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1.
Holist Nurs Pract ; 35(2): 60-64, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33555718

RESUMO

Presence of support persons enhances patient and family satisfaction. The introduction of the coronavirus disease-2019 (COVID-19) pandemic has impacted hospital operations and has reduced visitation. A virtual visitation program was implemented in critical care units to replicate visitation by video chat to ease stress on patients and family members to improve communication.


Assuntos
Cuidados Críticos/métodos , Telecomunicações/normas , Visitas a Pacientes , Atitude do Pessoal de Saúde , /transmissão , Cuidados Críticos/tendências , Família/psicologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/tendências , Pandemias/prevenção & controle , Pacientes/psicologia , Telecomunicações/tendências
2.
J Invasive Cardiol ; 33(2): E71-E76, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33348314

RESUMO

In Spring 2020, the United States epicenter of COVID-19 was New York City, in which the borough of the Bronx was particularly affected. This Fall, there has been a resurgence of COVID-19 in Europe and the Midwestern United States. We describe our experience transforming our cardiac catheterization laboratories to accommodate an influx of COVID-19 patients so as to provide other hospitals with a potential blueprint. We transformed our pre/postprocedural patient care areas into COVID-19 intensive care and step-down units and maintained emergent invasive care for ST-segment elevation myocardial infarction using existing space and personnel.


Assuntos
Cateterismo Cardíaco/métodos , Serviço Hospitalar de Cardiologia , Unidades de Cuidados Coronarianos , Cuidados Críticos , Controle de Infecções , Laboratórios Hospitalares/organização & administração , Inovação Organizacional , Infarto do Miocárdio com Supradesnível do Segmento ST , /epidemiologia , Serviço Hospitalar de Cardiologia/organização & administração , Serviço Hospitalar de Cardiologia/tendências , Unidades de Cuidados Coronarianos/métodos , Unidades de Cuidados Coronarianos/organização & administração , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/tendências , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Cidade de Nova Iorque/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Assistência Perioperatória/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
3.
Lancet Diabetes Endocrinol ; 9(2): 82-93, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33357491

RESUMO

BACKGROUND: We aimed to ascertain the cumulative risk of fatal or critical care unit-treated COVID-19 in people with diabetes and compare it with that of people without diabetes, and to investigate risk factors for and build a cross-validated predictive model of fatal or critical care unit-treated COVID-19 among people with diabetes. METHODS: In this cohort study, we captured the data encompassing the first wave of the pandemic in Scotland, from March 1, 2020, when the first case was identified, to July 31, 2020, when infection rates had dropped sufficiently that shielding measures were officially terminated. The participants were the total population of Scotland, including all people with diabetes who were alive 3 weeks before the start of the pandemic in Scotland (estimated Feb 7, 2020). We ascertained how many people developed fatal or critical care unit-treated COVID-19 in this period from the Electronic Communication of Surveillance in Scotland database (on virology), the RAPID database of daily hospitalisations, the Scottish Morbidity Records-01 of hospital discharges, the National Records of Scotland death registrations data, and the Scottish Intensive Care Society and Audit Group database (on critical care). Among people with fatal or critical care unit-treated COVID-19, diabetes status was ascertained by linkage to the national diabetes register, Scottish Care Information Diabetes. We compared the cumulative incidence of fatal or critical care unit-treated COVID-19 in people with and without diabetes using logistic regression. For people with diabetes, we obtained data on potential risk factors for fatal or critical care unit-treated COVID-19 from the national diabetes register and other linked health administrative databases. We tested the association of these factors with fatal or critical care unit-treated COVID-19 in people with diabetes, and constructed a prediction model using stepwise regression and 20-fold cross-validation. FINDINGS: Of the total Scottish population on March 1, 2020 (n=5 463 300), the population with diabetes was 319 349 (5·8%), 1082 (0·3%) of whom developed fatal or critical care unit-treated COVID-19 by July 31, 2020, of whom 972 (89·8%) were aged 60 years or older. In the population without diabetes, 4081 (0·1%) of 5 143 951 people developed fatal or critical care unit-treated COVID-19. As of July 31, the overall odds ratio (OR) for diabetes, adjusted for age and sex, was 1·395 (95% CI 1·304-1·494; p<0·0001, compared with the risk in those without diabetes. The OR was 2·396 (1·815-3·163; p<0·0001) in type 1 diabetes and 1·369 (1·276-1·468; p<0·0001) in type 2 diabetes. Among people with diabetes, adjusted for age, sex, and diabetes duration and type, those who developed fatal or critical care unit-treated COVID-19 were more likely to be male, live in residential care or a more deprived area, have a COVID-19 risk condition, retinopathy, reduced renal function, or worse glycaemic control, have had a diabetic ketoacidosis or hypoglycaemia hospitalisation in the past 5 years, be on more anti-diabetic and other medication (all p<0·0001), and have been a smoker (p=0·0011). The cross-validated predictive model of fatal or critical care unit-treated COVID-19 in people with diabetes had a C-statistic of 0·85 (0·83-0·86). INTERPRETATION: Overall risks of fatal or critical care unit-treated COVID-19 were substantially elevated in those with type 1 and type 2 diabetes compared with the background population. The risk of fatal or critical care unit-treated COVID-19, and therefore the need for special protective measures, varies widely among those with diabetes but can be predicted reasonably well using previous clinical history. FUNDING: None.


