyond the acute phase of infection, with implications for health-associated functioning and quality of life. Current studies of symptom persistence are highly heterogeneous, and future studies need longer follow-up, improved quality, and more standardized designs to reliably quantify risks.


Subject(s)
COVID-19/complications , Dyspnea/etiology , Fatigue/etiology , Sleep Wake Disorders/etiology , COVID-19/virology , Hospitalization , Humans , Pandemics , SARS-CoV-2 , Survivors
2.
Comput Struct Biotechnol J ; 19: 2537-2548, 2021.
Article in English | MEDLINE | ID: covidwho-1202140

ABSTRACT

There is an urgent need to identify new therapies that prevent SARS-CoV-2 infection and improve the outcome of COVID-19 patients. This pandemic has thus spurred intensive research in most scientific areas and in a short period of time, several vaccines have been developed. But, while the race to find vaccines for COVID-19 has dominated the headlines, other types of therapeutic agents are being developed. In this mini-review, we report several databases and online tools that could assist the discovery of anti-SARS-CoV-2 small chemical compounds and peptides. We then give examples of studies that combined in silico and in vitro screening, either for drug repositioning purposes or to search for novel bioactive compounds. Finally, we question the overall lack of discussion and plan observed in academic research in many countries during this crisis and suggest that there is room for improvement.

3.
J Prim Care Community Health ; 12: 21501327211010994, 2021.
Article in English | MEDLINE | ID: covidwho-1195909

ABSTRACT

The National Institute for Health and Care Excellence (NICE) describe "post COVID-19 syndrome" or "Long COVID" as a set of persistent physical, cognitive and/or psychological symptoms that continue for more than 12 weeks after illness and which are not explained by an alternative diagnosis. These symptoms are experienced not only by patients discharged from hospital but also those in the community who did not require inpatient care. To support the recovery of this group of people, a unique integrated rehabilitation pathway was developed following extensive service evaluations by Leeds Primary Care Services, Leeds Community Healthcare NHS Trust and Leeds Teaching Hospital NHS Trust. The pathway aligns itself to the NHS England "Five-point plan" to embed post-COVID-19 syndrome assessment clinics across England, supporting the comprehensive medical assessment and rehabilitation intervention for patients in the community. The pathway was first of its kind to be set up in the UK and comprises of a three-tier service model (level 1: specialist MDT service, level 2: community therapy teams and level 3: self-management). The MDT service brings together various disciplines with specialist skill sets to provide targeted individualized interventions using a specific core set of outcome measures including C19-YRS (Yorkshire Rehabilitation Scale). Community and primary care teams worldwide need such an integrated multidisciplinary comprehensive model of care to deal with the growing number of cases of post-COVID-19 syndrome effectively and in a timely manner.


Subject(s)
COVID-19 , COVID-19/complications , England , Humans , SARS-CoV-2 , State Medicine
4.
J Patient Saf ; 17(4): 256-263, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1165581

ABSTRACT

OBJECTIVES: This study aimed to determine the strategies used and critical considerations among an international sample of hospital leaders when mobilizing human resources in response to the clinical demands associated with the COVID-19 pandemic surge. METHODS: This was a cross-sectional, qualitative research study designed to investigate strategies used by health system leaders from around the world when mobilizing human resources in response to the global COVD-19 pandemic. Prospective interviewees were identified through nonprobability and purposive sampling methods from May to July 2020. The primary outcomes were the critical considerations, as perceived by health system leaders, when redeploying health care workers during the COVID-19 pandemic determined through thematic analysis of transcribed notes. Redeployment was defined as reassigning personnel to a different location or retraining personnel for a different task. RESULTS: Nine hospital leaders from 9 hospitals in 8 health systems located in 5 countries (United States, United Kingdom, New Zealand, Singapore, and South Korea) were interviewed. Six hospitals in 5 health systems experienced a surge of critically ill patients with COVID-19, and the remaining 3 hospitals anticipated, but did not experience, a similar surge. Seven of 8 hospitals redeployed their health care workforce, and 1 had a redeployment plan in place but did not need to use it. Thematic analysis of the interview notes identified 3 themes representing effective practices and lessons learned when preparing and executing workforce redeployment: process, leadership, and communication. Critical considerations within each theme were identified. Because of the various expertise of redeployed personnel, retraining had to be customized and a decentralized flexible strategy was implemented. There were 3 concerns regarding redeployed personnel. These included the fear of becoming infected, the concern over their skills and patient safety, and concerns regarding professional loss (such as loss of education opportunities in their chosen profession). Transparency via multiple different types of communications is important to prevent the development of doubt and rumors. CONCLUSIONS: Redeployment strategies should critically consider the process of redeploying and supporting the health care workforce, decentralized leadership that encourages and supports local implementation of system-wide plans, and communication that is transparent, regular, consistent, and informed by data.


