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1.
J Wound Care ; 30(3): 162-170, 2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33729846

RESUMO

OBJECTIVES: The aim of this study was to determine the impact of a specially designed care bundle on the development of facial pressure injuries (PI) among frontline healthcare workers wearing personal protective equipment (PPE) during the COVID-19 pandemic. The primary outcome of interest was the incidence of facial PIs. The secondary outcomes of interest were facial pain while wearing PPE and ease of use of the care bundle. METHODS: This study used a voluntary survey by questionnaire, supplemented by a qualitative analysis of interviews from a small purposive sample that took place in one large Irish hospital over a two-month period in 2020. The hospital was a city-based public university teaching hospital with 800 inpatient beds. The intervention was a care bundle consisting of skin protection, face mask selection, material use, skin inspection, cleansing and hydration developed in line with international best practice guidelines. All staff working in COVID-19 wards, intensive care units and the emergency department in the hospital were given a kitbag containing the elements of the care bundle plus an information pamphlet. Data were collected via a survey and interviews. RESULTS: A total of 114 staff provided feedback on the use of the care bundle. Before using the care bundle 29% (n=33) of the respondents reported developing a facial PI, whereas after using the care bundle only 8% (n=9) of the respondents reported developing a facial PI. The odds ratio (OR) of skin injury development was 4.75 (95% confidence interval (CI): 2.15-10.49; p=0.0001), suggesting that after the care bundle was issued, those who responded to the survey were almost five times less likely to develop a skin injury. Interviews with 14 staff determined that the bundle was easy to use and safe. CONCLUSION: Among those who responded to the survey, the use of the bundle was associated with a reduction in the incidence of skin injury from 29% to 8%, and respondents found the bundle easy to use, safe and effective. As with evidence from the international literature, this study has identified that when skincare is prioritised, and a systematic preventative care bundle approach is adopted, there are clear benefits for the individuals involved.


Assuntos
/epidemiologia , Traumatismos Faciais/etiologia , Corpo Clínico Hospitalar/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Traumatismos Ocupacionais/etiologia , Equipamento de Proteção Individual/efeitos adversos , Transmissão de Doença Infecciosa/prevenção & controle , Traumatismos Faciais/prevenção & controle , Humanos , Máscaras/efeitos adversos , Traumatismos Ocupacionais/prevenção & controle
2.
JAMA Netw Open ; 4(2): e2036297, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33533928

RESUMO

Importance: Given that 40% of hand function is achieved with the thumb, replantation of traumatic thumb injuries is associated with substantial quality-of-life benefits. However, fewer replantations are being performed annually in the US, which has been associated with less surgical expertise and increased risk of future replantation failures. Thus, understanding how interfacility transfers and hospital characteristics are associated with outcomes warrants further investigation. Objective: To assess the association of interfacility transfer, patient characteristics, and hospital factors with thumb replantation attempts and success. Design, Setting, and Participants: This cross-sectional study used data from the US National Trauma Data Bank from 2009 to 2016 for adult patients with isolated traumatic thumb amputation injury who underwent revision amputation or replantation. Data analysis was performed from May 4, 2020, to July 20, 2020. Exposures: Interfacility transfer, defined as transfer of a patient from 1 hospital to another to obtain care for traumatic thumb amputation. Main Outcomes and Measures: Replantation attempt and replantation success, defined as having undergone a replantation without a subsequent revision amputation during the same hospitalization. Multilevel logistic regression models were used to assess the associations of interfacility transfer, patient characteristics, and hospital factors with replantation outcomes. Results: Of 3670 patients included in this analysis, 3307 (90.1%) were male and 2713 (73.9%) were White; the mean (SD) age was 45.8 (16.5) years. A total of 1881 patients (51.2%) were transferred to another hospital; most of these patients were male (1720 [91.4%]) and White (1420 [75.5%]). After controlling for patient and hospital characteristics, uninsured patients were less likely to have thumb replantation attempted (odds ratio [OR], 0.61; 95% CI, 0.47-0.78) or a successful replantation (OR, 0.64; 95% CI, 0.49-0.84). Interfacility transfer was associated with increased odds of replantation attempt (OR, 1.34; 95% CI, 1.13-1.59), with 13% of the variation at the hospital level. Interfacility transfer was also associated with increased replantation success (OR, 1.23; 95% CI, 1.03-1.47), with 14% of variation at the hospital level. Conclusions and Relevance: In this cross-sectional study, interfacility transfer and particularly hospital-level variation were associated with increased thumb replantation attempts and successes. These findings suggest a need for creating policies that incentivize hospitals with replantation expertise to provide treatment for traumatic thumb amputations, including promotion of centralization of replantation care.


