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1.
S Afr Med J ; 110(2): 140-144, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657686

RESUMO

BACKGROUND: Anaesthesia-related mortality is an important, potentially avoidable cause of perioperative mortality. A procedure-related death notification (PRDN) instrument is completed by relevant medical practitioners after a procedure-related death and is used to audit practice and identify areas of care that require improvement. It is also used in medicolegal investigations when establishing cause of death, and in the case of litigation. The current South African (SA) PRDN instrument, designated the GW7/24 form, contains both surgical and anaesthetic sections and is considered to be outdated, inadequate and in need of revision. OBJECTIVES: To develop and validate a revised anaesthetic section of the SA PRDN instrument that can be used for procedure-related deaths in future and be used to update the GW7/24 form for epidemiological, forensic or academic use. METHODS: Lynn's two-stage model was utilised. After an extensive literature review, a provisional PRDN instrument was developed. This provisional instrument was debated and reviewed at a peer group discussion in which 6 local experts took part. These experts were anaesthetic and forensic pathology specialists who specifically have expert knowledge on procedure-related deaths. A revised PRDN instrument was developed, which was then rated by 8 national experts using a Likert scale. The content validity index (CVI) for each item and for the instrument as a whole was then established. Items with a CVI <0.88 were removed to formulate the final PRDN instrument. RESULTS: The provisional PRDN instrument consisted of 14 domains and 66 items. The revised PRDN instrument consisted of 13 domains and 65 items, of which 3 items with a CVI <0.88 were removed. The final PRDN instrument, after minor revisions based on suggestions from the 8 national experts, consisted of 18 domains and 79 items. Every item on the form was declared relevant and important by the national experts, with the final instrument scoring an overall CVI of 1. CONCLUSIONS: A comprehensive, updated and validated anaesthetic section of the SA PRDN instrument was developed. This could be used as a government and anaesthesiology society-endorsed template when updating the current GW7/24 form.


Assuntos
Anestesia/mortalidade , Causas de Morte , Morte , Documentação/métodos , Documentação/normas , Humanos , Reprodutibilidade dos Testes , África do Sul
2.
Ophthalmol Retina ; 4(6): 640-641, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32507277
5.
Psychol Trauma ; 12(5): 518-520, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32551758

RESUMO

It is estimated that more than 300,000 people have died because of COVID-19 globally. The vast majority of documented deaths have occurred within hospitals, leading to psychological impacts on both family members and health care workers. This paper describes the actions (online death notification education, remote crisis intervention, and support for health care professionals) taken at a hospital in Mexico to address the psychological impacts of the notification of a COVID-19-related death on both the deceased's relatives and the health care personnel involved. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus , Intervenção na Crise , Morte , Família , Serviços de Saúde Mental , Pandemias , Recursos Humanos em Hospital , Pneumonia Viral , Relações Profissional-Família , Apoio Social , Telemedicina , Humanos , México , Recursos Humanos em Hospital/educação , Recursos Humanos em Hospital/psicologia
6.
Hastings Cent Rep ; 50(3): 13-15, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32596910

RESUMO

I had been on the phone with Madeleine's mother for fifteen minutes, and she had sobbed throughout. She pleaded with me, "You won't even let our family visit her together. If you really want to help my daughter, you will let us stay with her." Madeleine, who was twenty-four years old, was dying of end-stage acute myeloid leukemia and was intubated in one of our intensive care units. Her intensivist had requested a clinical ethics consultation for potentially inappropriate medical treatment-in my world of clinical ethics consultation, routine stuff. Except that, in March 2020, nothing was routine anymore. The Covid-19 pandemic calls for creative thinking about ad hoc and post hoc bereavement efforts, and it may result in efforts to revise existing accounts of what constitutes a good death in order to accommodate patients' and families' experiences at the end of life during a pandemic.


Assuntos
Luto , Infecções por Coronavirus/epidemiologia , Morte , Família/psicologia , Pneumonia Viral/epidemiologia , Betacoronavirus , Consultoria Ética , Humanos , Pandemias
7.
Artigo em Alemão | MEDLINE | ID: mdl-32434264

