|
1
|
Sydora BC, Wilke MS, Ghosh M, Vine DF. The Impact of the COVID-19 Pandemic on Health and Health Care Experience in Those With Polycystic Ovary Syndrome. Int J Womens Health 2025; 17:287-298. [PMID: 39925784 PMCID: PMC11806697 DOI: 10.2147/ijwh.s504439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Accepted: 01/22/2025] [Indexed: 02/11/2025] Open
Abstract
Purpose Polycystic Ovary Syndrome (PCOS) is a complex endocrine-metabolic disorder and is associated with a variety of health disorders. The management of PCOS requires a multidisciplinary health care approach. The COVID-19 pandemic affected access and delivery of health care. The aim of this study was to assess the impact of the pandemic on the health and health care experience of those affected by PCOS. Patients and Methods An online survey was conducted January 2021 to July 2022 in Canada, open to anyone who identified as having PCOS. Data collected in REDCap included questions on demographics, symptoms, and experience of PCOS management during the pandemic. Results The majority (59%) of respondents (n=194, mean age 34±8 years) experienced pandemic-related employment changes and self-reported a high stress level (73±21/100). Of those who reported changes in body weight, 58% gained weight, which they attributed to unhealthy eating habits and a lack of exercise during the pandemic, and 16% lost weight, which they credited to increased physical activity and a shift towards healthier eating habits. The respondents ascribed the impact of COVID-related changes to clinic cancellations, delayed appointments, long wait times for referrals and lab work, lack of access to exercise facilities and insufficient social support. Some respondents voluntarily reduced access to health care services to limit COVID exposure. COVID-19-related health status was perceived as more important than their own PCOS-related symptoms. Virtual appointments via telehealth were regarded as beneficial for 20% of users. Conclusion Individuals with PCOS reported an overall reduction in COVID-related access to health care and supports. Some adapted to the use of telemedicine, while others experienced increased stress due to a lack of access to health care and an inability to manage their PCOS symptoms. The pandemic further highlighted that those with PCOS often experience a lack of accessibility to multidisciplinary health care and supports needed to manage their condition.
Collapse
Affiliation(s)
- Beate C Sydora
- Metabolic and Cardiovascular Disease Laboratory, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Michaelann S Wilke
- Metabolic and Cardiovascular Disease Laboratory, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| | - Mahua Ghosh
- Department of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Donna F Vine
- Metabolic and Cardiovascular Disease Laboratory, Faculty of Agricultural, Life & Environmental Sciences, University of Alberta, Edmonton, Canada
| |
Collapse
|
|
2
|
Das S, Khan R, Banerjee S, Ray S, Ray S. Alterations in Circadian Rhythms, Sleep, and Physical Activity in COVID-19: Mechanisms, Interventions, and Lessons for the Future. Mol Neurobiol 2024; 61:10115-10137. [PMID: 38702566 DOI: 10.1007/s12035-024-04178-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/04/2024] [Indexed: 05/06/2024]
Abstract
Although the world is acquitting from the throes of COVID-19 and returning to the regularity of life, its effects on physical and mental health are prominently evident in the post-pandemic era. The pandemic subjected us to inadequate sleep and physical activities, stress, irregular eating patterns, and work hours beyond the regular rest-activity cycle. Thus, perturbing the synchrony of the regular circadian clock functions led to chronic psychiatric and neurological disorders and poor immunological response in several COVID-19 survivors. Understanding the links between the host immune system and viral replication machinery from a clock-infection biology perspective promises novel avenues of intervention. Behavioral improvements in our daily lifestyle can reduce the severity and expedite the convalescent stage of COVID-19 by maintaining consistent eating, sleep, and physical activity schedules. Including dietary supplements and nutraceuticals with prophylactic value aids in combating COVID-19, as their deficiency can lead to a higher risk of infection, vulnerability, and severity of COVID-19. Thus, besides developing therapeutic measures, perpetual healthy practices could also contribute to combating the upcoming pandemics. This review highlights the impact of the COVID-19 pandemic on biological rhythms, sleep-wake cycles, physical activities, and eating patterns and how those disruptions possibly contribute to the response, severity, and outcome of SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Sandip Das
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, 502284, Telangana, India
| | - Rajni Khan
- National Institute of Pharmaceutical Education and Research (NIPER) - Hajipur, Vaishali, Hajipur, 844102, Bihar, India
| | - Srishti Banerjee
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, 502284, Telangana, India
| | - Shashikant Ray
- Department of Biotechnology, Mahatma Gandhi Central University, Motihari, 845401, India.
- Department of Pharmaceutical Sciences, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
| | - Sandipan Ray
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Kandi, Sangareddy, 502284, Telangana, India.
| |
Collapse
|
|
3
|
Huang APH, Lee YC, Wu MS. Quality and resilience of health care from a medical center perspective. J Formos Med Assoc 2024; 123 Suppl 3:S194-S199. [PMID: 39277493 DOI: 10.1016/j.jfma.2024.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Revised: 08/20/2024] [Accepted: 09/11/2024] [Indexed: 09/17/2024] Open
Abstract
National Taiwan University Hospital (NTUH) has demonstrated exceptional resilience and adaptability in its response to the COVID-19 pandemic. Since the outbreak in early 2020, NTUH has been at the forefront of Taiwan's healthcare system, taking proactive measures to prepare for and manage the pandemic. The hospital swiftly established dedicated outpatient clinics and wards, which were crucial in isolating and treating COVID-19 patients. NTUH also played a pivotal role in assisting the government with the development of diagnostic reagents and vaccines and contributing to the global effort to combat the disease. To address the long-term effects of COVID-19, NTUH established a special clinic for integrated care in September 2021, offering physical, occupational, and speech therapy to help patients recover and return to normal life. NTUH also shared its pandemic prevention experience internationally, participating in video conferences to discuss its preventive measures and best practices. In caring for frontline healthcare workers, NTUH established interdisciplinary care teams to provide psychological support, assistance with basic daily needs, and effective social, psychological, and mental health support programs. In conclusion, NTUH demonstrated efficient response capabilities and care for healthcare workers during the COVID-19 pandemic, providing valuable insights for future challenges in dealing with emerging infectious diseases.
Collapse
Affiliation(s)
- Abel Po-Hao Huang
- Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan; Institute of Polymer Science and Engineering, National Taiwan University, Taipei, Taiwan
| | - Yi-Chia Lee
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ming-Shiang Wu
- Departments of Internal Medicine, Pathology, and Surgery, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
|
4
|
Deussing EC, Post ER, Lee CJ, Adeniji AA, Sison AR, Kimball MM, Ng A, Anderson C, Freeman JD, Kirsch TD. Advancing Systematic Change in the National Disaster Medical System (NDMS): Early Implementation of the US Department of Defense NDMS Pilot Program. Health Secur 2024; 22:445-454. [PMID: 39320335 DOI: 10.1089/hs.2023.0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2024] Open
Affiliation(s)
- Eric C Deussing
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Emily R Post
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Clark J Lee
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Adeteju A Adeniji
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Allyson R Sison
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Michelle M Kimball
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Alison Ng
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Clemia Anderson
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Jeffrey D Freeman
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Thomas D Kirsch
- Eric C. Deussing, MD, MPH, FACPM, Capt MC USN (Ret.), is a Senior Advisor for Public Health and Former Director, Department of of Defense (DOD) National Disaster Medical System Pilot Program; Clemia Anderson III, MPH, Capt MSC USN, is Director, DOD National Disaster Medical System Pilot Program; Jeffrey D. Freeman, PhD, MPH, is Director; and Thomas D. Kirsch, MD, MPH, is Director Emeritus; all at the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD. Emily R. Post, PhD, is a Research Scientist; Clark J. Lee, JD, MPH, is a Senior Research Associate; Adeteju A. Adeniji, MPH, is a Research Coordinator; Allyson R. Sison, MA, is Stakeholder Engagement Manager; Michelle M. Kimball, MS, LTC USAR, is Director, Operations Mission; and Alison Ng, MS, is a Program Evaluator; all at the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, supporting the National Center for Disaster Medicine and Public Health, Uniformed Services University of the Health Sciences, Bethesda, MD
| |
Collapse
|
|
5
|
Anand P, D’Andrea E, Feldman W, Wang SV, Liu J, Brill G, DiCesare E, Lin KJ. A Dynamic Prognostic Model for Identifying Vulnerable COVID-19 Patients at High Risk of Rapid Deterioration. Pharmacoepidemiol Drug Saf 2024; 33:e5872. [PMID: 39135513 PMCID: PMC11418916 DOI: 10.1002/pds.5872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 09/25/2024]
Abstract
PURPOSE We aimed to validate and, if performance was unsatisfactory, update the previously published prognostic model to predict clinical deterioration in patients hospitalized for COVID-19, using data following vaccine availability. METHODS Using electronic health records of patients ≥18 years, with laboratory-confirmed COVID-19, from a large care-delivery network in Massachusetts, USA, from March 2020 to November 2021, we tested the performance of the previously developed prediction model and updated the prediction model by incorporating data after availability of COVID-19 vaccines. We randomly divided data into development (70%) and validation (30%) cohorts. We built a model predicting worsening in a published severity scale in 24 h by LASSO regression and evaluated performance by c-statistic and Brier score. RESULTS Our study cohort consisted of 8185 patients (Development: 5730 patients [mean age: 62; 44% female] and Validation: 2455 patients [mean age: 62; 45% female]). The previously published model had suboptimal performance using data after November 2020 (N = 4973, c-statistic = 0.60. Brier score = 0.11). After retraining with the new data, the updated model included 38 predictors including 18 changing biomarkers. Patients hospitalized after Jun 1st, 2021 (when COVID-19 vaccines became widely available in Massachusetts) were younger and had fewer comorbidities than those hospitalized before. The c-statistic and Brier score were 0.77 and 0.13 in the development cohort, and 0.73 and 0.14 in the validation cohort. CONCLUSION The characteristics of patients hospitalized for COVID-19 differed substantially over time. We developed a new dynamic model for rapid progression with satisfactory performance in the validation set.
