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Wattanachayakul P, Yanpiset P, Suenghataiphorn T, Srikulmontri T, Danpanichkul P, Rujirachun P, Polpichai N, Saowapa S, Casipit BA, Suparan K, Amanullah A. Impact of COVID-19 infection among patients hospitalized for conventional pacemaker implantation: Analysis of the Nationwide Inpatient Sample (NIS) 2020. J Arrhythm 2024; 40:905-912. [PMID: 39139863 PMCID: PMC11317689 DOI: 10.1002/joa3.13089] [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] [Received: 03/08/2024] [Revised: 05/06/2024] [Accepted: 05/21/2024] [Indexed: 08/15/2024] Open
Abstract
Introduction The cardiac pacemaker is indicated for treating various types of bradyarrhythmia, providing lifelong cardiovascular benefits. Recent data showed that COVID-19 has impacted procedure numbers and led to adverse long-term outcomes in patients with cardiac pacemakers. However, the impact of COVID-19 infection on the in-hospital outcome of patients undergoing conventional pacemaker implantation remains unclear. Method Patients aged above 18 years who were hospitalized for conventional pacemaker implantation in the Nationwide In-patient Sample (NIS) 2020 were identified using relevant ICD-10 CM and PCS codes. Multivariable logistic and linear regression models were used to analyze pre-specified outcomes, with the primary outcome being in-patient mortality and secondary outcomes including system-based and procedure-related complications. Results Of 108 020 patients hospitalized for conventional pacemaker implantation, 0.71% (765 out of 108 020) had a concurrent diagnosis of COVID-19 infection. Individuals with COVID-19 infection exhibited a lower mean age (73.7 years vs. 75.9 years, p = .027) and a lower female proportion (39.87% vs. 47.60%, p = .062) than those without COVID-19. In the multivariable logistic and linear regression models, adjusted for patient and hospital factors, COVID-19 infection was associated with higher in-hospital mortality (aOR 4.67; 95% CI 2.02 to 10.27, p < .001), extended length of stay (5.23 days vs. 1.04 days, p < .001), and linked with various in-hospital complications, including sepsis, acute respiratory failure, post-procedural pneumothorax, and venous thromboembolism. Conclusion Our study suggests that COVID-19 infection is attributed to higher in-hospital mortality, extended hospital stays, and increased adverse in-hospital outcomes in patients undergoing conventional pacemaker implantation.
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Affiliation(s)
- Phuuwadith Wattanachayakul
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Panat Yanpiset
- Faculty of Medicine Chiang Mai UniversityChiang MaiThailand
| | | | | | - Pojsakorn Danpanichkul
- Immunology Unit, Department of Microbiology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | | | | | | | - Bruce A. Casipit
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
| | - Kanokphong Suparan
- Immunology Unit, Department of Microbiology, Faculty of MedicineChiang Mai UniversityChiang MaiThailand
| | - Aman Amanullah
- Sidney Kimmel Medical CollegeThomas Jefferson UniversityPhiladelphiaPennsylvaniaUSA
- Division of Cardiovascular DiseaseJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
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Trébol J, Carabias-Orgaz A, Esteban-Velasco MC, García-Plaza A, González-Muñoz JI, Sánchez-Casado AB, Parreño-Manchado FC, Eguía-Larrea M, Alcázar-Montero JA. Digestive and breast cancer patients managed during the first wave of COVID-19 pandemic: Short and middle term outcomes. World J Methodol 2024; 14:92612. [PMID: 38983654 PMCID: PMC11229877 DOI: 10.5662/wjm.v14.i2.92612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/29/2024] [Accepted: 05/23/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The first wave of coronavirus disease 2019 (COVID-19) pandemic in Spain lasted from middle March to the end of June 2020. Spanish population was subjected to lockdown periods and scheduled surgeries were discontinued or reduced during variable periods. In our centre, we managed patients previously and newly diagnosed with cancer. We established a strategy based on limiting perioperative social contacts, preoperative screening (symptoms and reverse transcription-polymerase chain reaction) and creating separated in-hospital COVID-19-free pathways for non-infected patients. We also adopted some practice modifications (surgery in different facilities, changes in staff and guidelines, using continuously changing personal protective equipment…), that supposed new inconveniences. AIM To analyse cancer patients with a decision for surgery managed during the first wave, focalizing on outcomes and pandemic-related modifications. METHODS We prospectively included adults with a confirmed diagnosis of colorectal, oesophago-gastric, liver-pancreatic or breast cancer with a decision for surgery, regardless of whether they ultimately underwent surgery. We analysed short-term outcomes [30-d postoperative morbimortality and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection] and outcomes after 3 years (adjuvant therapies, oncological events, death, SARS-CoV-2 infection and vaccination). We also investigated modifications to usual practice. RESULTS From 96 included patients, seven didn't receive treatment that period and four never (3 due to COVID-19). Operated patients: 28 colon and 21 rectal cancers; laparoscopy 53.6%/90.0%, mortality 3.57%/0%, major complications 7.04%/25.00%, anastomotic leaks 0%/5.00%, 3-years disease-free survival (DFS) 82.14%/52.4% and overall survival (OS) 78.57%/76.2%. Six liver metastases and six pancreatic cancers: no mortality, one major complication, three grade A/B liver failures, one bile leak; 3-year DFS 0%/33.3% and OS 50.0%/33.3% (liver metastases/pancreatic carcinoma). 5 gastric and 2 oesophageal tumours: mortality 0%/50%, major complications 0%/100%, anastomotic leaks 0%/100%, 3-year DFS and OS 66.67% (gastric carcinoma) and 0% (oesophagus). Twenty breast cancer without deaths/major complications; 3-year OS 100% and DFS 85%. Nobody contracted SARS-CoV-2 postoperatively. COVID-19 pandemic-related changes: 78.2% treated in alternative buildings, 43.8% waited more than 4 weeks, two additional colostomies and fewer laparoscopies. CONCLUSION Some patients lost curative-intent surgery due to COVID-19 pandemic. Despite practice modifications and 43.8% delays higher than 4 weeks, surgery was resumed with minimal changes without impacting outcomes. Clean pathways are essential to continue surgery safely.
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Affiliation(s)
- Jacobo Trébol
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Ana Carabias-Orgaz
- Oftalmología, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
| | - María Carmen Esteban-Velasco
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Asunción García-Plaza
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Juan Ignacio González-Muñoz
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Ana Belén Sánchez-Casado
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Felipe Carlos Parreño-Manchado
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
| | - Marta Eguía-Larrea
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
| | - José Antonio Alcázar-Montero
- Cirugía General y del Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, Salamanca 37007, Salamanca, Spain
- Cirugía, Universidad de Salamanca, Salamanca 37007, Salamanca, Spain
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Yánez Benítez C, Ottolino Lavarte P, Richard L, Ivatury R, Ferrada R, Borráez O, Turegano F, Puyana JC, Aranda J, Pareja F, Peralta R, Rodríguez A. Innovation in surgical trauma care education: assessment of a Panamerican Trauma Society online surgical skills course hosted by the Spanish Surgical Association. Eur J Trauma Emerg Surg 2024; 50:1101-1110. [PMID: 38216674 DOI: 10.1007/s00068-023-02431-5] [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: 09/14/2023] [Accepted: 12/28/2023] [Indexed: 01/14/2024]
Abstract
PURPOSE Incorporating surgical skills education in trauma care is essential for young surgeons and surgical trainees. This study describes an innovative e-learning course for teaching trauma care surgical skills in an international cooperative setting. Furthermore, it aims to offer valuable insights on enhancing e-learning practices. METHODS The Panamerican Trauma Society and the Spanish Surgical Association have joined forces to launch an online course focusing on advanced trauma care surgical skills. This report provides an in-depth examination of the project and scrutinizes participant feedback through a post-course survey. The survey thoroughly evaluates their satisfaction level, the usefulness of the course content, and their view on its clinical relevance. RESULTS Three hundred eighty-two surgeons from 16 countries completed an online course. Three hundred seventy-nine of them responded to the post-course survey. The mean age was 36, with 64% females and 36% males. The course consisted of 9.9 h of academic content, including 5 h of video lectures and 4.9 h of live discussions. Ninety-seven percent of the participants were practicing general and acute care surgeons, and only 2% were exclusively dedicated to trauma surgery. Sixty-one percent of participants highly valued real-time interaction with faculty, and 95% believed their trauma surgical skills would improve. Additionally, 93% of the participants were satisfied or very satisfied with the e-learning experience. CONCLUSIONS The use of video-based instructional materials has revolutionized surgical education. With online courses in trauma surgery, surgeons can now improve their skills and better prepare themselves to handle severe trauma cases. This innovative approach to surgical education has proven to be very effective and can potentially enhance patients' quality of care.
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Affiliation(s)
- Carlos Yánez Benítez
- Department of General Surgery, San Jorge University Hospital, SALUD, Ave. Martínez de Velasco, 36, 22004, Huesca, Spain.
| | | | - Luis Richard
- Faculty of Medicine, Department of General Surgery, Universidad Autónoma de Centro, Domingo Luciani Hospital, Caracas, Venezuela
| | - Rao Ivatury
- School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Division of Trauma, Critical Care and Emergency General Surgery, Virginia Commonwealth University Medical Center, Richmond, VA, USA
| | | | - Oswaldo Borráez
- Department of General Surgery, San Blas Hospital, Bogotá, Colombia
| | - Fernando Turegano
- Department of General Surgery, Emergency Surgery Section, Gregorio Marañón Hospital, Madrid, Spain
| | | | - José Aranda
- Department of General Surgery, Emergency Surgery Section, Carlos Haya University Hospital, Málaga, Spain
| | - Felipe Pareja
- Department of General Surgery, Emergency Surgery Section, Virgen del Rocio University Hospital, Seville, Spain
| | - Rubén Peralta
- Department of Surgery, Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Aurelio Rodríguez
- University of Maryland, College Park, USA
- Drexel University College of Medicine, Philadelphia, USA
- R Adams Cowley Shock Trauma Center, Baltimore, USA
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Diress FT, Fentie DY, Endalew NS, Admass BA. Surgical team member's application of personal protective equipment: an observational study. Ann Med Surg (Lond) 2024; 86:1341-1345. [PMID: 38463072 PMCID: PMC10923328 DOI: 10.1097/ms9.0000000000001765] [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] [Received: 11/12/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Background Personal protective equipment (PPE) is a term used to refer to clothing or equipment that creates a barrier to protect an individual from work-place hazards, thereby protecting the worker against work-related injuries and illnesses. This study was aimed at determining the compliance of application of personal protective equipment against the standards. Methods One hundred surgical personnel were included in this study from 21 March 2023 to 23 April 2023. Data were collected through direct observation. The standards were directly changed into question forms with two integral checking components, "Yes", and "No". Data were entered and analyzed by statistical package of social sciences (SPSS) version 25. Result A total of 100 surgical personnel involved in surgical procedures were assessed for how they applied PPE. Majority of healthcare workers, 61.2%, were compliant with the communicable disease control standard on the application of PPE. The highest compliance rate was observed for the put-on gloves over the gown, while the lowest compliance rate was observed for wearing eye protection. Conclusion and recommendation The practice of PPE usage by surgical personnel was suboptimal. Healthcare facilities can better protect their staff and patients from the spread of infections and other hazards through PPE use protocols. Donning and doffing must always be methodical and supervised by another staff member, especially during surgical emergencies. PPE should be used in accordance with infection prevention and control guidelines and the level of risk involved in the specific procedure.
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Affiliation(s)
- Fikadu Tadesse Diress
- Department of Anesthesia, College of Medicine & Health Sciences, Bahir Dar University, Bahir Dar
| | - Demeke Yilkal Fentie
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Nigussie Simeneh Endalew
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Biruk Adie Admass
- Department of Anesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Jahangiri H, Zamanian Z, Daneshmandi H, Seif M, Jamshidi H. Investigating the short-term effects of using full-body hospital personal protective equipment and changes in physical workload intensity on human physiological and cognitive performance. ERGONOMICS 2023; 66:1295-1309. [PMID: 36343173 DOI: 10.1080/00140139.2022.2145375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/01/2022] [Indexed: 06/16/2023]
Abstract
The present study investigated the short-term effects of using Personal Protective Equipment (PPE) and physical workload intensity on human physiological and cognitive performance among 21 males and 19 females. PPE1 consisted of a medical coverall and surgical mask, while PPE2 consisted of impermeable full-body coverall, shoe covers, latex gloves, N95 mask, and face shield. Objective assessments were heart rate, energy expenditure, core body temperature, clothing microclimate temperature and humidity, and cognitive performance were the continuous performance test and N-Back test. Subjective assessments included thermal sensation, perceived fatigue/skin wetness/clothing moisture. Using PPE2 and increased workload intensity significantly increased the values of all physiological parameters and the subjective ratings of fatigue, thermal sensation, skin wetness, and clothing moisture. Moreover, the participants' cognitive performance was not affected by the type of PPE.Practitioner summary: Healthcare workers are at the highest risk in the fight against pandemics. Therefore, these people are required to use personal protective equipment. Using this equipment may have difficulties. The results show physiological strain and higher subjective ratings associated with using full-body hospital PPE and increased physical workload.
