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3.
Best Pract Res Clin Anaesthesiol ; 35(3): 293-306, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511220

RESUMEN

International hospitals and healthcare facilities are facing catastrophic financial challenges related to the COVID-19 pandemic. The American Hospital Association estimates a financial impact of $202.6 billion in lost revenue for America's hospitals and healthcare systems, or an average of $50.7 billion per month. Furthermore, it could cost low- and middle-income countries ~ US$52 billion (equivalent to US$8.60 per person) each four weeks to provide an effective healthcare response to COVID-19. In the setting of the largest daily COVID-19 new cases in the US, this burden will influence patient care, surgeries, and surgical outcomes. From a global economic standpoint, The World Bank projects that global growth is projected to shrink by almost 8% with poorer countries feeling most of the impact, and the United Nations projects that it will cost the global economy around 2 trillion dollars this year. Overall, a lack of preparedness was a major contributor to the struggles experienced by healthcare facilities around the world. Items such as personal protective equipment (PPE) for healthcare workers, hospital equipment, sanitizing supplies, toilet paper, and water were in short supply. These deficiencies were exposed by COVID-19 and have prompted healthcare organizations around the world to invent new essential plans for pandemic preparedness. In this paper, we will discuss the economic impact of COVID-19 on US and international hospitals, healthcare facilities, surgery, and surgical outcomes. In the future, the US and countries around the world will benefit from preparing a plan of action to use as a guide in the event of a disaster or pandemic.


Asunto(s)
COVID-19/economía , COVID-19/epidemiología , Costo de Enfermedad , Atención a la Salud/economía , Salud Global/economía , COVID-19/terapia , Atención a la Salud/tendencias , Salud Global/tendencias , Personal de Salud/economía , Personal de Salud/tendencias , Humanos , Pandemias , Equipo de Protección Personal/economía , Equipo de Protección Personal/tendencias , Estados Unidos/epidemiología
4.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511221

RESUMEN

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Asunto(s)
COVID-19/prevención & control , Personal de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Telemedicina/tendencias , COVID-19/diagnóstico , COVID-19/epidemiología , Humanos , Manejo del Dolor/métodos , Manejo del Dolor/tendencias , Pandemias/prevención & control , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/terapia , Telemedicina/métodos
5.
Best Pract Res Clin Anaesthesiol ; 35(3): 389-404, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511227

RESUMEN

The increase in interconnectedness of the global population has enabled a highly transmissible virus to spread rapidly around the globe in 2020. The COVID-19 (Coronavirus Disease 2019) pandemic has led to physical, social, and economic repercussions of previously unseen proportions. Although recommendations for pandemic preparedness have been published in response to previous viral disease outbreaks, these guidelines are primarily based on expert opinion and few of them focus on acute care staffing issues. In this review, we discuss how working in acute care medicine during a pandemic can affect the physical and mental health of medical and nursing staff. We provide ideas for limiting staff shortages and creating surge capacity in acute care settings, and strategies for sustainability that can help hospitals maintain adequate staffing throughout their pandemic response.


Asunto(s)
COVID-19/epidemiología , Cuidados Críticos/normas , Personal de Salud/normas , Recursos Humanos/normas , COVID-19/terapia , Cuidados Críticos/tendencias , Personal de Salud/tendencias , Humanos , Liderazgo , Pandemias/prevención & control , Recursos Humanos/tendencias
6.
Best Pract Res Clin Anaesthesiol ; 35(3): 425-435, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511230

RESUMEN

The novel SARS-CoV-2 pandemic starting in 2019 profoundly changed the world, and thousands of residents of New York City were affected, leading to one of the most acute surges in regional hospital capacity. As the largest academic medical center in the Bronx, Montefiore Medical Center was immediately impacted, and the entire hospital was mobilized to address the needs of its community. In this article, we describe our experiences as a large academic anesthesiology department during this pandemic. Our goals were to maximize our staff's expertise, maintain our commitment to wellness and safety, and preserve the quality of patient care. Lessons learned include the importance of critical care training presence and leadership, the challenges of converting an ambulatory surgery center to an intensive care unit (ICU), and the management of effective communication. Lastly, we provide suggestions for institutions facing an acute surge, or subsequent waves of COVID-19, based on a single center's experiences.


