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2.
Am Surg ; 86(6): 599-601, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683962

RESUMO

The chief of surgery of a 264-bed acute care facility and clinic system in Topeka, KS, USA, gives a chronology that illustrates the rapid and profound clinical, economic, and emotional impact of the SARS-CoV-2 outbreak on his hospital and community. In his view, the pandemic has laid bare the weaknesses of several factors basic to the modern US health care system and the resulting economic crisis: just-in-time supply chain technology; foreign sourcing of masks, gowns, and critical equipment, all at critical shortages during the crisis; rural hospital closings; lack of excess capacity through maximization of utilization for efficiency; and an overreliance on high revenue elective procedures and tests. His team was tested by an emergency operation for bowel obstruction that put all the isolation protocols into action. Despite their readiness and the success of the operation and the potential for telemedicine as an alternative to in-person evaluations and outpatient visits, the forced cancellation of all elective operations have led to the loss of revenue for both hospital system and providers, furlough and termination of workers, and financial hardship and uncertainty.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/psicologia , Hospitais Comunitários/economia , Corpo Clínico Hospitalar/psicologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/psicologia , Betacoronavirus , Protocolos Clínicos , Procedimentos Cirúrgicos Eletivos/economia , Fechamento de Instituições de Saúde/economia , Humanos , Controle de Infecções/métodos , Obstrução Intestinal/cirurgia , Kansas/epidemiologia , Isolamento de Pacientes , Equipamento de Proteção Individual/provisão & distribução , Downsizing Organizacional/economia , Telemedicina
3.
Am Surg ; 86(6): 577-584, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683966

RESUMO

Under the aegis of the American College of Surgeons (ACS), the senior author (SDW), a member of the Board of Regents of the ACS, interviewed 3 of his international colleagues in colon and rectal surgery who found themselves dealing with a flood of patients from the COVID-19 pandemic. Each was in a "hot spot" where the outbreak overwhelmed the capacities of the hospitals. Professor Antonino Spinelli of Milan dealt with the sudden increase in COVID-19 patients that threatened to push all other emergencies and urgent cancer cases aside. Providers lacked the personal protective equipment to be adequately safe in the environment. In Madrid, Dr Julio Mayol recounted how 10%-15% of the workers in his hospital were incapacitated by the virus, many of them doctors providing direct care to patients. The disease is so prevalent that all emergency patients are treated as though they have the infection. Having practices in Saudi Arabia and Spain, Dr Delia Cortés-Guiral saw how the former country controlled the epidemic through a strict lockdown of travel and closure of holy pilgrimage sites and social gatherings. In contrast, upon her return to her native country, she experienced the near-breakdown of the health care system by the suddenness of the outbreak. "There are now no specialists now, she says." All of the specialties are treating COVID-19 patients and all of us are learning at the same time how to deal with this disease."It is a nightmare now here in Spain".


Assuntos
Infecções por Coronavirus/terapia , Pandemias , Papel do Médico , Pneumonia Viral/terapia , Cirurgiões , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Serviço Hospitalar de Emergência , Humanos , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Itália/epidemiologia , Corpo Clínico Hospitalar , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Arábia Saudita/epidemiologia , Isolamento Social , Espanha/epidemiologia , Procedimentos Cirúrgicos Operatórios
4.
Lancet Glob Health ; 8(6): e790-e798, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32573443

