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1.
Assist Inferm Ric ; 39(2): 66-108, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-32686776

RESUMO

. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.


Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Infecções por Coronavirus , Enfermeiras e Enfermeiros/psicologia , Pandemias , Pneumonia Viral , Tomada de Decisão Clínica , Emergências , Administração Hospitalar , Humanos , Itália , Solidão , Enfermagem/métodos , Enfermagem/organização & administração , Equipe de Enfermagem , Isolamento de Pacientes
2.
Ann Agric Environ Med ; 27(2): 201-206, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32588593

RESUMO

INTRODUCTION: The article describes the process of converting a large multi-specialized hospital into one dedicated to COVID-19 patients, and present established standards of work organization in all the wards and training system of the medical and supporting staff. The several weeks pandemic of the COVID-19 disease has forced the healthcare systems of numerous countries to adjust their resources to the care of the growing number of COVID-19 patients. Managers were presented with the challenge of protecting the healthcare workers from transmission of the disease within medical institutions, and issues concerning the physical and psychological depletion of personnel. MATERIAL AND METHODS: Based on analyses of the structure and work processes in Central Clinical Hospital (CCH) reconstructive strategic plan was developed. It included: division of existing wards into observation and isolation wards; installing locks; weekly plan for supplying personal protection equipment (PPE); designating new access to the hospital and communication routes; training of medical and supporting staff. The plan was implemented from the first days of conversion of the hospital. RESULTS: The wards of the CCH were converted for observation and isolation, and each one was fitted with sanitary locks. There was a big improvement in the supply of PPE for the medical staff. Separation of the 'dirty' and 'clean' parts of the CCH were attained, and widespread intensive training not only protected personnel against infections, but also diminished unrest which was discernable at the beginning of conversion. CONCLUSIONS: The transformation efforts will ultimately be appraised at the end of the epidemic, but the data looks encouraging. Two weeks after conversion, the testing of hospital Staff was started and by the end of April, 459 tests were had been conducted, of which only 11 were positive.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Administração Hospitalar , Hospitais Especializados/organização & administração , Controle de Infecções/métodos , Pneumonia Viral/terapia , Pessoal de Saúde , Humanos , Pandemias , Equipamento de Proteção Individual , Polônia
4.
MEDICC Rev ; 22(2): 69-71, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32478713

RESUMO

Speaking remotely with US graduates of Havana's Latin American School of Medicine (ELAM), I found them at work on hospital floors, in ICUs and health centers across the United States, putting their professional and personal commitment to the test against COVID-19. Nowhere was that more evident than in New York City, the disease's epicenter, where one grad told me virtually every hospital has at least one MD from the Cuban school, which has provided free 6-year medical training for some 30,000 doctors since the school's founding in 1999. The student body comes primarily from low- and middle-income countries worldwide, but Cuba also provided 200 US students with scholarships. One of them is Dr Joaquín Morante (ELAM Class of 2012), who did his medical residency in internal medicine, followed by fellowships in pulmonary disease and critical care medicine. Triple-licensed in internal medicine, pulmonary and critical care medicine, he is now an attending physician on staff at Jacobi Medical Center in The Bronx, one of New York City's public hospitals, and considered a 'hot spot' due to its COVID-19 caseload. I spoke with him during a break at home in mid-April.Dr Joaquín Morante, ELAM Class of 2012: Pulmonologist, critical care attending physician at Jacobi Medical Center, New York City.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Médicos , Pneumonia Viral/epidemiologia , Cuba , Administração Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Masculino , Cidade de Nova Iorque/epidemiologia , Pandemias , Roupa de Proteção/provisão & distribução , Ventiladores Mecânicos/provisão & distribução
5.
Indian J Public Health ; 64(Supplement): S240-S242, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32496265