Asunto(s)
Centros Médicos Académicos/tendencias , Anestesiología/tendencias , COVID-19/epidemiología , Cuidados Críticos/tendencias , Reestructuración Hospitalaria/tendencias , Admisión y Programación de Personal/tendencias , Centros Médicos Académicos/normas , Anestesiología/normas , COVID-19/terapia , Cuidados Críticos/normas , Personal de Salud/normas , Personal de Salud/tendencias , Reestructuración Hospitalaria/normas , Humanos , Ciudad de Nueva York , Pandemias , Admisión y Programación de Personal/normas
7.
Best Pract Res Clin Anaesthesiol ; 35(3): 333-349, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34511223

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.


Asunto(s)
Manejo de la Vía Aérea/normas , COVID-19/prevención & control , Personal de Salud/normas , Hospitalización , Equipo de Protección Personal/normas , Guías de Práctica Clínica como Asunto/normas , Aerosoles , Manejo de la Vía Aérea/tendencias , COVID-19/epidemiología , Personal de Salud/tendencias , Hospitalización/tendencias , Humanos , Pandemias/prevención & control , Equipo de Protección Personal/tendencias
8.
PLoS One ; 16(9): e0257854, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34582483

RESUMEN

OBJECTIVES: Most COVID-19 related infections and deaths may occur in healthcare outside hospitals. Here we explored SARS-CoV-2 infections among healthcare workers (HCWs) in this setting. DESIGN: All healthcare providers in Stockholm, Sweden were asked to recruit HCWs at work for a study of past or present SARS-CoV-2 infections among HCWs. Study participants This study reports the results from 839 HCWs, mostly employees of primary care centers, sampled in June 2020. RESULTS: SARS-CoV-2 seropositivity was found among 12% (100/839) of HCWs, ranging from 0% to 29% between care units. Seropositivity decreased by age and was highest among HCWs <40 years of age. Within this age group there was 19% (23/120) seropositivity among women and 11% (15/138) among men (p<0.02). Current infection, as measured using PCR, was found in only 1% and the typical testing pattern of pre-symptomatic potential "superspreaders" found in only 2/839 subjects. CONCLUSIONS: Previous SARS-CoV-2 infections were common among younger HCWs in this setting. Pre-symptomatic infection was uncommon, in line with the strong variability in SARS-CoV-2 exposure between units. Prioritizing infection prevention and control including sufficient and adequate personal protective equipment, and vaccination for all HCWs are important to prevent nosocomial infections and infections as occupational injuries during an ongoing pandemic.


Asunto(s)
COVID-19/epidemiología , COVID-19/transmisión , Personal de Salud/tendencias , Adulto , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Equipo de Protección Personal , Factores de Riesgo , SARS-CoV-2/genética , SARS-CoV-2/patogenicidad , Suecia/epidemiología
9.
World Neurosurg ; 155: e142-e149, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34400327

RESUMEN

BACKGROUND: The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. METHODS: We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. RESULTS: There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. CONCLUSIONS: The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.


Asunto(s)
COVID-19/epidemiología , Atención a la Salud/tendencias , Países en Desarrollo , Sistemas de Información en Hospital/tendencias , Procedimientos Neuroquirúrgicos/tendencias , Brasil/epidemiología , COVID-19/economía , COVID-19/prevención & control , Atención a la Salud/economía , Países en Desarrollo/economía , Personal de Salud/economía , Personal de Salud/tendencias , Sistemas de Información en Hospital/economía , Humanos , Procedimientos Neuroquirúrgicos/economía , Equipo de Protección Personal/economía , Equipo de Protección Personal/tendencias
10.
Acad Med ; 96(6): 808-812, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34031302