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Vigilância da População , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Cuidados Críticos/tendências , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
5.
Medicine (Baltimore) ; 99(50): e23108, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327232

RESUMO

To explore the effect of Joanna Briggs Institute (JBI) physical restraint standards in improving physical restraint in critical and emergency department patients.Enrolled 300 critical patients admitted in our hospital's emergency department from January to December 2019: 150 patients admitted January to June 2019 as control group and 150 patients admitted July to December 2019 as observation group. Routine restraints were applied in control group. Emergency department nurses in the observation group received thematic and practical JBI standardized training. This included pre-restraint assessment, principles of physical restraint, informed consent, using a restraint decision-making wheel, and alternatives to physical restraint. The incidence of restraint-associated adverse events (e.g., skin bruising, swelling) and restraint utilization rate were examined between 2 groups.The incidence of adverse events and the restraint utilization rate were significantly lower in the observation group (P < .05).The application of JBI physical restraint standards for emergency department patients can effectively reduce the incidence of adverse events and the restraint utilization rate.


Assuntos
Cuidados Críticos/estatística & dados numéricos , Recursos Humanos de Enfermagem no Hospital/ética , Restrição Física/efeitos adversos , Restrição Física/ética , Estudos de Casos e Controles , Cuidados Críticos/tendências , Enfermagem de Cuidados Críticos/normas , Tomada de Decisões , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Consentimento Livre e Esclarecido , Masculino , Pessoa de Meia-Idade , Avaliação em Enfermagem/métodos , Recursos Humanos de Enfermagem no Hospital/educação , Estudos Prospectivos , Padrões de Referência
8.
Br J Hosp Med (Lond) ; 81(9): 1-9, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32990080

RESUMO

Guidance regarding appropriate use of personal protective equipment in hospitals is in constant flux as research into SARS-COV-2 transmission continues to develop our understanding of the virus. The risk associated with procedures classed as 'aerosol generating' is under constant debate. Current guidance is largely based on pragmatic and cautious logic, as there is little scientific evidence of aerosolization and transmission of respiratory viruses associated with procedures. The physical properties of aerosol particles which may contain viable virus have implications for the safe use of personal protective equipment and infection control protocols. As elective work in the NHS is reinstated, it is important that the implications of the possibility of airborne transmission of the virus in hospitals are more widely understood. This will facilitate appropriate use of personal protective equipment and help direct further research into the true risks of aerosolization during these procedures to allow safe streamlining of services for staff and patients.


Assuntos
Microbiologia do Ar , Infecções por Coronavirus , Cuidados Críticos , Fidelidade a Diretrizes/normas , Controle de Infecções , Pandemias , Equipamento de Proteção Individual , Pneumonia Viral , Gestão de Riscos/organização & administração , Aerossóis , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Cuidados Críticos/métodos , Cuidados Críticos/tendências , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Reino Unido/epidemiologia
9.
Intern Emerg Med ; 15(8): 1507-1515, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32979193

RESUMO

Transplant programs have been severely disrupted by the COVID-19 pandemic. Italy was one of the first countries with the highest number of deaths in the world due to SARS-CoV-2. Here we propose a management model for the reorganization of liver transplant (LT) activities and policies in a local intensive care unit (ICU) assigned to liver transplantation affected by restrictions on mobility and availability of donors and recipients as well as health personnel and beds. We describe the solutions implemented to continue transplantation activities throughout a given pandemic: management of donors and recipients' LT program, ICU rearrangement, healthcare personnel training and monitoring to minimize mortality rates of patients on the waiting list. Transplantation activities from February 22, 2020, the data of first known COVID-19 case in Italy's Emilia Romagna region to June 30, 2020, were compared with the corresponding period in 2019. During the 2020 study period, 38 LTs were performed, whereas 41 were performed in 2019. Patients transplanted during the COVID-19 pandemic had higher MELD and MELD-Na scores, cold ischaemia times, and hospitalization rates (p < 0.05); accordingly, they spent fewer days on the waitlist and had a lower prevalence of hepatocellular carcinoma (p < 0.05). No differences were found in the provenance area, additional MELD scores, age of donors and recipients, BMI, re-transplant rates, and post-transplant mortality. No transplanted patients contracted COVID-19, although five healthcare workers did. Ultimately, our policy allowed us to continue the ICU's operations by prioritizing patients hospitalized with higher MELD without any case of transplant infection due to COVID-19.