Subject(s)
COVID-19/therapy , Delivery of Health Care/organization & administration , Health Personnel/organization & administration , Leadership , Pandemics , COVID-19/epidemiology , Cross-Sectional Studies , Humans , New Zealand/epidemiology , Qualitative Research , Republic of Korea/epidemiology , Singapore/epidemiology , United Kingdom/epidemiology , United States/epidemiology
5.
Clin Nurse Spec ; 35(3): 138-146, 2021.
Article in English | MEDLINE | ID: covidwho-1165570

ABSTRACT

PURPOSE: The COVID-19 pandemic has significantly challenged healthcare organizations across the globe, forcing innovation, resourcefulness, and flexibility. The purpose of this article is to describe the impact of clinical nurse specialist practice on COVID-19 preparation at a military hospital. ENVIRONMENT OF CARE CHANGES: The pandemic required facilities to develop expansion plans to facilitate a potential surge of COVID-19 patients. Clinical nurse specialists collaborated to develop a plan to expand care capacity and streamline testing while designating specific critical care and medical-surgical areas for COVID-19 patients. STAFFING CONSIDERATIONS: To capitalize on the expanded bed capacity, clinical nurse specialists identified and trained outpatient nursing staff to serve as nurse extenders. DISCUSSION: Early in the pandemic, a lack of strong evidence-based interventions to mitigate transmission and treatment necessitated the development of innovative solutions. The clinical nurse specialist team established designated transport routes for COVID-19 patients, leveraged technology to improve methods of care, and cultivated a culture of innovation by providing on-the-spot meaningful recognition to staff. CONCLUSION: As leaders in healthcare, clinical nurse specialists are change agents that work to maintain high-quality, safe patient care even during a global pandemic.


Subject(s)
COVID-19/nursing , Hospitals, Military/organization & administration , Nurse Clinicians/organization & administration , COVID-19/epidemiology , Humans , Leadership , Nursing Evaluation Research , United States/epidemiology
6.
J Pharm Pract ; : 8971900211000691, 2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1148201

ABSTRACT

Current retrospective data have found up to 20% of COVID-19 infection had developed into severe cases with hyperinflammatory pulmonary symptoms. Interleukin 6 (IL-6) is recognized as a key mediator of hyperinflammation previously mentioned in cytokine release syndrome. This leads to implementing IL-6 pathway inhibition in severe COVID-19. This review aimed to explore the clinical evidences of using IL-6 antagonists in COVID-19 infection based on most recent available data. Relevant studies were searched through PubMed, scopus, and ISI databases focusing on interleukin-6 antagonists in cytokine release syndrome and prospective data on COVID-19 infection. Only papers in English were included in the search. There were several studies conducted to evaluate the potential efficacy and safety of IL-6 antagonists and mostly with tocilizumab. After the search, we found that studies recruited patients with severe COVID-19 and elevated inflammatory mediators such as C-reactive protein (CRP), IL-6, or ferritin to receive tocilizumab, situximab or sarilumab in combination with other medications. Result showed that these agents may provide a clinical advantage as patients were able to refrain from invasive ventilation support after initiating IL-6 antagonists. In summary, IL-6 pathway inhibition in severe COVID-19 may be an emerging candidate to subside pulmonary complication. These agents may carry benefits in COVID-19 infection as well as safety risks such as bone marrow suppression. Current pharmacists' role is to provide most recent update information as well as intensive monitoring plan in patients who receive IL-6 inhibitor. However, robust clinical evidences are warranted to confirm efficacy and safety of IL-6 antagonists.