RESUMEN

COVID-19 is a worldwide pandemic, with frontlines that look drastically different than in past conflicts: that is, women now make up a sizeable majority of the health care workforce. American women have a long history of helping in times of hardship, filling positions on the home front vacated by men who enlisted as soldiers during World War I and similarly serving in crucial roles on U.S. military bases, on farms, and in factories during World War II. The COVID-19 pandemic has represented a novel battleground, as the first in which women have taken center stage, not only in their roles as physicians, respiratory therapists, nurses, and the like, but also by serving in leadership positions and facilitating innovations in science, technology, and policy. Yet, the pandemic has exacerbated multiple pain points that have disproportionally impacted women in health care, including shortages in correctly sized personal protective equipment and uniforms, inadequate support for pregnant and breastfeeding providers, and challenges associated with work-life balance and obtaining childcare. While the pandemic has facilitated several positive advancements in addressing these challenges, there is still much work to be done for women to achieve equity and optimal support in their roles on the frontlines.


Asunto(s)
COVID-19/prevención & control , Fuerza Laboral en Salud/estadística & datos numéricos , Mujeres Trabajadoras/historia , Recursos Humanos/estadística & datos numéricos , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/virología , Empoderamiento , Femenino , Equidad de Género , Personal de Salud/tendencias , Historia del Siglo XX , Humanos , Liderazgo , Equipo de Protección Personal/provisión & distribución , SARS-CoV-2/aislamiento & purificación , Mujeres Trabajadoras/estadística & datos numéricos , Primera Guerra Mundial , Segunda Guerra Mundial
12.
Eur Rev Med Pharmacol Sci ; 25(9): 3632-3639, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-34002840

RESUMEN

OBJECTIVE: In the current pandemic, Health Care Workers (HCWs) are at a high risk of developing COVID-19. Preventive methods like the use of personal protective equipment, isolation, social distancing, and chemoprophylaxis show limited benefit. Despite standard prophylaxis, many of the HCWs develop COVID-19. Medical ozone therapy has immunomodulatory, antioxidant and antiviral effect, and, therefore, it can be explored as prophylaxis for COVID-19. PATIENTS AND METHODS: We conducted a retrospective controlled cohort study. IV ozonized saline was administered once a day for a total of 4 days in one month in addition to standard prophylaxis for COVID-19 to HCWs in a dedicated COVID hospital. Fresh ozonized saline was prepared for every administration and was given over 1 hour. RESULTS: There were 235 HCWs, 64 received the ozone prophylaxis and 171 did not. The incidence of COVID-19 was significantly (p=0.04) lesser in HCWs that received ozone prophylaxis (4.6%) as compared to those who did not (14.03%). The benefit was seen irrespective of the risk of exposure. In the red zone, 8.69% of the HCWs who received ozone prophylaxis tested positive as opposed to 15.3% of those who did not. In the orange zone, 4.34% of the HCWs who received ozone prophylaxis tested positive, remarkably lesser than those who did not (20%). In the green zone, none of the HCWs who received ozone prophylaxis tested positive; however, 3.4% of the HCWs who did not receive ozone prophylaxis tested positive. No major adverse events were noted. CONCLUSIONS: IV ozonized saline can be used in addition to the standard prophylactic regimen for the prevention of COVID-19 in HCWs. Prospective larger studies are required to establish the potency of IV ozonized saline as prophylaxis.


Asunto(s)
COVID-19/prevención & control , Personal de Salud/tendencias , Hospitalización/tendencias , Ozono/administración & dosificación , Profilaxis Pre-Exposición/tendencias , Solución Salina/administración & dosificación , Administración Intravenosa , Adulto , Antiinflamatorios/administración & dosificación , COVID-19/epidemiología , Estudios de Cohortes , Femenino , Humanos , India/epidemiología , Masculino , Profilaxis Pre-Exposición/métodos , Estudios Retrospectivos , Adulto Joven
13.
Pharmacogenomics ; 22(9): 515-517, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34032472

RESUMEN

The Pharmacogenomics Access & Reimbursement Symposium, a landmark event presented by the Golden Helix Foundation and the Pharmacogenomics Access & Reimbursement Coalition, was a 1-day interactive meeting comprised of plenary keynotes from thought leaders across healthcare that focused on value-based strategies to improve patient access to personalized medicine. Stakeholders including patients, healthcare providers, industry, government agencies, payer organizations, health systems and health policy organizations convened to define opportunities to improve patient access to personalized medicine through best practices, successful reimbursement models, high quality economic evaluations and strategic alignment. Session topics included health technology assessment, health economics, health policy and value-based payment models and innovation.