RESUMO

BACKGROUND: In the early stages of the outbreak of coronavirus disease 2019 (COVID-19) in Hubei, China, the local health-care system was overwhelmed. Physicians and nurses who had no infectious disease expertise were recruited to provide care to patients with COVID-19. To our knowledge, no studies on their experiences of combating COVID-19 have been published. We aimed to describe the experiences of these health-care providers in the early stages of the outbreak. METHODS: We did a qualitative study using an empirical phenomenological approach. Nurses and physicians were recruited from five COVID-19-designated hospitals in Hubei province using purposive and snowball sampling. They participated in semi-structured, in-depth interviews by telephone from Feb 10 to Feb 15, 2020. Interviews were transcribed verbatim and analysed using Haase's adaptation of Colaizzi's phenomenological method. FINDINGS: We recruited nine nurses and four physicians. Three theme categories emerged from data analysis. The first was "being fully responsible for patients' wellbeing-'this is my duty'". Health-care providers volunteered and tried their best to provide care for patients. Nurses had a crucial role in providing intensive care and assisting with activities of daily living. The second category was "challenges of working on COVID-19 wards". Health-care providers were challenged by working in a totally new context, exhaustion due to heavy workloads and protective gear, the fear of becoming infected and infecting others, feeling powerless to handle patients' conditions, and managing relationships in this stressful situation. The third category was "resilience amid challenges". Health-care providers identified many sources of social support and used self-management strategies to cope with the situation. They also achieved transcendence from this unique experience. INTERPRETATION: The intensive work drained health-care providers physically and emotionally. Health-care providers showed their resilience and the spirit of professional dedication to overcome difficulties. Comprehensive support should be provided to safeguard the wellbeing of health-care providers. Regular and intensive training for all health-care providers is necessary to promote preparedness and efficacy in crisis management. FUNDING: National Key R&D Program of China, Project of Humanities and Social Sciences of the Ministry of Education in China.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Surtos de Doenças , Corpo Clínico Hospitalar/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Adulto , China/epidemiologia , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Pandemias , Pesquisa Qualitativa , Adulto Jovem
5.
Med Clin North Am ; 104(4): 739-750, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32505264

RESUMO

Although not suitable for every patient encounter, rounding at the beside provides an opportunity to teach and augment the attitudes essential for optimal medical care. It also provides an opportunity to establish and grow the team's culture as well as the culture for each patient encounter. Finally, it provides the attending physician with an opportunity to assess learners' position on the supervision-to-autonomy spectrum, thereby ensuring appropriate supervision while enabling the autonomy necessary for optimal learner growth.


Assuntos
Corpo Clínico Hospitalar/educação , Cultura Organizacional , Visitas com Preceptor , Competência Clínica , Educação Médica Continuada , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Assistência Centrada no Paciente
6.
Psychol Trauma ; 12(S1): S105-S107, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32551763

RESUMO

This contribution draws from the experience of intensive care unit psychologists at 2 frontline hospitals in Milan, Italy, during the acute phase of the COVID-19 pandemic. In this contribution, we describe the main psychological needs observed in clinicians and in the families of COVID-19 patients and illustrate some psychological interventions implemented to respond to these needs. Containing emotions and promoting resilience were the aims of our interventions. In the future, psychological interventions should focus on the elaboration of traumatic experiences and losses. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Infecções por Coronavirus/terapia , Estado Terminal/terapia , Família/psicologia , Unidades de Terapia Intensiva , Corpo Clínico Hospitalar/psicologia , Recursos Humanos de Enfermagem no Hospital/psicologia , Pandemias , Pneumonia Viral/terapia , Psicoterapia/métodos , Resiliência Psicológica , Doença Aguda , Adulto , Humanos , Itália
7.
Psychol Trauma ; 12(S1): S128-S130, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32538648

RESUMO

In responding to the 2019 novel coronavirus (COVID-19), health-care workers have been exposed to a range of traumatic experiences, including the management of ventilators; provision of treatment; and issues with access to and the use of personal protective equipment. In this commentary, we use recent research on military decision-making to outline the damaging psychological effects of experiences that violate deeply held values. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Tomada de Decisão Clínica/ética , Infecções por Coronavirus/terapia , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/psicologia , Doenças Profissionais/psicologia , Pandemias , Pneumonia Viral/terapia , Trauma Psicológico/psicologia , Adulto , Humanos , Princípios Morais
8.
Psychol Trauma ; 12(S1): S146-S147, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32538660