RESUMO

The response to the first health worker case in India and novel strategies adopted in the context of evolving pandemic of COVID-19 is presented here. On the same day of confirmation, institutional COVID cell was established, and contact tracing was started. A total of 184 contacts were identified and quarantined. Hospital services were scaled down, and responsibilities were reassigned. In-house digital platforms were used for daily meetings, contact tracing, line listing, risk stratification, and research. Reverse transcription polymerase chain reaction-based severe acute respiratory syndrome-CoV2 testing facility was established in the institute. All high-risk contacts were given hydroxychloroquine prophylaxis. No secondary cases were found. Hospital preparedness, participatory decision-making through institutional COVID cell, optimal use of in-house digital platforms, and coordination with the state health department and national bodies, including Indian Council of Medical Research, were the supporting factors. Rapidly evolving guidelines, trepidation about the disease, logistic delays, and lack of support systems for people under quarantine were the challenges in the containment exercise.


Assuntos
Infecções por Coronavirus/prevenção & controle , Administração Hospitalar , Controle de Infecções/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Busca de Comunicante/métodos , Humanos , Quarentena/métodos
7.
Infez Med ; 28(suppl 1): 64-70, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32532941

RESUMO

Preparing for emerging respiratory pathogens is a fundamental requirement for enhancements of the safeguard in healthcare settings. We are facing an increasing pressure to be prepared more than before. Healthcare organizations should be ready to deal with such emerging infectious disease. Here, we share some points that are essential to be considered while we prepare our institutions to prevent the transmission of emerging respiratory pathogens such as MERS-CoV and the recently emerging pandemic of SARS-CoV-2, the causative agent of COVID-19.


Assuntos
Betacoronavirus , Defesa Civil/métodos , Doenças Transmissíveis Emergentes/prevenção & controle , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Coronavírus da Síndrome Respiratória do Oriente Médio , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Vírus da SARS , Síndrome Respiratória Aguda Grave/prevenção & controle , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Fidelidade a Diretrizes , Administração Hospitalar , Humanos , Comunicação Interdisciplinar , Isolamento de Pacientes , Recursos Humanos em Hospital/educação , Pneumonia Viral/diagnóstico , Pneumonia Viral/virologia , Equipamentos de Proteção , Arábia Saudita , Síndrome Respiratória Aguda Grave/epidemiologia , Avaliação de Sintomas , Triagem
9.
Artigo em Inglês | MEDLINE | ID: mdl-32481547

RESUMO

This paper describes the evolving role of robotics in healthcare and allied areas with special concerns relating to the management and control of the spread of the novel coronavirus disease 2019 (COVID-19). The prime utilization of such robots is to minimize person-to-person contact and to ensure cleaning, sterilization and support in hospitals and similar facilities such as quarantine. This will result in minimizing the life threat to medical staff and doctors taking an active role in the management of theCOVID-19 pandemic. The intention of the present research is to highlight the importance of medical robotics in general and then to connect its utilization with the perspective of COVID-19 management so that the hospital management can direct themselves to maximize the use of medical robots for various medical procedures. This is despite the popularity of telemedicine, which is also effective in similar situations. In essence, the recent achievement of the Korean and Chinese health sectors in obtaining active control of the COVID-19 pandemic was not possible without the use of state of the art medical technology.


Assuntos
Infecções por Coronavirus/epidemiologia , Assistência à Saúde/métodos , Administração Hospitalar , Controle de Infecções/métodos , Pneumonia Viral/epidemiologia , Robótica/métodos , Betacoronavirus , Humanos , Pandemias , Telemedicina
10.
Rev Esp Salud Publica ; 942020 Jun 16.
Artigo em Espanhol | MEDLINE | ID: mdl-32541647

