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1.
Acad Med ; 95(10): 1521-1523, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33006869

RESUMO

The COVID-19 pandemic is a public health emergency that demands leadership throughout the health care system. Leadership is the ability to guide a team or organization toward a stated goal or objective. In addition to hospital-wide leadership, there is need for leadership at the level of medical teams. Resident leadership is essential to ensure team function and patient care, yet residents are often overlooked as valuable leaders. This Perspective argues that residents can demonstrate leadership during a public health crisis by creating a culture of emotional intelligence in their medical teams. Emotional intelligence has been identified as a critical aspect of leadership and consists of self-awareness, self-management, social awareness, and relationship management. In psychiatry, patient interactions depend upon psychiatrists demonstrating a high level of attention to their own thoughts, feelings, and behaviors as well as those of the patient to communicate in a way that demonstrates both understanding and empathy. In this Perspective, a psychiatry resident uses expertise in emotional intelligence to recommend residents (1) be mindful, (2) ask and listen, (3) establish safety, and (4) unite around a common goal. These practical recommendations can be immediately implemented to increase emotional intelligence on medical teams to improve team function and patient care. Emotional intelligence is valuable at all levels of leadership, so hospital leadership and program directors should also heed these suggestions. While these recommendations are not unique to COVID-19, they are of paramount importance during the pandemic.


Assuntos
Infecções por Coronavirus/psicologia , Inteligência Emocional , Internato e Residência/organização & administração , Liderança , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/psicologia , Estudantes de Medicina/psicologia , Betacoronavirus , Humanos , Pandemias
3.
Emerg Med J ; 37(10): 630-636, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32948623

RESUMO

Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust's COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged.


Assuntos
Infecções por Coronavirus/terapia , Etiquetas de Emergência Médica/tendências , Serviço Hospitalar de Emergência/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/terapia , Tromboembolia/diagnóstico , Adulto , Fatores Etários , Idoso , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Progressão da Doença , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Seleção de Pacientes , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Medicina de Precisão/estatística & dados numéricos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Tromboembolia/epidemiologia , Tromboembolia/terapia , Reino Unido
4.
J Nepal Health Res Counc ; 18(2): 332-334, 2020 Sep 08.
Artigo em Inglês | MEDLINE | ID: mdl-32969406

RESUMO

Anaesthetic management of patients with Corona Virus Disease (COVID-19) posses multiple challenges. In the low-income nation like Nepal, factors like suboptimal infrastructure and resource limitations may add on to the existing challenges. Proper planning and preparedness can help to overcome the challenges and enhance safety of both the patients undergoing surgery and of the health care workers involved in patient management. Keywords: Anaesthetic management; COVID-19; Nepal.


Assuntos
Raquianestesia/métodos , Cesárea , Infecções por Coronavirus/complicações , Traumatismos da Perna/cirurgia , Pneumonia Viral/complicações , Adulto , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nepal/epidemiologia , Pandemias , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia
6.
Rech Soins Infirm ; (141): 60-69, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32988191

RESUMO

Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.


Assuntos
Enfermagem de Cuidados Paliativos na Terminalidade da Vida , Neoplasias/enfermagem , Equipe de Assistência ao Paciente/organização & administração , Humanos , Líbano , Estudos de Casos Organizacionais , Pesquisa Qualitativa
7.
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
8.
J Prim Care Community Health ; 11: 2150132720953680, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32909504