RESUMO

Conversations about death, dying and the end of life are usually difficult. They can turn out to be both a burden and a challenge for those engaging in these talks. There is evidence that talking early about end-of-life-topics shows positive effects concerning medical and psychological conditions of patients. Open communication addressing these topics can be part of family- and patient-centered talks in an intensive care department, known as a quality indicator of intensive care medicine. Further, these conversations are important and necessary in palliative care for providing a "good death". Nevertheless, these conversations are delayed or do not take place due to communication barriers of doctors, patients and caregivers. Barriers to end of life communication of physicians contain individual, personal or role-specific factors, lack of medical knowledge, including insecurities of prognosis, professional attitudes, clinical routines and the worry of harming patients with these talks. Regarding barriers to communication of patients and their family members, it could be differentiated between emotional, cognitive, relationship-related and external factors. It could be valuable to recognize these barriers to increase the possibility of end of life conversations in the near future.In daily medical routine end of life topics should be addressed early and actively. Especially the readiness for these conversations should be tested repeatedly and talks should be offered regularly. Critical events such as relapse, modulating therapy concepts and knowledge of unrealistic treatment expectations should be regarded as prompts to offer conversations about dying and end-of-life care actively.


Assuntos
Comunicação , Morte , Médicos , Assistência Terminal , Cuidadores , Humanos , Cuidados Paliativos
9.
Artigo em Inglês | MEDLINE | ID: mdl-32384598

RESUMO

How to overcome informational conformity consumer behavior when faced with threats of death is a social problem in response to COVID-19. This research is based on the terror management theory, the need to belong theory and the materialism theory. It uses a theoretical model to determine the relationships between threats of death and informational conformity consumer behavior. From 1453 samples collected during outbreak of COVID-19 in China, we used a structural equation model to test multiple research hypotheses. The result shows that threats of death are positively associated with a need to belong, materialism and informational conformity consumer behavior. The need to belong and materialism can play a mediating role between threats of death and information conformity consumption behavior, and perceived social support can play a moderating role between threats of death and information conformity consumption behavior.


Assuntos
Comércio , Comportamento do Consumidor , Infecções por Coronavirus , Comportamento de Busca de Informação , Pneumonia Viral , Conformidade Social , Apoio Social , Adulto , Atitude Frente a Morte , Betacoronavirus , China/epidemiologia , Comportamento do Consumidor/economia , Comportamento do Consumidor/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Morte , Feminino , Humanos , Controle Interno-Externo , Masculino , Modelos Teóricos , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Inquéritos e Questionários
11.
BMJ ; 369: m1501, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434791

RESUMO

OBJECTIVE: To provide an overview and critical appraisal of early warning scores for adult hospital patients. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, PsycInfo, and Embase until June 2019. ELIGIBILITY CRITERIA FOR STUDY SELECTION: Studies describing the development or external validation of an early warning score for adult hospital inpatients. RESULTS: 13 171 references were screened and 95 articles were included in the review. 11 studies were development only, 23 were development and external validation, and 61 were external validation only. Most early warning scores were developed for use in the United States (n=13/34, 38%) and the United Kingdom (n=10/34, 29%). Death was the most frequent prediction outcome for development studies (n=10/23, 44%) and validation studies (n=66/84, 79%), with different time horizons (the most frequent was 24 hours). The most common predictors were respiratory rate (n=30/34, 88%), heart rate (n=28/34, 83%), oxygen saturation, temperature, and systolic blood pressure (all n=24/34, 71%). Age (n=13/34, 38%) and sex (n=3/34, 9%) were less frequently included. Key details of the analysis populations were often not reported in development studies (n=12/29, 41%) or validation studies (n=33/84, 39%). Small sample sizes and insufficient numbers of event patients were common in model development and external validation studies. Missing data were often discarded, with just one study using multiple imputation. Only nine of the early warning scores that were developed were presented in sufficient detail to allow individualised risk prediction. Internal validation was carried out in 19 studies, but recommended approaches such as bootstrapping or cross validation were rarely used (n=4/19, 22%). Model performance was frequently assessed using discrimination (development n=18/22, 82%; validation n=69/84, 82%), while calibration was seldom assessed (validation n=13/84, 15%). All included studies were rated at high risk of bias. CONCLUSIONS: Early warning scores are widely used prediction models that are often mandated in daily clinical practice to identify early clinical deterioration in hospital patients. However, many early warning scores in clinical use were found to have methodological weaknesses. Early warning scores might not perform as well as expected and therefore they could have a detrimental effect on patient care. Future work should focus on following recommended approaches for developing and evaluating early warning scores, and investigating the impact and safety of using these scores in clinical practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017053324.


Assuntos
Cuidados Críticos/métodos , Hospitais/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Adulto , Idoso , Pressão Sanguínea , Deterioração Clínica , Cuidados Críticos/estatística & dados numéricos , Morte , Escore de Alerta Precoce , Feminino , Parada Cardíaca/epidemiologia , Frequência Cardíaca/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Oxiemoglobinas/metabolismo , Prognóstico , Taxa Respiratória/fisiologia , Temperatura , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
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