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Affiliation(s)
- Hamid Jahangiri
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Zamanian
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hadi Daneshmandi
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mozhgan Seif
- Non-Communicable Diseases Research Center, Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamid Jamshidi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
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Kumar P, Jain M, Amirthavaali G, Mishra TS, Sasmal PK, Lubaib K, Gond PK, Sarthak S. Impact of personal protective equipment on patient safety and health care workers. Med J Armed Forces India 2023; 79:531-538. [PMID: 37719904 PMCID: PMC10499652 DOI: 10.1016/j.mjafi.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 07/03/2021] [Indexed: 02/06/2023] Open
Abstract
Background The study aims to assess the effect of personal protective equipment (PPE) on the physical and psychological well-being of health care workers (HCWs) and its impact on patient safety. Methods After ethical approval, a 14-point questionnaire was circulated offline and online among the HCWs of ours institute, who were involved in performing invasive procedures while wearing a PPE. The responses were analysed using the SPSS software version 26. Results Of 198 responses, the mean duration of PPE use was 4.6 ± 1.52 h. Seventy percent of respondents suggested <4 h of continuous use of PPE. Seventy-seven percent found difficulties during the procedures while wearing PPE and agreed to errors while performing a procedure. Poor visibility (95.5%), fogging (84.9%), communication difficulty (75.3%), sweating (74.2%), posture-related discomfort (56.1%) and poor concentration (51%) were major causes. Anxiety (39.9%) and fear of spreading an infection to the family (42.9%) were major psychological effects. Eighty percent of HCWs raised concern over the quality of PPE, N95 mask and eye protector. The HCWs felt the need to improve the quality of PPEs, use extra padding around the ears, sealing the N95 mask with adhesive tape, besides using sign language for communication for more safety. Fifty percent graded the procedure-related difficulty level >6 on a Likert scale of 1-10. Conclusion PPE-related discomfort is common among the HCWs and could contribute to errors during an invasive procedure. Efforts to alleviate the physical and psychological well-being of the HCWs will be essential for reducing procedural error while wearing a PPE.
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Affiliation(s)
- Pankaj Kumar
- Associate Professor (General Surgery), AIIMS, Bhubaneswar, India
| | - Mantu Jain
- Associate Professor (Orthopedic Surgery), AIIMS, Bhubaneswar, India
| | | | | | | | - K.P. Lubaib
- Resident (Orthopedic Surgery), AIIMS, Bhubaneswar, India
| | - Preeti K. Gond
- Resident (Orthopedic Surgery), AIIMS, Bhubaneswar, India
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Zinn F, Mittelstädt JM. Effects of face masks on fairness in on-site personnel selection during a pandemic. Front Psychol 2023; 14:1168311. [PMID: 37720631 PMCID: PMC10500303 DOI: 10.3389/fpsyg.2023.1168311] [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: 02/17/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
Introduction Despite significant challenges, personnel selection procedures had to continue as on-site testing in the Covid-19 pandemic. Health and safety measures and specifically the use of face masks threaten to limit the fairness of cognitive testing and behavioral observation in the assessment center. Methods In this study, we compare the performance and pass rates of pilot selection under three different conditions in the selection campaigns of 2019 (pre-pandemic), 2020 (health and safety measures without mask), and 2021 (health and safety measures with mask). Results Mask wearing and other health and safety measures had no influence on the objective parameters of pilot selection. However, for some of the areas of competence in the assessment center subjective observability was rated lower for the condition with face masks. Discussion We conclude that the fairness and precision of selection processes are not compromised by wearing face masks and that a high degree of standardization in diagnostic instruments prevents a partially reduced subjective observability from affecting the selection's outcome.
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Bento A, Ferreira L, Yánez Benitez C, Koleda P, Fraga GP, Kozera P, Baptista S, Mesquita C, Alexandrino H. Worldwide snapshot of trauma team structure and training: an international survey. Eur J Trauma Emerg Surg 2023; 49:1771-1781. [PMID: 36414695 DOI: 10.1007/s00068-022-02166-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Trauma teams (TTs) are a key tool in trauma care, as they bring a multidisciplinary approach to the trauma patient, improving outcomes. Excellent teamwork (TW) requires not only individual skills but also training at non-technical skills (NTS). Although there is evidence supporting TTs, there is little information regarding how they are organized and trained. With this study, we intend to assess the reality of TTs all over the world, focusing on how they are organized and trained. MATERIALS AND METHODS We composed a 42-question sheet on Google Forms, in four different languages (English, Polish, Portuguese, and Spanish). The questions regarded the respondents' background, and their respective hospitals' trauma patient management, TT features and its training, NTS and TW. The survey was shared on social media, through the International Assessment Group of Online Surgical & Trauma Education community, and the European Society of Trauma and Emergency Surgery. Statistical analysis was performed on Statistical Package for the Social Sciences (SPSS®) version 27. RESULTS We obtained 296 answers from 52 different countries, with 6 having at least 10 answers (Brazil, Portugal, Poland, Spain, Italy, and USA). While the majority of the respondents (97%) agreed that TTs can improve outcomes, only 61% have a TT in their hospital, with 69% of these being dedicated TTs. General surgery (76%), trauma surgery (68%), and anesthesia (66%) were the three most common specialties in the teams. Teams performed briefings and debriefings with a frequency of, at least, "often" in only 49% and 38%, respectively. Only 50% and 33% of the respondents stated that their hospital provided trauma management courses focusing on individual technical skills, and TT training courses, respectively. The Advanced Trauma Life Support (85%), the Definitive Surgical and Anesthetic Trauma Care (38%), and the European Trauma Course (31%) were the three trauma management courses of choice. Regarding TT training courses, the European Trauma Course (52%) and local/in-house (42%) courses were the most common ones. Most participants (93%) stated that NTS were highly important in trauma care. However, only 60% of the respondents had postgraduate training on NTS and TW, and only 24% had this type of training on an undergraduate level. CONCLUSION The number of TTs worldwide does not match their relevance in trauma care. Institutions are not providing enough trauma courses, particularly TT training courses and NTS teaching. Implementing TT should include promotion of team courses, as well as team briefings and debriefings.
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Affiliation(s)
- André Bento
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Luís Ferreira
- Department of General Surgery, Hospital Central do Funchal, SESARAM, Funchal, Portugal
| | - Carlos Yánez Benitez
- General and Gastrointestinal Surgery, Royo Villanova Hospital, SALUD, Zaragoza, Spain
| | - Piotr Koleda
- Department of Medical Simulation, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences (SMS), University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Piotr Kozera
- Faculty of Medicine, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
| | - Sérgio Baptista
- Department of Anesthesiology, Centro Hospitalar do Médio Tejo, EPE, Tomar, Portugal
| | - Carlos Mesquita
- Head of Clinic (Consultancy in General and Emergency Surgery and Trauma), Private Practice Coimbra, Coimbra, Portugal
| | - Henrique Alexandrino
- Department of General Surgery, Faculty of Medicine, Coimbra University Hospital Center, University of Coimbra, Praceta Mota Pinto, 3000-045, Coimbra, Portugal
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Jonik S, Boszko M, Sztemberg E, Łepecki D, Grodziński B, Mikusek-Pham Van M, Marchel M, Kochman J, Kuśmierczyk M, Opolski G, Grabowski M, Mazurek T. Heart team consultations for patients with severe coronary artery disease or valvular heart disease in the era of the COVID-19 pandemic: a single-center experience. Front Cardiovasc Med 2023; 10:1203535. [PMID: 37539089 PMCID: PMC10395077 DOI: 10.3389/fcvm.2023.1203535] [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: 04/10/2023] [Accepted: 07/04/2023] [Indexed: 08/05/2023] Open
Abstract
Introduction The Heart Team (HT) as a group of experienced specialists is responsible for optimal decision-making for high-risk cardiac patients. The aim of this study was to investigate the impact of the COVID-19 pandemic on HT functioning. Methods In this retrospective, single-center study, we evaluated the cooperation of HT in terms of the frequency of meetings, the number of consulted patients, and the trends in choosing the optimal treatment strategies for complex individuals with severe coronary artery disease (CAD) or valvular heart disease (VHD) before and during the COVID-19 pandemic in Poland. Results From 2016 to May 2022, 301 HT meetings were held, and a total of 4,183 patients with severe CAD (2,060 patients) or severe VHD (2,123 patients) were presented. A significant decrease in the number of HT meetings and consulted patients (2019: 49 and 823 vs. 2020: 44 and 542 and 2021: 45 and 611, respectively, P < 0.001) as well as changes in treatment strategies-increase of conservative, reduction of invasive (2019: 16.7 and 51.9 patients/month vs. 2020: 20.4 and 24.8 patients/month and 2021:19.3 and 31.6 patients/month, respectively, P < 0.001)-were demonstrated with the spread of the COVID-19 pandemic. As the pandemic slowly receded, the observed changes began to return to the pre-pandemic trends. Conclusions The COVID-19 pandemic resulted in a decrease in the number of HT meetings and consulted patients and significant reduction of invasive procedures in favor of conservative management. Further studies should be aimed to evaluate the long-term implications of this phenomenon.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maria Boszko
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Elena Sztemberg
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dominik Łepecki
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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Lukowski J, Vasa A, Arguinchona C, ElRayes W, Frank MG, Galdys AL, Garcia MC, Garland JA, Kline S, Persson C, Ruby D, Sauer LM, Vasistha S, Carrasco S, Herstein JJ. A narrative review of high-level isolation unit operational and infrastructure features. BMJ Glob Health 2023; 8:e012037. [PMID: 37423621 DOI: 10.1136/bmjgh-2023-012037] [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: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 07/11/2023] Open
Abstract
High-level isolation units (HLIUs) are specially designed facilities for care and management of patients with suspected or confirmed high-consequence infectious diseases (HCIDs), equipped with unique infrastructure and operational features. While individual HLIUs have published on their experiences caring for patients with HCIDs and two previous HLIU consensus efforts have outlined key components of HLIUs, we aimed to summarise the existing literature that describes best practices, challenges and core features of these specialised facilities. A narrative review of the literature was conducted using keywords associated with HLIUs and HCIDs. A total of 100 articles were used throughout the manuscript from the literature search or from alternate methods like reference checks or snowballing. Articles were sorted into categories (eg, physical infrastructure, laboratory, internal transport); for each category, a synthesis of the relevant literature was conducted to describe best practices, experiences and operational features. The review and summary of HLIU experiences, best practices, challenges and components can serve as a resource for units continuing to improve readiness, or for hospitals in early stages of developing their HLIU teams and planning or constructing their units. The COVID-19 pandemic, a global outbreak of mpox, sporadic cases of viral haemorrhagic fevers in Europe and the USA, and recent outbreaks of Lassa fever, Sudan Ebolavirus, and Marburg emphasise the need for an extensive summary of HLIU practices to inform readiness and response.
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Affiliation(s)
- Joseph Lukowski
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | | | - Christa Arguinchona
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Wael ElRayes
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Maria G Frank
- School of Medicine, University of Colorado, Denver, Colorado, USA
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Alison L Galdys
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Mary C Garcia
- Department of Laboratory Services, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Jennifer A Garland
- Department of Hospital Epidemiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Susan Kline
- Division of Infectious Disease and International Medicine - Department of Medicine, University of Minnesota Medical School Twin Cities Campus, Minneapolis, Minnesota, USA
| | - Caroline Persson
- Biocontainment Unit, Denver Health and Hospital Authority, Denver, Colorado, USA
| | - Darrell Ruby
- Special Pathogens Program, Providence Sacred Heart Medical Center, Spokane, Washington, USA
| | - Lauren M Sauer
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sami Vasistha
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Sharon Carrasco
- Serious Communicable Disease Program, Emory University, Atlanta, Georgia, USA
| | - Jocelyn J Herstein
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
- Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA
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11
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Haward R, G R, Kalyan M. The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India. Cureus 2023; 15:e41910. [PMID: 37583728 PMCID: PMC10425167 DOI: 10.7759/cureus.41910] [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] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Context The proper usage of personal protective equipment (PPE) must be prioritised for health care workers (HCWs), where shortages and prolonged use of personal protective equipment can threaten safety in essential health services. Aims To evaluate the effect of personal protective equipment on the health and well-being of HCWs, physicians, nurses, and technicians on duty for COVID-19 rotational postings. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was conducted at a tertiary care centre in South India to assess the utilisation of personal protective equipment (PPE) during the second wave of COVID-19. A physical questionnaire was distributed to a total of 266 healthcare workers, aged 20 to 50, who had worked for a minimum of three consecutive days between May and August 2021. The objective of the study was to evaluate the effectiveness of PPE use among healthcare workers during the second wave of the COVID-19 pandemic. Statistical analysis The data analysis in this study was conducted using IBM Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp., Armonk, New York). The mean and standard deviation, or median, were used to present continuous variables, while frequency and percentage were used to present categorical variables. Furthermore, the minimum sample size required for this study was calculated to be 246 participants. Results The survey included 266 healthcare workers. The mean+/-SD of age was 28.18+/-5.64 and consisted of females (54.51%) and males (45.48%). The postings were in emergency (13.15%), intensive care unit (30.82%), and ward (56.01%), respectively. The HCWs who used PPE for four to seven days reported more symptoms than those who used it for one to three days. Discomforts experienced while wearing PPE were chest suffocation (49.62%), difficulty in performing intubation (36.09%), difficulty in seeing clearly (68.79%), dizziness (49.62%), excessive sweating (75.56%), micturition desire (52.63%), nausea (42.48%), retro-auricular pain (56.76%), stomach burns (27.44%), and thirst or dry throat (78.57%). The symptoms suffered after doffing were tiredness (69.17%), dry mouth (67.29%), dizziness (43.60%), headache (55.63%), chest suffocation (36.46%), dry skin (57.14%), reduced ability to concentrate (48.12%), dark-coloured urine (55.63%), reduced alertness (42.48%), and stomach burns (28.94%). The first thoughts after doffing were to drink water (68.42%), eat something (36.09%), clean yourself (61.27%), urinate (33.08%), and have some rest (29.32%), respectively. 81 (30.45%). The HCWs suffered skin injuries while wearing gloves. The time for restoring after a shift was 12 hours (37.59%), 24 hours (34.21%), 36 hours (11.65%), and 48 hours (16.59%). Pressure sores were reported on the forehead by 53 (19.92%) participants, the nose by 54 (20.30%), the cheek by 31 (11.65%), and behind the ear by 77 (65.71%) participants. The optimal size of PPE was experienced only by 76 (28.57%) participants, while 73 (27.44%) of them felt tight and 117 (43.98%) felt loose. Conclusions To minimise discomfort while managing infectious diseases, HCWs can adopt several practices like taking regular breaks, ensuring humane working hours, utilising high-quality PPE, and wearing properly fitting gear. By implementing these measures, HCWs can enhance their ability to handle infectious diseases effectively while prioritising their comfort and well-being.