RESUMO

BACKGROUND: Chronic spinal pain is one of the most common diseases in the United States. Underserved patients are most affected, and disproportionately may use opioid medications as they lack access to other therapies. It is therefore important to develop systems to treat spinal pain within the primary medical home. METHODS: We designed a prospective observational pilot study at a community health center to measure the effectiveness of two interventions among an underserved population: a multidisciplinary pain team and chiropractic care. Study outcomes were pain and functional disability measured by the Pain Disability Questionnaire (PDQ), and reduction of opioid dose at baseline and 6-12 months. Multivariate linear regression was used to determine associating factors for change in PDQ scores. RESULTS: Thirty-five individuals completed baseline and follow-up PDQs from August 2018 to May 2020. Overall, the mean baseline PDQ was 92.4 +/- 6.1 and the mean follow-up PDQ was 81.9 +/- 7.7, resulting in a mean improvement of -10.6 (95% CI 1.2 - -22.3, P = .08). Participants in the chiropractic team (mean change -25.0, P = .01) and those completing the study before COVID-19 (mean change = -22.6, P < .01) were found to have significantly greater improvement at follow-up. CONCLUSION: This observational study within a community health center resulted in improvement in spinal pain and disability with chiropractic care versus a multidisciplinary pain team. Offering similar services in primary care may help to address pain and disability, and hopefully limit external referrals, advanced imaging, and opioid prescriptions.


Assuntos
Dor Crônica/terapia , Prestação Integrada de Cuidados de Saúde/organização & administração , Manipulação Quiroprática , Equipe de Assistência ao Paciente/organização & administração , Doenças da Coluna Vertebral/terapia , Adolescente , Adulto , Canadá , Centros Comunitários de Saúde , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
10.
West J Emerg Med ; 21(5): 1076-1079, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-32970557

RESUMO

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has magnified the risk to healthcare providers when inititiating airway management, and safe tracheal intubation has become of paramount importance. Mitigation of risk to frontline providers requires airway management to be an orchestrated exercise based on training and purposeful simulation. Role allocation and closed-loop communication form the foundation of this exercise. We describe a methodical, 10-step approach from decision-making and meticulous drug and equipment choices to donning of personal protective equipment, and procedural concerns. This bundled approach will help reduce unplanned actions, which in turn may reduce the risk of aerosol transmission during airway management in resource-limited settings.


Assuntos
Manuseio das Vias Aéreas/métodos , Betacoronavirus , Tomada de Decisão Clínica/métodos , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pacotes de Assistência ao Paciente/métodos , Pneumonia Viral/transmissão , Aerossóis , Manuseio das Vias Aéreas/instrumentação , Manuseio das Vias Aéreas/normas , Infecções por Coronavirus/terapia , Países em Desenvolvimento , Humanos , Relações Interprofissionais , Pandemias , Pacotes de Assistência ao Paciente/instrumentação , Pacotes de Assistência ao Paciente/normas , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual , Pneumonia Viral/terapia
12.
Artigo em Inglês | MEDLINE | ID: mdl-32785110

RESUMO

BACKGROUND: Since the beginning of SARS-CoV-2 outbreak, a large number of infections have been reported among healthcare workers (HCWs). The aim of this study was to investigate the occurrence of SARS-CoV-2 infection among HCWs involved in the first management of infected patients and to describe the measures adopted to prevent the transmission in the hospital. METHODS: This prospective observational study was conducted between February 21 and April 16, 2020, in the Padua University Hospital (north-east Italy). The infection control policy adopted consisted of the following: the creation of the "Advanced Triage" area for the evaluation of SARS-CoV-2 cases, and the implementation of an integrated infection control surveillance system directed to all the healthcare personnel involved in the Advance Triage area. HCWs were regularly tested with nasopharyngeal swabs for SARS-CoV-2; body temperature and suggestive symptoms were evaluated at each duty. Demographic and clinical data of both patients and HCWs were collected and analyzed; HCWs' personal protective equipment (PPE) consumption was also recorded. The efficiency of the control strategy among HCWs was evaluated identifying symptomatic infection (primary endpoint) and asymptomatic infection (secondary endpoint) with confirmed detection of SARS-CoV-2. RESULTS: 7595 patients were evaluated in the Advanced Triage area: 5.2% resulted positive and 72.4% was symptomatic. The HCW team was composed of 60 members. A total of 361 nasopharyngeal swabs were performed on HCWs. All the swabs resulted negative and none of the HCWs reached the primary or the secondary endpoint. CONCLUSIONS: An integrated hospital infection control strategy, consisting of dedicated areas for infected patients, strict measures for PPE use and mass surveillance, is successful to prevent infection among HCWs.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pessoal de Saúde/organização & administração , Controle de Infecções/organização & administração , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Adulto , Infecções Assintomáticas/epidemiologia , Betacoronavirus , Temperatura Corporal , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Feminino , Pessoal de Saúde/normas , Humanos , Controle de Infecções/normas , Itália/epidemiologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Equipamento de Proteção Individual/estatística & dados numéricos , Equipamento de Proteção Individual/provisão & distribução , Estudos Prospectivos , Triagem/organização & administração
13.
J Rehabil Med ; 52(8): jrm00089, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32830284