Asunto(s)
Congresos como Asunto/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Reembolso de Seguro de Salud/tendencias , Asistencia Médica/tendencias , Farmacogenética/tendencias , District of Columbia , Personal de Salud/economía , Personal de Salud/tendencias , Accesibilidad a los Servicios de Salud/economía , Humanos , Reembolso de Seguro de Salud/economía , Asistencia Médica/economía , Farmacogenética/economía , Medicina de Precisión/economía , Medicina de Precisión/tendencias , Evaluación de la Tecnología Biomédica/economía , Evaluación de la Tecnología Biomédica/tendencias
14.
J Orthop Surg Res ; 16(1): 336, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34034785

RESUMEN

BACKGROUND: We report our experiences with COVID-19 in one of the largest referral orthopedic centers in the Middle East and aimed to describe the epidemiology and clinical characteristics of these patients. METHODS: During February 20 and April 20, 2020, patients who underwent orthopedic surgery and healthcare staff who were in contact with these patients were screened for COVID-19. To identify patients who were in the incubation period of COVID-19 during their hospital stay, all patients were tested again for COVID-19 4 weeks after discharge. RESULTS: Overall, 1244 patients underwent orthopedic surgery (1123 emergency and 121 elective) during the study period. Overall, 17 patients were diagnosed with COVID-19 during hospital admission and seven after discharge. Among the total 24 patients with COVID-19, 15 were (62.5%) males with a mean (SD) age of 47.0±1.6 years old. Emergency surgeries were performed in 20 (83.3%) patients, and elective surgery was done in the remaining 4 patients which included one case of posterior spinal fusion, spondylolisthesis, acromioclavicular joint dislocation, and one case of leg necrosis. A considerable number of infections occurred in patients with intertrochanteric fractures (n=7, 29.2%), followed by pelvic fractures (n=2, 8.3%), humerus fractures (n=2, 8.3%), and tibial plateau fractures (n=2, 8.3%). Fever (n=11, 45.8%) and cough (n=10, 37.5%) were the most common symptoms among patients. Laboratory examinations showed leukopenia in 2 patients (8.3%) and lymphopenia in 4 (16.7%) patients. One patient with a history of cancer died 2 weeks after discharge due to myocardial infarction. Among hospital staff, 26 individuals contracted COVID-19 during the study period, which included 13 (50%) males. Physicians were the most commonly infected group (n = 11), followed by operation room technicians (n = 5), nurses (n = 4), and paramedics (n = 4). CONCLUSIONS: Patients who undergo surgical treatment for orthopedic problems, particularly lower limb fractures with limited ambulation, are at a higher risk of acquiring COVID-19 infections, although they may not be at higher risks for death compared to the general population. Orthopedic surgeons in particular and other hospital staff who are in close contact with these patients must be adequately trained and given appropriate personal protective equipment during the COVID-19 outbreak.


Asunto(s)
COVID-19/epidemiología , COVID-19/transmisión , Personal de Salud/tendencias , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Procedimientos Ortopédicos/tendencias , Equipo de Protección Personal/tendencias , Adulto , COVID-19/prevención & control , Femenino , Hospitalización/tendencias , Humanos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Masculino , Persona de Mediana Edad , Medio Oriente/epidemiología , Exposición Profesional/prevención & control , Procedimientos Ortopédicos/métodos
15.
PLoS One ; 16(4): e0249660, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33886615

