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Butler AE, Riegel M, Speedie L, Ranse K, Buckley T. The impact of COVID-19 on the provision of bereavement support in Australian intensive care units: A national survey. Aust Crit Care 2024; 37:577-584. [PMID: 38065795 DOI: 10.1016/j.aucc.2023.10.008] [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: 07/09/2023] [Accepted: 10/20/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Bereavement support is a vital part of caring for families when a patient dies in the intensive care unit (ICU). Previous research has demonstrated that while many ICUs provide some informal aspects of bereavement care, formalised follow-up programmes are uncommon. The impacts of COVID-19 on ICU-based bereavement support are currently unknown. OBJECTIVES The objectives of this study were to explore the current provision of bereavement support in Australian ICUs and identify the impacts of the COVID-19 pandemic on these services. METHODS A cross-sectional exploratory web-based survey was used. The survey was distributed to one senior nurse in each public and private adult, paediatric, and neonatal ICU in Australia between April and July 2022. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Ethical approval was received from La Trobe University. RESULTS One hundred and four ICUs from 82 hospitals responded to the survey, with 36 units reporting a formal bereavement follow-up service. When compared to prepandemic levels, almost all of the common bereavement care practices explored in the survey were significantly reduced during the COVID-19 pandemic. Open-ended responses also demonstrated significant impacts of COVID-19 on bereavement care provision, particularly related to Restricted family togetherness, Logistical Challenges, and Impacts on Staff. Staff members reported adjusting care provision in response to these challenges by exploring Alternative family communications, Facilitation of family togetherness, and Increasing familysupports. CONCLUSIONS Many of the common elements of ICU-based bereavement care were significantly reduced during the COVID-19 pandemic. In addition, the number of formal bereavement follow-up services in Australian ICUs remains largely unchanged since 2015. Ongoing research is needed to explore the long-term effects of these changes on staff and family wellbeing and on ongoing provision of ICU-based bereavement support.
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Affiliation(s)
| | - Melissa Riegel
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
| | - Lisa Speedie
- School of Nursing and Midwifery, La Trobe University, Australia
| | - Kristen Ranse
- School of Nursing & Midwifery, Gold Coast Campus, Griffith University, Australia; Menzies Health Institute Queensland, Griffith University, Australia
| | - Thomas Buckley
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, University of Sydney, Camperdown, NSW, Australia
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Blank J, Shiroff AM, Kaplan LJ. Surgical Emergencies in Patients with Significant Comorbid Diseases. Surg Clin North Am 2023; 103:1231-1251. [PMID: 37838465 DOI: 10.1016/j.suc.2023.06.003] [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] [Indexed: 10/16/2023]
Abstract
Emergency surgery in patients with significant comorbidities benefits from a structured approach to preoperative evaluation, intra-operative intervention, and postoperative management. Providing goal concordant care is ideal using shared decision-making. When operation cannot achieve the patient's goal, non-operative therapy including Comfort Care is appropriate. When surgical therapy is offered, preoperative physiology-improving interventions are far fewer than in other phases. Reevaluation of clinical care progress helps define trajectory and inform goals of care. Palliative Care Medicine may be critical in supporting loved ones during a patient's critical illness. Outcome evaluation defines successful strategies and outline opportunities for improvement.
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Affiliation(s)
- Jacqueline Blank
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA
| | - Adam M Shiroff
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA; Surgical Services, Section of Surgical Critical Care and Emergency General Surgery, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA
| | - Lewis J Kaplan
- Department of Surgery, Division of Trauma, Surgical Critical Care, and Emergency Surgery, Perelman School of Medicine, University of Pennsylvania, 51 North 39th Street, MOB 1, Suite 120, Philadelphia, PA 19104, USA; Surgical Services, Section of Surgical Critical Care and Emergency General Surgery, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA 19104, USA.