RESUMO

OBJECTIVE: Decision making in hospitals, and especially in their own healthcare services, is hardly referenced in the literature. During the pandemic period, healthcare services have put in place contingency plans to minimize the consequences of the coronavirus on professionals and patients. However, the deployment of contingency plans and results are hardly shared, depriving other services of references to refute, compare or emulate the aforementioned plans. The objective of this work was the description of the implementation and evaluation of Contingency Plans in the Covid-19 pandemic in a unit of inflammatory bowel disease of a Digestive Service in the Sanitary Area of Pontevedra and O Salnés. METHODS: A team of managers and professionals adapted the 10 measures recommended by Deloitte to face a pandemic to the healthcare environment. The measures were then formulated as a checklist. From the Plan-Do-Check-Act improvement cycle, they were grouped into categories: risk management, organizational management and decision-making. Finally, an external team carried out a qualitative evaluation of the implementation of the contingency plan carried out. RESULTS: The Intestinal Inflammatory Disease Unit of the Digestive Service has obtained an assessment of compliance with the 10 recommended measures to confidently face a pandemic. CONCLUSIONS: Sharing the deployment of the contingency plan and its results is useful to identify good practices. This article shows a method to evaluate decision-making in pandemic situations. The outcomes faces the The Intestinal Inflammatory Disease Unit in an excelent position.


Assuntos
Infecções por Coronavirus/prevenção & controle , Administração Hospitalar , Departamentos Hospitalares/organização & administração , Doenças Inflamatórias Intestinais/terapia , Enteropatias/terapia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Betacoronavirus , Lista de Checagem , Infecções por Coronavirus/complicações , Tomada de Decisões , Assistência à Saúde , Planejamento em Desastres , Fidelidade a Diretrizes , Humanos , Doenças Inflamatórias Intestinais/complicações , Enteropatias/complicações , Pneumonia Viral/complicações , Avaliação de Programas e Projetos de Saúde , Saúde Pública , Gestão de Riscos , Espanha/epidemiologia
12.
Med Anthropol ; 39(5): 428-439, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32412308

RESUMO

By April 2020, COVID-19 lockdowns had restricted the movements of over half the world's population. As health authorities advise people living with chronic conditions to self-isolate because they are at particular risk of serious complications and death, the epidemiological split between communicable and noncommunicable disease is tenuous. We argue that much more is at stake for people living with (multiple) medical conditions than being "at risk" of infection of coronavirus. We emphasize the need to attend to the long-term effects of COVID-19, but also the importance of the continued care of people living with other lifelong medical conditions.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Doenças não Transmissíveis , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Doença Crônica , Infecções por Coronavirus/economia , Saúde Global , Administração Hospitalar , Hospitais , Humanos , Pandemias/economia , Pneumonia Viral/economia , Atenção Primária à Saúde , Quarentena , Fatores Socioeconômicos
13.
Am J Phys Med Rehabil ; 99(6): 453-458, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32433329

RESUMO

The coronavirus disease 2019 has and continues to overwhelm the medical establishment in New York City. It has moved faster and had rates of mortality higher than what were initially forecast. All departments within large hospital systems have had to learn lessons and adapt in real time to the crisis. We share our experience and what we have learned as it pertains to this pandemic and hope that it aides, guides, and influences other departments of physical medicine and rehabilitation regarding their potential roles and areas of growth during this time.


Assuntos
Infecções por Coronavirus/epidemiologia , Administração Hospitalar , Departamentos Hospitalares/organização & administração , Controle de Infecções/organização & administração , Medicina Física e Reabilitação , Pneumonia Viral/epidemiologia , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias
15.
J Emerg Manag ; 18(3): 261-266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32441042

RESUMO

BACKGROUND: While mass-casualty incidents (MCIs) may have competing absolute definitions, a universally ac-cepted criterion is one that strains locally available resources. In the fall of 2017, a MCI occurred in New York and Bellevue Hospital received multiple injured patients within minutes; lessons learned included the need for a formal-ized, efficient patient and injury tracking system. Our objective was to create an organized MCI clinical tracking form for civilian trauma centers. METHODS: After the MCI, the notes of the surgeon responsible for directing patient triage were analyzed. A suc-cinct, organized template was created that allows MCI directors to track demographics, injuries, interventions, and other important information for multiple patients in a real-time fashion. This tool was piloted during a subsequent MCI. RESULTS: In late 2018, the hospital received six patients following another MCI. They arrived within a 4-minute window, with 5 patients being critically injured. Two emergent surgeries and angioembolizations were performed. The tool was used by the MCI director to prioritize and expedite care. All physicians agreed that the tool assisted in orga-nizing diagnostic and therapeutic triage. CONCLUSIONS: During MCIs, a streamlined patient tracking template assists with information recall and communica-tion between providers and may allow for expedited care.