Collapse
Affiliation(s)
- Priyanka Anand
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Elvira D’Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - William Feldman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Shirley V. Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Elyse DiCesare
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
| | - Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School
| |
Collapse
|
|
6
|
Roberts LW. Learning to Prevent Medical Errors. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2024; 99:703-704. [PMID: 38920410 DOI: 10.1097/acm.0000000000005740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
|
|
7
|
Zhilkova A, Alsabahi L, Olson D, Maru D, Tsao TY, Morse ME. Hospital segregation, critical care strain, and inpatient mortality during the COVID-19 pandemic in New York City. PLoS One 2024; 19:e0301481. [PMID: 38603670 PMCID: PMC11008816 DOI: 10.1371/journal.pone.0301481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/16/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Hospital segregation by race, ethnicity, and health insurance coverage is prevalent, with some hospitals providing a disproportionate share of undercompensated care. We assessed whether New York City (NYC) hospitals serving a higher proportion of Medicaid and uninsured patients pre-pandemic experienced greater critical care strain during the first wave of the COVID-19 pandemic, and whether this greater strain was associated with higher rates of in-hospital mortality. METHODS In a retrospective analysis of all-payer NYC hospital discharge data, we examined changes in admissions, stratified by use of intensive care unit (ICU), from the baseline period in early 2020 to the first COVID-19 wave across hospital quartiles (265,329 admissions), and crude and risk-adjusted inpatient mortality rates, also stratified by ICU use, in the first COVID wave across hospital quartiles (23,032 inpatient deaths), based on the proportion of Medicaid or uninsured admissions from 2017-2019 (quartile 1 lowest to 4 highest). Logistic regressions were used to assess the cross-sectional association between ICU strain, defined as ICU volume in excess of the baseline average, and patient-level mortality. RESULTS ICU admissions in the first COVID-19 wave were 84%, 97%, 108%, and 123% of the baseline levels by hospital quartile 1-4, respectively. The risk-adjusted mortality rates for ICU admissions were 36.4 (CI = 34.7,38.2), 43.6 (CI = 41.5,45.8), 45.9 (CI = 43.8,48.1), and 45.7 (CI = 43.6,48.0) per 100 admissions, and those for non-ICU admissions were 8.6 (CI = 8.3,9.0), 10.9 (CI = 10.6,11.3), 12.6 (CI = 12.1,13.0), and 12.1 (CI = 11.6,12.7) per 100 admissions by hospital quartile 1-4, respectively. Compared with the reference group of 100% or less of the baseline weekly average, ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.17 (95% CI = 1.10, 1.26), 2.63 (95% CI = 2.31, 3.00), and 3.26 (95% CI = 2.82, 3.78) for inpatient mortality, and non-ICU admissions on a day for which the ICU volume was 101-150%, 151-200%, and > 200% of the baseline weekly average had odds ratios of 1.28 (95% CI = 1.22, 1.34), 2.60 (95% CI = 2.40, 2.82), and 3.44 (95% CI = 3.11, 3.63) for inpatient mortality. CONCLUSIONS Our findings are consistent with hospital segregation as a potential driver of COVID-related mortality inequities and highlight the need to desegregate health care to address structural racism, advance health equity, and improve pandemic resiliency.
Collapse
Affiliation(s)
- Anna Zhilkova
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Laila Alsabahi
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Donald Olson
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Duncan Maru
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Tsu-Yu Tsao
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| | - Michelle E. Morse
- Center for Health Equity and Community Wellness at the New York City Department of Health and Mental Hygiene, Long Island City, NY, United States of America
| |
Collapse
|
|
8
|
Carter D, Rosen A, Applebaum JR, Southern WN, Crossman DJ, Shelton RC, Auerbach A, Schnipper JL, Adelman JS. National Survey of Patient Safety Experiences in Hospital Medicine During the COVID-19 Pandemic. Jt Comm J Qual Patient Saf 2024; 50:260-268. [PMID: 38087723 DOI: 10.1016/j.jcjq.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 10/21/2023] [Accepted: 10/23/2023] [Indexed: 05/07/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, hospitals were caring for increasing numbers of patients with a novel and highly contagious respiratory illness, forcing adaptations in care delivery. The objective of this study was to understand the impact of these adaptations on patient safety in hospital medicine. METHODS The authors conducted a nationwide survey to understand patient safety challenges experienced by hospital medicine clinicians during the COVID-19 pandemic. The survey was distributed to members of the Society of Hospital Medicine via an e-mail listserv. It consisted of closed- and open-ended questions to elicit respondents' experience in five domains: error reporting and communication, staffing, equipment, personal protective equipment (PPE) and isolation practices, and infrastructure. Quantitative questions were reported as counts and percentages; qualitative responses were coded and analyzed for relevant themes. RESULTS Of 196 total responses, 167 respondents (85.2%) were attending physicians and 85 (43.8%) practiced at teaching hospitals. Safety concerns commonly identified included nursing shortages (71.0%), limiting patient interactions to conserve PPE (61.9%), and feeling that one was practicing in a more hazardous environment (61.4%). In free-text responses, clinicians described poor outcomes and patient decompensation due to provider and equipment shortages, as well as communication lapses and diagnostic errors resulting from decreased patient contact and the need to follow isolation protocols. CONCLUSION Efforts made to accommodate shortages in staff and equipment, adapt to limited PPE, and enforce isolation policies had unintended consequences that affected patient safety and created a more hazardous environment characterized by less efficient care, respiratory decompensations, diagnostic errors, and poor communication with patients.
Collapse
|
|
9
|
Quinn BP, Gunnelson LC, Kotin SG, Gauvreau K, Yeh MJ, Hasan B, Lozier J, Barry OM, Shahanavaz S, Batlivala SP, Salavitabar A, Foerster S, Goldstein B, Divekar A, Holzer R, Nicholson GT, O'Byrne ML, Whiteside W, Bergersen L. Catheterization for Congenital Heart Disease Adjustment for Risk Method II. Circ Cardiovasc Interv 2024; 17:e012834. [PMID: 38258562 DOI: 10.1161/circinterventions.123.012834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Current metrics used to adjust for case mix complexity in congenital cardiac catheterization are becoming outdated due to the introduction of novel procedures, innovative technologies, and expanding patient subgroups. This study aims to develop a risk adjustment methodology introducing a novel, clinically meaningful adverse event outcome and incorporating a modern understanding of risk. METHODS Data from diagnostic only and interventional cases with defined case types were collected for patients ≤18 years of age and ≥2.5 kg at all Congenital Cardiac Catheterization Project on Outcomes participating centers. The derivation data set consisted of cases performed from 2014 to 2017, and the validation data set consisted of cases performed from 2019 to 2020. Severity level 3 adverse events were stratified into 3 tiers by clinical impact (3a/b/c); the study outcome was clinically meaningful adverse events, severity level ≥3b (3bc/4/5). RESULTS The derivation data set contained 15 224 cases, and the validation data set included 9462 cases. Clinically meaningful adverse event rates were 4.5% and 4.2% in the derivation and validation cohorts, respectively. The final risk adjustment model included age <30 days, Procedural Risk in Congenital Cardiac Catheterization risk category, and hemodynamic vulnerability score (C statistic, 0.70; Hosmer-Lemeshow P value, 0.83; Brier score, 0.042). CONCLUSIONS CHARM II (Congenital Heart Disease Adjustment for Risk Method II) risk adjustment methodology allows for equitable comparison of clinically meaningful adverse events among institutions and operators with varying patient populations and case mix complexity performing pediatric cardiac catheterization.