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3
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Miao Y, Zhang W, Li Y, Wu J, Shen Z, Bai J, Zhu D, Ren R, Zhang J, Guo D, Tarimo CS, Li C, Dong W. Quantifying the benefits of healthy lifestyle behaviors and emotional expressivity in lowering the risk of COVID-19 infection: a national survey of Chinese population. BMC Public Health 2023; 23:2374. [PMID: 38037040 PMCID: PMC10687789 DOI: 10.1186/s12889-023-17158-6] [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: 08/05/2023] [Accepted: 11/04/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND COVID-19 is still prevalent in most countries around the world at the low level. Residents' lifestyle behaviors and emotions are critical to prevent COVID-19 and keep healthy, but there is lacking of confirmative evidence on how residents' lifestyle behaviors and emotional expressivity affected COVID-19 infection. METHODS Baseline study was conducted in August 2022 and follow-up study was conducted in February 2023. Baseline survey collected information on residents' basic information, as well as their lifestyle behaviors and emotions. Follow-up study was carried out to gather data on COVID-19 infection condition. Binary logistic regression was utilized to identify factors that may influence COVID-19 infection. Attributable risk (AR) was computed to determine the proportion of unhealthy lifestyle behaviors and emotional factors that could be attributed to COVID-19 infection. Sensitivity analysis was performed to test the robustness of the results. RESULTS A total of 5776 participants (46.57% males) were included in this study, yielding an overall COVID-19 infection rate of 54.8% (95%CI: 53.5 - 56.0%). The findings revealed that higher stress levels [aOR = 1.027 (95%CI; 1.005-1.050)] and lower frequency in wearing masks, washing hands, and keeping distance [aOR = 1.615 (95%CI; 1.087-2.401)], were positively associated with an increased likelihood of COVID-19 infection (all P < 0.05). If these associations were causal, 8.1% of COVID-19 infection would have been prevented if all participants had normal stress levels [Attributable Risk Percentage: 8.1% (95%CI: 5.9-10.3%)]. A significant interaction effect between stress and the frequency in wearing masks, washing hands, and keeping distance on COVID-19 infection was observed (β = 0.006, P < 0.001), which also was independent factor of COVID-19 infection. CONCLUSIONS The overall COVID-19 infection rate among residents is at a medium level. Residents' increasing stress and decreasing frequency in wearing masks and washing hands and keeping distance contribute to increasing risk of infection, residents should increase the frequency of mask-wearing, practice hand hygiene, keep safe distance from others, ensure stable emotional state, minimize psychological stress, providing evidence support for future responses to emerging infectious diseases.
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Affiliation(s)
- Yudong Miao
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Wanliang Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Yi Li
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Jian Wu
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Zhanlei Shen
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Junwen Bai
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Dongfang Zhu
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Ruizhe Ren
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Jingbao Zhang
- Department of Health Management, College of Public Health, Zhengzhou University, Henan, China
| | - Dan Guo
- Department of Neurology, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Clifford Silver Tarimo
- Department of Science and Laboratory Technology, Dar es salaam Institute of Technology, Dar es Salaam, Tanzania
| | - Chengpeng Li
- Department of Human Resources, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China
| | - Wenyong Dong
- Department of Hypertension, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Henan, China.