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Affiliation(s)
- Raymond Haward
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Ridhima G
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Meenakshi Kalyan
- Internal Medicine, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
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12
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Luton OW, Stacey BS, Mellor K, James OP, Williams IM, Warren N, Egan RJ, Bailey DM, Lewis WG. Personal protective equipment-induced systemic hypercapnic hypoxaemia: translational implications for impaired cognitive-clinical functional performance. Br J Surg 2023; 110:606-613. [PMID: 36930564 DOI: 10.1093/bjs/znad067] [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: 03/12/2022] [Revised: 11/23/2022] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Personal protective equipment (PPE) adversely affects pulmonary gas exchange and may result in systemic hypercapnic hypoxaemia and headache. This study aimed to determine what extent PPE affects cerebral symptoms, global cerebral blood flow, and cognitive functional performance. METHODS Higher surgical trainees participated in a randomized, repeated-measures, crossover study, completing 60 min of laparoscopic surgical simulation in both standard operating attire and type 3 PPE. Measurements were collected at baseline and after 60 min of simulation. The primary outcome measure was headache. Headache was examined using the validated visual analogue scale (VAS) and Environmental Symptoms Questionnaire C (ESQ-C), global cerebral blood flow with duplex ultrasonography, and visuospatial and executive gross/fine motor function with grooved peg board (GPB) and laparoscopic bead (LSB) board tasks. RESULTS Thirty-one higher surgical trainees (20 men, 11 women) completed the study. Compared with standard operating attire, PPE increased headache assessment scores (mean(s.d.) VAS score 3.5(5.6) versus 13.0(3.7), P < 0.001; ESQ-C score 1.3(2.0) versus 5.9(5.1), P < 0.001) and was associated with poorer completion times for GPB-D (61.4(12.0) versus 71.1(12.4) s; P = 0.034) and LSB (192.5(66.9) versus 270.7(135.3) s; P = 0.025) tasks. Wearing PPE increased heart rate (82.5(13.6) versus 93.5(13.0) beats/min; P = 0.022) and skin temperature (36.6(0.4) versus 37.1(0.5)°C; P < 0.001), but decreased peripheral oxygen saturation (97.9(0.8) versus 96.8(1.0) per cent; P < 0.001). Female higher surgical trainees exhibited higher peripheral oxygen saturation across all conditions. No differences were observed in global cerebral blood flow as a function of attire, time or sex. CONCLUSION Despite no marked changes in global cerebral blood flow, type 3 PPE was associated with increased headache scores and cerebral symptoms (VAS and ESQ-C) alongside impaired executive motor function highlighting the clinical implications of PPE-induced impairment for cognitive-clinical performance.
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Affiliation(s)
- Oliver W Luton
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - Benjamin S Stacey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Treforest, UK
| | - Katie Mellor
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - Osian P James
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
| | - Ian M Williams
- Department of Surgery, University Hospital of Wales, Cardiff, UK
| | - Neil Warren
- Wales Institute of Minimal Access Therapy, Cardiff University, Cardiff, UK
| | - Richard J Egan
- Department of Surgery, Morriston Hospital, Swansea, UK
- School of Medicine, Swansea University, Swansea, UK
| | - Damian M Bailey
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, Treforest, UK
| | - Wyn G Lewis
- Health Education and Improvement Wales' School of Surgery, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Cardiff, UK
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13
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Nilasaroya A, Kop AM, Collier RC, Kennedy B, Kelsey LJ, Pollard F, Ha JF, Morrison DA. Establishing local manufacture of PPE for healthcare workers in the time of a global pandemic. Heliyon 2023; 9:e13349. [PMID: 36816240 PMCID: PMC9922675 DOI: 10.1016/j.heliyon.2023.e13349] [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] [Received: 03/20/2022] [Revised: 01/10/2023] [Accepted: 01/25/2023] [Indexed: 02/16/2023] Open
Abstract
A face shield is a secondary personal protective equipment (PPE) for healthcare workers (HCW). Worn with the appropriate face masks/respirators, it provides short term barrier protection against potentially infectious droplet particles. Coronavirus disease 2019 (COVID-19) caused a spike in demand for PPE, leading to a shortage and risking the safety of HCW. Transport restrictions further challenged the existing PPE supply chain which has been reliant on overseas-based manufacturers. Despite the urgency in demand, PPE must be properly tested for functionality and quality. We describe the establishment of local face shields manufacture in Western Australia to ensure adequate PPE for HCW. Ten thousand face shields for general use (standard) and for ear, nose and throat (ENT) specialist use were produced. Materials and design considerations are described, and the face shields were vigorously tested to the relevant Standards to ensure their effectiveness as a protective barrier, including splash and impact resistance. Comparative testing with traditional and other novel face shields was also undertaken. Therapeutic Goods Administration (TGA) licence was obtained to manufacture and supply the face shields as a Class I medical device. The swiftness of process is a credit to collaboration from industry, academia and healthcare.
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Affiliation(s)
- Anastasia Nilasaroya
- Centre for Implant Technology and Retrievals Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, 6000, Australia
| | - Alan Matthew Kop
- Centre for Implant Technology and Retrievals Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, 6000, Australia
| | - Ryan Christopher Collier
- Centre for Implant Technology and Retrievals Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, 6000, Australia
| | - Brendan Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands, Western Australia, 6009, Australia and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, 6009, Australia,Department of Electrical, Electronic & Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia,Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
| | - Lachlan James Kelsey
- Vascular Engineering Laboratory, Harry Perkins Institute of Medical Research, QEII Medical Centre, Nedlands and Centre for Medical Research, The University of Western Australia, Crawley, Western Australia, 6009, Australia,Department of Mechanical Engineering, School of Engineering, The University of Western Australia, 35 Stirling Highway, Perth, Western Australia, 6009, Australia
| | - Faz Pollard
- Adarsh Australia, 6 Crocker Drive, Malaga, Western Australia, 6090, Australia
| | - Jennifer Fong Ha
- Department of Paediatrics Otolaryngology Head & Neck Surgery, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, Western Australia, 6009, Australia,Murdoch ENT, Wexford Medical Centre, Suite 17-18, Level 1, 3 Barry Marshall Parade, Murdoch, Western Australia, 6150, Australia,Department of Surgery, The University of Western Australia, Stirling Highway, Nedlands, Western Australia, 6009, Australia
| | - David Anthony Morrison
- Centre for Implant Technology and Retrievals Analysis (CITRA), Department of Medical Engineering and Physics, Royal Perth Hospital, Perth, Western Australia, 6000, Australia,Corresponding author.
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14
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Chau A, Hofmeyr R. Hypothesis-generating procedures and unmasking novel associations in large observational studies: are we doing harm while doing good? Anaesthesia 2023; 78:9-13. [PMID: 36178605 DOI: 10.1111/anae.15877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 12/13/2022]
Affiliation(s)
- A Chau
- Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.,Department of Anesthesia, BC Women's Hospital, Vancouver, BC, Canada.,Department of Anesthesia, St. Paul's Hospital, Vancouver, BC, Canada
| | - R Hofmeyr
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital, Cape Town, South Africa.,Department of Anaesthesia and Peri-operative Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
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15
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Hunt A, Ting J, Schweitzer D, Laakso E, Stewart I. Personal protective equipment for COVID-19 among healthcare workers in an emergency department: An exploratory survey of workload, thermal discomfort and symptoms of heat strain. Emerg Med Australas 2022; 35:483-488. [PMID: 36478390 PMCID: PMC9877975 DOI: 10.1111/1742-6723.14152] [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: 07/13/2022] [Revised: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To examine workload, thermal discomfort and heat-related symptoms among healthcare workers (HCWs) in an Australian ED during the COVID-19 pandemic. METHODS A cross-sectional study design was employed among HCWs in an ED at a metropolitan hospital in Brisbane, Australia. Respondents provided demographic information including their self-reported age, sex, height, weight, role (e.g. doctor, nurse), and whether they wore personal protective equipment (PPE) during their shift, rated as either Full PPE, Partial PPE, or usual uniform or scrubs. The workload of HCWs was assessed with the National Aeronautics and Space Administration's task load index (NASA-TLX). Thermal discomfort was evaluated using scales from the International Organisation for Standardisation. Responders rated their subjective heat illness using the Environmental Symptoms Questionnaire. RESULTS Fifty-nine HCWs completed the survey (27 male, 31 female, one prefer not to answer). Overall workload from the NASA-TLX was 64.6 (interquartile range [IQR] 56.5-73.3) for doctors, 72.5 (IQR 63.3-83.3) for nurses and 66.7 (IQR 58.3-74.17) for other staff, representing moderate to high ratings. Eighty-one percent reported thermal sensation to be slightly warm, warm, or hot, and 88% reported being uncomfortable, ranging from slightly to extremely. Ninety-seven percent reported at least one heat-strain symptom. More than 50% reported light-headedness or headache and approximately 30% reported feeling dizzy, faint, or weak. CONCLUSIONS ED HCWs experience thermal discomfort when wearing PPE. Combined with their workloads, HCWs experienced symptoms related to heat strain. Therefore, careful consideration should be given to managing heat strain among HCWs when wearing PPE in an ED.
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Affiliation(s)
- Andrew Hunt
- School of Biomedical Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - Joseph Ting
- School of Public Health and Social Work, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia,Department of Emergency MedicineMater HospitalBrisbaneQueenslandAustralia
| | - Daniel Schweitzer
- Centre for NeurosciencesMater HospitalBrisbaneQueenslandAustralia,Wesley HospitalBrisbaneQueenslandAustralia,School of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - E‐Liisa Laakso
- Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia,Menzies Health Institute QueenslandGriffith UniversityGold CoastQueenslandAustralia
| | - Ian Stewart
- School of Exercise and Nutrition Sciences, Faculty of HealthQueensland University of TechnologyBrisbaneQueenslandAustralia
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16
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Jin H, Xiao M, Gong Z, Zhao Y. Influence of Different Protection States on the Mental Fatigue of Nurses During the COVID-19 Pandemic. Healthc Policy 2022; 15:1917-1929. [PMID: 36268181 PMCID: PMC9578785 DOI: 10.2147/rmhp.s377936] [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] [Received: 06/09/2022] [Accepted: 10/01/2022] [Indexed: 11/05/2022] Open
Abstract
Background COVID-19 has brought greater workload pressures to the medical field, such as medical staff being required to wear personal protective equipment (PPE). While PPE can protect the safety of staff during the pandemic, it can also accelerate the accumulation of fatigue among operators. Objective This study explores the influence of different protection states on the mental fatigue of nurses. Methods In this study, 10 participants (5 males and 5 females) were randomly selected among applicants to monitor mental fatigue during the nurses’ daily work in four different PPE states (low temperature and low protection; low temperature and high protection; high temperature and low protection; high temperature and high protection). The NASA subjective mental fatigue scale was used for subjective evaluation. Reaction time, attention concentration, attention distribution, memory, and main task completion time were used for objective evaluation. Results The results demonstrated a significant difference in the effects of different protection states on mental fatigue. The state of high temperature and high protection had the greatest influence on mental fatigue, the state of low temperature and low protection had the least, and states of high (low) temperature and low (high) protection had intermediate effects on mental fatigue. Furthermore, the correlation between the subjective and objective fatigue indices was analyzed using a multiple regression model. Conclusion This study clarified the influence of different protection states on the mental fatigue of nurses, and verified that nurses require more time and energy to complete the same work as before under high protection states. It provides a basis for evaluating the mental fatigue of nurses in the unique period of the COVID-19 pandemic and specific ideas for optimizing the nursing process.