RESUMO

The COVID-19 pandemic has changed the way doctors approach palliative and end-of-life care, which has undoubtedly affected the mental health of patients, families, and health care professionals. Given these circumstances, doctors working on the front line are vulnerable to moral injury and compassion fatigue. This is a reflection of 2 junior doctors experiencing firsthand demands of caring for patients during the outbreak. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Fadiga por Compaixão , Infecções por Coronavirus/terapia , Corpo Clínico Hospitalar , Cuidados Paliativos , Pandemias , Pneumonia Viral/terapia , Relações Profissional-Família , Trauma Psicológico , Assistência Terminal , Adulto , Fadiga por Compaixão/etiologia , Fadiga por Compaixão/psicologia , Inglaterra , Humanos , Corpo Clínico Hospitalar/ética , Corpo Clínico Hospitalar/psicologia , Princípios Morais , Cuidados Paliativos/ética , Cuidados Paliativos/psicologia , Relações Profissional-Família/ética , Trauma Psicológico/etiologia , Trauma Psicológico/psicologia , Assistência Terminal/ética , Assistência Terminal/psicologia
9.
Hu Li Za Zhi ; 67(3): 38-47, 2020 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-32495328

RESUMO

BACKGROUND: Establishing a positive reporting culture, which helps medical and healthcare workers learn from errors and reduce the risks of future adverse events, is essential to fostering a culture of patient safety. PURPOSE: The objectives of this study were to investigate the differences among the three levels of hospitals in terms of the knowledge and attitudes of hospital staff regarding the patient safety reporting system and to identify the potential factors affecting these differences. METHODS: This cross-sectional study was carried out in six hospitals, including two academic medical centers, two regional hospitals, and two district hospitals. The subjects were physicians, nurses, medical technicians, and administrative staffs. Data were collected using a patient safety reporting questionnaire. RESULTS: Three hundred and forty-eight participants were recruited, with 348 valid questionnaires returned (response rate: 100%). The average score for knowledge of patient safety reporting was 12.76 (total possible score: 14). Age, work position, and work experience were significantly associated with knowledge of patient safety reporting (p < .01). The patient safety reporting attitudes questionnaire comprised 21 items, each of which was scored using a five-point Likert scale. The mean score for each item was 3.92 ± 0.50. Gender, age, work position, work experience, and job discipline were significantly associated with attitude toward reporting (p < .01). The level of hospital was found to significantly impact attitudes toward patient safety reporting (p = .01), with participants working at medical centers scoring the highest. In addition, participants who were older and in more-senior positions scored higher and more positively for both knowledge and attitudes. CONCLUSIONS: The key factors to successfully fostering a strong patient safety reporting culture are staff security, a reliable reporting system, and a user-friendly interface. Improving attitudes toward reporting requires more resources and time than improving knowledge of reporting, which may be improved using education and promotion. Regional hospitals may invest more resources to enhance positive attitudes toward reporting and increase the willingness of staff to report.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Corpo Clínico Hospitalar/psicologia , Segurança do Paciente , Gestão da Segurança/organização & administração , Estudos Transversais , Hospitais , Humanos , Corpo Clínico Hospitalar/estatística & dados numéricos , Cultura Organizacional , Inquéritos e Questionários
10.
Head Neck ; 42(7): 1597-1609, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32496637

RESUMO

BACKGROUND: Otolaryngologists are among the highest risk for COVID-19 exposure. METHODS: This is a cross-sectional, survey-based, national study evaluating academic otolaryngologists. Burnout, anxiety, distress, and depression were assessed by the single-item Mini-Z Burnout Assessment, 7-item Generalized Anxiety Disorder Scale, 15-item Impact of Event Scale, and 2-item Patient Health Questionnaire, respectively. RESULTS: A total of 349 physicians completed the survey. Of them, 165 (47.3%) were residents and 212 (60.7%) were males. Anxiety, distress, burnout, and depression were reported in 167 (47.9%), 210 (60.2%), 76 (21.8%), and 37 (10.6%) physicians, respectively. Attendings had decreased burnout relative to residents (odds ratio [OR] 0.28, confidence interval [CI] [0.11-0.68]; P = .005). Females had increased burnout (OR 1.93, CI [1.12.-3.32]; P = .018), anxiety (OR 2.53, CI [1.59-4.02]; P < .005), and distress (OR 2.68, CI [1.64-4.37]; P < .005). Physicians in states with greater than 20 000 positive cases had increased distress (OR 2.01, CI [1.22-3.31]; P = .006). CONCLUSION: During the COVID-19 pandemic, the prevalence of burnout, anxiety, and distress is high among academic otolaryngologists.