RESUMEN

BACKGROUND: Evidence-based medicine (EBM) is a widely accepted scientific advancement in clinical settings that helps achieve better, safer, and more cost-effective healthcare. However, presently, validated instruments to evaluate healthcare professionals' attitude and practices toward implementing EBM are not widely available. Therefore, the present study aimed to determine the validity and reliability of a newly developed knowledge, attitude, and practice (KAP) questionnaire on EBM for use among healthcare professionals. METHODS: The Noor Evidence-Based Medicine Questionnaire was tested among physicians in a government hospital between July and August 2018. Exploratory factor analysis and internal consistency reliability-based Cronbach's alpha statistic were conducted. RESULTS: The questionnaire was distributed among 94 physicians, and 90 responded (response rate of 95.7%). The initial number of items in the KAP domains of the Noor Evidence-Based Medicine Questionnaire were 15, 17, and 13, respectively; however, two items in the practice domain with communalities <0.25 and factor loadings <0.4 were removed. The factor structure accounted for 52.33%, 66.29%, and 55.39% of data variance in the KAP domains, respectively. Cronbach's alpha values were 0.81, 0.81, and 0.84 for KAP domains, respectively, indicating high reliability. CONCLUSIONS: This questionnaire can be used to evaluate the knowledge, attitudes, and behaviour of healthcare professionals toward EBM. Future testing of this questionnaire among other medical personnel groups will help expand the scope of this tool.


Asunto(s)
Medicina Basada en la Evidencia/métodos , Medicina Basada en la Evidencia/tendencias , Psicometría/instrumentación , Actitud del Personal de Salud , Competencia Clínica/estadística & datos numéricos , Estudios Transversales , Análisis Factorial , Personal de Salud/psicología , Personal de Salud/tendencias , Humanos , Malasia , Reproducibilidad de los Resultados , Encuestas y Cuestionarios
16.
Rev Esp Quimioter ; 34(3): 214-219, 2021 Jun.
Artículo en Español | MEDLINE | ID: mdl-33829723

RESUMEN

OBJECTIVE: Proper hand hygiene is the main measure in the prevention and control of infection associated with healthcare. It describes how the pandemic period of 2020 has influenced the evolution of the degree of compliance with hand hygiene practices in health professionals at the Hospital Universitario Insular de Gran Canaria with respect to previous years. METHODS: Descriptive cross-sectional study of direct observation on compliance with the five moments of hand hygiene in the 2018-2020 period. Adherence is described with the frequency distribution of the different moments in which it was indicated. RESULTS: Total adherence has increased from 42.5% in 2018, to 47.6% in 2019, and 59.2% in 2020 (p <0.05). Total adherence was greater in the moments after contact with the patient (67%) than in the moments before contact (48%). The area with the highest adherence was dialysis (83%). There is a greater adherence in open areas than in hospitalization areas (65% vs 56%). Higher adherence was determined in physicians (73%) and nurses (74%), than in nursing assistants (50%) (p<0.05). CONCLUSIONS: In 2020 there was an increase in adherence to hand hygiene compared to previous years. A higher percentage of adherence was determined in physicians and nurses than in nursing assistants. We consider that the current SARS-CoV-2 pandemic has played a relevant role in this increase in adherence.


Asunto(s)
COVID-19/epidemiología , Higiene de las Manos/tendencias , Personal de Salud , Pandemias , COVID-19/prevención & control , Estudios Transversales , Higiene de las Manos/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Personal de Salud/tendencias , Humanos , Cuerpo Médico de Hospitales/estadística & datos numéricos , Cuerpo Médico de Hospitales/tendencias , Asistentes de Enfermería/estadística & datos numéricos , Asistentes de Enfermería/tendencias , Personal de Enfermería en Hospital/estadística & datos numéricos , Personal de Enfermería en Hospital/tendencias , España , Centros de Atención Terciaria
17.
Indian J Med Ethics ; VI(2): 1-6, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33908368

RESUMEN

The Covid-19 pandemic has not only highlighted societal inequalities but also shown how a resilient health service is essential for protecting citizens. The NHS was founded in 1948 to provide universal healthcare but has been under sustained attack for the past thirty years. As a seven-year-old patient with osteomyelitis, the NHS almost certainly saved my life. Seventy years later I reflect on the humanising and civilising aspects of the NHS, the need for doctors to be advocates and custodians, as well as clinicians working in the best interests of their individual patients; and the requirement for the medical profession to understand the social determinants of ill health and how these can be ameliorated. The reward for engaging in this struggle: a healthier world in the widest sense and greater satisfaction for all those working in the prevention and treatment of ill health.