Collapse
Affiliation(s)
- Brian P Quinn
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Lauren C Gunnelson
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Sarah G Kotin
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Mary J Yeh
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| | - Babar Hasan
- Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplantation, Pakistan (B.H.)
| | - John Lozier
- Division of Pediatric Cardiology, UH Rainbow Babies and Children's Hospital, Cleveland, OH (J.L.)
| | - Oliver M Barry
- Division of Pediatric Cardiology, Columbia University Medical Center, New York Presbyterian/Morgan Stanley Children's Hospital (O.M.B.)
| | - Shabana Shahanavaz
- Cincinnati Children's Hospital-Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)
| | - Sarosh P Batlivala
- Cincinnati Children's Hospital-Heart Institute and Department of Pediatrics, University of Cincinnati College of Medicine, OH (S.S., S.P.B.)
| | - Arash Salavitabar
- The Heart Center, Nationwide Children's Hospital, Columbus, OH (A.S.)
| | - Susan Foerster
- Division of Pediatric Cardiology, Children's Wisconsin, Milwaukee (S.F.)
| | - Bryan Goldstein
- Heart Institute, UPMC Children's Hospital of Pittsburgh and Department of Pediatrics, University of Pittsburgh School of Medicine, PA (B.G.)
| | - Abhay Divekar
- Division of Pediatric Cardiology, UT Southwestern Medical Center, Children's Medical Center Dallas, TX (A.D.)
| | - Ralf Holzer
- Division of Pediatric Cardiology, Department of Pediatrics, University of California Davis, Sacramento (R.H.)
| | - George T Nicholson
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt University Medical Center, Nashville, TN (G.T.N.)
| | - Michael L O'Byrne
- Division of Cardiology, Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania (M.L.O.)
| | - Wendy Whiteside
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor (W.W.)
| | - Lisa Bergersen
- Department of Cardiology, Boston Children's Hospital, MA (B.P.Q., L.C.G., S.G.K., K.G., M.J.Y., L.B.)
| |
Collapse
|
|
10
|
Wachekwa I, Camanor SW, Kpoeh-Thomas T, Glaydor F, Barclay-Korboi YM, Moses JS, Bartekwa-Gwaikolo JW. A review of the John F. Kennedy Medical Center's response to the COVID-19 pandemic in Liberia. Front Public Health 2024; 11:1258938. [PMID: 38264239 PMCID: PMC10803570 DOI: 10.3389/fpubh.2023.1258938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Objective Over the past decades, the world has experienced a series of emerging and re-emerging infectious disease pandemics with dire consequences for economies and healthcare delivery. Hospitals are expected to have the ability to detect and respond appropriately to epidemics with minimal disruptions to routine services. We sought to review the John F. Kennedy Medical Center's readiness to respond to the COVID-19 pandemic. Methods We used the pretest-posttest design in June 2021 and May 2023 to assess the hospital's improvements in its COVID-19 readiness capacity by collecting data on the hospital's characteristics and using the WHO COVID-19 Rapid hospital readiness checklist. We scored each readiness indicator according to the WHO criteria and the hospital's overall readiness score, performed the chi-square test for the change in readiness (change, 95% CI, p-value) between 2021 and 2023, and classified the center's readiness (poor: < 50%, fair: 50-79%, or satisfactory: ≥80%). The overall hospital readiness for COVID-19 response was poor in 2021 (mean score = 49%, 95% CI: 39-57%) and fair in 2023 (mean score = 69%, 95% CI: 56-81%). The mean change in hospital readiness was 20% (95% CI: 5.7-35%, p-value = 0.009). Between 2021 and 2023, the hospital made satisfactory improvements in leadership and incident management system [from 57% in 2021 to 86% in 2023 (change = 29%, 95% CI: 17-41%, p < 0.001)]; risk communication and community engagement [38-88% (change = 50%, 95% CI: 39-61%, p < 0.001)]; patient management [63-88% (change = 25%, 95% CI: 14-36%, p < 0.001)]; and rapid identification and diagnosis [67-83% (change = 16%, 95% CI: 4.2-28%, p = 0.009)]. The hospital made fair but significant improvements in terms of coordination and communication [42-75% (change = 33%, 95% CI: 20-46%, p < 0.001)], human resources capacity [33-75% (change = 42%, 95% CI: 29-55%, p < 0.001)], continuation of critical support services [50-75% (PD = 25%, 95% CI: 12-38%, p < 0.001)], and IPC [38-63% (change = 25%, 12-38%, p < 0.001)]. However, there was no or unsatisfactory improvement in terms of surveillance and information management; administration, finance, and business continuity; surge capacity; and occupational and mental health psychosocial support. Conclusion Substantial gaps still remain in the hospital's readiness to respond to the COVID-19 outbreak. The study highlights the urgent need for investment in resilient strategies to boost readiness to respond to future outbreaks at the hospital.
Collapse
Affiliation(s)
- Ian Wachekwa
- Department of Internal Medicine, John F. Kennedy Medical Center, Monrovia, Liberia
- Office of the Chief Medical Officer, John F. Kennedy Medical Center, Monrovia, Liberia
- Infection Prevention and Control Unit, John F. Kennedy Medical Center, Monrovia, Liberia
| | - Sia Wata Camanor
- Office of the Chief Medical Officer, John F. Kennedy Medical Center, Monrovia, Liberia
| | | | - Facia Glaydor
- Epi-Surveillance, John F. Kennedy Medical Center, Monrovia, Liberia
| | | | - J. Soka Moses
- Partnership for Research on Vaccines and Infectious Diseases in Liberia, Monrovia, Liberia
| | - Joyce Weade Bartekwa-Gwaikolo
- Department of Internal Medicine, John F. Kennedy Medical Center, Monrovia, Liberia
- Infection Prevention and Control Unit, John F. Kennedy Medical Center, Monrovia, Liberia
| |
Collapse
|
|
11
|
Nguyen A, Rajski B, Furey V, Duffner L, Young B, Husain IA. Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH). Am J Otolaryngol 2024; 45:104029. [PMID: 37659226 DOI: 10.1016/j.amjoto.2023.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Describe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. STUDY DESIGN Retrospective cohort study. SETTING Long-term acute care hospital. SUBJECTS AND METHODS A retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. RESULTS Amongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. CONCLUSION LTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.
Collapse
Affiliation(s)
- Alvin Nguyen
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America.
| | - Barbara Rajski
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Vicki Furey
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Lisa Duffner
- RML Specialty Hospital - Office of Clinical Research, Hinsdale, IL, United States of America
| | - Bryce Young
- Midwestern University Chicago of Osteopathic Medicine, Downers Grove, IL, United States of America
| | - Inna A Husain
- Community Hospital, Department of Otolaryngology, Munster, IN, United States of America
| |
Collapse
|
|
12
|
Okkerman L, Moeke D, Janssen S, van Andel J. The Inflow, Throughput and Outflow of COVID-19 Patients in Dutch Hospitals: Experiences from Experts and Middle Managers. Healthcare (Basel) 2023; 12:18. [PMID: 38200924 PMCID: PMC10779109 DOI: 10.3390/healthcare12010018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
At the beginning of 2020, the large and unforeseen inflow of COVID-19 patients had a deep impact on the healthcare operations of Dutch hospitals. From a patient flow logistics perspective, each hospital handled the situation largely in its own particular and improvised way. Nevertheless, some hospitals appeared to be more effective in their dealing with this sudden demand for extra care than others. This prompted a study into the factors which hindered and facilitated effective operations during this period. We provide an overview of actions and measures for organizing and managing the inflow, throughput and outflow of COVID-19 patients within Dutch hospitals from various types of departments in a large number of hospitals in The Netherlands, based on interviews with nine experts and twelve hospital managers. Ten actions or measures have been identified, which have been divided into the following three dimensions: Streamlining of the underlying in- and external processes, reducing unnecessary or undesirable inflow of patients and increasing or making more adequate use of the available (human) capacity. The main lessons learned are the importance of integral tuning in the care process, giving up habits and self-interest, good information provision and the middle manager as a linking pin.