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Laurent R, Correia P, Lachand R, Diconne E, Ezingeard E, Bruna F, Guenier PA, Page D, Périnel-Ragey S, Thiéry G. Long-term outcomes of COVID-19 intensive care unit survivors and their family members: a one year follow-up prospective study. Front Public Health 2023; 11:1236990. [PMID: 37614444 PMCID: PMC10442651 DOI: 10.3389/fpubh.2023.1236990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 07/17/2023] [Indexed: 08/25/2023] Open
Abstract
Purpose To describe the long-term physical, functional and mental status of COVID-19 intensive care unit (ICU) patients and their family members 1 year after ICU discharge. Methods We performed a prospective observational cohort study among patients admitted to the ICU for COVID-19-associated respiratory failure and their family members. Patients attended a one-year follow-up consultation with family members. Physical, functional and respiratory outcomes were collected. In addition, participants completed the Hospital Anxiety and Depression Scale and the Revised Impact of Event Scale. Qualitative components were collected during a 2-h face-to-face interview. Results Fifty-four patients and 42 family members were included. Thirty-four (63%) patients reported chronic fatigue and 37 (68.5%) dyspnea. Computed tomography scans were abnormal in 34 patients (72.3%). Anxiety symptoms were present in 23 (48%) patients and 26 (66%) family members, depression in 11 (23%) and 13 (33%), and post-traumatic stress disorder in 12 (25%) and 23 (55%), respectively. Visit limitation was reported as the most painful experience for family members. Numerous patients recalled nightmares that contributed to the anxiety. Long-term reconstruction was difficult for both patients and family members. Conclusion The vast majority of patients and their relatives reported long-term consequences on various physical and mental components, leading to a profound impact on their well-being.
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Affiliation(s)
- Raphael Laurent
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Patricia Correia
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Raphael Lachand
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Eric Diconne
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Eric Ezingeard
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Franklin Bruna
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Pierre-Alban Guenier
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Dominique Page
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
| | - Sophie Périnel-Ragey
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
- Université Jean Monnet, Saint-Etienne, France
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon, Lyon, France
| | - Guillaume Thiéry
- Service de Médecine Intensive Réanimation G, Centre Hospitalier Universitaire de Saint-Etienne, St Etienne, France
- Université Jean Monnet, Saint-Etienne, France
- Laboratoire INSERM 1059 SAINBIOSE, Université Jean Monnet, Saint-Etienne, France
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Hermann B, Benghanem S, Jouan Y, Lafarge A, Beurton A. The positive impact of COVID-19 on critical care: from unprecedented challenges to transformative changes, from the perspective of young intensivists. Ann Intensive Care 2023; 13:28. [PMID: 37039936 PMCID: PMC10088619 DOI: 10.1186/s13613-023-01118-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/04/2023] [Indexed: 04/12/2023] Open
Abstract
Over the past 2 years, SARS-CoV-2 infection has resulted in numerous hospitalizations and deaths worldwide. As young intensivists, we have been at the forefront of the fight against the COVID-19 pandemic and it has been an intense learning experience affecting all aspects of our specialty. Critical care was put forward as a priority and managed to adapt to the influx of patients and the growing demand for beds, financial and material resources, thereby highlighting its flexibility and central role in the healthcare system. Intensivists assumed an essential and unprecedented role in public life, which was important when claiming for indispensable material and human investments. Physicians and researchers around the world worked hand-in-hand to advance research and better manage this disease by integrating a rapidly growing body of evidence into guidelines. Our daily ethical practices and communication with families were challenged by the massive influx of patients and restricted visitation policies, forcing us to improve our collaboration with other specialties and innovate with new communication channels. However, the picture was not all bright, and some of these achievements are already fading over time despite the ongoing pandemic and hospital crisis. In addition, the pandemic has demonstrated the need to improve the working conditions and well-being of critical care workers to cope with the current shortage of human resources. Despite the gloomy atmosphere, we remain optimistic. In this ten-key points review, we outline our vision on how to capitalize on the lasting impact of the pandemic to face future challenges and foster transformative changes of critical care for the better.