Assuntos
Amputação Traumática/cirurgia , Hospitais/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Reimplante , Polegar/lesões , Adulto , Fatores Etários , Certificação , Estudos Transversais , Feminino , Traumatismos dos Dedos/cirurgia , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Seguro Saúde , Modelos Logísticos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Medicare , Pessoa de Meia-Idade , Análise Multinível , Razão de Chances , Cirurgiões Ortopédicos/provisão & distribução , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento , Estados Unidos
3.
BMJ Open ; 11(2): e043837, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33619195

RESUMO

OBJECTIVES: Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING: Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS: We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS: Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION: A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.


Assuntos
Transmissão de Doença Infecciosa do Paciente para o Profissional , Corpo Clínico Hospitalar , Doenças Profissionais , Adulto , /prevenção & controle , /transmissão , Países em Desenvolvimento , Feminino , Hospitais Universitários/organização & administração , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Modelos Organizacionais , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Política Organizacional , Equipamento de Proteção Individual , Estudos Prospectivos , Medição de Risco , Centros de Atenção Terciária/organização & administração
5.
Aten. prim. (Barc., Ed. impr.) ; 52(9): 608-616, nov. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-198437

RESUMO

OBJETIVO: Estimar la prevalencia de burnout y malestar psicológico de los médicos residentes de Medicina Familiar y Comunitaria (MFyC) de dos unidades docentes y determinar su relación con el año de residencia, los estilos de vida y las condiciones laborales. DISEÑO: Estudio transversal. Emplazamiento: Atención Primaria. Participantes: Se realizaron encuestas presenciales a los residentes de dos unidades docentes (n = 278), incluyendo a todos los residentes de la muestra. El porcentaje de respuesta fue del 76,9%. MEDICIONES PRINCIPALES: Prevalencia de burnout mediante la escala Maslach Burnout Inventory (MBI) y prevalencia de malestar psicológico mediante la escala General Health Questionnaire-12 (GHQ-12). También variables sobre estilos de vida, organización laboral y consumo de drogas. RESULTADOS: El 72% de los participantes son mujeres. La prevalencia de burnout es del 33,8% (IC 95% 27,0-40,6), siendo del 25,6% (IC 95% 19,5-31,7) el agotamiento emocional, 37,9% (IC 95% 31,0-44,7) la despersonalización y 52,9% (IC 95% 45,9-59,9) la baja realización personal. La prevalencia aumenta de forma significativa en todas las dimensiones a partir del segundo año de residencia, excepto en la realización personal. La prevalencia de malestar emocional es del 40,4% (IC 95% 33,5-47,3), sin diferencias significativas según año de residencia. De los residentes con malestar psicológico, el 50,0% presenta también burnout, mientras que este porcentaje es del 22,1% entre los que no presentan malestar psicológico. CONCLUSIONES: La prevalencia de malestar emocional y de burnout (especialmente en baja realización personal) es elevada en los residentes de Medicina Familiar y Comunitaria. Esta es superior a la descrita en estudios previos para otros colectivos de profesionales de la salud y se debe tener en cuenta para desarrollar medidas preventivas