Collapse
Affiliation(s)
- Lidy Okkerman
- Research Group Logistics & Alliances, HAN University of Applied Sciences, 6802 EJ Arnhem, The Netherlands; (D.M.)
| | | | | | | |
Collapse
|
|
13
|
Munasinghe NL, O'Reilly G, Cameron P. Lessons learned from the COVID-19 response in Sri Lankan hospitals: an interview of frontline healthcare professionals. Front Public Health 2023; 11:1280055. [PMID: 38125853 PMCID: PMC10731292 DOI: 10.3389/fpubh.2023.1280055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction The COVID-19 pandemic revealed the lack of preparedness in health systems, even in developed countries. Studies published on COVID-19 management experiences in developing countries, including Sri Lanka, are significantly low. Therefore, lessons learned from pandemic management would be immensely helpful in improving health systems for future disaster situations. This study aimed to identify enablers and barriers to COVID-19 management in Sri Lankan hospitals through healthcare workers' perceptions. Methods Frontline doctors and nurses from different levels of public hospitals were interviewed online. Both inductive and deductive coding and thematic analysis were performed on the transcribed data. Result and discussion This study identified four themes under enablers: preparing for surge, teamwork, helping hands and less hospital-acquired infections. Seven themes were identified as barriers: lack of information sharing, lack of testing facilities, issues with emergency equipment, substandard donations, overwhelmed morgues, funding issues and psychological impact. These preparedness gaps were more prominent in smaller hospitals compared with larger hospitals. Recommendations were provided based on the identified gaps. Conclusion The insights from this study will allow health administrators and policymakers to build upon their hospital's resources and capabilities. These findings may be used to provide sustainable solutions, strengthening the resilience of the local Sri Lankan health system as well as the health systems of other countries.
Collapse
Affiliation(s)
- Nimali Lakmini Munasinghe
- Faculty of Medicine, Nursing and Health Sciences, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | |
Collapse
|
|
14
|
Ruhm CJ. The Evolution of Excess Deaths in the United States During the First 2 Years of the COVID-19 Pandemic. Am J Epidemiol 2023; 192:1949-1959. [PMID: 37222463 PMCID: PMC10988222 DOI: 10.1093/aje/kwad127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 09/01/2022] [Accepted: 05/20/2023] [Indexed: 05/25/2023] Open
Abstract
Understanding consequences of the COVID-19 pandemic requires information on the excess mortality resulting from it. Multiple studies have examined excess deaths during the pandemic's initial stages, but how these have changed over time is unclear. National- and state-level death counts and population data from 2009 to 2022 were used in this analysis to evaluate excess fatalities from March 2020 to February 2021 and March 2021 to February 2022, with deaths from earlier years used to project baseline counts. The outcomes were total, group-specific, cause-specific, and age-by-cause excess fatalities, and numbers and percentages directly involving COVID-19. Excess deaths declined from 655,735 (95% confidence interval: 619,028, 691,980) during the first pandemic year to 586,505 (95% confidence interval: 532,823, 639,205) in the second. The reductions were particularly large for Hispanics, Blacks, Asians, seniors, and residents of states with high vaccination rates. Excess deaths increased from the first to second year for persons younger than 65 years and in low-vaccination states. Excess mortality from some diseases declined, but those from alcohol, drug, vehicle, and homicide causes likely increased between the first and second pandemic year, especially for prime-age and younger individuals. The share of excess fatalities involving COVID-19 decreased modestly over time, with little change in its role as an underlying versus contributing cause of death.
Collapse
Affiliation(s)
- Christopher J Ruhm
- Correspondence to Prof. Christopher J. Ruhm, Frank Batten School of Leadership & Public Policy, University of Virginia, 235 McCormick Road, P.O. Box 400893, Charlottesville, VA 22904-4893 (e-mail: )
| |
Collapse
|
|
15
|
Barchielli C, Vainieri M, Seghieri C, Salutini E, Zoppi P. The Function of Bed Management in Pandemic Times-A Case Study of Reaction Time and Bed Reconversion. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6179. [PMID: 37372765 DOI: 10.3390/ijerph20126179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 06/29/2023]
Abstract
The last decade was characterized by the reduction in hospital beds throughout Europe. When facing the COVID pandemic, this has been an issue of major importance as hospitals were seriously overloaded with an unexpected growth in demand. The dichotomy formed by the scarcity of beds and the need for acute care was handled by the Bed Management (BM) function. This case study explores how BM was able to help the solidness of the healthcare system, managing hospital beds at best and recruiting others in different settings as intermediate care in a large Local Health Authority (LHA) in central Italy. Administrative data show how the provision of appropriate care was achieved by recruiting approximately 500 beds belonging to private healthcare facilities affiliated with the regional healthcare system and exercising the best BM function. The ability of the system to absorb the extra demand caused by COVID was made possible by using intermediate care beds, which were allowed to stretch the logistic boundaries of the hospitals, and by the promptness of Bed Management in converting beds into COVID beds and reconverting them, and by the timely management of internal patient logistics, thus creating space according to the healthcare demands.
Collapse
Affiliation(s)
- Chiara Barchielli
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
| | - Milena Vainieri
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Chiara Seghieri
- Management and Healthcare Laboratory, Institute of Management, Sant'Anna School of Advanced Studies, 56127 Pisa, Italy
| | - Eleonora Salutini
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
| | - Paolo Zoppi
- Department of Nursing and Obstetrics, Azienda USL Toscana Centro, 50123 Firenze, Italy
| |
Collapse
|
|
16
|
Patel V, Cieslak K, Hertig J. Improving Safety by Evaluating the Impact of the Supply Chain and Drug Shortages on Health-Systems. Hosp Pharm 2023; 58:120-124. [PMID: 36890955 PMCID: PMC9986569 DOI: 10.1177/00185787221126338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The COVID-19 pandemic has shown how fragile our healthcare supply chain is with product delays, drug shortages, and labor shortages being exacerbated in recent years. Objective: This article reviews current threats to the healthcare supply chain that impact patient safety and highlights potential solutions for the future. Method: A review of the literature was conducted, and important up-to-date resources associated with drug shortages and supply chain were analyzed to build foundational knowledge. Potential supply chain threats and solutions were then explored through further literature analyses. Conclusions: The information provided in this article helps to brief pharmacy leaders on current supply chain issues and solutions that can be integrated throughout the healthcare supply chain in the future.
Collapse
Affiliation(s)
- Vraj Patel
- Butler University, Indianapolis, IN,
USA
| | | | | |
Collapse
|
|
17
|
A comparative analysis of outpatient nutrition clinic scheduling outcomes based on in-person and telehealth patient care delivery modalities ☆. HEALTHCARE ANALYTICS (NEW YORK, N.Y.) 2023; 3:100163. [PMID: 36999092 PMCID: PMC10032049 DOI: 10.1016/j.health.2023.100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 02/08/2023] [Accepted: 03/20/2023] [Indexed: 03/24/2023]
Abstract
During the start of the global COVID-19 pandemic in March 2020, patient care modalities changed from in-person to telehealth to comply with physical distancing guidelines. Our study uniquely examines operations data from three distinct periods: before the transition to telehealth, early transition from in-person care to telehealth, and the eventual adoption of telehealth. We present a comparative analysis of outpatient nutrition clinic scheduling outcomes based on care delivery modality. We used descriptive statistics to report means and variance and frequencies. We used inferential statistics to make comparisons: categorical data were compared using chi- square analysis with post-hoc comparisons using a z-test with alpha at 0.05. Means of continuous variables were compared using ANOVA with Tukey HSD post-hoc analysis. We found patient demographics remained widely unchanged across the three distinct periods as the demand for telehealth visits increased, with a notable rise in return patient visits, signaling both adaptability across the patient population and acceptance of the telehealth modality. These analyses along with evidence from the included literature review point to many the benefits of telehealth, thus telehealth as a healthcare delivery modality is here to stay. Our work serves as a foundation for future studies in this field, provides information for decision-makers in telehealth-related strategic planning, and can be utilized in advocacy for the extension of telehealth coverage.