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Affiliation(s)
- Bertrand Hermann
- Service de Médecine Intensive - Réanimation, Hôpital Européen Georges Pompidou (HEGP), Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
| | - Sarah Benghanem
- Faculté de Médecine, Université Paris Cité, Paris, France
- INSERM U1266, Institut de Psychiatrie et Neurosciences de Paris (IPNP), Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Cochin, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Centre - Université Paris Cité (GHU AP-HP Centre - Université Paris Cité), Paris, France
| | - Youenn Jouan
- Service de Médecine Intensive - Réanimation, CHRU Tours, Tours, France
- Service de Réanimation Chirurgicale Cardiovasculaire & Chirurgie Cardiaque, CHRU Tours, Tours, France
- INSERM U1100 Centre d'Etudes des Pathologies Respiratoires, Faculté de Médecine de Tours, Tours, France
| | - Antoine Lafarge
- Faculté de Médecine, Université Paris Cité, Paris, France
- Service de Médecine Intensive - Réanimation, Hôpital Saint Louis, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Nord - Université Paris Cité (AP-HP Nord - Université Paris Cité), Paris, France
| | - Alexandra Beurton
- Service de Médecine Intensive - Réanimation, Hôpital Tenon, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université (GHU AP-HP Sorbonne Université), Paris, France.
- Service de Médecine Intensive - Réanimation, Hôpital Pitié Salpêtrière, Groupe hospitalo-universitaire Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris, France.
- UMRS 1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Sorbonne Université, Paris, France.
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Jungestrand L, Holm E, Rose L, Wolf A, Ringdal M. Family member perspectives on intensive care unit in-person visiting restrictions during the COVID-19 pandemic: A qualitative study. Intensive Crit Care Nurs 2023; 75:103347. [PMID: 36470700 PMCID: PMC9637525 DOI: 10.1016/j.iccn.2022.103347] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/17/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Family member presence in the intensive care unit is important for patient well-being and recovery. Limitations to visits increase the risk of psychological distress in family members. During the COVID-19 pandemic, in-person visiting restrictions were introduced to prevent the spread of infection. PURPOSE To explore the experience of in-person visiting restrictions imposed during the pandemic on family members of patients with COVID-19 admitted to an intensive care unit. METHOD Qualitative method with thematic analysis. Individual semi-structured telephone interviews were conducted. FINDINGS We interviewed 21 family members. The results are presented in one overall theme with two main themes and five sub-themes. The theme 'Striving for closeness even at a distance describes the experience of being kept at a physical distance when participants needed closeness the most. Even participants who were allowed in-person visits perceived a 'distance' due to personal protective equipment or because they could only view the patient from a window. Participants reported that contact with and information about the patient was of utmost importance. Visits were viewed as essential in providing for the patient's wellbeing. Meaningful contact with the ICU team was vital for getting useful information. Phone calls became a lifeline, with digital aids such as video calls used occasionally to overcome the feeling of distance. CONCLUSION Visiting restrictions imposed during the COVID-19 pandemic made straightforward and comprehensible communication of information from the ICU team more essential to reduce family members' perceptions of distance and exclusion from the intensive care unit.
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Affiliation(s)
- Linda Jungestrand
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden
| | - Emma Holm
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden
| | - Louise Rose
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Axel Wolf
- Sahlgrenska University Hospital, Department of Anesthesiology and Intensive Care, Gothenburg, Sweden; Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mona Ringdal
- Kungälvs hospital, Department of Anesthesiology and Intensive Care, Kungälv, Sweden; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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7
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苏 思, 宫 艺, 赵 逸, 倪 舒, 师 乐, 鲍 彦, 陆 林. [Challenges of and Responses to Mental Health Problems in the Post-COVID-19 Era]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2023; 54:217-222. [PMID: 36949675 PMCID: PMC10409176 DOI: 10.12182/20230260301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Indexed: 03/24/2023]
Abstract
Since the first outbreak of the coronavirus disease 2019 (COVID-19), prevention and control of the pandemic remains a grim issue because of the continuous emergence of new variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, and the constant emergence of new domestic outbreaks. During the COVID-19 pandemic, mental and psychological problems have increased significantly among different populations, including patients of COVID-19 and their families, health workers, college students, adolescents, children, and even the general population. At present, the COVID-19 epidemic situation in China is rather complicated. The general population is confronted with a variety of challenges, including the threat of infection or reinfection, lower efficiency in study and work, and reduced incomes, and is hence experiencing many mental health problems related to the epidemic situation. Therefore, the relevant governmental departments and health institutions in China have attached high importance to the mental health issue in the process of implementing pandemic control measures of COVID-19. Close collaboration to implement the required epidemic prevention and control measures, improvements in the mental health services for public health emergencies in China, and commitment to the protection of the mental health and well-being of the people in the post-pandemic era have become the top priorities for now. Based on a review of the mental health problems related to COVID-19 pandemic, we suggested strategies to deal with mental health problems in the post-COVID-19 era.
