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1.
GMS J Med Educ ; 38(1): Doc1, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33659606

RESUMO

Introduction: In summer term 2020, the clinical phase of the undergraduate medical curriculum at University Medical Center Göttingen was restructured since distance teaching had to be used predominantly due to contact restrictions during the COVID-19 pandemic. This paper investigates the impact of restructuring the clinical curriculum on medical students' satisfaction and learning outcomes. Methods: In each cohort, the 13-week curriculum was divided into two parts: During the first 9 weeks, factual knowledge was imparted using distance teaching by means of a modified inverted classroom approach. This was followed by a 4-week period of adapted classroom teaching involving both real and virtual patients in order to train students' practical skills. The evaluation of the 21 clinical modules comprised students' satisfaction with distance teaching as well as students' learning outcome. The latter was assessed by means of comparative self-assessment (CSA) gain and the results of the module exams, respectively. Data of summer term 2020 (= distance teaching, DT) were compared with respective data of winter term 2019/20 (= classroom teaching, CT) and analysed for differences and correlations. Results: Response rates of evaluations were 51.3% in CT and 19.3% in DT. There was no significant difference between mean scores in module exams in CT and DT, respectively. However, CSA gain was significantly lower in DT (p=0.047) compared with CT. Further analyses revealed that CSA gain depended on the time point of data collection: CSA gain was lower the more time had passed since the end of a specific module. Moreover, we found positive correlations between CSA gain and students' satisfaction with various aspects of distance teaching, particularly with "communication between teachers and students" (rho=0.674; p=0.002). Discussion and conclusions: Although some limitations and confounding factors have to be taken into account (such as evaluation response rates, assessment time points, and proportion of familiar items in module exams), the following recommendations can be derived from our findings: A valid assessment of students' learning outcome by means of exam results requires that as few exam items as possible are familiar to the students. CSA gain seems to be valid if assessment time points are standardised and not contaminated by students' learning activities for other modules. Good communication between teachers and students may contribute to increase students' satisfaction with distance teaching.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Educação de Graduação em Medicina/organização & administração , Satisfação Pessoal , Estudantes de Medicina/psicologia , Competência Clínica , Comunicação , Currículo , Educação a Distância , Avaliação Educacional/métodos , Avaliação Educacional/normas , Humanos , Pandemias , Aprendizagem Baseada em Problemas/organização & administração , Realidade Virtual
2.
Acad Med ; 96(3): 375-380, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33661849

RESUMO

A critical shortage of physicians is looming in the United States. The situation in Kentucky is especially dire, especially in rural areas. Class size constraints have resulted in the University of Kentucky College of Medicine (UK COM) unable to admit over 100 qualified Kentuckians each year. This article describes how leadership at University of Kentucky committed to addressing the state physician shortage while simultaneously strengthening relationships with critical partners through the establishment of two 4-year UK COM regional medical campuses. Based on criteria (such as a commitment to educating physicians, ample patients, sufficient willing physician preceptors, etc.), partners selected were Med Center Health, the leading health care system in southwestern Kentucky, and St. Elizabeth Healthcare, the predominant health care system in northern Kentucky. These regional campuses allow UK COM to expand its class size to 201 and total enrollment to 804, increasing from historically 70 to currently 120 graduates per year expected to practice in Kentucky. Critical to the success of this expansion is the buy-in of leadership and the Admissions Committee to consider students with a wider range of Medical College Admission Test scores. The regional clinical partners have substantially increased their teaching opportunities, with a greater ability to attract physicians. Both partners have made substantial financial contributions in support of the regional campuses. These relationships have energized UK COM engagement with its area alumni and have resulted in fewer Kentuckians referred out of state for advanced specialty care. Partnerships are also occurring with UK COM to increase graduate medical education offerings at the regional sites, fulfilling the vision of "training Kentuckians in Kentucky to practice in Kentucky."