OBJECTIVE: To estimate the prevalence of burnout and psychological distress among trainee General Practitioners of two training placements and its relationship with the year of residence, lifestyle and working conditions. DESIGN: Cross-sectional study. LOCATION: Primary Care. PARTICIPANTS: On-site surveys for all trainees of two training placements (n = 278), including all trainees of the sample. The response percentage is 76.9%. MAIN MEASUREMENTS: Prevalence of burnout using the Maslach Burnout Inventory (MBI) scale and prevalence of psychological distress using the General Health Questionnaire-12 scale (GHQ-12). Also variables on lifestyles, labor organization and drug use. Outcomes: 72% of participants are women. The prevalence of burnout is 33.8% (CI 95% 27.0-40.6), being 25.6% (CI 95% 19.5-31.7) emotional exhaustion, 37.9% (CI 95% 31.0-44.7) depersonalization and 52.9% (CI 95% 45.9-59.9) the low personal accomplishment. Prevalence increases significantly in all dimensions after the second year of training, except in personal accomplishment. The prevalence of emotional distress is 40.4% (CI 95% 33.5-47.3), without significant differences according to year of training. In the group of trainees with psychological distress, 50.0% also have burnout, while this percentage is 22.1% among those who do not present psychological distress. CONCLUSIONS: The prevalence of emotional distress and burnout (especially in low personal accomplishment) is high in trainee General Practitioners. The prevalence in higher than the described in previous studies for other groups of health professionals and should be taken into account to develop preventive measures


Assuntos
Humanos , Masculino , Feminino , Adulto , Esgotamento Psicológico/epidemiologia , Estresse Psicológico/epidemiologia , Corpo Clínico Hospitalar/psicologia , Corpo Clínico Hospitalar/estatística & dados numéricos , Estudos Transversais , Inquéritos e Questionários , Internato e Residência , Escalas de Graduação Psiquiátrica , Estilo de Vida , Prevalência , Fatores de Tempo , Fatores de Risco , Estatísticas não Paramétricas , Medicina de Família e Comunidade , Espanha/epidemiologia
6.
Rev. esp. enferm. dig ; 112(11): 854-859, nov. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198770

RESUMO

INTRODUCCIÓN: el uso del consentimiento informado es necesario en los procedimientos invasivos como documento garantizador de la relación sanitaria ética y de la seguridad del paciente. OBJETIVO: analizar si se poseen y utilizan los documentos de consentimiento informado para paracentesis en los centros sanitarios, así como obtener algunos datos de interés sobre la técnica. MATERIAL Y MÉTODO: realizamos un estudio observacional descriptivo mediante una encuesta transversal on-line difundida por redes sociales, destinada a los especialistas y residentes de aparato digestivo durante diciembre de 2019. RESULTADOS: incluimos 203 encuestas anónimas (55,2 % adjuntos y 44,8 % residentes) de 74 centros sanitarios de 34 provincias españolas. Noventa encuestados (44,3 %) tenían dicho documento en sus centros; de estos, 29 (32,2 %) lo entregaban siempre; 31 (34,4 %), algunas veces; y 21 (23,3 %), nunca. Setenta y dos profesionales (35,5 %) contestaron no tenerlo y 41 (20,5 %), ser desconocedores; de entre ellos, 77 (68,1 %) consideraban necesaria su creación, 31 (27,4 %) no lo creían así y cinco (4,4 %) no contestaron. En cuanto a la técnica, 173 facultativos (85,2 %) realizan la punción bajo visión directa y 30 (14,8 %), ecoguiada en la mayoría de las ocasiones. Ciento nueve (53,7 %) aplican siempre anestésico local, 80 (39,4 %) lo aplican en algunas ocasiones y 14 (6,9 %) no lo utilizan. Ciento sesenta y siete encuestados (82,3 %) consideraron que es una técnica sencilla, frente a 36 (17,7 %) que la consideran de complejidad intermedia. En cuanto al riesgo, 150 (73,5 %) lo consideran bajo y 52 (25,6 %), medio. Noventa y nueve de ellos (48,8 %) refieren haber tenido complicaciones menores y 37 (18,2 %), mayores. CONCLUSIONES: la paracentesis es una técnica habitual en los servicios de digestivo y, a pesar de ser considerada sencilla y segura, entraña complicaciones. Por ello consideramos necesaria la formación reglada en esta técnica, así como la creación, difusión y utilización de los consentimientos informados dada la importante variabilidad intra e interhospitalaria que presenta