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Affiliation(s)
- 思贞 苏
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
| | - 艺邈 宫
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
| | - 逸苗 赵
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
- 北京大学前沿交叉学科研究院,北大-清华生命科学联合中心 (北京 100191) Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100191, China
| | - 舒羽 倪
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
- 北京大学前沿交叉学科研究院,北大-清华生命科学联合中心 (北京 100191) Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100191, China
| | - 乐 师
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
| | - 彦平 鲍
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
- 北京大学前沿交叉学科研究院,北大-清华生命科学联合中心 (北京 100191) Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100191, China
| | - 林 陆
- 北京大学第六医院,北京大学精神卫生研究所,国家卫生健康委员会精神卫生学重点实验室(北京大学),国家精神心理疾病临床医学研究中心 (北京 100191)Peking University Sixth Hospital, Peking University Institute of Mental Health, Key Laboratory of Mental Health of the National Health Commission (Peking University), and National Clinical Research Center for Mental Disorders, Beijing 100191, China
- 北京大学前沿交叉学科研究院,北大-清华生命科学联合中心 (北京 100191) Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing 100191, China
- 北京大学中国药物依赖性研究所 (北京 100191)National Institute on Drug Dependence, Peking University, Beijing 100191, China
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8
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Reid JC, Dennis B, Hoad N, Clarke F, Hanmiah R, Vegas DB, Boyle A, Toledo F, Rudkowski JC, Soth M, Heels-Ansdell D, Cheung A, Willison K, Neville TH, Cheung J, Woods A, Cook D. Enhancing end of life care on general internal medical wards: the 3 Wishes Project. BMC Palliat Care 2023; 22:11. [PMID: 36788522 PMCID: PMC9925934 DOI: 10.1186/s12904-023-01133-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Initially developed in the intensive care unit (ICU) at St. Joseph's Healthcare Hamilton (SJHH) the 3 Wishes Project (3WP) provides personalized, compassionate care to dying patients and their families. The objective of this study was to develop and evaluate 3WP expansion strategies for patients cared for on General Internal Medicine (GIM) wards in our hospital. METHODS From January 2020-November 2021, we developed a phased, multicomponent approach for program expansion. We enrolled patients on the GIM wards who had a high probability of dying in hospital, then elicited, implemented, and documented wishes for them or their families. Data were analyzed descriptively. RESULTS From March 2020 to November 2020, we implemented staff education and engagement activities, created an Expansion Coordinator position, held strategic consultations, and offered enabling resources. From March 2020 to November 2021, we enrolled 62 patients and elicited 281 wishes (median [1st, 3rd quartiles] 4 [4, 5] wishes/patient). The most common wish categories were personalizing the environment (67 wishes, 24%), rituals and spiritual support (42 wishes, 15%), and facilitating connections (39 wishes, 14%). The median [1st, 3rd] cost/patient was $0 [0, $10.00] (range $0 to $86); 91% of wishes incurred no cost to the program. CONCLUSIONS The formal expansion of the 3WP on GIM wards has been successful despite COVID-19 pandemic disruptions. While there is still work ahead, these data suggest that implementing the 3WP on the GIM wards is feasible and affordable. Increased engagement of the clinical team during the pandemic suggests that it is positively received.