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Affiliation(s)
- Haizhe Jin
- Department of Industrial Engineering, School of Business Administration, Northeastern University, Shenyang, People’s Republic of China
| | - Meng Xiao
- School of Business Administration, Northeastern University, Shenyang, People’s Republic of China
| | - Zibo Gong
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, People’s Republic of China,Correspondence: Zibo Gong, Department of Radiology, Shengjing Hospital of China Medical University, No. 36, Sanhao Street, Heping District, Shenyang, People’s Republic of China, Email
| | - Yinan Zhao
- Department of Neurology, The First Hospital of China Medical University, Shenyang, People’s Republic of China,Yinan Zhao, Department of Neurology, The First Hospital of China Medical University, Shenyang, People’s Republic of China, Email
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17
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Kaushik J, Riyaz E, Chaitanya YVK, Nair R, Kumar A, Singh A, Parihar JKS, Srikant S, Shetty R. An insight into the altered ophthalmic dynamics during the COVID-19 pandemic. Indian J Ophthalmol 2022; 70:3643-3648. [PMID: 36190064 PMCID: PMC9789823 DOI: 10.4103/ijo.ijo_254_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose The objective of this survey-based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology. Methods The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question. Results A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic-appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor. Conclusion The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department-based and surgical procedures in ophthalmology.
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Affiliation(s)
- Jaya Kaushik
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India,Correspondence to: Dr. Jaya Kaushik, Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra - 411 040, India. E-mail:
| | - Eram Riyaz
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - YVK Chaitanya
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - Renu Nair
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ashok Kumar
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - Ankita Singh
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - JKS Parihar
- Department of Ophthalmology and Post Graduate Training and Education, Centre for Sight, New Delhi, India
| | - S Srikant
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
| | - Rakesh Shetty
- Department of Ophthalmology, Golden Jublee Block, Armed Forces Medical College, Pune, Maharashtra, India
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18
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Sadeghian P, Bi Y, Cao G, Sadrizadeh S. Reducing the risk of viral contamination during the coronavirus pandemic by using a protective curtain in the operating room. Patient Saf Surg 2022; 16:26. [PMID: 35933393 PMCID: PMC9356414 DOI: 10.1186/s13037-022-00332-x] [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] [Received: 03/25/2022] [Accepted: 06/22/2022] [Indexed: 11/15/2022] Open
Abstract
Background Airborne transmission diseases can transfer long and short distances via sneezing, coughing, and breathing. These airborne repertory particles can convert to aerosol particles and travel with airflow. During the Coronavirus disease 2019 (COVID-19) pandemic, many surgeries have been delayed, increasing the demand for establishing a clean environment for both patient and surgical team in the operating room. Methods This study aims to investigate the hypothesis of implementing a protective curtain to reduce the transmission of infectious contamination in the surgical microenvironment of an operating room. In this regard, the spread of an airborne transmission disease from the patient was evaluated, consequently, the exposure level of the surgical team. In the first part of this study, a mock surgical experiment was established in the operating room of an academic medical center in Norway. In the second part, the computational fluid dynamic technique was performed to investigate the spread of airborne infectious diseases. Furthermore, the field measurement was used to validate the numerical model and guarantee the accuracy of the applied numerical models. Results The results showed that the airborne infectious agents reached the breathing zone of the surgeons. However, using a protective curtain to separate the microenvironment between the head and lower body of the patient resulted in a 75% reduction in the spread of the virus to the breathing zone of the surgeons. The experimental results showed a surface temperature of 40 ˚C, which was about a 20 ˚C increase in temperature, at the wound area using a high intensity of the LED surgical lamps. Consequently, this temperature increase can raise the patient's thermal injury risk. Conclusion The novel method of using a protective curtain can increase the safety of the surgical team during the surgery with a COVID-19 patient in the operating room.
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Affiliation(s)
- Parastoo Sadeghian
- Department of Civil and Architectural Engineering, KTH Royal Institute of Technology, Brinellvägen 23, 10044, Stockholm, Sweden.
| | - Yang Bi
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guangyu Cao
- Department of Energy and Process Engineering, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sasan Sadrizadeh
- Department of Civil and Architectural Engineering, KTH Royal Institute of Technology, Brinellvägen 23, 10044, Stockholm, Sweden
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19
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Roche AD, McConnell AC, Donaldson K, Lawson A, Tan S, Toft K, Cairns G, Colle A, Coleman AA, Stewart K, Digard P, Norrie J, Stokes AA. Personalised 3D printed respirators for healthcare workers during the COVID-19 pandemic. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:963541. [PMID: 35982716 PMCID: PMC9380470 DOI: 10.3389/fmedt.2022.963541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/05/2022] [Indexed: 11/22/2022] Open
Abstract
Widespread issues in respirator availability and fit have been rendered acutely apparent by the COVID-19 pandemic. This study sought to determine whether personalized 3D printed respirators provide adequate filtration and function for healthcare workers through a Randomized Controlled Trial (RCT). Fifty healthcare workers recruited within NHS Lothian, Scotland, underwent 3D facial scanning or 3D photographic reconstruction to produce 3D printed personalized respirators. The primary outcome measure was quantitative fit-testing to FFP3 standard. Secondary measures included respirator comfort, wearing experience, and function instrument (R-COMFI) for tolerability, Modified Rhyme Test (MRT) for intelligibility, and viral decontamination on respirator material. Of the 50 participants, 44 passed the fit test with the customized respirator, not significantly different from the 38 with the control (p = 0.21). The customized respirator had significantly improved comfort over the control respirator in both simulated clinical conditions (p < 0.0001) and during longer wear (p < 0.0001). For speech intelligibility, both respirators performed equally. Standard NHS decontamination agents were able to eradicate 99.9% of viral infectivity from the 3D printed plastics tested. Personalized 3D printed respirators performed to the same level as control disposable FFP3 respirators, with clear communication and with increased comfort, wearing experience, and function. The materials used were easily decontaminated of viral infectivity and would be applicable for sustainable and reusable respirators.
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Affiliation(s)
- Aidan D. Roche
- Deanery of Clinical Sciences, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Alistair C. McConnell
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
| | - Karen Donaldson
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
- *Correspondence: Karen Donaldson
| | - Angus Lawson
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, United Kingdom
| | - Spring Tan
- Roslin Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Kate Toft
- Department of Speech and Language Therapy, St John's Hospital, Livingston, United Kingdom
| | - Gillian Cairns
- Department of Speech and Language Therapy, Royal Hospital for Sick Children, Edinburgh, United Kingdom
| | - Alexandre Colle
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
| | | | - Ken Stewart
- Deanery of Clinical Sciences, Queens Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Paul Digard
- Roslin Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - John Norrie
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, United Kingdom
| | - Adam A. Stokes
- School of Engineering, Institute for Integrated Micro and Nano Systems, The University of Edinburgh, Edinburgh, United Kingdom
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Shugaba A, Lambert JE, Bampouras TM, Nuttall HE, Gaffney CJ, Subar DA. Should All Minimal Access Surgery Be Robot-Assisted? A Systematic Review into the Musculoskeletal and Cognitive Demands of Laparoscopic and Robot-Assisted Laparoscopic Surgery. J Gastrointest Surg 2022; 26:1520-1530. [PMID: 35426034 PMCID: PMC9296389 DOI: 10.1007/s11605-022-05319-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/26/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgeons are among the most at risk of work-related musculoskeletal health decline because of the physical demands of surgery, which is also associated with cognitive fatigue. Minimally invasive surgery offers excellent benefits to patients but the impact of robotic or laparoscopic surgery on surgeon well-being is less well understood. This work examined the musculoskeletal and cognitive demands of robot-assisted versus standard laparoscopic surgery. METHODS Medline, Embase and Cochrane databases were systematically searched for 'Muscle strain' AND 'musculoskeletal fatigue' AND 'occupational diseases' OR 'cognitive fatigue' AND 'mental fatigue' OR 'standard laparoscopic surgery' AND 'robot-assisted laparoscopic surgery'. Primary outcomes measured were electromyographic (EMG) activity for musculoskeletal fatigue and questionnaires (NASA-TLX, SMEQ, or Borg CR-10) for cognitive fatigue. A systematic review was conducted in accordance with the Synthesis Without Meta-analysis (SWiM) Guidelines. The study was preregistered on Prospero ID: CRD42020184881. RESULTS Two hundred and ninety-eight original titles were identified. Ten studies that were all observational studies were included in the systematic review. EMG activity was consistently lower in robotic than in laparoscopic surgery in the erector spinae and flexor digitorum muscles but higher in the trapezius muscle. This was associated with significantly lower cognitive load in robotic than laparoscopic surgery in 7 of 10 studies. CONCLUSIONS Evidence suggests a reduction in musculoskeletal demands during robotic surgery in muscles excluding the trapezius, and this is associated with most studies reporting a reduced cognitive load. Robotic surgery appears to have less negative cognitive and musculoskeletal impact on surgeons compared to laparoscopic surgery.
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Affiliation(s)
- Abdul Shugaba
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK.
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK.
| | - Joel E Lambert
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
| | | | - Helen E Nuttall
- Department of Psychology, Lancaster University, Lancaster, LA1 4YG, UK
| | | | - Daren A Subar
- Royal Blackburn Hospital, East Lancashire NHS Hospitals Trust, Blackburn, BB2 3HH, UK
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21
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Yehuda R, Joshua L, Rodrigo V, Ramona NR. Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients. Transplant Proc 2022; 54:1528-1533. [PMID: 35871876 PMCID: PMC9157021 DOI: 10.1016/j.transproceed.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.
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22
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Medical masks' and respirators' pattern of use, adverse effects and errors among Portuguese health care professionals during the COVID-19 pandemic: A cross-sectional study. Am J Infect Control 2022; 50:618-623. [PMID: 34653529 PMCID: PMC8511873 DOI: 10.1016/j.ajic.2021.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 12/21/2022]
Abstract
Background During COVID-19 pandemic, a shortage of surgical masks (Mask) and respirators (Resp) was experienced worldwide. We aimed to assess its pattern of use, adverse effects and user errors by Portuguese health care professionals (HCP). Methods A cross-sectional study was conducted through snowball convenience sample, collected by email/ social media to health care organizations. Participants answered an online anonymous survey in March 2021. Results Mean age of 3052 respondents was 42.1 years old, 83.6% were female and 77.8% provided direct health care to COVID-19 patients. Mean time of use per shift was 6-8 hours in 40.8% of the participants. 28.0% reported never changing it during their shift. Resp use (vs Mask) was more associated with discomfort (58.2% vs 26.8%), affecting task performance (41.5 vs 18.9%) and communication (55.0 vs 40.9%), dyspnea (36.0 vs 14.4%), skin rash (37.5 vs 19.4%) and headache (37.5 vs 19.4%). Frequent user errors included touching the front while in use (70.1% Mask vs 66.3% Resp) and omitting hand hygiene before (61.8% Mask vs 55.0% Resp) or after use (61.3% Mask vs 57.0% Resp). Average number of errors was higher for Mask (4.3), than for Resp (3.2) (all: P < .001). Conclusions Most HCP admitted an extended use of Mask/ Resp. Resp were more prone to adverse effects and Mask more prone to errors. Strategies to reinforce good practices should be considered.
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Manookian A, Dehghan Nayeri N, Shahmari M. Physical problems of prolonged use of personal protective equipment during the COVID-19 pandemic: A scoping review. Nurs Forum 2022; 57:874-884. [PMID: 35575417 PMCID: PMC9347983 DOI: 10.1111/nuf.12735] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/29/2022]
Abstract
Background It is widely believed that using personal protective equipment (PPE) provides high levels of protection for healthcare workers (HCWs) in the fight against coronavirus disease (COVID‐19). However, the long‐term use of PPE is inconvenient for HCWs and may cause physical discomfort. These factors could result in poor compliance and disrupt the health and safety of HCWs, which may negatively affect the patient's safety. Objective This study aimed to investigate the literature for the purpose of collecting convincing evidence of HCWs' physical problems associated with PPE use during the COVID‐19 pandemic. Methods This scoping review was conducted using PubMed, Embase, ProQuest, Science Direct, Springer, Biomed Central, and Google Scholar to identify the related literature. Results HCWs have experienced various physical disorders including skin, respiratory, musculoskeletal, nervous, urinary, and circulatory system problems that are associated with PPE in various body systems. Among these, skin problems were the most frequent physical problems. Conclusions The literature demonstrated the adverse impacts of using PPE on HCWs. Therefore, healthcare policymakers should take the appropriate measures to improve the work environment during the COVID‐19 pandemic, which could consequently prevent and mitigate the adverse effects of using PPE.
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Affiliation(s)
- Arpi Manookian
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.,USERN Care (TUMS) Office, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Nahid Dehghan Nayeri
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehraban Shahmari
- Department of Medical-Surgical, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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24
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Zhang Y, Wang SK, Zheng B. Force application of laparoscopic surgeons under the impact of heavy personal protective equipment. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2022; 5:106-110. [PMID: 35578593 PMCID: PMC9096646 DOI: 10.1016/j.lers.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 04/30/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Objective Surgeons are required to wear heavy personal protective equipment while delivering care to patients during the COVID-19 pandemic. We examined the impact of wearing double gloves on surgeons’ performance in laparoscopic surgery. Methods Eleven surgeons-in-training at the Surgical Simulation Research Lab of the University of Alberta were recruited to perform laparoscopic cutting tasks in simulation while wearing none, one pair, and two pairs of surgical gloves. Forces applied to laparoscopic instruments were measured. Results Wearing gloves prolonged task times (one pair of gloves: 301.6 ± 61.7 s; two pairs of gloves: 295.8 ± 65.3 s) compared with no gloves (241.7 ± 46.9 s; p = 0.043). Wearing double gloves increased cutting errors (20.4 ± 5.1 mm2) compared with wearing one pair of gloves (16.9 ± 5.5 mm2) and no gloves (14.4 ± 4.6 mm2; p = 0.030). Wearing gloves reduced the peak force (one pair of gloves: 2.4 ± 0.7 N; two pairs of gloves: 2.7 ± 0.6 N; no gloves: 3.4 ± 1.4 N; p = 0.049), and the total force (one pair of gloves: 10.1 ± 2.8 N; two pairs of gloves: 10.3 ± 2.6 N; no glove: 12.6 ± 1.9 N; p = 0.048) delivered onto laparoscopic scissors compared with wearing no glove. Conclusion The combined effects of wearing heavy gloves and using tools reduced the touching sensation, which limited the surgeons’ confidence in performing surgical tasks. Increasing practice in simulation is suggested to allow surgeons to overcome difficulties brought by personal protective equipment.