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Consentimento Livre e Esclarecido/estatística & dados numéricos , Paracentese/ética , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Estudos Transversais , Internet , Corpo Clínico Hospitalar/estatística & dados numéricos , Padrões de Prática Médica , Espanha
7.
Acta Dermatovenerol Alp Pannonica Adriat ; 29(3): 115-122, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32975297

RESUMO

INTRODUCTION: This questionnaire study evaluates dermatological complaints that may arise due to hygiene measures and anxiety among healthcare professionals (HCPs) during the COVID-19 outbreak. METHODS: A total of 526 volunteers, consisting of doctors and nurses, participated. Demographic features, personal hygiene behavior, personal protective equipment (PPE) use, Hospital Anxiety and Depression Scale-Anxiety (HADS-A) parameters, and symptoms of various dermatological diseases (xerosis, eczema, acne, hair loss, palmar hyperhidrosis, xeromycteria, urticaria, aphthous stomatitis, and seborrheic dermatitis) were investigated. RESULTS: Although the frequency and severity of many dermatological complaints increased during the pandemic period, the most frequent increase was observed in the frequency of complaints suggesting xerosis and eczema. We found that complaints suggesting xerosis and eczema were seen on the hands 2.44 and 3.57 times, respectively, as a result of washing hands 10 times/day, and that handwashing times of 10 seconds or more significantly increased the risk of eczema (5.44 times). Another remarkable result was a fivefold increase in acne complaints among those using any mask. The severity of all complaints except hair loss and seborrheic dermatitis correlated significantly with HADS-A. CONCLUSIONS: Our study showed that the frequency and severity of some dermatological complaints increased in HCPs.


Assuntos
Infecções por Coronavirus/epidemiologia , Eczema/epidemiologia , Dermatoses da Mão/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Betacoronavirus , Feminino , Luvas Protetoras/estatística & dados numéricos , Humanos , Higiene , Masculino , Exposição Ocupacional/efeitos adversos , Pandemias , Inquéritos e Questionários , Turquia
8.
Aust Health Rev ; 44(5): 741-747, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862832

RESUMO

Objective A pilot study to: (1) describe the ability of emergency physicians to provide primary consults at an Australian, major metropolitan, adult emergency department (ED) during the COVID-19 pandemic when compared with historical performance; and (2) to identify the effect of system and process factors on productivity. Methods A retrospective cross-sectional description of shifts worked between 1 and 29 February 2020, while physicians were carrying out their usual supervision, flow and problem-solving duties, as well as undertaking additional COVID-19 preparation, was documented. Effect of supervisory load, years of Australian registration and departmental flow factors were evaluated. Descriptive statistical methods were used and regression analyses were performed. Results A total of 188 shifts were analysed. Productivity was 4.07 patients per 9.5-h shift (95% CI 3.56-4.58) or 0.43 patients per h, representing a 48.5% reduction from previously published data (P<0.0001). Working in a shift outside of the resuscitation area or working a day shift was associated with a reduction in individual patient load. There was a 2.2% (95% CI: 1.1-3.4, P<0.001) decrease in productivity with each year after obtaining Australian medical registration. There was a 10.6% (95% CI: 5.4-15.6, P<0.001) decrease in productivity for each junior physician supervised. Bed access had no statistically significant effect on productivity. Conclusions Emergency physicians undertake multiple duties. Their ability to manage their own patients varies depending on multiple ED operational factors, particularly their supervisory load. COVID-19 preparations reduced their ability to see their own patients by half. What is known about the topic? An understanding of emergency physician productivity is essential in planning clinical operations. Medical productivity, however, is challenging to define, and is controversial to measure. Although baseline data exist, few studies examine the effect of patient flow and supervision requirements on the emergency physician's ability to perform primary consults. No studies describe these metrics during COVID-19. What does this paper add? This pilot study provides a novel cross-sectional description of the effect of COVID-19 preparations on the ability of emergency physicians to provide direct patient care. It also examines the effect of selected system and process factors in a physician's ability to complete primary consults. What are the implications for practitioners? When managing an emergency medical workforce, the contribution of emergency physicians to the number of patients requiring consults should take into account the high volume of alternative duties required. Increasing alternative duties can decrease primary provider tasks that can be completed. COVID-19 pandemic preparation has significantly reduced the ability of emergency physicians to manage their own patients.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Eficiência Organizacional/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/tendências , Corpo Clínico Hospitalar/organização & administração , Assistência Centrada no Paciente/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Agendamento de Consultas , Austrália , Betacoronavirus/patogenicidade , Estudos Transversais , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Previsões , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Corpo Clínico Hospitalar/tendências , Pessoa de Meia-Idade , Pandemias/estatística & dados numéricos , Assistência Centrada no Paciente/estatística & dados numéricos , Projetos Piloto , Estudos Retrospectivos
9.
J Infect ; 81(3): 427-434, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32615198