Assuntos
Centros Médicos Acadêmicos/organização & administração , Mão de Obra em Saúde/estatística & dados numéricos , Médicos/estatística & dados numéricos , Política Pública/legislação & jurisprudência , Centros Médicos Acadêmicos/provisão & distribução , Redes Comunitárias , Educação de Pós-Graduação em Medicina/organização & administração , Humanos , Kentucky/epidemiologia , Médicos/provisão & distribução , Encaminhamento e Consulta/estatística & dados numéricos , Encaminhamento e Consulta/tendências , População Rural/estatística & dados numéricos , Especialização/estatística & dados numéricos , Planejamento Estratégico/normas , Estados Unidos/epidemiologia
3.
Nurs Adm Q ; 45(2): 114-117, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570878

RESUMO

The COVID-19 pandemic has affected millions of Americans, including health care staff. This article traces the experience of 1 nurse leader as she falls ill, only to learn that she has, indeed, been infected with the virus. She describes her 4-week quarantine, including the impact on her family and her attempts to continue to support her staff. As she recovers from the acute onslaught of COVID, the focus shifts back to her nurse leader role. In this role, she and her colleagues manage the logistics of caring for more than 150 COVID-positive patients a day in the 719-bed academic medical center. This included staffing the hospital, given the extreme challenges of staff availability limited by concerns such as school closings and at-risk family members. Now with the hospital's daily volume of COVID-positive patients greatly reduced, there is an opportunity to reflect on lessons learned, including what went well during the peak of the crisis and where there were opportunities. Leadership and staff are experiencing a sense of pride at their exceptional care of this complex population, even while exploring opportunities to be even better prepared should COVID erupt once again.


Assuntos
/enfermagem , Recursos Humanos de Enfermagem no Hospital/organização & administração , Centros Médicos Acadêmicos/organização & administração , /fisiopatologia , Feminino , Humanos , Liderança , Pandemias , Quarentena
4.
Nurs Adm Q ; 45(2): 126-134, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33570880

RESUMO

This article describes how a national nursing association and a major academic medical center responded to the coronavirus disease-2019 (COVID-19) pandemic during the first wave of the outbreak in the United States (January to August 2020). The organizations share their lived experiences as they quickly found themselves at the forefront of the crisis. The article discusses how early warning signs from a world away sparked collaboration, innovation, and action that grew to a coordinated, organization-wide response. It also explores how leaders in 2 distinct but interrelated environments rose to the challenge to leverage the best their organizations had to offer, relying on the expertise of each to navigate changes that were made to almost every aspect of work. From tentative first steps to rapid implementation of innovative policies and procedures, the organizations share lessons learned and benefits reaped. The article includes practical crisis response strategies for the nursing profession and health care systems moving forward.


Assuntos
Centros Médicos Acadêmicos/organização & administração , American Nurses' Association/organização & administração , Assistência à Saúde/organização & administração , Liderança , Fortalecimento Institucional/organização & administração , Humanos , Cidade de Nova Iorque/epidemiologia , Pandemias
5.
J Am Board Fam Med ; 34(Suppl): S229-S232, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33622844

RESUMO

The threat to the public health of the United States from the COVID-19 pandemic is causing rapid, unprecedented shifts in the health care landscape. Community health centers serve the patient populations most vulnerable to the disease yet often have inadequate resources to combat it. Academic medical centers do not always have the community connections needed for the most effective population health approaches. We describe how a bridge between a community health center partner (Roots Community Health Center) and a large academic medical center (Stanford Medicine) brought complementary strengths together to address the regional public health crisis. The 2 institutions began the crisis with an overlapping clinical and research faculty member (NKT). Building on that foundation, we worked in 3 areas. First, we partnered to reach underserved populations with the academic center's newly developed COVID test. Second, we developed and distributed evidence-based resources to these same communities via a large community health navigator team. Third, as telemedicine became the norm for medical consultation, the 2 institutions began to research how reducing the digital divide could help improve access to care. We continue to think about how best to create enduring partnerships forged through ongoing deeper relationships beyond the pandemic.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Centros Comunitários de Saúde/organização & administração , Atenção Primária à Saúde/métodos , /epidemiologia , California/epidemiologia , Comportamento Cooperativo , Humanos , Pandemias , Telemedicina/organização & administração
6.
Med Ref Serv Q ; 40(1): 35-47, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33625328

RESUMO

In response to the COVID-19 pandemic and the subsequent Stay At Home order, the Southern Illinois University Medical Library utilized new technologies and implemented new virtual service models in order to improve internal communication, and to continue providing services and resources to patrons remotely. The changes happened quickly, and the librarians faced several challenges during this time, but things went smoothly overall and there were some considerable silver linings. Several of the newly adopted technologies, service models, and virtual resource offerings proved to be extremely effective and their use will continue beyond the duration of the pandemic.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Disseminação de Informação/métodos , Bibliotecas Digitais/organização & administração , Bibliotecas Digitais/estatística & dados numéricos , Bibliotecas Médicas/organização & administração , Bibliotecas Médicas/estatística & dados numéricos , Humanos , Illinois
7.
World Neurosurg ; 148: e172-e181, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33385598