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Affiliation(s)
- Yao Zhang
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
| | - Shuyi Kiana Wang
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, University of Alberta, Edmonton, Alberta, Canada
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25
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Ashour DM, Elkitkat RS, Gabr H, Yosef M, Singh Grewal D, Saleh MI. Challenges of personal protective equipment use among ophthalmologists during the COVID-19 pandemic: A multicenter international study. Eur J Ophthalmol 2022; 32:1398-1405. [PMID: 34180262 PMCID: PMC9111902 DOI: 10.1177/11206721211028037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/05/2021] [Indexed: 01/03/2023]
Abstract
PURPOSE To explore the possible challenges and difficulties of using Personal Protective Equipment (PPE) in ophthalmic practice during the Coronavirus disease 2019 (COVID-19) pandemic. METHODS This is a multicenter, international survey among practicing ophthalmologists across different countries. The survey was conducted from September 9th to October 24th, 2020. It included a total of 23 questions that navigated through the currently adopted recommendations in different clinical situations. The survey also assessed the convenience of using various PPE in ophthalmic practice and addressed the clarity of the examination field while using various PPE during clinical or surgical procedures. RESULTS One hundred and seventy-two ophthalmologists completed the survey (101 from Egypt, 50 from the USA, and 21 from four other countries). The analysis of the responses showed that most ophthalmologists use face masks without significant problems during their examinations, while face shields followed by protective goggles were the most inconvenient PPE in the current ophthalmic practice. Moreover, most of the participants (133, 77.3%) noticed an increase in their examination time when using PPE. Furthermore, a considerable percentage of the respondents (70, 40.7%) stopped using one or more of the PPE due to inconvenience or discomfort. CONCLUSIONS Due to the unique nature of the ophthalmic examination, certain PPE are not ophthalmologist-friendly. Innovative PPE should be tailored for prompt, more convenient, and clearer ophthalmological practice.
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Affiliation(s)
- Doaa Maamoun Ashour
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
| | - Rania Serag Elkitkat
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
- Watany Eye Hospital, Cairo, Egypt
- Watany Research and Development Center,
Cairo, Egypt
| | - Hesham Gabr
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
- Department of Ophthalmology, Duke
University, Durham, NC, USA
| | - Mostafa Yosef
- Department of Community, Environmental
and Occupational Medicine, Ain Shams University, Cairo, Egypt
| | | | - Mohamed Ibrahim Saleh
- Department of Ophthalmology, Faculty of
Medicine, Ain Shams University, Cairo, Egypt
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26
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Leung R, Cook MM, Capra MF, Johnstone KR. The contribution of respiratory and hearing protection use to psychological distress in the workplace: a scoping review. Int Arch Occup Environ Health 2022; 95:1647-1659. [PMID: 35474491 PMCID: PMC9041289 DOI: 10.1007/s00420-022-01863-7] [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] [Received: 12/23/2021] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Workers from various industries use personal protective equipment (PPE) including masks, respirators, and hearing protection to reduce their exposures to workplace hazards. Many studies have evaluated the physiological impacts of PPE use, but few have assessed the psychological impacts. The aim of the present study was to carry out a scoping review to compile existing evidence and determine the extent of knowledge on workplace mask, respirator or hearing protection use as a psychosocial hazard (stressor) that could result in a stress response and potentially lead to psychological injury. METHODS The scoping review followed recognized methods and was conducted using Ovid Emcare, PubMed, Sage Journals, ScienceDirect, Scopus, SpringerLink, Google Scholar and preprint databases (OSF Preprints and medRxiv). Articles on the stressors associated with the use of masks, respirators, and hearing protection were included. The extracted data included author(s) name, year of publication, title of article, study design, population data, stressors assessed, and key findings. RESULTS We retrieved 650 articles after removal of duplicates, of which 26 were deemed eligible for inclusion for review. Identified factors associated with PPE use that could potentially create a stress response were identified: communication impacts, physical impacts, psychological illness symptoms, cognitive impacts, and perceived PPE-related impacts. Evidence for respirators suggest that there may be psychological injury associated with their use. However, hearing protection appears to have a protective effect in reducing psychological symptoms such as anxiety, depression, and aggression. CONCLUSIONS Mask or respirator use may lead to an increase in work-related stress. Whereas hearing protection may have protective effects against psychological symptoms and improves speech intelligibility. More research is needed to better understand potential psychosocial impacts of mask, respirator and/or hearing protection use.
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Affiliation(s)
- Richard Leung
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia.
| | - Margaret M Cook
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Mike F Capra
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
| | - Kelly R Johnstone
- School of Earth and Environmental Sciences, The University of Queensland, Brisbane, Australia
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Oosthuizen I, Saunders GH, Manchaiah V, Swanepoel DW. Impact of SARS-CoV-2 Virus (COVID-19) Preventative Measures on Communication: A Scoping Review. Front Public Health 2022; 10:815259. [PMID: 35419343 PMCID: PMC8995421 DOI: 10.3389/fpubh.2022.815259] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Face coverings and distancing as preventative measures against the spread of the Coronavirus disease 2019 may impact communication in several ways that may disproportionately affect people with hearing loss. A scoping review was conducted to examine existing literature on the impact of preventative measures on communication and to characterize the clinical implications. Method A systematic search of three electronic databases (Scopus, PubMed, CINAHL) was conducted yielding 2,158 articles. After removing duplicates and screening to determine inclusion eligibility, key data were extracted from the 50 included articles. Findings are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Extension for Scoping Reviews, including the PRISMA-ScR checklist. Results Studies fell into three categories: Studies addressing the impacts of personal protective equipment (PPE) and/or distancing on communication in healthcare contexts (n = 20); studies examining the impact of preventative measures on communication in everyday life (n = 13), and studies measuring the impact of face coverings on speech using acoustic and/or behavioral measures (n = 29). The review revealed that masks disrupt verbal and non-verbal communication, as well as emotional and social wellbeing and they impact people with hearing loss more than those without. These findings are presumably because opaque masks attenuate sound at frequencies above 1 kHz, and conceal the mouth and lips making lipreading impossible, and limit visibility of facial expressions. While surgical masks cause relatively little sound attenuation, transparent masks and face shields are highly attenuating. However, they are preferred by people with hearing loss because they give access to visual cues. Conclusion Face coverings and social distancing has detrimental effects that extend well beyond verbal and non-verbal communication, by affecting wellbeing and quality of life. As these measures will likely be part of everyday life for the foreseeable future, we propose that it is necessary to support effective communication, especially in healthcare settings and for people with hearing loss.
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Affiliation(s)
- Ilze Oosthuizen
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
| | - Gabrielle H. Saunders
- Manchester Centre for Audiology and Deafness (ManCAD), University of Manchester, Manchester, United Kingdom
| | - Vinaya Manchaiah
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Department of Otolaryngology–Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO, United States
- UCHealth Hearing and Balance, University of Colorado Hospital, Aurora, CO, United States
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, India
| | - De Wet Swanepoel
- Department of Speech-language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
- Virtual Hearing Lab, Collaborative Initiative Between University of Colorado School of Medicine, Aurora, CO, United States, and University of Pretoria, Pretoria, South Africa
- Ear Science Institute Australia, Subiaco, WA, Australia
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Uyan M, Özdemir A, Kalcan S, Tomas K, Demiral G, Pergel A, Tarım İA. Effects of COVID-19 pandemic on colorectal cancer surgery. SAO PAULO MED J 2022; 140:244-249. [PMID: 34586288 PMCID: PMC9610251 DOI: 10.1590/1516-3180.2021.0357.r1.30062021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/30/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND The coronavirus disease-19 (COVID-19) pandemic has changed the course of diseases that require emergency surgery. OBJECTIVE To evaluate the effect of the COVID-19 pandemic on colorectal cancer disease stage. DESIGN AND SETTING Retrospective analysis in the city of Rize, Turkey. METHODS This was a comparative analysis on two groups of patients with various symptoms who underwent surgical colorectal cancer treatment. Group 1 comprised patients operated between March 11, 2019, and December 31, 2019; while group 2 comprised patients at the same time of the year during the COVID-19 pandemic. RESULTS Groups 1 and 2 included 56 and 48 patients, respectively. The rate of presentation to the emergency service was higher in Group 2 (P < 0.02). The stage of the pathological lymph nodes and the rate of liver metastasis was higher in Group 2 (P < 0.004 and P < 0.041, respectively). The disease stage was found to be more advanced in Group 2 (P < 0.005). The rate of postoperative complications was higher in Group 2 (P < 0.014). CONCLUSION The presentation of patients with suspicious findings to the hospital was delayed, due both to the fear of catching COVID-19 and to the pandemic precautions that were proposed and implemented by healthcare authorities worldwide. Among the patients who presented to the hospital with emergency complaints and in whom colorectal cancer was detected, their disease was at a more advanced stage and thus a higher number of emergency oncological surgical procedures were performed on those patients.
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Affiliation(s)
- Mikail Uyan
- MD, PhD. Assistant Professor, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - Ali Özdemir
- MD, PhD. General Surgeon, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - Süleyman Kalcan
- MD, PhD. Assistant Professor, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - Kadir Tomas
- MD, PhD. General Surgeon, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - Gökhan Demiral
- MD, PhD. Associate Professor, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - Ahmet Pergel
- MD, PhD. Professor, Department of General Surgery, Recep Tayyip Erdoğan University Medical Faculty, Rize, Turkey.
| | - İsmail Alper Tarım
- MD, PhD. Assistant Professor, Department of General Surgery, Ondokuz Mayıs University Medical Faculty, Samsun, Turkey.
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Ilgen O, Saatli B, Timur T, Kula H, Kandemir S, Kurt S, Cagliyan E. Measures against COVID-19 pandemic - a single tertiary center experience. J OBSTET GYNAECOL 2022; 42:1532-1538. [PMID: 35142254 DOI: 10.1080/01443615.2021.2021506] [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: 12/15/2022]
Abstract
This paper reports the measures taken to manage the impact of the COVID-19 pandemic on O&G services in a tertiary referal centre and their outcomes. All the patients included in this study received inpatient treatment and underwent surgery between March 10 2020 and end of June 2020, including obstetric or gynaecologic cases combined. Data including age, diagnosis, operation, duration of preoperative and postoperative hospital stay, COVID-19 status were recorded. COVID-19 status of the patients was diagnosed with a nasopharyngeal swab test. Thirty-seven (20%) of 177 operations were performed because of gynaecologic reasons. The rest of them were caesarean sections (C/S). In gynaecologic cases, 22 (59%) of 37 were emergent operations, nine (24%) cases were oncologic and six (16%) cases were elective gynaecological surgeries. On the other hand, 43 (30%) of 140 patients, who underwent caesarean sections, were urgent surgeries. The rest were elective and planned caesarean sections. Only five patients (2.8%) who had undergone caesarean sections were tested positive for COVID-19. No COVID-19 transmission to staff was recorded in this period. Measures against the COVID-19 pandemic must be multidisciplinary and is crucial to prevent the spread of the disease to staff in close contact.Impact StatementWhat is already known on this subject? COVID-19 pandemic has been a crucial health problem worldwide. Healthcare workers work intensely to protect people from the pandemic. It is especially important to protect healthcare professionals and hospitalized patients from virus transmission. Therefore, utilization of personal protective equipment such as masks, gloves and goggles is obligatory, and hygiene rules such as sanitization of hands are strictly followed.What the results of this study add? This study adds the experience and success of a tertiary centre regarding the measure against COVID-19 to the literature. No viral transmission was detected to healthcare workers and other patients from COVID-19 patients. Hence, measures that mentioned in the present study should be an example to other centres for protection against pandemic.What the implications are of these findings for clinical practice and/or further research? As mentioned above, measures that are explained in the present study should be an example to other centres for protection against the pandemic. Further larger size clinical studies are needed to prove the beneficial effect of the measures that still used against pandemic.