Collapse
|
|
18
|
de Granda-Orive JI, Martínez-García MÁ. What have we learnt from Covid-19 Pandemia? Looking to the future. Pulmonology 2023; 29:108-110. [PMID: 36270889 PMCID: PMC9458698 DOI: 10.1016/j.pulmoe.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- J I de Granda-Orive
- Respiratory Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratoria - CIBERES, Universidad Complutense Madrid, Spain.
| | - M Á Martínez-García
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Centro de Investigación Biomédica En Red de Enfermedades Respiratorias - CIBERES, Valencia, Spain
| |
Collapse
|
|
19
|
Myles S, Leslie K, Adams TL, Nelson S. Regulating in the public interest: Lessons learned during the COVID-19 pandemic. Healthc Manage Forum 2023; 36:36-41. [PMID: 35924971 PMCID: PMC9353312 DOI: 10.1177/08404704221112286] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
This article has three aims. First, to reflect on how conceptualizations of the public interest may have shifted due to COVID-19. Second, to focus on the implications of regulatory responses for the health workforce and corresponding lessons as health leaders and systems transition from pandemic response to pandemic recovery. Third, to identify how these lessons lead to potential directions for future research, connecting regulation in a whole-of-systems approach to health system safety and health workforce capacity and sustainability. Pandemic regulatory responses highlighted both strengths and limitations of regulatory structures and frameworks. The COVID-19 pandemic may have introduced new considerations around regulating in the public interest, particularly as the impact of regulatory responses on the health workforce continues to be examined. Clearly articulating practitioner practice parameters, reducing barriers to practice, and working collaboratively with stakeholders were primary aspects of regulators' pandemic responses that impacted the health workforce.
Collapse
Affiliation(s)
- Sophia Myles
- University of Toronto, Toronto, Ontario, Canada
- Athabasca University, Athabasca, Alberta, Canada
| | | | | | | |
Collapse
|
|
20
|
Lin KJ, D'Andrea E, Desai RJ, Gagne JJ, Liu J, Wang SV. Prospective validation of a dynamic prognostic model for identifying COVID-19 patients at high risk of rapid deterioration. Pharmacoepidemiol Drug Saf 2022; 32:545-557. [PMID: 36464785 PMCID: PMC9877647 DOI: 10.1002/pds.5580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 11/22/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND We sought to develop and prospectively validate a dynamic model that incorporates changes in biomarkers to predict rapid clinical deterioration in patients hospitalized for COVID-19. METHODS We established a retrospective cohort of hospitalized patients aged ≥18 years with laboratory-confirmed COVID-19 using electronic health records (EHR) from a large integrated care delivery network in Massachusetts including >40 facilities from March to November 2020. A total of 71 factors, including time-varying vital signs and laboratory findings during hospitalization were screened. We used elastic net regression and tree-based scan statistics for variable selection to predict rapid deterioration, defined as progression by two levels of a published severity scale in the next 24 h. The development cohort included the first 70% of patients identified chronologically in calendar time; the latter 30% served as the validation cohort. A cut-off point was estimated to alert clinicians of high risk of imminent clinical deterioration. RESULTS Overall, 3706 patients (2587 in the development and 1119 in the validation cohort) met the eligibility criteria with a median of 6 days of follow-up. Twenty-four variables were selected in the final model, including 16 dynamic changes of laboratory results or vital signs. Area under the ROC curve was 0.81 (95% CI, 0.79-0.82) in the development set and 0.74 (95% CI, 0.71-0.78) in the validation set. The model was well calibrated (slope = 0.84 and intercept = -0.07 on the calibration plot in the validation set). The estimated cut-off point, with a positive predictive value of 83%, was 0.78. CONCLUSIONS Our prospectively validated dynamic prognostic model demonstrated temporal generalizability in a rapidly evolving pandemic and can be used to inform day-to-day treatment and resource allocation decisions based on dynamic changes in biophysiological factors.
Collapse
Affiliation(s)
- Kueiyu Joshua Lin
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA,Department of MedicineMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Elvira D'Andrea
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Rishi J. Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Joshua J. Gagne
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Jun Liu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Shirley V. Wang
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women's Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| |
Collapse
|
|
21
|
Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
Collapse
Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY.
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | - Edward J Septimus
- Department of Population Medicine, Harvard Medical School, Boston, MA
| | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
| |
Collapse
|
|
22
|
Beyls C, Huette P, Viart C, Mestan B, Haye G, Guilbart M, Bernasinski M, Besserve P, Leviel F, Witte Pfister A, De Dominicis F, Jounieaux V, Berna P, Dupont H, Abou-Arab O, Mahjoub Y. Mortality of COVID-19 Patients Requiring Extracorporeal Membrane Oxygenation During the Three Epidemic Waves. ASAIO J 2022; 68:1434-1442. [PMID: 36194473 DOI: 10.1097/mat.0000000000001787] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Clinical presentation and mortality of patients treated with extracorporeal membrane oxygenation (ECMO) for COVID-19 acute respiratory distress syndrome (CARDS) were different during the French epidemic waves. The management of COVID-19 patients evolved through waves as much as knowledge on that new viral disease progressed. We aimed to compare the mortality rate through the first three waves of CARDS patients on ECMO and identify associated risk factors. Fifty-four consecutive ECMO for CARDS hospitalized at Amiens University Hospital during the three waves were included. Patients were divided into three groups according to their hospitalization date. Clinical characteristics and outcomes were compared between groups. Pre-ECMO risk factors predicting 90 day mortality were evaluated using multivariate Cox regression. Among 54 ECMO (median age of 61[48-65] years), 26% were hospitalized during the first wave (n = 14/54), 26% (n = 14/54) during the second wave, and 48% (n = 26/54) during the third wave. Time from first symptoms to ECMO was higher during the second wave than the first wave. (17 [12-23] days vs. 11 [9-15]; p < 0.05). Ninety day mortality was higher during the second wave (85% vs. 43%; p < 0.05) but less during the third wave (38% vs. 85%; P < 0.05). Respiratory ECMO survival prediction score and time from symptoms onset to ECMO (HR 1.12; 95% confidence interval [CI]: 1.05-1.20; p < 0.001) were independent factors of mortality. After adjustment, time from symptoms onset to ECMO was an independent factor of 90 day mortality. Changes in CARDS management from first to second wave-induced a later ECMO cannulation from symptoms onset with higher mortality during that wave. The duration of COVID-19 disease progression could be selection criteria for initiating ECMO.
Collapse
Affiliation(s)
- Christophe Beyls
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
- Department of Thoracic Surgery, UR UPJV 7518 SSPC (Simplification of Care of Complex Surgical Patients) Research Unit, University of Picardie Jules Verne, Amiens, France
| | - Pierre Huette
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Christophe Viart
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Benjamin Mestan
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Guillaume Haye
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Mathieu Guilbart
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Michael Bernasinski
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Patricia Besserve
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Florent Leviel
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | | | | | | | - Pascal Berna
- Department of Thoracic Surgery, Clinique Pauchet, Amiens, France
| | - Hervé Dupont
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Osama Abou-Arab
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| | - Yazine Mahjoub
- From the Department of Anesthesiology and Critical Care Medicine, Amiens University Hospital, Amiens, France
| |
Collapse
|
|
23
|
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 (COVID-19) pandemic has posed great challenges to intensive care units (ICUs) across the globe. The objective of this review is to provide an overview on how ICU surging was managed during COVID-19 pandemic, with a special focus on papers published in the last 18 months. RECENT FINDINGS From the onset of the COVID-19 pandemic, it was apparent that the biggest challenge was the inequity of access to an adequately equipped and staffed ICU bed. The first wave was overwhelming; large surge of patients required critical care, resources were limited and non-COVID-19 care processes were severely compromised. Various approaches were used to address ICU staffing shortage and to expand the physical ICU space capacity. Because of restrictions to family visitations in most ICUs, the pandemic posed a threat to communication and family-centered ICU care. The pandemic, especially during the first wave, was accompanied by a high level of apprehension in the community, many uncertainties about clinical course and therapy and an influx of speculations and misinformation. SUMMARY Although healthcare systems learned how to face some of the challenges with subsequent waves, the pandemic had persistent effects on healthcare systems.
Collapse
|
|
24
|
ICU Admission Tool for Congenital Heart Catheterization (iCATCH): A Predictive Model for High Level Post-Catheterization Care and Patient Management. Pediatr Crit Care Med 2022; 23:822-830. [PMID: 35830709 DOI: 10.1097/pcc.0000000000003028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Currently, there are no prediction tools available to identify patients at risk of needing high-complexity care following cardiac catheterization for congenital heart disease. We sought to develop a method to predict the likelihood a patient will require intensive care level resources following elective cardiac catheterization. DESIGN Prospective single-center study capturing important patient and procedural characteristics for predicting discharge to the ICU. Characteristics significant at the 0.10 level in the derivation dataset (July 1, 2017 to December 31, 2019) were considered for inclusion in the final multivariable logistic regression model. The model was validated in the testing dataset (January 1, 2020 to December 31, 2020). The novel pre-procedure cardiac status (PCS) feature, collection started in January 2019, was assessed separately in the final model using the 2019 through 2020 dataset. SETTING Tertiary pediatric heart center. PATIENTS All elective cases coming from home or non-ICU who underwent a cardiac catheterization from July 2017 to December 2020. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 2,192 cases were recorded in the derivation dataset, of which 11% of patients ( n = 245) were admitted to the ICU, while 64% ( n = 1,413) were admitted to a medical unit and 24% ( n = 534) were discharged home. In multivariable analysis, the following predictors were identified: 1) weight less than 5 kg and 5-9.9 kg, 2) presence of systemic illness, 3) recent cardiac intervention less than 90 days, and 4) ICU Admission Tool for Congenital Heart Catheterization case type risk categories (1-5), with C -statistics of 0.79 and 0.76 in the derivation and testing cohorts, respectively. The addition of the PCS feature fit into the final model resulted in a C -statistic of 0.79. CONCLUSIONS The creation of a validated pre-procedural risk prediction model for ICU admission following congenital cardiac catheterization using a large volume, single-center, academic institution will improve resource allocation and prediction of capacity needs for this complex patient population.