7.
Reg Anesth Pain Med ; 46(6): 478-481, 2021 06.
Article in English | MEDLINE | ID: covidwho-1148173

ABSTRACT

BACKGROUND AND OBJECTIVES: The role of telemedicine in the evaluation and treatment of patients with spinal disorders is rapidly expanding, brought on largely by the COVID-19 pandemic. Within this context, the ability of pain specialists to accurately diagnose and plan appropriate interventional spine procedures based entirely on telemedicine visits, without an in-person evaluation, remains to be established. In this study, our primary objective was to assess the relevance of telemedicine to interventional spine procedure planning by determining whether procedure plans established solely from virtual visits changed following in-person evaluation. METHODS: We reviewed virtual and in-person clinical encounters from our academic health system's 10 interventional spine specialists. We included patients who were seen exclusively via telemedicine encounters and indicated for an interventional procedure with documented procedural plans. Virtual plans were then compared with the actual procedures performed following in-person evaluation. Demographic data as well as the type and extent of physical examination performed by the interventional spine specialist were also recorded. RESULTS: Of the 87 new patients included, the mean age was 60 years (SE 1.4 years) and the preprocedural plan established by telemedicine, primarily videoconferencing, did not change for 76 individuals (87%; 95% CI 0.79 to 0.94) following in-person evaluation. Based on the size of our sample, interventional procedures indicated solely during telemedicine encounters may be accurate in 79%-94% of cases in the broader population. CONCLUSIONS: Our findings suggest that telemedicine evaluations are a generally accurate means of preprocedural assessment and development of interventional spine procedure plans. These findings clearly demonstrate the capabilities of telemedicine for evaluating spine patients and planning interventional spine procedures.


Subject(s)
COVID-19 , Preoperative Care/methods , Spinal Diseases/surgery , Spine/surgery , Telemedicine , Humans , Middle Aged , Pandemics , SARS-CoV-2
8.
J Vasc Access ; : 11297298211000881, 2021 Mar 16.
Article in English | MEDLINE | ID: covidwho-1138507

ABSTRACT

Patients with end-stage kidney disease are at increased risk of death from coronavirus disease 2019 (COVID-19). In addition, severe COVID-19 has been associated with an increased risk of arterial and venous thromboses. In this report, we describe the case of a hemodialysis patient who developed an otherwise-unexplained thrombosis of an arteriovenous fistula during a symptomatic COVID-19 infection. Despite prompt treatment with three technically successful thrombectomies along with systemic intravenous heparin and two rounds of catheter-directed thrombolysis with tissue plasminogen activator, the fistula rapidly re-thrombosed each time and he required tunneled dialysis catheter placement. He subsequently required admission for hypoxemia from COVID-19 pneumonia and ultimately developed a catheter-related blood stream infection that likely contributed to his death. As the fistula had been previously well functioning and no angiographic explanation for the thrombosis was found, we speculate in this case the recurrent thromboses were related to the hypercoagulable state characteristic of severe COVID-19. Interventionalists performing hemodialysis access procedures should be aware of the prothrombotic state associated with COVID-19 and should consider it when deliberating how to best plan and approach access interventions in patients with symptomatic COVID-19.