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Affiliation(s)
- Julie C. Reid
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Brittany Dennis
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Neala Hoad
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - France Clarke
- grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Rajendar Hanmiah
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Daniel Brandt Vegas
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Boyle
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Feli Toledo
- grid.416721.70000 0001 0742 7355Department of Spiritual Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Jill C. Rudkowski
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Mark Soth
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Diane Heels-Ansdell
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada
| | - Andrew Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Kathleen Willison
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada ,grid.25073.330000 0004 1936 8227School of Nursing, Faculty of Health Sciences, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Thanh H. Neville
- grid.19006.3e0000 0000 9632 6718Department of Medicine, Division of Pulmonary & Critical Care, University of California Los Angeles, Los Angeles, CA 90095 USA
| | - Jason Cheung
- grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
| | - Anne Woods
- grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.25073.330000 0004 1936 8227Division of Palliative Care, Department of Family Medicine, Faculty of Health Sciences, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 6th Floor, Hamilton, ON L8P 1H6 Canada
| | - Deborah Cook
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.25073.330000 0004 1936 8227Department of Medicine, Faculty of Health Sciences, McMaster University, McMaster University Medical Centre, 1280 Main Street West, 2C Area, Hamilton, ON L8S 4K1 Canada ,grid.416721.70000 0001 0742 7355Department of Critical Care, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada ,grid.416721.70000 0001 0742 7355Department of Medicine, St. Joseph’s Healthcare Hamilton, 50 Charlton Avenue East, Hamilton, ON L8N 4A6 Canada
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9
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Dainty KN, Seaton MB, Molloy S, Robinson S, Haberman S. "I don't know how we would have coped without it." Understanding the Importance of a Virtual Hospital Visiting Program During the COVID-19 Pandemic. J Patient Exp 2023; 10:23743735231155808. [PMID: 36798695 PMCID: PMC9926367 DOI: 10.1177/23743735231155808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
Abstract
As the COVID-19 pandemic reached Canada in full strength, the concept of allowing visiting to patients became an impossibility in most healthcare organizations. In March 2020, hospitals across Canada made the decision to close to visitors. This was a complicated decision which left admitted patients with very little option for connecting with family and friends other than through the telephone. In response, North York General Hospital launched a virtual family visiting (VFV) program across all inpatient units. Here we report the findings of a qualitative study of the program informed by an interpretive descriptive approach. Interviews were conducted with families who participated in the VFV program at North York General Hospital in Toronto, Canada during the first wave of the COVID pandemic. A total of 24 family members were interviewed. As anticipated, the family members were all extremely pleased with the opportunity to connect virtually and very satisfied with the VFV program. What was less anticipated was the anxiety and distress that families experienced in being separated from their loved ones. Our data analysis revealed 4 key themes which we have labeled (a) the unforeseen consequences of separation trauma, (b) increased vulnerability of patients and family, (c) a lifeline of human connection, and (d) the role of the facilitator as a connector. This work contributes significantly to a system-level understanding of the impact of imposed separation, increased vulnerability, and the importance of providing an alternative way for families to be present with their loved ones in these unprecedented times.
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Affiliation(s)
- Katie N Dainty
- Patient-Centred Outcomes, North York General Hospital, Toronto, ON, Canada,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada,Katie N Dainty, Office of Research & Innovation, North York General Hospital, 4001 Leslie Street, Suite LE-140, Toronto, Ontario M2K 3E1, Canada.