Collapse
|
|
25
|
Martins MS, Lourenção DCDA, Pimentel RRDS, de Oliveira JM, Manganoti LTDCN, Modesto RC, Silva MSDS, Dos Santos MJ. Recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic: a scoping review. BMJ Open 2022; 12:e060182. [PMID: 36123068 PMCID: PMC9485646 DOI: 10.1136/bmjopen-2021-060182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 08/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To map the recommendations for hospitalised patient safety in the context of the COVID-19 pandemic. DESIGN Scoping review using the method recommended by the Joanna Briggs Institute. DATA SOURCES Databases: Medline, SCOPUS, EMBASE, ScienceDirect, LILACS, CINAHL and IBECS; grey literature platform: Google Scholar; and 11 official websites of leading healthcare institutions were searched on 27 April 2021 and updated on 11 April 2022. ELIGIBILITY CRITERIA We included documents that present recommendations for the safety of hospitalised patients in the context of the COVID-19 pandemic, published in any language, from 2020 onwards. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in pairs with consensus rounds. A descriptive analysis was carried out to present the main characteristics of the articles. Qualitative data from the extraction of recommendations were analysed through content analysis. RESULTS One hundred and twenty-five documents were included. Most papers were identified as expert consensus (n=56, 44.8%). Forty-six recommendations were identified for the safety of hospitalised patients: 17 relating to the reorganisation of health services related to the flow of patients, the management of human and material resources and the reorganisation of the hospital environment; 11 on the approach to the airways and the prevention of the spread of aerosols; 11 related to sanitary and hygiene issues; 4 about proper use of personal protective equipment and 3 for effective communication. CONCLUSIONS The recommendations mapped in this scoping review present the best practices produced so far and serve as a basis for planning and implementing good practices to ensure safe hospital care, during and after COVID-19. The engagement of everyone involved in the care of hospitalised patients is essential to consolidate the mapped recommendations and provide dignified, safe and quality care.
Collapse
Affiliation(s)
| | | | | | - Janine Melo de Oliveira
- Escola de Enfermagem, Universidade Federal de Alagoas, Maceio, Brazil
- Curso de Enfermagem, Universidade Estadual de Ciências da Saúde de Alagoas, Maceio, Brazil
| | | | | | | | - Marcelo José Dos Santos
- Career Guidance Department, Universidade de São Paulo Escola de Enfermagem, Sao Paulo, Brazil
| |
Collapse
|
|
26
|
Akbulut S, Hargura AS, Garzali IU, Aloun A, Colak C. Clinical presentation, management, screening and surveillance for colorectal cancer during the COVID-19 pandemic. World J Clin Cases 2022; 10:9228-9240. [PMID: 36159422 PMCID: PMC9477669 DOI: 10.12998/wjcc.v10.i26.9228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/29/2022] [Accepted: 08/05/2022] [Indexed: 02/05/2023] Open
Abstract
Management of colorectal cancer (CRC) was severely affected by the changes implemented during the pandemic, and this resulted in delayed elective presentation, increased emergency presentation, reduced screening and delayed definitive therapy. This review was conducted to analyze the impact of the coronavirus disease 2019 (COVID-19) pandemic on management of CRC and to identify the changes made in order to adapt to the pandemic. We performed a literature search in PubMed, Medline, Index Medicus, EMBASE, SCOPUS, Reference Citation Analysis (https://www.referencecitationanalysis.com/) and Google Scholar using the following keywords in various combinations: Colorectal cancer, elective surgery, emergency surgery, stage upgrading, screening, surveillance and the COVID-19 pandemic. Only studies published in English were included. To curtail the spread of COVID-19 infection, there were modifications made in the management of CRC. Screening was limited to high risk individuals, and the screening tests of choice during the pandemic were fecal occult blood test, fecal immunochemical test and stool DNA testing. The use of capsule colonoscopy and open access colonoscopy was also encouraged. Blood-based tests like serum methylated septin 9 were also encouraged for screening of CRC during the pandemic. The presentation of CRC was also affected by the pandemic with more patients presenting with emergencies like obstruction and perforation. Stage migration was also observed during the pandemic with more patients presenting with more advanced tumors. The operative therapy of CRC was altered by the pandemic as more emergencies surgeries were done, which may require exteriorization by stoma. This was to reduce the morbidity associated with anastomosis and encourage early discharge from the hospital. There was also an initial reduction in laparoscopic surgical procedures due to the fear of aerosols and COVID-19 infection. As we gradually come out of the pandemic, we should remember the lessons learned and continue to apply them even after the pandemic passes.
Collapse
Affiliation(s)
- Sami Akbulut
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| | - Abdirahman Sakulen Hargura
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, Kenyatta University Teaching, Referral and Research Hospital, Nairobi 00100, Kenya
| | - Ibrahim Umar Garzali
- Department of Surgery, Inonu University Faculty of Medicine, Malatya 44280, Turkey
- Department of Surgery, Aminu Kano Teaching Hospital, Kano 700101, Nigeria
| | - Ali Aloun
- Department of Surgery, King Hussein Medical Center, Amman 11855, Jordan
| | - Cemil Colak
- Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya 44280, Turkey
| |
Collapse
|
|
27
|
Mc Fadden S, Flood T, Watson A, Shepherd P. The lessons learned working in diagnostic and therapeutic radiography departments through the COVID-19 pandemic in Northern Ireland, UK. What can we do differently the next time? Radiography (Lond) 2022; 28 Suppl 1:S68-S76. [PMID: 36008264 PMCID: PMC9359931 DOI: 10.1016/j.radi.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Following the emergence of the COVID-19 pandemic in January 2020, a radical restructure of NHS services occurred, prioritising the acute needs of infected patients. This included suspending routine procedures, leading to an inevitable resurgence in the future, placing increased demands on the NHS, including diagnostic and therapeutic radiographers. With radiography departments already experiencing staff shortages due to COVID-19 related illnesses and vulnerable staff shielding, there is a need to implement plans within radiography departments to ensure their sustainability in the future. METHODS A mixed methods study was undertaken in Northern Ireland, involving distribution of a survey to diagnostic and therapeutic radiographers alongside conducting interviews with radiography department managers. RESULTS 106 radiographers completed the survey, with 9 radiography managers and 2 band eight superintendents participating in interviews. Over 60% of participants felt that morale declined in their departments, with the majority feeling that the pandemic had a negative impact on their physical or mental health and wellbeing. Managers felt that to improve staff morale and motivation, incentives need to be offered including remuneration, flexible working and support for professional development. CONCLUSION Whilst predicting when the next wave of a COVID-19 variant or the next pandemic will occur is impossible, preparation and planning will help manage the situation better. This requires identifying clinical areas for expansion/retraction and having access to additional staff to meet the demands on the service to ensure all patients receive care not just those acutely ill. IMPLICATIONS FOR PRACTICE This study has identified key lessons learned from the pandemic within the radiography departments. This will enable preparation and strategic planning for future pandemics.