9.
Front Public Health ; 8: 590096, 2020.
Article in English | MEDLINE | ID: covidwho-1090392

ABSTRACT

Following the outbreak of COVID-19, multidisciplinary research focusing on the long-term effects of the COVID-19 infection and the complete recovery is still scarce. With regards to long-term consequences, biomarkers of physiological effects as well as the psychological experiences are of significant importance for comprehensively understanding the complete COVID-19 recovery. The present research surveys the IgG antibody titers and the impact of COVID-19 as a traumatic experience in the aftermath of the active infection period, around 2 months after diagnosis, in a subset of COVID-19 patients from the first wave (March-April 2020) of the outbreak in Northern Cyprus. Associations of antibody titers and psychological survey measures with baseline characteristics and disease severity were explored, and correlations among various measures were evaluated. Of the 47 serology tests conducted for presence of IgG antibodies, 39 (83%) were positive. We identified trends demonstrating individuals experiencing severe or critical COVID-19 disease and/or those with comorbidities are more heavily impacted both physiologically and mentally, with higher IgG titers and negative psychological experience compared to those with milder disease and without comorbidities. We also observed that more than half of the COVID-19 cases had negative psychological experiences, being subjected to discrimination and verbal harassment/insult, by family/friends. In summary, as the first study co-evaluating immune response together with mental status in COVID-19, our findings suggest that further multidisciplinary research in larger sample populations as well as community intervention plans are needed to holistically address the physiological and psychological effects of COVID-19 among the cases.


Subject(s)
Antibodies, Viral/blood , COVID-19 Serological Testing , COVID-19/immunology , Immunoglobulin G/blood , SARS-CoV-2/immunology , Adolescent , Adult , Biomarkers/blood , COVID-19/psychology , Cyprus , Female , Follow-Up Studies , Humans , Male , Middle Aged , Psychological Tests
10.
BMJ Open Qual ; 10(1)2021 02.
Article in English | MEDLINE | ID: covidwho-1084233

ABSTRACT

Effective communication between members of the multidisciplinary team is imperative for patient safety. Within the Medicine for the Elderly wards at Royal Victoria Hospital (RVH) in Dundee, we identified an inefficient process of information-sharing between the orthopaedics outpatient department (OPD) at the main teaching hospital and our hospital's rehabilitation teams, and sought to improve this by introducing several changes to the work system. Our aim was for all patients who attended the OPD clinic to have a plan communicated to the RVH team within 24 hours.Before our intervention, clinic letters containing important instructions for ongoing rehabilitation were dictated by the OPD team, transcribed and uploaded to an electronic system before the RVH team could access them. We analysed clinic attendances over a 4-week period and found that it took 15 days on average for letters to be shared with the RVH teams. We worked with both teams to develop a clinical communication tool and new processes, aiming to expedite the sharing of key information. Patients attended the OPD with this form, the clinician completed it at the time of their appointment and the form returned with the patient to RVH on the same day.We completed multiple Plan-Do-Study-Act cycles; before our project was curtailed by the COVID-19 pandemic. During our study period, seven patients attended the OPD with a form, with all seven returning to RVH with a completed treatment plan documented by the OPD clinician. This allowed rehabilitation teams to have access to clinic instructions generated by orthopaedic surgeons almost immediately after a patient attended the clinic, essentially eliminating the delay in information-sharing.The introduction of a simple communication tool and processes to ensure reliable transfer of information can expedite information-sharing between secondary care teams and can potentially reduce delays in rehabilitation.


Subject(s)
COVID-19/rehabilitation , Health Services for the Aged/standards , Patient Care Team/standards , Quality Improvement , Secondary Care/standards , Aged , Aged, 80 and over , Communication , Female , Humans , Interprofessional Relations , Male , SARS-CoV-2 , Secondary Care/methods
11.
J Am Pharm Assoc (2003) ; 61(4S): S7-S11, 2021.
Article in English | MEDLINE | ID: covidwho-1074795