Assuntos
Infecções por Coronavirus/epidemiologia , Internato e Residência , Corpo Clínico Hospitalar/psicologia , Otorrinolaringologistas/psicologia , Pneumonia Viral/epidemiologia , Adulto , Ansiedade/epidemiologia , Betacoronavirus , Esgotamento Profissional/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Otorrinolaringologistas/estatística & dados numéricos , Pandemias , Fatores Sexuais , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
11.
Med Leg J ; 88(2): 57-64, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32515258

RESUMO

This is a personal view from London as the Covid-19 pandemic continues to spread here and the situation changes from day to day. As such it can only be a snapshot caught in time; it is not a diary of events. The Coronavirus Act 2020 gives Government enormous powers and was passed by Parliament in one day of debate immediately before it closed early for the Easter break. In March, the government imposed a "lockdown: the closure of all" but "essential" businesses and people other than essential workers must work from home but are allowed out for exercise and food shopping but must maintain 2 m apart, the "social distancing rule". The aim is to suppress the spread of the virus, reduce the death toll and "protect the National Health Service (NHS)" which needed time to empty wards and expand its intensive care unit (ICU) capability to deal with an expected influx of thousands of very sick patients. I discuss whether this strategy is working, how and why it has rapidly been altered to respond to criticism. Why was the Government so slow to seek the help of private laboratories to assist with testing? Why was the personal protective equipment (PPE) guidance altered only after criticism? I look at the impact of the lockdown on the UK economy, the changes to practice of medicine and speeding of scientific research. Cooperating with the lockdown has its price; is it harming the health and mental health of children, people living in households with potentially abusive partners or parents and those who are disabled or financially desperate? Is the cure worse than the disease? The Economy is being devastated by the lockdown and each day of lockdown it is worse. Is litigation being seeded even now by the pandemic? Notwithstanding unprecedented Government financial help many businesses are on the edge of collapse, people will lose their jobs and pensioners income. The winners include pharmacies, supermarkets, online food retailers, Amazon, online apps, providers of video games, services, streaming and scientific research laboratories, manufacturers of testing kits, ventilators, hand sanitisers, coffins, undertakers, etc. The British public is cooperating with lockdown but are we less productive at home? Parents with babies and children often child minders, school, grandparents or paid help which is not now available. Will current reliance on video-conferencing and video calls permanently change the way we work and will we need smaller city offices? Will we travel less? Will medical and legal practice and civil and criminal trials be generally carried out remotely? Will social distancing with self-isolation and job losses and business failures fuel depression? Is Covid-19 comparable to past epidemics like the Plague and Spanish flu?


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Ansiedade/epidemiologia , Comércio/legislação & jurisprudência , Controle de Doenças Transmissíveis , Infecções por Coronavirus/transmissão , Direito Penal , Depressão/epidemiologia , Economia , Previsões , Liberdade , Regulamentação Governamental , Habitação/economia , Humanos , Internet , Londres/epidemiologia , Corpo Clínico Hospitalar/provisão & distribução , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Pandemias , Pânico , Autonomia Pessoal , Pneumonia Viral/transmissão , Administração em Saúde Pública , Quarentena , Instituições Acadêmicas , Políticas de Controle Social , Isolamento Social , Telemedicina , Viagem , Triagem
12.
Int J Surg ; 79: 206-212, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32497751

RESUMO

The rapidly spreading coronavirus infection (COVID-19) worldwide has contracted all aspects of health systems. Developing countries that mostly have a weaker healthcare system and insufficient resources are likely to be the most hardly affected by the pandemic. Cancers are frequently diagnosed in late stages with higher case-fatality rates compared to those in high-income countries. Delayed diagnosis, lack of cancer awareness, low adherence to treatment, and unequal or limited access to treatment are among the challenging factors of cancer management in developing countries. Elective cancer surgeries are often considered to be postponed during COVID-19 pandemic to preserve valuable hospital resources such as personal protection equipment, hospital bed, intensive care unit capacity, and manpower to screen and treat the affected individuals. However, specific considerations to defer cancer surgery in developing countries might need to be carefully adjusted to counterbalance between preventing COVID-19 transmission and preserving patients 'long-term life expectancy and quality of life.