Collapse
Affiliation(s)
- S Mc Fadden
- Diagnostic Radiography and Imaging School of Health Sciences University of Ulster Shore Road Newtownabbey Co. Antrim, BT37 OQB, UK.
| | - T Flood
- Radiotherapy and OncologySchool of Health Sciences, Ulster University, BT37 0QB, UK.
| | - A Watson
- School of Health Sciences, Ulster University, BT37 0QB, UK.
| | - P Shepherd
- Radiotherapy and Oncology School of Health Sciences, Ulster University, Jordanstown Campus, Newtownabbey, BT37 0QB, UK.
| |
Collapse
|
|
28
|
Knaus WA, Kehoe S, Lindley C. All Public Health is Local: Lessons From Eagle County During the First 2 Years of the Coronavirus Disease-2019 Pandemic. Med Care 2022; 60:596-601. [PMID: 35797458 PMCID: PMC9256900 DOI: 10.1097/mlr.0000000000001736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND During the coronavirus disease-2019 (COVID-19) pandemic cumulative United States COVID-19 deaths per capita were higher than all other large, high-income nations, but with substantial variation across the country. OBJECTIVE The aim was to detail the public health response during the pandemic in Eagle County, Colorado. RESEARCH DESIGN AND MEASURES Observational study using pre-COVID-19 county public health metrics. Pandemic actions were recorded from a narrative summary of daily phone consultations by a county-wide taskforce and interviews. Outcomes obtained from local, state, and nationally reported databases. METHODS Eagle County began with a life expectancy of 85.9, low all-cause age-adjusted death rates equal for both White and Latinx populations, a high household median income, and other prepandemic advantages. It also launched an innovative, independent county-wide taskforce lead by experienced mid-level managers. The taskforce implemented rapid communication of decision consequences, made immediate course corrections without traditional organizational approvals or contradictory political pressures. RESULTS Eagle County was first in Colorado to obtain Personal Protective Equipment and to establish a drive-through testing facility. The COVID-19 case fatality rate was 0.34%. The sole intensive care unit never reached maximum capacity. By March 2022, Eagle County had administered at least 1 vaccine dose to 100% of the population and 83% were fully vaccinated. CONCLUSIONS It is not possible to directly attribute superior outcomes to either the baseline characteristics of Eagle County or its innovative taskforce design and deployment. Rather this report highlights the potential impact that improving the baseline health status of US citizens and permitting novel problem-solving approaches by local public health officials might have for the next pandemic.
Collapse
Affiliation(s)
- William A. Knaus
- Emeritus Professor of Public Health Sciences University of Virginia School of Medicine, Edwards, CO
| | - Shaneis Kehoe
- Director Project Management, Disease Prevention, and Public Health Response, Colorado Department of Public Health and the Environment, Denver, CO
| | - Chris Lindley
- Vail Health, Eagle Valley Behavioral Health, Vail, CO
| |
Collapse
|
|
29
|
Moraru AC, Floria M, Nafureanu E, Iov DE, Serban L, Scripcariu V, Popescu DM. Costs for a hospital stay: another lesson learned from the COVID-19 pandemic. ROMANIAN JOURNAL OF MILITARY MEDICINE 2022. [DOI: 10.55453/rjmm.2022.125.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background and aim: After two years of pandemic, planning and budgeting for use of healthcare resources and services is very important. Inpatient COVID-19 hospitalizations costs, regardless of ICD-10 procedure codes, in a Covid-19 support military hospital were analyzed. Methods: The national protocol for the treatment of Covid-19 infection was applied. The costs for laboratory tests, drugs, protection equipment and radiological investigations (imaging techniques such as computed-tomography or radiography), hospitalization days and food were assessed. Results: In our hospital, from August 2020 through June 2021, 241 patients were hospitalized with COVID-19: mean age 59.92±7.8 years, 46% men, 26% military personnel, 11.57±3 days of hospitalization; two third of patients had moderate and severe forms of COVID-19. The main manifestations were: 69% respiratory (18% with severe pneumonia), 3.3% cardiac (2.9% with pulmonary embolism, diagnosed by computed tomography angiography), 28% digestive and 33% psychiatric (most commonly anxiety). The average estimated costs were about 3000€/patient, without significant differences based on disease severity. Equipment costs were 2 times higher than for drugs and 3 times than for laboratory tests. Conclusions: In a Covid-19 support military hospital that cared for patients with predominantly moderate forms of COVID-19, the costs for equipment were much higher than those for treatment. New criteria for hospitalization of these forms of COVID-19 deserve to be analyzed in order to avoid useless costs
Collapse
|
|
30
|
Crotty BH, Dong Y, Laud P, Hanson RJ, Gershkowitz B, Penlesky AC, Shah N, Anderes M, Green E, Fickel K, Singh S, Somai MM. Hospitalization Outcomes Among Patients With COVID-19 Undergoing Remote Monitoring. JAMA Netw Open 2022; 5:e2221050. [PMID: 35797044 PMCID: PMC9264036 DOI: 10.1001/jamanetworkopen.2022.21050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Health care systems have implemented remote patient monitoring (RPM) programs to manage patients with COVID-19 at home, but the associations between participation and outcomes or resource utilization are unclear. Objective To assess whether an RPM program for COVID-19 is associated with lower or higher likelihood of hospitalization and whether patients who are admitted present earlier or later for hospital care. Design, Setting, and Participants This retrospective, observational, cohort study of RPM was performed at Froedtert & Medical College of Wisconsin Health Network, an academic health system in southeastern Wisconsin. Participants included patients with internal primary care physicians and a positive SARS-CoV-2 test in the ambulatory setting between March 30, 2020, and December 15, 2020. Data analysis was performed from February 15, 2021, to February 2, 2022. Exposures Activation of RPM program. Main Outcomes and Measures Hospitalizations within 2 to 14 days of a positive test. Inverse propensity score weighting was used to account for differences between groups. Sensitivity analyses were performed looking at usage of the RPM among patients who activated the program. Results A total of 10 660 COVID-19-positive ambulatory patients were eligible, and 9378 (88.0%) had email or mobile numbers on file and were invited into the RPM program; the mean (SD) age was 46.9 (16.3) years and 5448 patients (58.1%) were women. Patients who activated monitoring (5364 patients [57.2%]) had a mean (SD) of 35.3 (33.0) check-ins and a mean (SD) of 1.27 (2.79) (median [IQR], 0 [0-1]) free-text comments. A total of 878 patients (16.4%) experienced at least 1 alert; 128 of 5364 activated patients (2.4%) and 158 of 4014 inactivated patients (3.9%) were hospitalized (χ21 = 18.65; P < .001). In weighted regression analysis, activation of RPM was associated with a lower odds of hospitalization (odds ratio, 0.68; 95% CI, 0.54-0.86; P = .001) adjusted for demographics, comorbidities, and time period. Monitored patients had a longer mean (SD) time between test and hospitalization (6.67 [3.21] days vs 5.24 [3.03] days), a shorter length of stay (4.44 [4.43] days vs 7.14 [8.63] days), and less intensive care use (15 patients [0.3%] vs 44 patients [1.1%]). Conclusions and Relevance These findings suggest that activation of an RPM program is associated with lower hospitalization, intensive care use, and length of stay among patients with COVID-19.
Collapse
Affiliation(s)
- Bradley H. Crotty
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| | - Yilu Dong
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Purushottam Laud
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Ryan J. Hanson
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Bradley Gershkowitz
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Annie C. Penlesky
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Neemit Shah
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Michael Anderes
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Erin Green
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Karen Fickel
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
| | - Siddhartha Singh
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Melek M. Somai
- Collaborative for Healthcare Delivery Science, Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
- Inception Labs at Froedtert & Medical College of Wisconsin Health Network, Milwaukee
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
| |
Collapse
|
|
31
|
Nilsson K, Landstad BJ, Ekberg K, Nyberg A, Sjöström M, Hagqvist E. Physicians' experiences of challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in Sweden. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2022. [DOI: 10.1108/ijhg-01-2022-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThis aim of this study was to explore how hospital-based physicians in Sweden experienced the challenges in working conditions related to the provision of care during the initial response to the COVID-19 pandemic in 2020 when hospitals transitioned to pandemic care.Design/methodology/approachThe study has a qualitative design. Twenty-five hospital-based physicians were interviewed about their experiences from working in a hospital while healthcare organisations initially responded to COVID-19 pandemic in 2020. A thematic analysis was used to analyse the empirical material.FindingsThe analysis resulted in four themes: involuntary self-management, a self-restrictive bureaucracy, passive occupational safety and health (OSH) management, and information overload. These themes reflect how the physicians perceived their work situation during the pandemic and how they tried to maintain quality care for their patients.Practical implicationsThe study gives valuable insights for formulating preparedness in regard to crisis management plans that can secure the provision of care for future emergencies in the healthcare services.Originality/valueThis paper shows that a crisis management plans in the healthcare services should include decision structures and management, measures of risk assessment and OSH management, and the maintenance of personnel wellbeing. A prepared healthcare management can preserve quality care delivery while under crisis.