Assuntos
Serviços Médicos de Emergência , Incidentes com Feridos em Massa , Administração Hospitalar , Hospitais , Humanos , New York , Triagem
16.
Artigo em Inglês | MEDLINE | ID: mdl-32471066

RESUMO

The Coronavirus Disease (Covid-19) pandemic is rapidly spreading across the world, representing an unparalleled challenge for health care systems. There are differences in the estimated fatality rates, which cannot be explained easily. In Italy, the estimated case fatality rate was 12.7% in mid-April, while Germany remained at 1.8%. Moreover, it is to be noted that different areas of Italy have very different lethality rates. Due to the complexity of Covid-19 patient management, it is of paramount importance to develop a well-defined clinical workflow in order to avoid the inconsistent management of patients. The Integrated Care Pathway (ICP) represents a multidisciplinary outline of anticipated care to support patient management in the Sant'Andrea Hospital, Rome. The main objective of this pilot study was to develop a new ICP evaluated by care indicators, in order to improve the COVID-19 patient management. The suggested ICP was developed by a multi-professional team composed of different specialists and administrators already involved in clinical and management processes. After a review of current internal practices and published evidences, we identified (1) the activities performed during care delivery, (2) the responsibilities for these activities, (3) hospital structural adaptation needs and potential improvements, and (4) ICP indicators. The process map formed the basis of the final ICP document; 160 COVID-19 inpatients were considered, and the effect of the ICP implementation was evaluated over time during the exponential phase of the COVID-19 pandemic. In conclusion, a rapid adoption of ICP and regular audits of quality indicators for the management of COVID-19 patients might be important tools to improve the quality of care and outcomes.


Assuntos
Protocolos Clínicos/normas , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Administração Hospitalar , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus , Humanos , Itália/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Projetos Piloto , Qualidade da Assistência à Saúde/organização & administração , Fluxo de Trabalho
20.
Cardiovasc Intervent Radiol ; 43(6): 810-819, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32342164

RESUMO

BACKGROUND: The novel coronavirus 2019 (SARS-CoV-2) has caused wide dissemination across the world. Global health systems are facing the unprecedented challenges. Here we shared the experiences and lessons in emergency responses and management from our hospital, a government-assigned regional anti-Covid-19 general hospital in Nanjing, Jiangsu Province, China. METHODS: Our periodic strategies in dealing with Covid-19 were described in detail. An administrative response including the establishment of Emergency Leadership Committee that was in full charge of management was established. Modifications of infrastructure including the Fever Clinic, inpatient ward, outpatient clinic and operation room were carried out. Special arrangements for outpatient services, hospitalization and surgeries were introduced. Medical personnel training and patient educations were performed. Initiations of Covid-19 researches and application of information technology were introduced. FINDINGS: Since January 16, three cases have been confirmed in our hospital and no healthcare-associated infection was found. During the epidemics, 6.46% staffs suffered depression, 9.87% had anxiety, and 98% were satisfied with the infection control policy. Shortages in staffs and medical consumables, and limitation in space were the obstacles we encountered. INTERPRETATION: As the cost of in-hospital transmission is unbearable, our experiences and lessons suggested that prompt actions should be taken immediately to decrease or eliminate potential in-hospital transmission. Experience shared herein may be useful for those facilities that are and may encounter Covid-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Betacoronavirus , China/epidemiologia , Surtos de Doenças , Serviço Hospitalar de Emergência , Administração Hospitalar , Hospitais Gerais , Humanos , Pandemias , Fluxo de Trabalho
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