RESUMO

BACKGROUND: The institution-wide response of the University of California San Diego Health system to the 2019 novel coronavirus disease (COVID-19) pandemic was founded on rapid development of in-house testing capacity, optimization of personal protective equipment usage, expansion of intensive care unit capacity, development of analytic dashboards for monitoring of institutional status, and implementation of an operating room (OR) triage plan that postponed nonessential/elective procedures. We analyzed the impact of this triage plan on the only academic neurosurgery center in San Diego County, California, USA. METHODS: We conducted a de-identified retrospective review of all operative cases and procedures performed by the Department of Neurosurgery from November 24, 2019, through July 6, 2020, a 226-day period. Statistical analysis involved 2-sample z tests assessing daily case totals over the 113-day periods before and after implementation of the OR triage plan on March 16, 2020. RESULTS: The neurosurgical service performed 1429 surgical and interventional radiologic procedures over the study period. There was no statistically significant difference in mean number of daily total cases in the pre-versus post-OR triage plan periods (6.9 vs. 5.8 mean daily cases; 1-tail P = 0.050, 2-tail P = 0.101), a trend reflected by nearly every category of neurosurgical cases. CONCLUSIONS: During the COVID-19 pandemic, the University of California San Diego Department of Neurosurgery maintained an operative volume that was only modestly diminished and continued to meet the essential neurosurgical needs of a large population. Lessons from our experience can guide other departments as they triage neurosurgical cases to meet community needs.


Assuntos
/epidemiologia , Hospitais Universitários/organização & administração , Neurocirurgia/organização & administração , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Centros Médicos Acadêmicos/organização & administração , Neoplasias Encefálicas/cirurgia , California/epidemiologia , Derivações do Líquido Cefalorraquidiano/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos , Procedimentos Endovasculares/estatística & dados numéricos , Número de Leitos em Hospital , Departamentos Hospitalares/organização & administração , Humanos , Controle de Infecções , Disseminação de Informação/métodos , Unidades de Terapia Intensiva , Laboratórios Hospitalares , Sistemas Multi-Institucionais , Salas Cirúrgicas , Política Organizacional , Equipamento de Proteção Individual/provisão & distribução , Estudos Retrospectivos , Medição de Risco , Capacidade de Resposta ante Emergências , Triagem , Procedimentos Cirúrgicos Vasculares/estatística & dados numéricos , Ventiladores Mecânicos/provisão & distribução , Ferimentos e Lesões/cirurgia
8.
J Nurs Adm ; 51(1): 19-25, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278197

RESUMO

BACKGROUND: Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE: This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS: Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS: Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION: Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.


Assuntos
Centros Médicos Acadêmicos/tendências , Admissão do Paciente/normas , Centros Médicos Acadêmicos/organização & administração , Humanos , Tempo de Internação/tendências , Admissão do Paciente/tendências , Fatores de Tempo , População Urbana
10.
Nurs Leadersh (Tor Ont) ; 33(3): 9-14, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33097100

RESUMO

During my career, I have had many mantras, including "I love to wonder what will happen tomorrow" and "It's all about relationships." Well, I have been rewarded in spades because nothing has been predictable or stable about our professional practice environments since COVID-19 infiltrated our organizations. I have been challenged to develop and implement changes at The Hospital for Sick Children - a 300-bed tertiary pediatric academic health sciences centre in Toronto, ON - that we had never contemplated before. I believe that staying true to my leadership values and core principles has been essential when taking on such challenges and staying afloat during these tumultuous times.


Assuntos
Infecções por Coronavirus/enfermagem , Hospitais Pediátricos/organização & administração , Relações Interprofissionais , Enfermeiras Administradoras/psicologia , Pandemias , Pneumonia Viral/enfermagem , Centros Médicos Acadêmicos/organização & administração , Criança , Infecções por Coronavirus/epidemiologia , Humanos , Liderança , Ontário/epidemiologia , Pneumonia Viral/epidemiologia , Centros de Atenção Terciária/organização & administração
11.
Acad Med ; 95(10): 1485-1487, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33002905