ABSTRACT

The purpose of this commentary is to describe the Johns Hopkins Home Care Group's (JHHCG) Community-based Pharmacy Residency Medication Therapy Management (MTM) rotation, summarize adjustments made to the rotation after the onset of the coronavirus disease 2019 (COVID-19) pandemic, describe key learnings from the adjustments, and provide a call to action for other residency programs seeking to improve their rotations amidst pandemic restrictions. MTM clinical pharmacists at JHHCG collaborate with patients to identify barriers to adherence, review medications, and develop plans for improvement. Through improved medication adherence, the goals for this program are to reduce adverse effects, patient cost, and medical visits or hospital admissions. Central to this practice is the belief that strong patient relationships are necessary to uncover the root cause of medication nonadherence. In Postgraduate Year-1 (PGY-1) community-based pharmacy residency training, new pharmacists learn the value of building relationships with patients and working through complex problems during this clinical experience. By assisting patients with complex medical conditions and social situations, new pharmacists gain skills in patient care, pharmacy operations, and medication access challenges. As the COVID-19 pandemic forced the discontinuation of face-to-face interactions in this setting, rotation experiences for residents were adapted with the goal of continuing high-impact patient interactions and keeping everyone involved safe. Although considerable changes were made to the MTM rotation because of the COVID-19 pandemic, residents were still able to provide meaningful clinical care telephonically and continued to learn valuable patient care skills. Most importantly, high quality care was still delivered to the patients despite considerable challenges. The major challenge for the residents' clinical experiences as a result of the adjustments has been finding an impactful volume of complex patients to enhance their skills. Other residency programs are encouraged to consider three recommendations to improve their rotations moving forward.


Subject(s)
COVID-19 , Internship and Residency , Humans , Medication Therapy Management , Pandemics , Pharmacists , SARS-CoV-2
12.
Pituitary ; 24(2): 143-145, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1074463

ABSTRACT

PURPOSE: Side effects of the coronavirus disease 2019 (COVID-19) vaccines include pain at the injection site, fatigue, headache, myalgias, arthralgias, chills, and fever, all of which can be early indicators of an increased need for glucocorticoid replacement in patients with adrenal insufficiency. The Pituitary Society surveyed its membership to understand planned approaches to glucocorticoid management in patients with adrenal insufficiency who will receive a COVID-19 vaccine. METHODS: Members were asked to complete up to 3 questions regarding their planned approach for use of glucocorticoid replacement in patients with proven adrenal insufficiency. RESULTS: Surveys were sent to 273 members and 103 responded. Thirty-six percent plan to recommend that patients automatically increase glucocorticoid dosage with administration of the first vaccine injection. Of these, 84% plan to increase glucocorticoid dose on the day of vaccination, and 49% plan to increase glucocorticoid dose prior to vaccination. Of the 64% who do not plan to recommend automatic glucocorticoid dose increase with vaccine administration, 88% plan to increase the dose if the patient develops a fever, and 47% plan to increase the dose if myalgias and arthralgias occur. CONCLUSIONS: Most clinicians plan to maintain the current glucocorticoid dose with vaccine administration. The vast majority plan and to increase glucocorticoid dose in case of fever, and just under half in case of arthralgias and myalgias. These survey results offer suggested management guidance for glucocorticoid management in patients with adrenal insufficiency.


Subject(s)
Adrenal Insufficiency/drug therapy , COVID-19 Vaccines/therapeutic use , COVID-19/prevention & control , Glucocorticoids/therapeutic use , Adrenal Insufficiency/epidemiology , Adrenal Insufficiency/pathology , COVID-19/epidemiology , COVID-19/immunology , COVID-19 Vaccines/adverse effects , Dexamethasone/adverse effects , Dexamethasone/therapeutic use , Endocrinology/organization & administration , Endocrinology/standards , Humans , Hypothalamo-Hypophyseal System/drug effects , Pandemics , Pituitary Diseases/therapy , Pituitary-Adrenal System/drug effects , Practice Patterns, Physicians'/standards , SARS-CoV-2/immunology , Societies, Medical , Surveys and Questionnaires
13.
Expert Opin Investig Drugs ; 30(2): 111-117, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1066124