RESUMO

OBJECTIVE: COVID-19 is a multisystem illness that has considerable long-term physical, psychological, cognitive, social and vocational sequelae in survivors. Given the scale of this burden and lockdown measures in most countries, there is a need for an integrated rehabilitation pathway using a tele-medicine approach to screen and manage these sequelae in a systematic and efficient way. METHODS: A multidisciplinary team of professionals in the UK developed a comprehensive pragmatic telephone screening tool, the COVID-19 Yorkshire Rehabilitation Screen (C19-YRS), and an integrated rehabilitation pathway, which spans the acute hospital trust, community trust and primary care service within the National Health Service (NHS) service model. RESULTS: The C19-YRS telephone screening tool, developed previously, was used to screen symptoms and grade their severity. Referral criteria thresholds were applied to the output of C19-YRS to inform the decision-making process in the rehabilitation pathway. A dedicated multidisciplinary COVID-19 rehabilitation team is the core troubleshooting forum for managing complex cases with needs spanning multiple domains of the health condition. CONCLUSION: The authors recommend that health services dealing with the COVID-19 pandemic adopt a comprehensive telephone screening system and an integrated rehabilitation pathway to manage the large number of survivors in a timely and effective manner and to enable the provision of targeted interventions.


Assuntos
Betacoronavirus , Serviços de Saúde Comunitária/organização & administração , Infecções por Coronavirus/reabilitação , Procedimentos Clínicos/organização & administração , Assistência à Saúde/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/reabilitação , Telemedicina/organização & administração , Serviços de Saúde Comunitária/métodos , Assistência à Saúde/métodos , Humanos , Pandemias , Encaminhamento e Consulta/organização & administração , Medicina Estatal/organização & administração , Sobreviventes , Telemedicina/métodos , Reino Unido
15.
Hu Li Za Zhi ; 67(4): 89-97, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32748383

RESUMO

BACKGROUND & PROBLEMS: According to the literature, 74%-84% of patients in adult critical care units have an indwelling catheter. The majority of medical and healthcare infections are urinary tract infections, which are related to urinary catheter usage. Furthermore, critical infections may cause bacteremia, which increases the risk of mortality. Prior to this project, over three-quarters (78.7%) of patients in our unit used a urinary catheter, which is a rate that is higher than all other intensive care units of our hospital's internal medicine department. Due to Foley placement, removal and care of catheters requires collaboration of teamwork. Thus, the concept of team resource management may be applied to improve the situation. PURPOSE: The aim of this study was to reduce the urinary catheter usage rate in our intensive care unit to less than 69.3%. RESOLUTIONS: This project summarized the reasons for the high catheter usage rate in this unit on 2017/1/3 and implemented several approaches to improve the situation from 2017/2/1 to 2017/6/30. These approaches included affixing reminder labels to indwelling catheters, using an ultrasound bladder scanner as a substitute for intermittent catheterization, evaluating indwelling catheters, establishing flow planning for post-catheter removal, holding cross-team meetings, and adopting a reward system. During the improvement period, we held collaborative conference meetings weekly to discuss solutions, evaluate end-of-the-month progress, and set reward policies. RESULTS: We lowered the average urinary catheter usage rate from 78.7% on 2017/3/1 to 57.8% on 2017/6/30, achieving a 26.5% reduction in catheter usage. CONCLUSIONS: This project both effectively reduced the unnecessary use of urinary catheters and significantly strengthened team spirit in our unit, thus improving the quality of medical care provided.