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Affiliation(s)
- Orkun Ilgen
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Bahadır Saatli
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Tunc Timur
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Hakan Kula
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Selim Kandemir
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Erkan Cagliyan
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Etheridge JC, Moyal-Smith R, Sonnay Y, Brindle ME, Yong TT, Tan HK, Lim C, Havens JM. Non-technical skills in surgery during the COVID-19 pandemic: An observational study. Int J Surg 2022; 98:106210. [PMID: 34995803 PMCID: PMC8730762 DOI: 10.1016/j.ijsu.2021.106210] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 12/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Non-technical skills are critical to surgical safety. We examined the impact of the COVID-19 pandemic on non-technical skills of operating room (OR) teams in Singapore. MATERIALS AND METHODS Observers rated live operations using the Oxford NOTECHS system. Pre- and post-COVID observations were captured from November 2019 to January 2020 and from January 2021 to February 2021, respectively. Scores were compared using Schuirmann's Two One-Sided Test procedure. Multivariable linear regression was used to adjust for case mix. A 10% margin of equivalence was set a priori. RESULTS Observers rated 159 cases: 75 pre-COVID and 84 post-COVID. There were significant differences between groups in surgical department and surgeon-reported case complexity (both P < 0.001). Total NOTECHS scores increased post-COVID on raw analysis (36.1 vs 38.0, P < 0.001) but remained within the margin of equivalence (90% CI 1.3 to 2.6, P < 0.001). Multivariable analysis demonstrated a similar increase within the margin of equivalence (2.0, 90% CI 1.3 to 2.7). Teamwork and cooperation scores increased by 1.0 post-COVID (90% CI 0.8 to 1.3); all other subcomponent scores were equivalent. CONCLUSION Non-technical skills before and after the peak of the COVID-19 pandemic were equivalent but not equal. A small but statistically significant improvement post-COVID was driven by an increase in teamwork and cooperation skills. These findings may reflect an improvement in team cohesion, which has been observed in teams under duress in other settings such as the military. Future work should explore the effect of the pandemic on OR culture, team cohesion, and resilience.
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Affiliation(s)
- James C. Etheridge
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA,Corresponding author. 401 Park Drive, 3rd Floor West, Boston, MA, 02215, USA
| | - Rachel Moyal-Smith
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Yves Sonnay
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mary E. Brindle
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Tze Tein Yong
- Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore
| | - Hiang Khoon Tan
- Division of Surgery and Surgical Oncology, Singapore General Hospital, National Cancer Centre Singapore, Singapore,Duke-NUS Global Health Institute, Singapore
| | - Christine Lim
- International Safety and Policy, Johnson and Johnson Medical Devices, New Brunswick, NJ, USA
| | - Joaquim M. Havens
- Ariadne Labs, Brigham and Women's Hospital, Harvard T.H. Chan School of Public Health, Boston, MA, USA,Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA
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Grishina A, Link F, Arend A, Kleemann F, Tober-Lau P, Andree D, Münn F, Gruendl M, Quante M, Lederhuber H, Albertsmeier M, Struller F, Grützmann R, Königsrainer A, Löffler MW. A survey among physicians in surgery and anesthesiology departments after the first surge of SARS-CoV-2 infections in Germany. Wien Klin Wochenschr 2022; 134:361-370. [PMID: 35061080 PMCID: PMC8780051 DOI: 10.1007/s00508-021-02000-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/21/2021] [Indexed: 11/01/2022]
Abstract
Summary
Background
The SARS-CoV‑2 pandemic has extensively challenged healthcare systems all over the world. Many elective operations were postponed or cancelled, changing priorities and workflows in surgery departments.
Aims
The primary aim of this cross-sectional study was to assess the workload and psychosocial burden of surgeons and anesthesiologists, working in German hospitals during the first wave of SARS-CoV‑2 infections in 2020.
Methods
Quantitative online survey on the workplace situation including psychosocial and work-related stress factors among resident and board-certified surgeons and anesthesiologists. Physicians in German hospitals across all levels of healthcare were contacted via departments, professional associations and social media posts.
Results
Among 154 total study participants, 54% of respondents stated a lack of personal protective equipment in their own wards and 56% reported increased staff shortages since the onset of the pandemic. While routine practice was reported as fully resumed in 71% of surgery departments at the time of the survey, work-related dissatisfaction among responding surgeons and anesthesiologists increased from 24% before the pandemic to 36% after the first wave of infections. As a countermeasure, 94% of participants deemed the establishment of action plans to increase pandemic preparedness and strengthening German public health systems a useful measure to respond to current challenges.
Conclusion
The aftermath of the first wave of SARS-CoV‑2 infections in Germany has left the surgical staff strained, despite temporarily decreased workloads. Overall, a critical review of the altered conditions is indispensable to identify and promote effective solutions and prudent action plans required to address imminent challenges.
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Wells HJ, Raithatha M, Elhag S, Turner J, Osuri P, Kannan S. Impact of full personal protective equipment on alertness of healthcare workers: a prospective study. BMJ Open Qual 2022; 11:bmjoq-2021-001551. [PMID: 35042689 PMCID: PMC8768932 DOI: 10.1136/bmjoq-2021-001551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022] Open
Abstract
The COVID-19 pandemic has resulted in healthcare workers (HCWs) having to wear full personal protective equipment (FPPE) even for routine patient care. When worn for prolonged periods, FPPE has the potential to adversely affect the ability of HCW to carry out their tasks. This study aimed to assess the impact of FPPE on the alertness levels of HCWs in the intensive care unit. Fifty HCWs were tested using psychomotor vigilance test (PVT) and serial sevens test (SST) on two occasions during their shift—once without FPPE and once after they had been in FPPE for at least 2 hours. The median time in FPPE was 2.5 hours. FPPE induced a significant increase in the average reaction time and the number of false responses in PVT. Subjects took longer to complete SST in FPPE compared with without it. This study demonstrates that being in FPPE for as little as 2.5 hours can adversely affect HCW alertness. The findings of this study are relevant in terms of workforce environment considerations as the use of FPPE in certain settings is likely to become a regular feature.
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Affiliation(s)
- Helena Jane Wells
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Meera Raithatha
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Sabba Elhag
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - James Turner
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Pranav Osuri
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Santhana Kannan
- Critical Care, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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33
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Kienbacher CL, Grafeneder J, Tscherny K, Krammel M, Fuhrmann V, Niederer M, Neudorfsky S, Herbich K, Schreiber W, Herkner H, Roth D. The use of personal protection equipment does not negatively affect paramedics' attention and dexterity: a prospective triple-cross over randomized controlled non-inferiority trial. Scand J Trauma Resusc Emerg Med 2022; 30:2. [PMID: 35012592 PMCID: PMC8744370 DOI: 10.1186/s13049-021-00990-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic led to widespread use of personal protection equipment (PPE), including filtering face piece (FFP) masks, throughout the world. PPE. Previous studies indicate that PPE impairs neurocognitive performance in healthcare workers. Concerns for personnel safety have led to special recommendations regarding basic life support (BLS) in patients with a potential SARS-CoV-2 infection, including the use of PPE. Established instruments are available to assess attention and dexterity in BLS settings, respectively. We aimed to evaluate the influence of PPE with different types of FFP masks on these two neuropsychological components of EMS personnel during BLS. METHODS This was a randomized controlled non-inferiority triple-crossover study. Teams of paramedics completed three 12-min long BLS scenarios on a manikin after having climbed three flights of stairs with equipment, each in three experimental conditions: (a) without pandemic PPE, (b) with PPE including a FFP2 mask with an expiration valve and (c) with PPE including an FFP2 mask without an expiration valve. The teams and intervention sequences were randomized. We measured the shift in concentration performance using the d2 test and dexterity using the nine-hole peg test (NHPT). We compared results between the three conditions. For the primary outcome, the non-inferiority margin was set at 20 points. RESULTS Forty-eight paramedics participated. Concentration performance was significantly better after each scenario, with no differences noted between groups: d2 shift control versus with valve - 8.3 (95% CI - 19.4 to 2.7) points; control versus without valve - 8.5 (- 19.7 to 2.7) points; with valve versus without valve 0.1 (- 11.1 to 11.3) points. Similar results were found for the NHPT: + 0.3 (- 0.7 to 1.4), - 0.4 (- 1.4 to 0.7), 0.7 (- 0.4 to 1.8) s respectively. CONCLUSION Attention increases when performing BLS. Attention and dexterity are not inferior when wearing PPE, including FFP2 masks. PPE should be used on a low-threshold basis.
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Affiliation(s)
- Calvin Lukas Kienbacher
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jürgen Grafeneder
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Katharina Tscherny
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Mario Krammel
- Emergency Medical Services Vienna, Radetzkystraße 1, 1030, Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Lichtentaler Gasse 4/1/R03, 1090, Vienna, Austria
| | - Verena Fuhrmann
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Maximilian Niederer
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sabine Neudorfsky
- Emergency Medical Services Vienna, Radetzkystraße 1, 1030, Vienna, Austria
| | - Klaus Herbich
- Emergency Medical Services Vienna, Radetzkystraße 1, 1030, Vienna, Austria
| | - Wolfgang Schreiber
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
- PULS - Austrian Cardiac Arrest Awareness Association, Lichtentaler Gasse 4/1/R03, 1090, Vienna, Austria
| | - Harald Herkner
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Saha M, Wadhwa B, Gaba P, Chaudhary K, Sharma K, Gaur S, Doda P. Retrospective analysis of the outcome of the anaesthetic procedures in COVID-19 parturient undergoing cesarean delivery in a tertiary care hospital in Delhi, India. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2022. [DOI: 10.4103/joacc.joacc_93_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ashraf I, Nikookam Y, Hong A, Lowe A, Mann J, Ebadian M, Gnanappiragasam D, Abbott R, Veitch D, Wernham A. A Multi-centre Qualitative Study of Patient Skin Surgery Experience during the Covid-19 Pandemic in the United Kingdom. Clin Exp Dermatol 2021; 47:953-956. [PMID: 34939208 DOI: 10.1111/ced.15078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 12/05/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022]
Abstract
Understanding patient concerns regarding skin surgery during the Covid-19 pandemic is a vital way of learning from individual experiences. A shift towards using absorbable superficial sutures has been anecdotally observed. We explored patient attitudes to the use of absorbable sutures and their experiences and perceptions of attending for skin surgery during the pandemic. 35 participants were interviewed (74% male, 100% White British, mean age 72.5 years; range 43-95 years). Participants were reassured by precautions taken to minimise exposure and risk from Covid-19. The majority (86%) did not feel that personal protective equipment worn by staff impaired their experience. 29% reported their experience of attending for skin surgery during the lockdown period was more efficient and organised than on pre-pandemic visits. 94% of participants would opt to have absorbable sutures again or had no strong preference for either suture type. Based on their experiences, most participants would have no concerns about attending for further skin surgery during the pandemic and would opt to have absorbable sutures.
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Affiliation(s)
| | | | - Albert Hong
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK
| | - Ashima Lowe
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Jasmine Mann
- Dermatology Department, Nottingham Treatment Centre, Nottingham University Hospitals NHS Trust, UK
| | - Mona Ebadian
- University Hospitals Leicester NHS Trust, Leicester, UK
| | | | - Rachel Abbott
- Cardiff and Vale University Health Board, Cardiff, UK
| | - David Veitch
- University Hospitals Leicester NHS Trust, Leicester, UK
| | - Aaron Wernham
- Department of Dermatology, Walsall Healthcare NHS Trust, Walsall, UK.,University Hospitals Leicester NHS Trust, Leicester, UK
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36
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Xie Y, Kulpanowski D, Ong J, Nikolova E, Tran NM. Predicting Covid-19 emergency medical service incidents from daily hospitalisation trends. Int J Clin Pract 2021; 75:e14920. [PMID: 34569674 DOI: 10.1111/ijcp.14920] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/23/2021] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The aim of our retrospective study was to quantify the impact of Covid-19 on the temporal distribution of emergency medical services (EMS) demand in Travis County, Austin, Texas and propose a robust model to forecast Covid-19 EMS incidents. METHODS We analysed the temporal distribution of EMS calls in the Austin-Travis County area between 1 January 2019 and 31 December 2020. Change point detection was performed to identify the critical dates marking changes in EMS call distributions, and time series regression was applied for forecasting Covid-19 EMS incidents. RESULTS Two critical dates marked the impact of Covid-19 on the distribution of EMS calls: March 17th, when the daily number of non-pandemic EMS incidents dropped significantly, and 13 May, by which the daily number of EMS calls climbed back to 75% of the number in pre-Covid-19 time. The new daily count of the hospitalisation of Covid-19 patients alone proves a powerful predictor of the number of pandemic EMS calls, with an r2 value equal to 0.85. In particular, for every 2.5 cases, where EMS takes a Covid-19 patient to a hospital, one person is admitted. CONCLUSION The mean daily number of non-pandemic EMS demand was significantly less than the period before the Covid-19 pandemic. The number of EMS calls for Covid-19 symptoms can be predicted from the daily new hospitalisation of Covid-19 patients. These findings may be of interest to EMS departments as they plan for future pandemics, including the ability to predict pandemic-related calls in an effort to adjust a targeted response.