| | - M Bianca Seaton
- Research and Innovation, North York General Hospital, Toronto, ON, Canada
| | - Sean Molloy
- Quality, Patient and Family Centered Care and Care Transitions, North York General Hospital, Toronto, ON, Canada
| | - Stephanie Robinson
- Quality and Patient Safety Specialist, North York General Hospital, Toronto, ON, Canada
| | - Shana Haberman
- Quality and Patient Safety Specialist, North York General Hospital, Toronto, ON, Canada
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10
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Hriberšek M, Eibensteiner F, Kapral L, Teufel A, Nawaz FA, Cenanovic M, Sai CS, Devkota HP, De R, Singla RK, Parvanov ED, Tsagkaris C, Atanasov AG, Schaden E. "Loved ones are not 'visitors' in a patient's life"-The importance of including loved ones in the patient's hospital stay: An international Twitter study of #HospitalsTalkToLovedOnes in times of COVID-19. Front Public Health 2023; 11:1100280. [PMID: 36778575 PMCID: PMC9909431 DOI: 10.3389/fpubh.2023.1100280] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
Background Hospitals are institutions whose primary task is to treat patients. Family-centered care, which considers loved ones as equal partners in patient care, has been gaining recognition in the adult care setting. Our aim was to record experiences of and opinions on communication between hospital-based healthcare providers and patients' loved ones, related but not limited to the rigorous mitigation measures implemented during the COVID-19 pandemic. Methods The Twitter profile @HospitalsTalkTo and hashtag #HospitalsTalkToLovedOnes were created to interact with the Twitter public between 7 June 2021 and 7 February 2022. Conversations surrounding #HospitalsTalkToLovedOnes were extracted and subjected to natural language processing analysis using term frequency and Markov chain analysis. Qualitative thematic analysis was performed on the 10% most interacted tweets and of tweets mentioning "COVID" from a personal experience-based subset. Results We collected 4412 unique tweets made or interacted by 7040 Twitter users from 142 different countries. The most frequent words were patient, hospital, care, family, loved and communication. Thematic analysis revealed the importance of communication between patients, patients' loved ones and hospitals; showed that patients and their loved ones need support during a patient's hospital journey; and that pediatric care should be the gold standard for adult care. Visitation restrictions due to COVID-19 are just one barrier to communication, others are a lack of phone signal, no space or time for asking questions, and a complex medical system. We formulate 3 recommendations to improve the inclusion of loved ones into the patient's hospital stay. Conclusions "Loved ones are not 'visitors' in a patient's life". Irrespective of COVID-19, patient's loved ones need to be included during the patient's hospital journey. Transparent communication and patient empowerment increase patient safety and improve the hospital experience for both the patients and their loved ones. Our findings underline the need for the concept of family-centered care to finally be implemented in adult nursing clinical practice.
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Affiliation(s)
- Mojca Hriberšek
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Fabian Eibensteiner
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Division of Pediatric Nephrology and Gastroenterology, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Lorenz Kapral
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Anna Teufel
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria
| | - Faisal A. Nawaz
- Department of Psychiatry, Al Amal Psychiatric Hospital, Dubai, United Arab Emirates
| | | | | | - Hari Prasad Devkota
- Graduate School of Pharmaceutical Sciences, Kumamoto University, Kumamoto, Japan,Pharmacy Program, Gandaki University, Pokhara, Nepal
| | - Ronita De
- Department of ICMR-NICED Virus Lab, Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, Kolkata, West Bengal, India
| | - Rajeev K. Singla
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu, Sichuan, China,School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Emil D. Parvanov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Translational Stem Cell Biology, Research Institute of the Medical University of Varna, Varna, Bulgaria
| | | | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Biotechnology and Nutrigenomics, Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, Magdalenka, Poland
| | - Eva Schaden
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, Vienna, Austria,Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria,*Correspondence: Eva Schaden ✉
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11
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McPeake J, Kentish-Barnes N, Banse E, Anderson L, Cuzco C, Azoulay E, Quasim T, Castro P, Puxty K. Clinician perceptions of the impact of ICU family visiting restrictions during the COVID-19 pandemic: an international investigation. Crit Care 2023; 27:33. [PMID: 36681838 PMCID: PMC9862209 DOI: 10.1186/s13054-023-04318-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/11/2023] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To guarantee the safety of the public, clinicians and patients during the COVID-19 pandemic, hospital visits were severely restricted internationally. There are limited data on the precise impact of these visiting restrictions on Intensive Care Unit clinicians. Our objectives therefore were to explore the impact of family visitation restrictions on clinicians and care delivery and describe innovation alongside areas for potential improvement. METHODS A qualitative approach using focus groups was employed. We recruited members of the multi-disciplinary team from Spain, France and the UK. Framework analysis was used to synthesize and interpret data. RESULTS In total, 28 staff from multiple international sites contributed to data across six focus groups: 12 from the UK, 9 from France and 7 from Spain. In relation to the key aims, we derived four themes: the emergence of new technologies, relationships and rapport establishment, communication challenges and end-of-life care provision. Across each theme, the overarching concepts of clinician emotional exhaustion and emotional distress emerged alongside the negative impact on job satisfaction. CONCLUSION The impact of COVID-19 family visitation restrictions is far reaching. Future research should examine the wider impact of family presence in the ICU.