RESUMO

BACKGROUND: Significant nosocomial transmission of SARS-CoV-2 has been demonstrated. Understanding the prevalence of SARS-CoV-2 carriage amongst HCWs at work is necessary to inform the development of HCW screening programmes to control nosocomial spread. METHODS: Cross-sectional 'snapshot' survey from April-May 2020; HCWs recruited from six UK hospitals. Participants self-completed a health questionnaire and underwent a combined viral nose and throat swab, tested by Polymerase Chain Reaction (PCR) for SARS-CoV-2 with viral culture on majority of positive samples. FINDINGS: Point prevalence of SARS-CoV-2 carriage across the sites was 2.0% (23/1152 participants), median cycle threshold value 35.70 (IQR:32.42-37.57). 17 were previously symptomatic, two currently symptomatic (isolated anosmia and sore throat); the remainder declared no prior or current symptoms. Symptoms in the past month were associated with threefold increased odds of testing positive (aOR 3.46, 95%CI 1.38-8.67; p = 0.008). SARS-CoV-2 virus was isolated from only one (5%) of nineteen cultured samples. A large proportion (39%) of participants reported symptoms in the past month. INTERPRETATION: The point-prevalence is similar to previous estimates for HCWs in April 2020, though a magnitude higher than in the general population. Based upon interpretation of symptom history and testing results including viral culture, the majority of those testing positive were unlikely to be infectious at time of sampling. Development of screening programmes must balance the potential to identify additional cases based upon likely prevalence, expanding the symptoms list to encourage HCW testing, with resource implications and risks of excluding those unlikely to be infectious with positive tests. FUNDING: Public Health England.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adulto , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Estudos Transversais , Inglaterra , Feminino , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Estudos Prospectivos , RNA Viral , Reação em Cadeia da Polimerase em Tempo Real , Inquéritos e Questionários , Adulto Jovem
10.
J Infect Public Health ; 13(10): 1453-1455, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32694083

RESUMO

Since the outbreak of novel coronavirus (SARS-CoV-2)-infected pneumonia (COVID-19), numerous medical staff are fighting on the frontline. However, the possibility of occult infection in medical staff is ignored in many recent studies. Herein, we collected data in a COVID-19 designated hospital from January 22, 2020 to March 10, 2020. A total of 33 medical staff had at least one nucleic acid test of throat swab, immunoglobulin G (IgG) or IgM serum antibody test, and chest computed tomography (CT), were enrolled. Finally, we identified 25 cases (75.8%) were isolated for hospitalized treatment after positive virus detection. In addition, 4 cases who were all negative for nucleic acid test detection with no clinical symptoms, and none of their chest CT were abnormal. However, the results of serum IgG or IgM antibody test in these 4 cases were positive, suggesting the presence of occult infection. In conclusion, data from our single center indicated that SARS-CoV-2 had a high medical infection rate (29/33 = 87.9%) and might have a potential risk of occult infection.