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Affiliation(s)
- Yangxinyu Xie
- Department of Computer Science, University of Texas at Austin, Austin, Texas, USA
| | - David Kulpanowski
- Department of Emergency Medical Services, City of Austin, Austin, Texas, USA
| | - Joshua Ong
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Evdokia Nikolova
- Department of Electrical and Computer Engineering, University of Texas at Austin, Austin, Texas, USA
| | - Ngoc M Tran
- Department of Mathematics, University of Texas at Austin, Austin, Texas, USA
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37
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Desdiani D, Sutarto AP, Kharisma AN, Safitri H, Hakim AF, Rusyda SH. Sequelae in COVID-19 patients 3 months after hospital discharge or completion of self-isolation. Health Sci Rep 2021; 4:e444. [PMID: 34984236 PMCID: PMC8691487 DOI: 10.1002/hsr2.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Desdiani Desdiani
- Faculty of MedicineUniversitas Sultan Ageng TirtayasaCilegonIndonesia
- Department of Pulmonology and Respiratory MedicineBhayangkara Brimob HospitalDepokIndonesia
| | | | | | - Hera Safitri
- Faculty of MedicineUniversitas AndalasPadangIndonesia
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Petrica A, Lungeanu D, Ciuta A, Marza AM, Botea MO, Mederle OA. Using 360-degree video for teaching emergency medicine during and beyond the COVID-19 pandemic. Ann Med 2021; 53:1520-1530. [PMID: 34612105 PMCID: PMC8510619 DOI: 10.1080/07853890.2021.1970219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 08/13/2021] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE During the COVID-19 pandemic, emergency medicine (EM) teachers had to employ innovative methods to ensure the continuity of the education process. The purpose of this study was to explore the adequacy of the 360-degree video (video 360) technology in EM education in the context of: (a) students' attitudes towards the video 360; (b) students' academic performance in their required examination at the end of the EM course compared to the assessment results of students from the previous academic year. METHODS A mixed-method research project enrolled the fourth-year medical students who attended the required EM course during the first semester of the academic year 2020-2021 when all activities with undergraduate students went online and teaching scenarios recorded in the video 360 format were employed. Data collection was two-fold: (a) anonymous questionnaires, complemented with basic YouTube analytics; (b) multiple-choice questionnaires (MCQ) and oral examination, contrasting the results with those in 2019-2020. Data analysis used descriptive statistics and non-parametric methods. RESULTS Seventy-nine students (53 females and 26 males) participated in the project and all completed the EM course. Students' interest in and their acceptance of the video 360 technology were high (total scoring in the upper 20% of the respective scales), with consistently good performance in two parallel, independent, interview-based oral/practical evaluations (Spearman correlation coefficient R = 0.665, p < .001). The majority scored over 90% in the summative MCQ, with higher values compared to their colleagues' during the previous academic year (with on-site teaching): scoring percentages with mean ± standard deviation of 92.52 ± 4.57 and 76.67 ± 18.77, respectively. CONCLUSION Our project showed that the video 360 scenarios were effective in teaching EM. In the long term, employing this accessible and inexpensive educational approach would add value to on-site training by enriching the exposure to a specific ED environment.KEY MESSAGESMedical students valued the 360-degree video scenarios as contributing substantially to their EM knowledge and preparedness.Examination results confirmed the 360-degree video scenarios as viable in EM teaching.The 360-degree video technology would be a sustainable solution for hybrid medical teaching in the long term.
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Affiliation(s)
- Alina Petrica
- “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Diana Lungeanu
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
| | - Alexandru Ciuta
- “Pius Brinzeu” Emergency Clinical County Hospital, Timisoara, Romania
| | - Adina M. Marza
- Multidisciplinary Center for Research, Evaluation, Diagnosis, and Therapies in Oral Medicine, Department of Surgery, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Emergency Clinical Municipal Hospital, Timisoara, Romania
| | - Mihai-Octavian Botea
- Department of Surgery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Ovidiu A. Mederle
- Multidisciplinary Center for Research, Evaluation, Diagnosis, and Therapies in Oral Medicine, Department of Surgery, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania
- Emergency Clinical Municipal Hospital, Timisoara, Romania
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39
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Kapoor S, Gupta A, Saidha PK. Ear, Nose, and Throat Practice Guidelines: An Update for COVID-19. Int Arch Otorhinolaryngol 2021; 25:e621-e627. [PMID: 34777595 PMCID: PMC8580158 DOI: 10.1055/s-0041-1736424] [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] [Received: 05/07/2021] [Accepted: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction
Amidst another wave of COVID-19, the alarming number of cases per day in India has affected the healthcare system and professionals tremendously. As the disease burden continues to increase, ear, nose, and throat (ENT) specialists remain at high risk of exposure to this aerosol borne virus. This requires the creation and regulation of protocols for conducting routine clinical practice, especially by ENT specialists.
Objectives
To review the available literature and to propose strategies and recommendations for ENT practitioners to conduct their regular practice amidst this pandemic.
Data synthesis
A systematic review of the available literature on ENT practice during the COVID-19 pandemic was done. Out of the many protocols proposed in various studies, the most practical and feasible ones that could be adopted by practicing ENT doctors/ surgeons in the long run were selected. Adequate precautions and use of high level of personal protective equipment (PPE) is required to be adopted by all practicing ENT doctors. Use of teleconsultation has been promoted as it limits face-to-face exposure. Proper guidelines should be followed for both emergency and elective surgeries. Endoscopy can be used as a safe and useful tool for ENT examination.
Conclusion
As practicing otorhinolaryngologists, it is of utmost importance that we take all necessary precautions and adopt safety measures in our clinical practice while conducting out patient department (OPD) consultations, operative procedures, and emergency care to protect our patients, ourselves, and other healthcare staff during this time.
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Affiliation(s)
- Sahil Kapoor
- Department of Ear, Nose, and Throat, Faculty of Medicine and Health Sciences, SGT University, Gurgaon, Haryana, India
| | - Ayushi Gupta
- Department of Ear, Nose, and Throat, Faculty of Medicine and Health Sciences, SGT University, Gurgaon, Haryana, India
| | - Poonam Kumar Saidha
- Department of Ear, Nose, and Throat, Faculty of Medicine and Health Sciences, SGT University, Gurgaon, Haryana, India
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40
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Truche P, Campos LN, Marrazzo EB, Rangel AG, Bernardino R, Bowder AN, Buda AM, Faria I, Pompermaier L, Rice HE, Watters D, Dantas FLL, Mooney DP, Botelho F, Ferreira RV, Alonso N. Association between government policy and delays in emergent and elective surgical care during the COVID-19 pandemic in Brazil: a modeling study. ACTA ACUST UNITED AC 2021; 3:100056. [PMID: 34725652 PMCID: PMC8552244 DOI: 10.1016/j.lana.2021.100056] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/01/2022]
Abstract
Background The impact of public health policy to reduce the spread of COVID-19 on access to surgical care is poorly defined. We aim to quantify the surgical backlog during the COVID-19 pandemic in the Brazilian public health system and determine the relationship between state-level policy response and the degree of state-level delays in public surgical care. Methods Monthly estimates of surgical procedures performed per state from January 2016 to December 2020 were obtained from Brazil's Unified Health System Informatics Department. Forecasting models using historical surgical volume data before March 2020 (first reported COVID-19 case) were constructed to predict expected monthly operations from March through December 2020. Total, emergency, and elective surgical monthly backlogs were calculated by comparing reported volume to forecasted volume. Linear mixed effects models were used to model the relationship between public surgical delivery and two measures of health policy response: the COVID-19 Stringency Index (SI) and the Containment & Health Index (CHI) by state. Findings Between March and December 2020, the total surgical backlog included 1,119,433 (95% Confidence Interval 762,663–1,523,995) total operations, 161,321 (95%CI 37,468–395,478) emergent operations, and 928,758 (95%CI 675,202–1,208,769) elective operations. Increased SI and CHI scores were associated with reductions in emergent surgical delays but increases in elective surgical backlogs. The maximum government stringency (score = 100) reduced emergency delays to nearly zero but tripled the elective surgical backlog. Interpretation Strong health policy efforts to contain COVID-19 ensure minimal reductions in delivery of emergent surgery, but dramatically increase elective backlogs. Additional coordinated government efforts will be necessary to specifically address the increased elective backlogs that accompany stringent responses.
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Affiliation(s)
- Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | | | - Enzzo Barrozo Marrazzo
- Institute of Biological Sciences, Faculty of Medicine Pontifícia Universidade Católica de Minas Gerais Poços de Caldas, MG, Brazil
| | - Ayla Gerk Rangel
- Faculty of Medical Sciences, Universidad Católica Argentina, Buenos Aires, Argentina
| | - Ramon Bernardino
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Alexis N Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | - Alexandra M Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | - Isabella Faria
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
| | - Laura Pompermaier
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, United States
| | - Henry E Rice
- Duke University Medical Center and Duke Global Health Institute, Durham, NC, United States
| | - David Watters
- Deakin University and Barwon Health, Melbourne, Australia
| | | | | | | | | | - Nivaldo Alonso
- Department of Plastic Surgery, University of São Paulo, São Paulo, Brazil
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Endometriosis Surgery during the First Wave of the COVID-19 Pandemic: A Brazilian Single Institution Experience. Case Rep Obstet Gynecol 2021; 2021:5040873. [PMID: 34721912 PMCID: PMC8548982 DOI: 10.1155/2021/5040873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction. Early in the 2020 Coronavirus pandemic stay-at-home guidelines, there were public health orders that elective surgeries be deferred to prioritize hospital beds for critically ill COVID-19 patients. Besides, several reasons led to the postponement of consultations, diagnostic tests, and elective therapeutic procedures. As a result, some women with endometriosis faced chronification of their pain and decreased prospects for pregnancy. The aim of this study was to describe individual responses to minimally invasive complete excision of endometriosis through 40 days of follow-up of women whose endometriosis was considered severe enough to proceed with surgery during the fourth, fifth, and sixth months of constraints imposed by the pandemic. Preventive strategies and safety measures employed to protect patients and staff from acquiring or transmitting Coronavirus infection are presented. Case Presentation. This case series report enrolled 11 consecutive Brazilian women (ages 22 to 47 y) who underwent minimally invasive surgical treatment of endometriosis between June 26 and August 17, 2020. Cases of endometriosis requiring more urgent surgery were promptly identified and considered individually. The strict safety measures were well accepted by patients. No women developed any flu-like or COVID-19-related symptoms (cough, dyspnea, fever, or anosmia) in the 40 days of postoperative follow-up. One of the most praised measures reported by patients was the routine testing of the patient, the person who would accompany her in the hospital, and all medical staff and employees. Discussion. It is feasible to safely perform elective endometriosis surgery in selected cases during a pandemic.
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Davies PS, Sinnerton RJ, MacInnes A, Faulkner AC, Hutchison PD, Greensmith TS, Roberts L, Clift B. Re-starting elective orthopaedic services in NHS Tayside during the COVID-19 pandemic. Surgeon 2021; 19:e230-e236. [PMID: 33308925 PMCID: PMC7676371 DOI: 10.1016/j.surge.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 10/16/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Elective orthopaedic operations were suspended at the start of the COVID-19 lockdown. Three pathways were created to allow patients to undergo urgent elective operations in NHS Tayside as soon as it was deemed safe to do so. METHODS We examined elective orthopaedic activity in NHS Tayside during and immediately after the Scottish lockdown. Elective operations performed between 27 March 2020 and 10 August 2020 were included and compared with cases performed between 27 March and 10 August in both 2018 and 2019. Primary outcomes were 30-day mortality, 30-day complications, and nosocomial infection rates of COVID-19. FINDINGS Fewer elective operations were performed in 2020 (258) compared with 2019 (1196) and 2018 (1261). The rate of nosocomial infection in the 2020 cohort was 0%. The 30-day mortality rate was 0%. Over 98% of patients agreed to undergo surgery after a detailed consenting process. INTERPRETATION We were able to re-start a safe elective orthopaedic service in the early stages of recovery from the COVID-19 pandemic, compatible with the guidelines set by the Royal College of Surgery of England and the British Orthopaedic Association. Our findings will serve to reassure regions with sufficient resources that it is acceptable to restart elective surgery for urgent priority cases. They may provide a template for planned surgical care in the event of further pandemics.
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Affiliation(s)
- Peter Se Davies
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK.
| | - Robert Jh Sinnerton
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
| | - Alasdair MacInnes
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
| | - Alastair C Faulkner
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
| | - Peter D Hutchison
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
| | - Thomas Sw Greensmith
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
| | - Louise Roberts
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK
| | - Benedict Clift
- Department of Trauma and Orthopaedics, Ninewells Hospital, Dundee, UK; The University of Dundee, UK
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Spang RP, Pieper K. The tiny effects of respiratory masks on physiological, subjective, and behavioral measures under mental load in a randomized controlled trial. Sci Rep 2021; 11:19601. [PMID: 34599253 PMCID: PMC8486780 DOI: 10.1038/s41598-021-99100-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 09/20/2021] [Indexed: 02/08/2023] Open
Abstract
Since the outbreak of the coronavirus disease (COVID-19), face coverings are recommended to diminish person-to-person transmission of the SARS-CoV-2 virus. Some public debates concern claims regarding risks caused by wearing face masks, like, e.g., decreased blood oxygen levels and impaired cognitive capabilities. The present, pre-registered study aims to contribute clarity by delivering a direct comparison of wearing an N95 respirator and wearing no face covering. We focused on a demanding situation to show that cognitive efficacy and individual states are equivalent in both conditions. We conducted a randomized-controlled crossover trial with 44 participants. Participants performed the task while wearing an N95 FFR versus wearing none. We measured physiological (blood oxygen saturation and heart rate variability), behavioral (parameters of performance in the task), and subjective (perceived mental load) data to substantiate our assumption as broadly as possible. We analyzed data regarding both statistical equivalence and differences. All of the investigated dimensions showed statistical equivalence given our pre-registered equivalence boundaries. None of the dimensions showed a significant difference between wearing an FFR and not wearing an FFR.Trial Registration: Preregistered with the Open Science Framework: https://osf.io/c2xp5 (15/11/2020). Retrospectively registered with German Clinical Trials Register: DRKS00024806 (18/03/2021).