RESUMO

In this Invited Commentary, the author applies a historical lens to explore a fundamental paradox in U.S. medical education: the fact that long after women gained parity with men in matriculation to medical school, women remain highly underrepresented in leadership positions in academic medicine. The reasons for this are many and complex, but at the core are the subtle but hurtful indignities ("microinequities") experienced by women physicians and an academic culture that expects single-minded dedication to work, regardless of the costs to faculty members' personal lives. Achieving parity for women in academic leadership will require changing the culture of medical schools and teaching hospitals to correct these 2 fundamental obstacles. In recent years, many medical schools and teaching hospitals have made efforts to improve opportunities and satisfaction for women trainees and physicians, enacting reforms to improve work-life balance for all faculty. It is plausible to imagine a future in which flexible time frames to achieve tenure and promotion are universally available to both women and men, with high scholarly standards firmly maintained. If this occurs, it will represent a profound legacy for women in academic medicine, for their generations of professional sacrifice and advocacy for a more equitable culture will have changed its culture.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Docentes de Medicina/organização & administração , Cultura Organizacional , Médicas/organização & administração , Sexismo/história , Centros Médicos Acadêmicos/história , Docentes de Medicina/história , Feminino , História do Século XIX , História do Século XX , Humanos , Liderança , Médicas/história
12.
Acad Med ; 95(10): 1479-1482, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006867

RESUMO

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.


Assuntos
Docentes de Medicina/educação , Previsões , Liderança , Diretores Médicos/educação , Médicas/organização & administração , Centros Médicos Acadêmicos/organização & administração , Docentes de Medicina/organização & administração , Feminino , Identidade de Gênero , Humanos , Diretores Médicos/organização & administração , Avaliação de Programas e Projetos de Saúde
13.
Can J Surg ; 63(5): E442-E448, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33026310

RESUMO

BACKGROUND: The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the contribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. METHODS: To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multidisciplinary meetings were prospectively collected. We report data for 365 consecutive days from Dec. 30, 2016, to Dec. 29, 2017. RESULTS: The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. CONCLUSION: Integrating a PA on an ACS team adds value to patient care by providing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consultations and effective organization of the ACS team members.


Assuntos
Cuidados Críticos/organização & administração , Salas Cirúrgicas/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Assistentes Médicos/organização & administração , Papel Profissional , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/estatística & dados numéricos , Canadá , Cuidados Críticos/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/organização & administração , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Salas Cirúrgicas/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Assistentes Médicos/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/estatística & dados numéricos
14.
Med Ref Serv Q ; 39(4): 344-358, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085950

RESUMO

In this case study, the University of Nevada, Las Vegas Health Sciences Library describes how a flexible and technology-focused service model, liaison relationships, and individual expertise all contributed towards rapid mobilization of online instruction, virtual library services, and new resources to keep pace with the sudden needs of their user communities in the School of Medicine, School of Dental Medicine and local Las Vegas community prior to and during stay-at-home mandates related to the COVID-19 global pandemic of 2020.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Infecções por Coronavirus , Educação a Distância/organização & administração , Bibliotecas Digitais/organização & administração , Bibliotecas Médicas/organização & administração , Serviços de Biblioteca/organização & administração , Pandemias , Pneumonia Viral , Betacoronavirus , Humanos , Nevada , Estudos de Casos Organizacionais
15.
Simul Healthc ; 15(5): 303-309, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32910106

RESUMO

INTRODUCTION: Working under extreme stress can cause medical professionals to deviate from clinical guidelines even if they know of their existence, let alone in situations such as COVID-19 where guidelines are unclear, fluid, and resources limited. In situ simulation has been proven an effective tool for training medical professionals during previous healthcare crises, eg, Ebola, influenza, as well as for assessing the preparedness of centers by identifying potential latent safety threats. In this article, we describe our ongoing simulation activities to ensure that our staff is best prepared to adapt to the challenges of COVID-19. METHODS: This is a prospective preparedness assessment and training intervention at a tertiary care academic center in Lebanon during the COVID-19 pandemic. In situ simulations followed by debriefing with good judgment occur daily involving native teams of 3 to 5 professionals in the newly established COVID intensive care unit and wards, the adult and pediatric intensive care unit and wards, and the emergency department. The simulations are assessed by the instructor using the Simulation Team Assessment Tool and by the participants using the Simulation Effectiveness Tool. Transcripts of recorded simulation debriefings are analyzed for content for latent safety threats using the SHELL Framework (Software-Hardware-Equipment-Liveware). RESULTS: In 2 weeks, we conducted 15 simulations with 106 participants and 47 observers. Simulation Team Assessment Tool scores show an overall improvement across the hospital over time [101.5 ± 13 (80-134)]. Participants' feedback on the Simulation Effectiveness Tool has been predominantly positive on the educational and practical benefits of the simulation activity. Data from debriefings and observations demonstrated the following categories of latent safety threats: inadequate preparedness on infection control, uncertainty of guidelines on oxygen supplementation and intubation protocols, lack of leadership and communication, overall panic, and others. CONCLUSIONS: Our single-center preparedness intervention demonstrated multiple latent safety threats in relation to COVID-19, which can be recognized through simulation before translating into actual patient care.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/educação , Capacitação em Serviço/organização & administração , Pneumonia Viral/epidemiologia , Treinamento por Simulação/organização & administração , Manuseio das Vias Aéreas/métodos , Betacoronavirus , Comunicação , Humanos , Controle de Infecções , Liderança , Líbano/epidemiologia , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Guias de Prática Clínica como Assunto , Estudos Prospectivos
16.
West J Emerg Med ; 21(5): 1114-1117, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32970563