ABSTRACT

Introduction: The COVID-19 pandemic has prompted researchers to conduct non-randomized studies in an effort to find an off-label drug that can effectively combat the virus and its effects. While these studies can expedite the drug approval process, researchers must carefully design and analyze such studies in order to perform rigorous science that is reproducible and credible. This article focuses on several key design and analysis considerations that can improve the scientific rigor of non-randomized studies of off-label drugs. Areas covered: The aim of this article is to provide an overview of best approaches that should be considered for non-randomized studies on off-label drugs. We discuss these approaches in detail and use a non-randomized study by Rivera et al. in Cancer Discovery as an example of methods that have been undertaken for COVID-19. Expert opinion: While non-randomized studies are inherently biased, they may be unavoidable in situations such as the COVID-19 pandemic, where researchers need to find an effective treatment quickly. We believe that a well-formed experimental design, high-quality data collection, and a well-thought-out statistical and data analysis plan are sufficient to produce rigorous and credible results for making an optimal decision.


Subject(s)
COVID-19/drug therapy , Clinical Trials as Topic/methods , Hydroxychloroquine/therapeutic use , Pandemics , Research Design , Data Interpretation, Statistical , Humans , Off-Label Use , Propensity Score , Sensitivity and Specificity , Treatment Outcome
14.
BMJ Open Respir Res ; 8(1)2021 01.
Article in English | MEDLINE | ID: covidwho-1015697

ABSTRACT

INTRODUCTION: The COVID-19 pandemic has impacted specialty chronic obstructive pulmonary disease (COPD) care. We examined the degree to which care has moved to remote approaches, eliciting clinician and patient perspectives on what is appropriate for ongoing remote delivery. METHODS: Using an online research platform, we conducted a survey and consensus-building process involving clinicians and patients with COPD. RESULTS: Fifty-five clinicians and 19 patients responded. The majority of clinicians felt able to assess symptom severity (n=52, 95%), reinforce smoking cessation (n=46, 84%) and signpost to other healthcare resources (n=44, 80%). Patients reported that assessing COPD severity and starting new medications were being addressed through remote care. Forty-three and 31 respondents participated in the first and second consensus-building rounds, respectively. When asked to rate the appropriateness of using remote delivery for specific care activities, respondents reached consensus on 5 of 14 items: collecting information about COPD and overall health status (77%), providing COPD education and developing a self-management plan (74%), reinforcing smoking cessation (81%), deciding whether patients should seek in-person care (72%) and initiating a rescue pack (76%). CONCLUSION: Adoption of remote care delivery appears high, with many care activities partially or completely delivered remotely. Our work identifies strengths and limitations of remote care delivery.


Subject(s)
Attitude of Health Personnel , Patient Education as Topic , Practice Patterns, Physicians' , Pulmonary Disease, Chronic Obstructive/therapy , Self-Management , Smoking Cessation , Telemedicine/methods , Adult , Aged , Attitude to Health , COVID-19 , Delivery of Health Care/methods , Female , Humans , Male , Middle Aged , Nurses , Patient Acceptance of Health Care , Physical Therapists , Physicians , Practice Patterns, Nurses' , Pulmonary Disease, Chronic Obstructive/physiopathology , SARS-CoV-2 , Severity of Illness Index , Surveys and Questionnaires , United Kingdom
15.
Plast Reconstr Surg Glob Open ; 8(11): e3320, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-969485