Assuntos
Unidades de Terapia Intensiva/organização & administração , Equipe de Assistência ao Paciente/organização & administração , Cateteres Urinários/estatística & dados numéricos , Humanos , Pesquisa em Avaliação de Enfermagem , Cateterismo Urinário/enfermagem
17.
Hosp Pediatr ; 10(9): 810-819, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32847961

RESUMO

The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread quickly across the globe, creating unique and pressing challenges for today's physicians. Although this virus disproportionately affects adults, initial SARS-CoV-2 infection can present a significant disease burden for the pediatric population. A review of the literature yields descriptive studies in pediatric patients; however, no evidence-based or evidence-informed guidelines for the diagnosis and treatment of the hospitalized pediatric patient have been published in peer-reviewed journals. The authors, working at a quaternary care children's hospital in the national epicenter of the SARS-CoV-2 pandemic, found an urgent need to create a unified, multidisciplinary, evidence-informed set of guidelines for the diagnosis and management of coronavirus disease 2019 in children. In this article, the authors describe our institutional practices for the hospitalized pediatric patient with confirmed or suspected initial SARS-CoV-2 infection. The authors anticipate that developing evidence-informed and institution-specific guidelines will lead to improvements in care quality, efficiency, and consistency; minimization of staff risk of exposure to SARS-CoV-2; and increased provider comfort in caring for pediatric patients with SARS-CoV-2 infection.


Assuntos
Betacoronavirus , Bem-Estar da Criança/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Procedimentos Clínicos/organização & administração , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Criança , Difusão de Inovações , Gerenciamento Clínico , Hospitais Pediátricos/organização & administração , Humanos , Pandemias , Equipe de Assistência ao Paciente/organização & administração
19.
BMJ Open ; 10(8): e040898, 2020 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-32801210

RESUMO

OBJECTIVES: Pressures on healthcare systems due to COVID-19 has impacted patients without COVID-19 with surgery disproportionally affected. This study aims to understand the impact on the initial management of patients with brain tumours by measuring changes to normal multidisciplinary team (MDT) decision making. DESIGN: A prospective survey performed in UK neurosurgical units performed from 23 March 2020 until 24 April 2020. SETTING: Regional neurosurgical units outside London (as the pandemic was more advanced at time of study). PARTICIPANTS: Representatives from all units were invited to collect data on new patients discussed at their MDT meetings during the study period. Each unit decided if management decision for each patient had changed due to COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome measures included number of patients where the decision to undergo surgery changed compared with standard management usually offered by that MDT. Secondary outcome measures included changes in surgical extent, numbers referred to MDT, number of patients denied surgery not receiving any treatment and reasons for any variation across the UK. RESULTS: 18 units (75%) provided information from 80 MDT meetings that discussed 1221 patients. 10.7% of patients had their management changed-the majority (68%) did not undergo surgery and more than half of this group not undergoing surgery had no active treatment. There was marked variation across the UK (0%-28% change in management). Units that did not change management could maintain capacity with dedicated oncology lists. Low volume units were less affected. CONCLUSION: COVID-19 has had an impact on patients requiring surgery for malignant brain tumours, with patients receiving different treatments-most commonly not receiving surgery or any treatment at all. The variations show dedicated cancer operating lists may mitigate these pressures. STUDY REGISTRATION: This study was registered with the Royal College of Surgeons of England's COVID-19 Research Group (https://www.rcseng.ac.uk/coronavirus/rcs-covid-research-group/).


Assuntos
Neoplasias Encefálicas/cirurgia , Tomada de Decisão Clínica , Infecções por Coronavirus/epidemiologia , Equipe de Assistência ao Paciente/organização & administração , Pneumonia Viral/epidemiologia , Betacoronavirus , Assistência à Saúde , Inglaterra/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Pandemias , Estudos Prospectivos
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