RESUMO

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has seriously impacted clinical research operations in academic medical centers due to social distancing measures and stay-at-home orders. The purpose of this paper is to describe the implementation of a program to continue clinical research based out of an emergency department (ED) using remote research associates (RA). METHODS: Remote RAs were trained and granted remote access to the electronic health record (EHR) by the health system's core information technology team. Upon gaining access, remote RAs used a dual-authentication process to gain access to a host-based, firewall-protected virtual network where the EHR could be accessed to continue screening and enrollment for ongoing studies. Study training for screening and enrollment was also provided to ensure study continuity. RESULTS: With constant support and guidance available to establish this EHR access pathway, the remote RAs were able to gain access relatively independently and without major technical troubleshooting. Each remote RA was granted access and trained on studies within one week and self-reported a high degree of program satisfaction, EHR access ease, and study protocol comfort through informal evaluation surveys. CONCLUSIONS: In response to the COVID-19 pandemic, we virtualized a clinical research program to continue important ED-based studies.


Assuntos
Betacoronavirus , Pesquisa Biomédica/organização & administração , Infecções por Coronavirus/prevenção & controle , Registros Eletrônicos de Saúde , Serviço Hospitalar de Emergência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pesquisadores/organização & administração , Centros Médicos Acadêmicos/organização & administração , California , Humanos , Informática Médica , Desenvolvimento de Programas
18.
J Hosp Med ; 15(8): 483-488, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32804610

RESUMO

IMPORTANCE: Although intensive care unit (ICU) adaptations to the coronavirus disease of 2019 (COVID-19) pandemic have received substantial attention , most patients hospitalized with COVID-19 have been in general medical units. OBJECTIVE: To characterize inpatient adaptations to care for non-ICU COVID-19 patients. DESIGN: Cross-sectional survey. SETTING: A network of 72 hospital medicine groups at US academic centers. MAIN OUTCOME MEASURES: COVID-19 testing, approaches to personal protective equipment (PPE), and features of respiratory isolation units (RIUs). RESULTS: Fifty-one of 72 sites responded (71%) between April 3 and April 5, 2020. At the time of our survey, only 15 (30%) reported COVID-19 test results being available in less than 6 hours. Half of sites with PPE data available reported PPE stockpiles of 2 weeks or less. Nearly all sites (90%) reported implementation of RIUs. RIUs primarily utilized attending physicians, with few incorporating residents and none incorporating students. Isolation and room-entry policies focused on grouping care activities and utilizing technology (such as video visits) to communicate with and evaluate patients. The vast majority of sites reported decreases in frequency of in-room encounters across provider or team types. Forty-six percent of respondents reported initially unrecognized non-COVID-19 diagnoses in patients admitted for COVID-19 evaluation; a similar number reported delayed identification of COVID-19 in patients admitted for other reasons. CONCLUSION: The COVID-19 pandemic has required medical wards to rapidly adapt with expanding use of RIUs and use of technology emerging as critical approaches. Reports of unrecognized or delayed diagnoses highlight how such adaptations may produce potential adverse effects on care.