ABSTRACT

The COVID-19 global pandemic has impacted plastic surgery training in the United States, requiring unprecedented measures to prepare for potential surges in critically ill patients. This study investigates how plastic surgery programs responded to this crisis, as well as how successful these changes were, through a survey of program directors and of residents at academic training programs in the United States. METHODS: Two separate anonymous online surveys were conducted via REDCap between April 16 and June 4, 2020. The first survey was distributed to program directors, and the second was distributed to plastic surgery residents. Resident responses were then subdivided for an analysis between geographic regions. RESULTS: Of the 59 program director responses (43.7%), the majority of programs implemented a platoon approach for resident coverage. A minority did the same for attending coverage. In total, 92% transitioned to virtual didactics only. Plastic surgery residents covered alternative services at 25% of responding institutions, and an additional 68% had a plan in place for responding to personnel shortages. Overall, residents were satisfied with their program's response in a variety of categories. When subdivided based on geographic region, respondents in the Northeast and Northwest were less satisfied with resident wellness, personal and loved ones' safety, and program communication. CONCLUSIONS: With the possibility of a "second wave," successful methods of academic programs adapting to the pandemic should be communicated to reduce the future impact. Increased frequency of communications between program directors and residents can improve mental health and wellness of the resident population.

16.
Surg Innov ; 28(1): 123-133, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-835741

ABSTRACT

It is inevitable that some patients with suspected or confirmed COVID-19 may require urgent surgical procedures. The objective of this review was to discuss the modifications required in the operating room during COVID-19 times for minimal access, laparoscopy, and robotic surgery, especially with regard to minimally invasive surgical instruments, buffalo filter, trocars with smoke evacuator, and special personal protection equipment. We have discussed the safety measures to be followed for the suspected or confirmed COVID-19 patient. In addition to surgical patients, health care workers should also protect themselves by following the guidelines and recommendations while treating these patients. Although there is little evidence of viral transmission through laparoscopic or open approaches, we recommend modifications to surgical practice such as the use of safe smoke evacuation and minimizing energy device use to reduce the risk of exposure to aerosolized particles to the health care team. Therefore, hospitals must follow specific protocols and arrange suitable training of the health care workers. Following well-established plans to accomplish un-deferrable surgeries in COVID-19-positive patients is strongly recommended.


Subject(s)
COVID-19/epidemiology , COVID-19/prevention & control , Infection Control/organization & administration , Laparoscopy , Robotic Surgical Procedures , COVID-19/transmission , Humans , Perioperative Care
17.
West J Emerg Med ; 21(5): 1059-1066, 2020 Aug 17.
Article in English | MEDLINE | ID: covidwho-793477

ABSTRACT

At the heart of the unparalleled crisis of COVID-19, healthcare workers (HCWs) face several challenges treating patients with COVID-19: reducing the spread of infection; developing suitable short-term strategies; and formulating long-term plans. The psychological burden and overall wellness of HCWs has received heightened awareness in news and research publications. The purpose of this study was to provide a review on current publications measuring the effects of COVID-19 on wellness of healthcare providers to inform interventional strategies. Between April 6-May 17, 2020, we conducted systematic searches using combinations of these keywords and synonyms in conjunction with the controlled vocabulary of the database: "physician," "wellness, "wellbeing," "stress," "burnout," "COVID-19," and "SARS-CoV-2." We excluded articles without original data, research studies regarding the wellness of non-healthcare occupations or the general public exclusively, other outbreaks, or wellness as an epidemic. A total of 37 studies were included in this review. The review of literature revealed consistent reports of stress, anxiety, and depressive symptoms in HCWs as a result of COVID-19. We describe published data on HCW distress and burnout but urge future research on strategies to enhance HCW well-being.


Subject(s)
Anxiety/etiology , Betacoronavirus , Burnout, Professional/etiology , Coronavirus Infections , Depression/etiology , Health Personnel/psychology , Pandemics , Pneumonia, Viral , Sleep Wake Disorders/etiology , Anxiety/epidemiology , Anxiety/prevention & control , Anxiety/psychology , Burnout, Professional/epidemiology , Burnout, Professional/prevention & control , Burnout, Professional/psychology , COVID-19 , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Cost of Illness , Depression/epidemiology , Depression/prevention & control , Depression/psychology , Global Health/statistics & numerical data , Humans , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Risk Factors , SARS-CoV-2 , Sleep Wake Disorders/epidemiology , Sleep Wake Disorders/prevention & control , Sleep Wake Disorders/psychology
18.
J Clin Nurs ; 29(21-22): 4270-4280, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-719388