Assuntos
Anticorpos Antivirais/sangue , Infecções Assintomáticas , Betacoronavirus/imunologia , Infecções por Coronavirus/diagnóstico , Hospitais Especializados , Corpo Clínico Hospitalar/estatística & dados numéricos , Pneumonia Viral/diagnóstico , RNA Viral/sangue , Adulto , Betacoronavirus/genética , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Radiografia Torácica , Tomografia Computadorizada por Raios X
13.
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
14.
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
15.
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
16.
BMC Health Serv Res ; 20(1): 388, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32380987

RESUMO

BACKGROUND: Patient safety is important, as in increasingly complex medical systems, the potential for unintended harm to patients also increases. This study assessed the attitudes of doctors in the Gaza Strip towards patient safety and medical error. It also explored variables that impacted their attitudes. METHODS: Doctors, working for at least 6 months in one of the four major government hospitals of the Gaza Strip, were invited to complete a 28-item, self-administered Arabic version of the Attitudes to Patient Safety Questionnaire III (APSQ-III); which assessed patient safety attitudes over nine domains, independent of the workplace. RESULTS: A total of 150 doctors from four government hospitals participated in this study, representing 43.5% of all 345 doctors working in the four study hospitals at the time of the study. The mean age was 36.6 (±9.7) years. The majority (72.7%) were males, 28.7% worked in surgical, 26.7% in pediatric, 23.3% in medical, 16.7% in obstetrics and gynecology, and 4.7% in other departments. Most participants (62.0%) had never received patient safety training. The overall APSQ score was 3.58 ± 0.3 (of a maximum of 5). The highest score was received by the domain "Working hours as a cause of errors" (4.16) and the lowest score by "Importance of Patient Safety in the Curriculum" (3.25). Older doctors with more professional experience had significantly higher scores than younger doctors (p = 0.003), demonstrating more positive attitudes toward patient safety. Furthermore, patient safety attitudes became more positive with increasing years of experience in some domains. However, no significant impact on overall APSQ scores was found by workplace, specialty or whether the participants had received previous training about patient safety. CONCLUSION: Doctors in Gaza demonstrated relatively positive patient safety attitudes in areas of "team functioning" and "working hours as a cause for error", but neutral attitudes in understanding medical error or patient safety training within the curriculum. Patient safety concepts appear to be acquired by doctors via informal learning over time in the job. Inclusion of such concepts into formal postgraduate curricula might improve patient safety attitudes among younger and less experienced doctors, support behaviour change and improve patient outcomes.


Assuntos
Atitude do Pessoal de Saúde , Corpo Clínico Hospitalar/psicologia , Segurança do Paciente , Adulto , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Oriente Médio , Inquéritos e Questionários
18.
Medicina (B Aires) ; 80(3): 219-228, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32442936

RESUMO

A process of feminization of the medical profession is observed, however, the massive access of women is associated with new gender inequalities named horizontal and vertical segregation. Horizontal segregation manifests itself in the unequal distribution of men and women in certain medical specialties and vertical segregation, in the limited representation of women in most high professional positions. The objective of this study was to determine how men and women are distributed in the different stages of the process that involves entering the medical residency system of an universitary hospital from Buenos Aires, Argentina, and to analyze the horizontal and vertical segregation of gender in the process of admission to medical residencies. Based on data from applicants to an universitary hospital, in the 2015-2017 period, a multiple logistic regression analysis was conducted to adjust the odds ratio of being male or female with potential confounders. There was no association between being man or woman and the performance of the exam, its approval and the admission to the interview. The adjusted odds ratio for the admission to the residency of men with respect to women was 2.03 (1.44-2.85). For the surgical residencies it was 2.75 (1.54-4.92) and for clinical it was 1.89 (1.17-3.00). In the inscription, women opted mainly for clinical residencies, and men for surgical purposes. Horizontal and vertical segregation was observed in the process of the residency. Making gender segregation visible will allow generating an equitable society.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , Adulto , Argentina , Feminino , Humanos , Modelos Logísticos , Masculino , Análise Multivariada , Estudos Retrospectivos , Distribuição por Sexo , Fatores Sexuais , Estatísticas não Paramétricas , Adulto Jovem
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