Assuntos
Cuidados Críticos/métodos , Transplante de Fígado/métodos , Pandemias/estatística & dados numéricos , Adulto , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/tendências , Aglomeração , Doença Hepática Terminal/complicações , Doença Hepática Terminal/epidemiologia , Doença Hepática Terminal/cirurgia , Feminino , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Itália/epidemiologia , Transplante de Fígado/normas , Transplante de Fígado/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia
13.
Am Heart J ; 227: 74-81, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32682106

RESUMO

Critical care cardiology has been impacted by the coronavirus disease-2019 (COVID-19) pandemic. COVID-19 causes severe acute respiratory distress syndrome, acute kidney injury, as well as several cardiovascular complications including myocarditis, venous thromboembolic disease, cardiogenic shock, and cardiac arrest. The cardiac intensive care unit is rapidly evolving as the need for critical care beds increases. Herein, we describe the changes to the cardiac intensive care unit and the evolving role of critical care cardiologists and other clinicians in the care of these complex patients affected by the COVID-19 pandemic. These include practical recommendations regarding structural and organizational changes to facilitate care of patients with COVID-19; staffing and personnel changes; and health and safety of personnel. We draw upon our own experiences at NewYork-Presbyterian Columbia University Irving Medical Center to offer insights into the unique challenges facing critical care clinicians and provide recommendations of how to address these challenges during this unprecedented time.


Assuntos
Cardiologia/tendências , Doenças Cardiovasculares , Infecções por Coronavirus , Cuidados Críticos , Unidades de Terapia Intensiva/organização & administração , Pandemias , Pneumonia Viral , Betacoronavirus , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/terapia , Doenças Cardiovasculares/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Cuidados Críticos/métodos , Cuidados Críticos/organização & administração , Cuidados Críticos/tendências , Humanos , Cidade de Nova Iorque , Inovação Organizacional , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia
19.
Int J Med Inform ; 139: 104165, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32402986

RESUMO

OBJECTIVE: Identify opportunities to improve the interaction between clinicians and Tele-Critical Care (Tele-CC) programs through an analysis of alert occurrence and reactivation in a specific Tele-CC application. MATERIALS AND METHODS: Data were collected automatically through the Philips eCaremanager® software system used at multiple hospitals in the Avera health system. We evaluated the distribution of alerts per patient, frequency of alert types, time between consecutive alerts, and Tele-CC clinician choice of alert reactivation times. RESULTS: Each patient generated an average of 79.8 alerts during their ICU stay (median 31.0; 25th - 75th percentile 10.0-89.0) with 46.4 for blood pressure and 38.4 for oxygenation. The most frequent alerts for continuous physiological parameters were: MAP limit (28.9 %), O2/RR (26.4 %), MAP trend (16.5 %), HR trend (12.1 %), and HR limit (11.3 %). The median time between consecutive alerts for one parameter was less than 10 min for 86 % of patients. Tele-CC providers responded to all alert types with immediate reactivation 47-88 % of the time. Limit alerts had longer reactivation times than their trend alert counterparts (p-value < .001). CONCLUSIONS: The alert type specific differences in frequency, time occurrence and provider choice of reactivation time provide insight into how clinicians interact with the Tele-CC system. Systems engineering enhancements to Tele-CC software algorithms may reduce alert burden and thereby decrease clinicians' cognitive workload for alert assessment. Further study of Tele-CC alert generation, alert presentation to clinicians, and the clinicians' options to respond to these alerts may reduce provider workload, minimize alert desensitization, and optimize the ability of Tele-CC clinicians to provide efficient and timely critical care management.


Assuntos
Cuidados Críticos/métodos , Sistemas de Apoio a Decisões Clínicas/normas , Sistemas de Registro de Ordens Médicas/normas , Telemedicina/métodos , Carga de Trabalho/normas , Cuidados Críticos/tendências , Humanos , Telemedicina/tendências
20.
Curr Opin Anaesthesiol ; 33(3): 381-387, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32371638

RESUMO

PURPOSE OF REVIEW: A number of high profile conjoined twin separations have been extensively covered by the world media. Anaesthesia for conjoined twins is a procedure rarely experienced by paediatric anaesthetists. The increased survival of the twins has prompted discussion as to the most appropriate selection of patients, teams and hospitals to provide exceptional anaesthetic care. RECENT FINDINGS: The number of conjoined twins presenting for surgery remains low with many infants not surviving foetal or early neonatal life. Anaesthetic management of less common conjoined infants such as craniopagus twins has highlighted the benefit of careful patient selection, extensive preoperative investigations and meticulous multidisciplinary team planning. The role of simulation of possible adverse perioperative events has been highlighted. Three dimensional anatomical models and virtual reality systems have permitted surgical planning in advance of actual intervention. A number of legal and ethical concerns have been reported especially in the setting of emergency separation where surgery is likely to contribute to death of one of the twins. SUMMARY: There appears to be an expanding role for international teams with extensive separation experience becoming involved in international teleconferencing to improve patient management in low-resource countries. Whether the perioperative outcome is better when the conjoined twins are transferred to major centres for surgery or teams operate in the twin's country of origin remains to be seen.


Assuntos
Manuseio das Vias Aéreas , Anestesia/tendências , Cuidados Críticos , Gêmeos Unidos/cirurgia , Manuseio das Vias Aéreas/tendências , Criança , Cuidados Críticos/tendências , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Ressuscitação
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