Collapse
|
|
32
|
Dainty KN, Seaton MB, Estacio A, Hicks LK, Jamieson T, Ward S, Yu CH, Mosko JD, Kassardjian CD. Virtual Specialist Care during the COVID-19 Pandemic: A Multi-Method Study of Patient Experience. JMIR Med Inform 2022; 10:e37196. [PMID: 35482950 PMCID: PMC9239568 DOI: 10.2196/37196] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
Background Transitioning nonemergency, ambulatory medical care to virtual visits in light of the COVID-19 global pandemic has been a massive shift in philosophy and practice that naturally came with a steep learning curve for patients, physicians, and clinic administrators. Objective We undertook a multimethod study to understand the key factors associated with successful and less successful experiences of virtual specialist care, particularly as they relate to the patient experience of care. Methods This study was designed as a multimethod patient experience study using survey methods, descriptive qualitative interview methodology, and administrative virtual care data collected by the hospital decision support team. Six specialty departments participated in the study (endoscopy, orthopedics, neurology, hematology, rheumatology, and gastroenterology). All patients who could speak and read English and attended a virtual specialist appointment in a participating clinic at St. Michael’s Hospital (Toronto, Ontario, Canada) between October 1, 2020, and January 30, 2021, were eligible to participate. Results During the study period, 51,702 virtual specialist visits were conducted in the departments that participated in the study. Of those, 96% were conducted by telephone and 4% by video. In both the survey and interview data, there was an overall consensus that virtual care is a satisfying alternative to in-person care, with benefits such as reduced travel, cost, time, and SARS-CoV-2 exposure, and increased convenience. Our analysis further revealed that the specific reason for the visit and the nature and status of the medical condition are important considerations in terms of guidance on where virtual care is most effective. Technology issues were not reported as a major challenge in our data, given that the majority of “virtual” visits reported by our participants were conducted by telephone, which is an important distinction. Despite the positive value of virtual care discussed by the majority of interview participants, 50% of the survey respondents still indicated they would prefer to see their physician in person. Conclusions Patient experience data collected in this study indicate a high level of satisfaction with virtual specialty care, but also signal that there are nuances to be considered to ensure it is an appropriate and sustainable part of the standard of care.
Collapse
Affiliation(s)
- Katie N Dainty
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | - M Bianca Seaton
- North York General Hospital, 4001 Leslie StreetLE-140, Toronto, CA
| | | | - Lisa K Hicks
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Sarah Ward
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | | - Jeff D Mosko
- Unity Health - St. Michael's Hospital, Toronto, CA
| | | |
Collapse
|
|
33
|
Airoldi F, Tavano D, Ambrosio G. Stress-testing interventional cardiology organization to streamline procedures during COVID-19 pandemic, and beyond. Int J Cardiol 2022; 354:84-85. [PMID: 35235840 PMCID: PMC8882250 DOI: 10.1016/j.ijcard.2022.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Affiliation(s)
| | - Davide Tavano
- Division of Cardiology, IRCCS MultiMedica, Milan, Italy
| | - Giuseppe Ambrosio
- Division of Cardiology, and Center for Clinical and Translational Researc-CERICLET, University of Perugia School of Medicine, Perugia, Italy.
| |
Collapse
|
|
34
|
|
|
35
|
Changal K, Veria S, Mack S, Paternite D, Sheikh SA, Patel M, Mir T, Sheikh M, Ramanathan PK. Myocardial injury in hospitalized COVID-19 patients: a retrospective study, systematic review, and meta-analysis. BMC Cardiovasc Disord 2021; 21:626. [PMID: 34972516 PMCID: PMC8719604 DOI: 10.1186/s12872-021-02450-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/28/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The majority of studies evaluating the effect of myocardial injury on the survival of COVID-19 patients have been performed outside of the United States (U.S.). These studies have often utilized definitions of myocardial injury that are not guideline-based and thus, not applicable to the U.S. PATIENT POPULATION METHODS The current study is a two-part investigation of the effect of myocardial injury on the clinical outcome of patients hospitalized with COVID-19. The first part is a retrospective analysis of 268 patients admitted to our healthcare system in Toledo, Ohio, U.S.; the second part is a systematic review and meta-analysis of all similar studies performed within the U.S. RESULTS In our retrospective analysis, patients with myocardial injury were older (mean age 73 vs. 59 years, P 0.001), more likely to have hypertension (86% vs. 67%, P 0.005), underlying cardiovascular disease (57% vs. 24%, P 0.001), and chronic kidney disease (26% vs. 10%, P 0.004). Myocardial injury was also associated with a lower likelihood of discharge to home (35% vs. 69%, P 0.001), and a higher likelihood of death (33% vs. 10%, P 0.001), acute kidney injury (74% vs. 30%, P 0.001), and circulatory shock (33% vs. 12%, P 0.001). Our meta-analysis included 12,577 patients from 8 U.S. states and 55 hospitals who were hospitalized with COVID-19, with the finding that myocardial injury was significantly associated with increased mortality (HR 2.43, CI 2.28-3.6, P 0.0005). The prevalence of myocardial injury ranged from 9.2 to 51%, with a mean prevalence of 27.2%. CONCLUSION Hospitalized COVID-19 patients in the U.S. have a high prevalence of myocardial injury, which was associated with poorer survival and outcomes.
Collapse
Affiliation(s)
- Khalid Changal
- Cardiovascular Medicine, University of Toledo, Toledo, OH, USA
| | - Spiro Veria
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Sean Mack
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - David Paternite
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Shoaib Altaf Sheikh
- Internal Medicine, Nazareth Hospital (Trinity Health), Philadelphia, PA, USA
| | - Mitra Patel
- Department of Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Tanveer Mir
- Internal Medicine, Detroit Medical Center, Wayne State University, Detroit, MI, USA
| | - Mujeeb Sheikh
- Department of Cardiovascular Medicine, Interventional Cardiology, Promedica Toledo Hospital, 2109 Hughes Dr, Jobst Tower 3rd Floor, Toledo, OH, 43606, USA.
| | - P Kasi Ramanathan
- Department of Cardiovascular Medicine, Interventional Cardiology, Promedica Toledo Hospital, 2109 Hughes Dr, Jobst Tower 3rd Floor, Toledo, OH, 43606, USA
| |
Collapse
|
|
36
|
Leo CG, Sabina S, Tumolo MR, Bodini A, Ponzini G, Sabato E, Mincarone P. Burnout Among Healthcare Workers in the COVID 19 Era: A Review of the Existing Literature. Front Public Health 2021; 9:750529. [PMID: 34778184 PMCID: PMC8585922 DOI: 10.3389/fpubh.2021.750529] [Citation(s) in RCA: 152] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/07/2021] [Indexed: 12/23/2022] Open
Abstract
In the current period of global public health crisis due to the COVID-19, healthcare workers are more exposed to physical and mental exhaustion - burnout - for the torment of difficult decisions, the pain of losing patients and colleagues, and the risk of infection, for themselves and their families. The very high number of cases and deaths, and the probable future "waves" raise awareness of these challenging working conditions and the need to address burnout by identifying possible solutions. Measures have been suggested to prevent or reduce burnout at individual level (physical activity, balanced diet, good sleep hygiene, family support, meaningful relationships, reflective practices and small group discussions), organizational level (blame-free environments for sharing experiences and advices, broad involvement in management decisions, multi-disciplinary psychosocial support teams, safe areas to withdraw quickly from stressful situations, adequate time planning, social support), and cultural level (involvement of healthcare workers in the development, implementation, testing, and evaluation of measures against burnout). Although some progress has been made in removing the barrier to psychological support to cope with work-related stress, a cultural change is still needed for the stigma associated with mental illness. The key recommendation is to address the challenges that the emergency poses and to aggregate health, well-being and behavioral science expertise through long term researches with rigorous planning and reporting to drive the necessary cultural change and the improvement of public health systems.
Collapse
Affiliation(s)
- Carlo Giacomo Leo
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Saverio Sabina
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Maria Rosaria Tumolo
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
| | - Antonella Bodini
- Institute for Applied Mathematics and Information Technologies “E. Magenes,” National Research Council, Milan, Italy
| | - Giuseppe Ponzini
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
| | - Eugenio Sabato
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
- Respiratory Diseases Unit, “A. Perrino” P.O., Brindisi, Italy
| | - Pierpaolo Mincarone
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
| |
Collapse
|
|
37
|
Ridolo E, Incorvaia C, Gritti B, Pucciarini F. The quest for improving general and in hospital health care during COVID-19 pandemic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021422. [PMID: 34487056 PMCID: PMC8477086 DOI: 10.23750/abm.v92i4.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Erminia Ridolo
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.
| | | | - Bruna Gritti
- School of Human Sciences Gaetana Agnesi, Milan, Italy.
| | - Francesco Pucciarini
- Allergy and Clinical Immunology, Medicine and Surgery Department, University of Parma, Parma, Italy.
| |
Collapse
|