Assuntos
Centros Médicos Acadêmicos/organização & administração , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/epidemiologia , Controle de Infecções/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Estudos Transversais , Fidelidade a Diretrizes , Humanos , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Estados Unidos/epidemiologia
19.
Gen Hosp Psychiatry ; 66: 96-102, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32763640

RESUMO

BACKGROUND: Psychological morbidity in both patients and family members related to the intensive care unit (ICU) experience is an often overlooked, and potentially persistent, healthcare problem recognized by the Society of Critical Care Medicine as Post-intensive Care Syndrome (PICS). ICU diaries are an intervention increasingly under study with potential to mitigate ICU-related psychological morbidity, including ICU-related post-traumatic stress disorder (PTSD), depression and anxiety. As we encounter a growing number of ICU survivors, in particular in the wake of the coronavirus pandemic, clinicians must be equipped to understand the severity and prevalence of significant psychiatric complications of critical illness. METHODS: We compared the efficacy of the ICU diary, written by family and healthcare workers during the patient's intensive care course, versus education alone in reducing acute PTSD symptoms after discharge. Patients with an ICU stay >72 h, who were intubated and mechanically ventilated over 24 h, were recruited and randomized to either receive a diary at bedside with psychoeducation or psychoeducation alone. Intervention patients received their ICU diary within the first week of admission into the intensive care unit. Psychological symptom screening with IES-R, PHQ-8, HADS and GAD-7 was conducted at baseline within 1 week of ICU discharge and at weeks 4, 12, and 24 after ICU discharge. Change from baseline in these scores was assessed using Wilcoxon rank sum tests. RESULTS: From September 26, 2017 to September 25, 2018, our team screened 265 patients from the surgical and medical ICUs at a single large academic urban hospital. 60 patients were enrolled and randomized, of which 35 patients completed post-discharge follow-up, (n = 18) in the diary intervention group and (n = 17) in the education-only control group. The control group had a significantly greater decrease in PTSD, hyperarousal, and depression symptoms at week 4 compared to the intervention group. There were no significant differences in other measures, or at other follow-up intervals. Both study groups exhibited clinically significant PTSD symptoms at all timepoints after ICU discharge. Follow-up phone interviews with patients revealed that while many were interested in getting follow-up for their symptoms, there were many barriers to accessing appropriate therapy and clinical attention. CONCLUSIONS: Results from psychological screening tools demonstrate no benefit of ICU diaries versus bedside education-alone in reducing PTSD symptoms related to the intensive care stay. However, our study finds an important gap in clinical practice - patients at high risk for PICS are infrequently connected to appropriate follow-up care. Perhaps ICU diaries would prove beneficial if utilized to support the work within a program providing wrap-around services and close psychiatric follow up for PICS patients. This study demonstrates the high prevalence of ICU-related PTSD in our cohort of survivors, the high barrier to accessing care for appropriate treatment of PICS, and the consequence of that barrier-prolonged psychological morbidity. TRIAL REGISTRATION: NCT04305353. GRANT IDENTIFICATION: GH-17-022 (Arnold P. Gold Foundation).


Assuntos
Centros Médicos Acadêmicos/organização & administração , Ansiedade , Cuidados Críticos , Estado Terminal/psicologia , Depressão , Unidades de Terapia Intensiva/organização & administração , Transtornos de Estresse Pós-Traumáticos , Assistência ao Convalescente , Ansiedade/diagnóstico , Ansiedade/etiologia , Ansiedade/terapia , Infecções por Coronavirus/psicologia , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/psicologia , Depressão/diagnóstico , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Sobreviventes
20.
Plast Reconstr Surg ; 146(2): 447-454, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740604

RESUMO

Plastic surgeons have the unique perspective of working with all types of patients and care teams from almost all specialties in surgery and medicine, which creates unique challenges in times of distress. As the initial epicenter of coronavirus disease 2019 cases in the United States, the University of Washington program was required to rapidly develop strategies to deal with the escalating crisis. All aspects of the program were affected, including the need to triage the urgency of plastic surgery care, safe staffing of plastic surgery teams, and the role of plastic surgery in the greater hospital community. In addition, as a residency training program, limiting the impact of resident education and maintaining a sense of community and connection among members of the program developed into important considerations. The authors hope that the narrative of their experience will provide insight into the decisions made in the University of Washington health care system but also remind others that they are not alone in dealing with the challenges of this pandemic.


Assuntos
Infecções por Coronavirus/prevenção & controle , Controle de Infecções/normas , Internato e Residência/organização & administração , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Cirurgia Plástica/educação , Universidades/organização & administração , Centros Médicos Acadêmicos/organização & administração , Centros Médicos Acadêmicos/normas , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Humanos , Internato e Residência/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Procedimentos Cirúrgicos Reconstrutivos/educação , Cirurgiões/educação , Cirurgiões/organização & administração , Universidades/normas , Washington , Recursos Humanos/organização & administração , Recursos Humanos/normas
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