ABSTRACT

AIM AND OBJECTIVE: To explore nurses' experiences regarding shift patterns while providing front-line care for COVID-19 patients in isolation wards of hospitals in Shanghai and Wuhan during the novel coronavirus pandemic. Our findings will help to optimise shift work scheduling, use the existing nursing workforce more efficiently and improve nursing quality. BACKGROUND: Nurses are one of the main professionals fighting against COVID-19. Providing care for COVID-19 patients is challenging. In isolation wards, the workload has increased, and the workflow and shift patterns are completely different from the usual. More importantly, there is a shortage of nurses. Therefore, it is essential and urgent to arrange nurses' shifts correctly and use the existing workforce resources efficiently. DESIGN: A qualitative descriptive study of 14 nurses in Chinese hospitals was conducted. METHODS: Semi-structured interviews were used based on the phenomenological research method; data were analysed using Colaizzi's method of data analysis. This study aligns with the COREQ checklist. RESULTS: Four themes were extracted: assess the competency of nurses to assign nursing work scientifically and reasonably, reorganise nursing workflow to optimise shift patterns, communicate between managers and front-line nurses to humanise shift patterns, and nurses' various feelings and views on shift patterns. CONCLUSION: It is necessary to arrange shift patterns scientifically and allocate workforce rationally to optimise nursing workforce allocation, reduce nurses' workload, improve nursing quality and promote physical and mental health among nurses during the COVID-19 pandemic. RELEVANCE TO CLINICAL PRACTICE: This study emphasised nurses' experiences on shift patterns in isolation wards, providing useful information to manage shift patterns. Nursing managers should arrange shifts scientifically, allocate nursing workforce rationally, formulate emergency plans and establish emergency response rosters during the COVID-19 pandemic.


Subject(s)
COVID-19/nursing , Nursing Staff, Hospital/organization & administration , Personnel Staffing and Scheduling/organization & administration , Workflow , Adult , China , Female , Humans , Middle Aged , Pandemics , Qualitative Research , SARS-CoV-2 , Workload/psychology
19.
Ann Thorac Med ; 15(3): 107-117, 2020.
Article in English | MEDLINE | ID: covidwho-679546

ABSTRACT

With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.

20.
Cancer Med ; 9(17): 6082-6092, 2020 09.
Article in English | MEDLINE | ID: covidwho-656022

ABSTRACT

During the first quarter of 2020 the world is experiencing a pandemic of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), a novel beta coronavirus that is responsible for the 2019 novel coronavirus disease (COVID-19). The COVID-19 pandemic revealed that healthcare systems around the world were not prepared to deal with either the direct effects of the pandemic or with the indirect effects that are imposed on the health of patients with chronic disorders such as cancer patients. Some challenges and dilemmas currently faced during the pandemic include the management of cancer patients during the treatment and follow-up phases, the assessment of the safety of treatments currently used for the management of SARS-CoV-2 for use in cancer patients, the development of psychoeducation and emotional support for cancer patients and the safe conduct of clinical trials involving participation of cancer patients. Evidence from the literature supports the need for the urgent development of a holistic contingency plan which will include clear guidelines for the protection and comprehensive care of cancer patients. The implementation of such a plan is expected to have many beneficial effects by mainly minimizing the increased morbidity and mortality of cancer patients that could result as an adverse consequence of the COVID-19 or future pandemics.


Subject(s)
COVID-19 , Holistic Health , Neoplasms/psychology , Neoplasms/therapy , COVID-19/therapy , Child , Clinical Trials as Topic , Health Services Accessibility , Humans , Person-Centered Psychotherapy , Social Support , Stem Cell Transplantation , Stress, Psychological
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