.


Asunto(s)
COVID-19 , Atención a la Salud/estadística & datos numéricos , Atención a la Salud/tendencias , Personal de Salud/tendencias , Pandemias , Medicina Estatal/estadística & datos numéricos , Medicina Estatal/tendencias , Adulto , Femenino , Predicción , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , SARS-CoV-2 , Reino Unido
18.
Br J Anaesth ; 127(1): 56-64, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33685636

RESUMEN

BACKGROUND: Although sedation during gastrointestinal endoscopy is widely used in China, the characteristics of sedation use, including regional distribution, personnel composition, equipment used, and drug selection, remain unclear. The present study aimed to provide insights into the current practice and regional distribution of sedation for gastrointestinal endoscopy in China. METHODS: A questionnaire consisting of 19 items was distributed to directors of anaesthesiology departments and anaesthesiologists in charge of endoscopic sedation units in mainland China through WeChat. RESULTS: The results from 2758 participating hospitals (36.7% of the total) showed that 9 808 182 gastroscopies (69.3%) and 4 353 950 colonoscopies (30.7%), with a gastroscopy-to-colonoscopy ratio of 2.3, were conducted from January to December 2016. Sedation was used with 4 696 648 gastroscopies (47.9%) and 2 148 316 colonoscopies (49.3%), for a ratio of 2.2. The most commonly used sedative was propofol (61.0% for gastroscopies and 60.4% for colonoscopies). Haemoglobin oxygen saturation (SpO2) was monitored in most patients (96.1%). Supplemental oxygen was routinely administered, but the availability of other equipment was variable (anaesthesia machine in 64.9%, physiological monitor in 84.4%, suction device in 72.3%, airway equipment in 75.5%, defibrillator in 32.7%, emergency kit in 57.0%, and difficult airway kit in 20.8% of centres responding). CONCLUSIONS: The sedation rate for gastrointestinal endoscopy is much lower in China than in the USA and in Europe. The most commonly used combination of sedatives was propofol plus an opioid (either fentanyl or sufentanil). Emergency support devices, such as difficult airway devices and defibrillators, were not usually available.


Asunto(s)
Anestesia/métodos , Endoscopía Gastrointestinal/métodos , Endoscopía Gastrointestinal/tendencias , Personal de Salud/tendencias , Hospitales/tendencias , Encuestas y Cuestionarios , Analgésicos Opioides/administración & dosificación , Anestésicos Intravenosos/administración & dosificación , China/epidemiología , Humanos , Proyectos Piloto , Estudios Retrospectivos
19.
PLoS One ; 16(3): e0248025, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33657167

RESUMEN

INTRODUCTION: Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals. In this study we sought to determine if tracking smell sensitivity and loss using an at-home assessment could identify SARS-CoV-2 infection in HCW. METHODS AND FINDINGS: We performed a prospective cohort study tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, behavioral at-home assessment of olfaction with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and real-time quantitative polymerase chain reaction testing to identify SARS-CoV-2 infection. Our main measures were the prevalence of smell loss in SARS-CoV-2-positive HCW versus SARS-CoV-2-negative HCW, and timing of smell loss relative to SARS-CoV-2 test positivity. SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. HCW with SARS-CoV-2 infection were more likely to report smell loss than SARS-CoV-2-negative HCW on both the at-home assessment and the screening questionnaire (9/17, 53% vs 105/456, 23%, P < .01). 6/9 (67%) of SARS-CoV-2-positive HCW reporting smell loss reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among SARS-CoV-2-positive HCW who reported smell loss compared to those without smell loss (9/9, 100% vs 3/8, 38%, P < .01). CONCLUSIONS: In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of SARS-CoV-2 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.


Asunto(s)
Anosmia/epidemiología , COVID-19/diagnóstico , Personal de Salud/tendencias , Adulto , Anosmia/diagnóstico , Anosmia/virología , Infecciones Asintomáticas/epidemiología , COVID-19/epidemiología , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , SARS-CoV-2/patogenicidad , Autoinforme , Olfato/fisiología , Estados Unidos/epidemiología
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