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Affiliation(s)
- Joanne McPeake
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Nancy Kentish-Barnes
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Emilie Banse
- Psychological Sciences Research Institute, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Lynne Anderson
- Department of Anaesthetics, Golden Jubilee National Hospital, Glasgow, UK
| | - Cecilia Cuzco
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
- Department of Fundamental Care and Medical-Surgical Nursing, Nursing School of Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Elie Azoulay
- AP-HP Nord, Saint Louis Hospital, Medical Intensive Care, Famiréa Research Group, Paris, France
| | - Tara Quasim
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Pedro Castro
- Medical Lntensive Care Unit, Hospital Clínic of Barcelona, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Kathryn Puxty
- Intensive Care Unit, Glasgow Royal Infirmary, Glasgow, UK
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
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12
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Ohbe H, Goto T, Okada A, Yasunaga H. Association between COVID-19 pandemic and mental disorders in spouses of intensive care unit patients. Intensive Care Med 2023; 49:112-114. [PMID: 36446853 PMCID: PMC9708118 DOI: 10.1007/s00134-022-06941-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan.,TXP Medical Co. Ltd., 7-3-1-252 Hongo, Bunkyo-Ku, Tokyo, 1138454, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 1130033, Japan
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13
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Xiao L, Amin R, Nonoyama ML. Long-term mechanical ventilation and transitions in care: A narrative review. Chron Respir Dis 2023; 20:14799731231176301. [PMID: 37170874 PMCID: PMC10184211 DOI: 10.1177/14799731231176301] [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] [Indexed: 05/13/2023] Open
Abstract
OBJECTIVES Individuals dependent on long-term mechanical ventilation (LTMV) for their day-to-day living are a heterogenous population who go through several transitions over their lifetime. This paper describes three transitions: 1) institution/hospital to community/home, 2) pediatric to adult care, and 3) active treatment to end-of-life for ventilator-assisted individuals (VAIs). METHODS A narrative review based on literature and the author's collective practical and research experience. Four online databases were searched for relevant articles. A manual search for additional articles was completed and the results are summarized. RESULTS Transitions from hospital to home, pediatric to adult care, and to end-of-life for VAIs are complex and challenging processes. Although there are several LTMV clinical practice guidelines highlighting key components for successful transition, there still exists gaps and inconsistencies in care. Most of the literature and experiences reported to date have been in developed countries or geographic areas with funded healthcare systems. CONCLUSIONS For successful transitions, the VAIs and their support network must be front-and-center. There should be a coordinated, systematic, and holistic plan (including a multi-disciplinary team), life-time follow-up, with bespoke consideration of jurisdiction and individual circumstances.
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Affiliation(s)
- Lena Xiao
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Reshma Amin
- Division of Respiratory Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Mika Laura Nonoyama
- Faculty of Health Sciences, University of Ontario Institute of Technology, Oshawa, ON, Canada
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