Assuntos
Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Neoplasias/cirurgia , Pneumonia Viral/epidemiologia , Betacoronavirus , Neoplasias da Mama/cirurgia , Infecções por Coronavirus/transmissão , Assistência à Saúde , Transmissão de Doença Infecciosa/prevenção & controle , Procedimentos Cirúrgicos Eletivos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Controle de Infecções , Unidades de Terapia Intensiva/organização & administração , Corpo Clínico Hospitalar/provisão & distribução , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/transmissão , Qualidade de Vida , Neoplasias Cutâneas/cirurgia , Neoplasias de Tecidos Moles/cirurgia
18.
Med Sci Monit ; 26: e925669, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32468998

RESUMO

BACKGROUND A growing body of evidence suggests that in the face of life adversity, threats, or other major stressful events, resilience is more conducive to individual adaptation and growth. MATERIAL AND METHODS The Connor-Davidson Resilience Scale and the Chinese Perceived Stress Scale were used to evaluate the resilience and perceived stress of 600 medical staff members from the radiology departments in 32 public hospitals in Sichuan Province, China, respectively. Multiple linear regression was used to analyze factors related to resilience. RESULTS The total resilience score was 65.76±17.26, wherein the toughness dimension score was 33.61±9.52, the strength dimension score was 21.25±5.50, and the optimism dimension score was 10.91±3.15. There was a significant negative correlation between perceived stress and resilience (r=-0.635, P<0.001). According to multivariate analysis, the total perceived stress score (ß=-1.318, P<0.001), gender (ß=-4.738, P<0.001), knowledge of COVID-19 (ß=2.884, P=0.043), knowledge of COVID-19 protective measures (ß=3.260, P=0.042), and availability of adequate protective materials (ß=-1.268, P=0.039) were independent influencing factors for resilience. CONCLUSIONS The resilience level of the medical staff in the radiology departments during the outbreak of COVID-19 was generally low, particularly regarding toughness. More attention should be paid to resilience influence factors such as high perceived stress, female gender, lack of understanding of COVID-19 and protective measures, and lack of protective materials, and targeted interventions should be undertaken to improve the resilience level of the medical staff in the radiology departments during the outbreak of COVID-19.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/psicologia , Corpo Clínico Hospitalar/psicologia , Pneumonia Viral/psicologia , Serviço Hospitalar de Radiologia , Resiliência Psicológica , Adaptação Psicológica , Adulto , China , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Análise Fatorial , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Equipamento de Proteção Individual , Pneumonia Viral/prevenção & controle , Enfermagem Radiológica e de Imagem , Radiologistas/psicologia , Amostragem , Estresse Psicológico/etiologia , Inquéritos e Questionários , Tecnologia Radiológica
20.
West J Emerg Med ; 21(3): 499-502, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32421497

RESUMO

The global COVID-19 pandemic has become one of the largest clinical and operational challenges faced by emergency medicine, and our EDs continue to see increased volumes of infected patients, many of whom are not only ill, but acutely aware and fearful of their circumstances and potential mortality. Given this, there may be no more important time to focus on staff-patient communication and expression of compassion. However, many of the techniques usually employed by emergency clinicians to provide comfort to patients and their families are made more challenging or impossible by the current circumstances. Geriatric ED patients, who are at increased risk of severe disease, are particularly vulnerable to the effects of isolation. Despite many challenges, emergency clinicians have at their disposal a myriad of tools that can still be used to express compassion and empathy to their patients. Placing emphasis on using these techniques to maximize humanism in the care of COVID-19 patients during this crisis has the potential to bring improvements to ED patient care well after this pandemic has passed.


Assuntos
Betacoronavirus , Comunicação , Infecções por Coronavirus/psicologia , Empatia , Humanismo , Pneumonia Viral/psicologia , Relações Profissional-Paciente , Idoso , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência/organização & administração , Hospitalização , Humanos , Corpo Clínico Hospitalar/psicologia , Pandemias , Admissão do Paciente , Alta do Paciente , Isolamento de Pacientes/psicologia , Pneumonia Viral/terapia , Relações Profissional-Família
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