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Affiliation(s)
- Robert P Spang
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany.
| | - Kerstin Pieper
- Quality and Usability Lab, Institute of Software Engineering and Theoretical Computer Science, Electrical Engineering and Computer Science, Technical University of Berlin, Berlin, Germany
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Abstract
Orientation The coronavirus disease 2019 (COVID-19) pandemic led to fundamental changes in the workplace for many, particularly healthcare workers. Research purpose This study explored healthcare workers’ (ophthalmologists, nurses and support staff) experiences of anxiety, depression, burnout, resilience and coping strategies during lockdown Levels 2 and 3 in an Ophthalmic consulting practice and hospital in South Africa. Motivation for the study The increased workplace stress and vulnerability associated with working during the COVID-19 pandemic introduced an unprecedented level of risk for healthcare workers. Factors contributing to psychological distress must be identified and appropriately mitigated, to prevent dire human and economic costs. Research approach/design and method A survey was sent out at two separate times to a convenience sample of 31 and 15 healthcare workers respectively. The survey consisted of a demographics section, Hospital Anxiety and Depression Scale, Burnout Measure short-version, Brief Cope Inventory, Connor Davidson Resilience Inventory and six open-ended questions investigating personal health and support experiences during COVID-19. Descriptive analyses and thematic analysis were used for data analysis. Main findings The sample of healthcare workers experienced some degree of psychological distress, including anxiety, burnout and a lack of social support on both surveys. However, these symptoms were alleviated by personal factors, including positive coping mechanisms, high resilience and organisational support. Practical/managerial implications Healthcare facilities should consider in-house structures focusing on building resilience and positive coping mechanisms, whilst ensuring that workplace conditions are optimal for staff members. Contribution/value-add This study provides some insight into both the risk and protective factors experienced by health workers during the COVID-19 pandemic.
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Alarfaj MA, Foula MS, Alshammary S, Nwesar FA, Eldamati AM, Alomar A, Abdulmomen AA, Alarfaj L, Almulhim A, Alarfaj O, Zakaria HM. Impact of wearing personal protective equipment on the performance and decision making of surgeons during the COVID-19 pandemic: An observational cross-sectional study. Medicine (Baltimore) 2021; 100:e27240. [PMID: 34664867 PMCID: PMC8448053 DOI: 10.1097/md.0000000000027240] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/28/2021] [Indexed: 01/10/2023] Open
Abstract
During the coronavirus disease 2019 (COVID-19) pandemic, the mandatory use of personal protective equipment (PPE) has resulted in a significant reduction in the infection rate among health care workers (HCWs). However, there are some ongoing concerns about the negative impact of using PPE for prolonged periods.This study examined the impact of wearing PPE on surgeons' performance and decision making during the COVID-19 pandemic.In this cross-sectional study, an anonymous online questionnaire was created and disseminated to surgeons all over the Eastern Province of Saudi Arabia. The questionnaire included the demographic data, the local hospital policies, the non-technical skills (e.g., communication, vision, and comfort) and the technical skills, and the process of decision making.From June 2020 to August 2020, 162 surgeons participated in this questionnaire. Of them, 80.2% were aged from 26 to 45 years, 70.4% have received a special training for PPE, and 59.3% of participants have operated on COVID-19 confirmed cases. A negative impact of wearing PPE was reported on their overall comfort, vision, and communication skills (92.6%, 95.1%, and 82.8%, respectively). The technical skills and decision making were not significantly affected (60.5% and 72.8%, respectively). More preference for conservative approach, damage control procedures, and/or open approach was reported.Despite its benefits, PPE is associated with a significant negative impact on the non-technical skills (including vision, communication, and comfort) as well as a non-significant negative impact on technical skills and decision making of surgeons. Extra efforts should be directed to improve PPE, especially during lengthy pandemics.
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Affiliation(s)
- Mosab A. Alarfaj
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Mohammed S. Foula
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Shadi Alshammary
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Fayrouz A. Nwesar
- Department of Obstetrics and Gynaecology, Alexandria Maternity University Hospital, Alexandria, Egypt
| | - Ahmed M. Eldamati
- Department of Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Abdullah Alomar
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Abdulrahim A. Abdulmomen
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
| | - Leenah Alarfaj
- Department of Surgery, King Fahad Specialist Hospital, Dammam Saudi Arabia
| | - Abdulmohsen Almulhim
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Odai Alarfaj
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hazem M. Zakaria
- Department of Surgery, King Fahad University Hospital, Imam Abdulrahman Bin Faisal University, Al-Khobar, Saudi Arabia
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Abbas M, Ghazanfar A. The impact of coronavirus disease 2019 pandemic on working dynamics of junior and middle grade doctors in the United Kingdom: Learning from their experience requires immediate improvement in health care planning and management-An outcome analysis of a nationwide survey. SAGE Open Med 2021; 9:20503121211039081. [PMID: 34777803 PMCID: PMC8580500 DOI: 10.1177/20503121211039081] [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] [Received: 02/02/2021] [Accepted: 07/26/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic had an unprecedented impact on health services across the world resulting in increased demand of intensive care capacity, opening Nightingale hospitals, and mass movement of doctors across various specialities. This unplanned redeployment raised concerns among various health care workers. The objective of the current study is to explore working dynamics and experience of junior and middle grade doctors during current pandemic. METHODS We organised a nationwide cross-sectional survey of junior and middle grade doctors working in the United Kingdom. The survey was aimed to study their level of participation during coronavirus disease 2019 pandemic and its impact on their clinical practices and well-being. RESULTS In total, 1564 completed questionnaires with representations from all regions of the United Kingdom were included. The mean age of respondents was 30.64 years (95% confidence interval +1.025; standard deviation = 9.9057). There were 51.5% females with significantly more participants from Black, Asian, and minority ethnic group (n = 835, p = 0.0073); 963 (61.6%, p ⩽ 0.0001) doctors were redeployed outside their primary speciality. The major redeployments were from other specialities to Intensive Therapy Units (41.8%, p ⩽ 0.001); 63.3% of respondents spend more than 8 weeks in redeployed speciality (p ⩽ 0.0001). There was a significant impact of coronavirus disease 2019 on personal, mental, and physical well-being of doctors. The major areas requiring immediate attention include proper leadership and clinical support (64.1%), pre-redeployment planning and induction (48.5%), redeployment according to the skills and/or in familiar specialities (44.6%), and regular mental and physical well-being checks (37%). CONCLUSION The outcome of the survey concluded with four major recommendations, including the need to have a named supervisor for these doctors, structured induction program, regular well-being checks, and involving them in crisis planning. These recommendations will help to shape future health care policies and management particularly when it is related to redeployment of doctors during any crisis or pandemic.
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Affiliation(s)
- Madiha Abbas
- Department of Anaesthesia and Intensive Care Unit, Epsom and St Helier Hospitals NHS Trust, London, UK
| | - Abbas Ghazanfar
- Department of Renal and Transplant, St George’s University Hospitals NHS Foundation Trust, London, UK
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Danacioglu YO, Soytas M, Polat S, Ozdemir O, Arikan O, Yenice MG, Atis RG, Tasci AI. A nationwide survey on the impact of COVID-19 pandemic on minimal invasive surgery in urology practice. Int J Clin Pract 2021; 75:e14309. [PMID: 33932070 PMCID: PMC8236925 DOI: 10.1111/ijcp.14309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/27/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The beta-coronavirus (COVID-19) pandemic has changed the clinical approach of 93% of urologists worldwide, and this situation has affected the use of laparoscopic and robot-assisted laparoscopic methods, which are known as minimally invasive surgery (MIS). This study aimed to determine the effects of the COVID-19 pandemic on MIS in urology practice at national level. DESIGN, SETTING AND PARTICIPANTS A total of 234 urologists in Turkey participated in an online survey between August 22 and September 23, 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistical analyses were conducted to determine the participants' demographic characteristics and responses to multiple-choice questions. RESULTS While 54% of urologists stated that they were concerned about the possibility that the patients planned to undergo MIS were carrying COVID-19 or false-negative for the virus, 51% considered that open surgery was safer than MIS in this regard. The pandemic led to a difference in the preferences of 40% of the urologists in relation to open or MIS methods, and during the pandemic, 39% of the urologists always directed their patients to open surgery. It was determined that during the pandemic, there was a statistical decrease in the intensity and weekly application of MIS methods among all surgical procedures compared to the pre-pandemic (P < .001 and P < .001, respectively). MIS was preferred for oncological operations by 97.3% of the urologists during the pandemic, with the most performed operation being radical nephrectomy (90.7%). Among oncological operations, radical prostatectomy was most frequently postponed. To prevent virus transmission during MIS, 44% of the urologists reported that they always used an additional evacuation system and 52% took additional precautions. There were a total of 27 healthcare workers who took part in MIS and tested positive for COVID-19 after the operation. CONCLUSIONS Although the number of operations has decreased during the ongoing pandemic, MIS is a method that can be preferred due to its limited contamination and mortality in urology practice provided that safety measures are taken and guideline recommendations are followed.
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Affiliation(s)
- Yavuz Onur Danacioglu
- Department of UrologyBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
| | - Mustafa Soytas
- Faculty of MedicineDepartment of UrologyMedipol UniversityIstanbulTurkey
| | - Salih Polat
- Faculty of MedicineDepartment of UrologyAmasya UniversityAmasyaTurkey
| | - Osman Ozdemir
- Department of UrologyBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
| | - Ozgur Arikan
- Faculty of MedicineDepartment of UrologyMedipol UniversityIstanbulTurkey
| | - Mustafa Gurkan Yenice
- Department of UrologyBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
| | | | - Ali Ihsan Tasci
- Department of UrologyBakirkoy Dr. Sadi Konuk Training and Research HospitalIstanbulTurkey
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Kavanagh FG, Callanan D, Connolly C, Brinkman D, Fitzgerald C, Elsafty N, Thong G, Hintze J, Barry C, Kinsella J, Timon C, Lennon P, Dias A, O'Brien D, Sheahan P. Pre-operative testing for SARS-CoV-2 and outcomes in otolaryngology surgery during the pandemic: A multi-center experience. Laryngoscope Investig Otolaryngol 2021; 6:773-779. [PMID: 34401502 PMCID: PMC8356888 DOI: 10.1002/lio2.613] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/23/2021] [Accepted: 06/16/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Preoperative testing for COVID-19 has become widely established to avoid inadvertent surgery on patients with COVID-19 and prevent hospital outbreaks. METHODS A prospective cross sectional study was carried out in two university hospitals examining the pre-operative protocols for patients undergoing otolaryngology surgery and the incidence of COVID-19 within 30 days of surgery in patients and the otolaryngologists performing surgery. RESULTS One hundred and seventy-three patients were recruited. One hundred and twenty-three (71%) patients "cocooned" for 14 days prior to surgery. All completed a questionnaire prior to admission. One hundred and fifty-six patients (90%) had reverse transcriptase-polymerase chain reaction (RT-PCR) nasopharyngeal swabs, 14 patients (8%) had CT thorax. No cases of COVID-19 were detected among patients followed up at 30 days. Two surgeons developed COVID-19 early during the study period. CONCLUSION Current pre-operative testing protocols consisting primarily of questionnaires and RT-PCR resulted in zero cases of COVID in this cohort. It is possible that COVID-19 restrictions and high proportion of patients cocooning preoperatively were factors in ensuring a low rate of COVID-19 post-operatively.
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Affiliation(s)
- Fergal G. Kavanagh
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- Institute of Research, Royal College of Surgeons in IrelandDublin 2Ireland
| | - Deirdre Callanan
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- ENTO Research UnitCollege of Medicine and Health, University College CorkCorkIreland
| | - Carmel Connolly
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- ENTO Research UnitCollege of Medicine and Health, University College CorkCorkIreland
| | - David Brinkman
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- ENTO Research UnitCollege of Medicine and Health, University College CorkCorkIreland
| | - Conall Fitzgerald
- Department of Otolaryngology, Head and Neck SurgerySt James HospitalDublin 8Ireland
| | - Naisrin Elsafty
- Department of Otolaryngology, Head and Neck SurgeryRoyal Victoria Eye and Ear HospitalDublin 2Ireland
| | - Gerard Thong
- Department of Otolaryngology, Head and Neck SurgeryRoyal Victoria Eye and Ear HospitalDublin 2Ireland
| | - Justin Hintze
- Department of Otolaryngology, Head and Neck SurgeryRoyal Victoria Eye and Ear HospitalDublin 2Ireland
| | - Conor Barry
- Department of Maxillofacial SurgerySt James HospitalDublin 8Ireland
| | - John Kinsella
- Department of Otolaryngology, Head and Neck SurgerySt James HospitalDublin 8Ireland
| | - Conrad Timon
- Department of Otolaryngology, Head and Neck SurgeryRoyal Victoria Eye and Ear HospitalDublin 2Ireland
- Department of Otolaryngology, Head and Neck SurgerySt James HospitalDublin 8Ireland
| | - Paul Lennon
- Department of Otolaryngology, Head and Neck SurgeryRoyal Victoria Eye and Ear HospitalDublin 2Ireland
- Department of Otolaryngology, Head and Neck SurgerySt James HospitalDublin 8Ireland
| | - Andrew Dias
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- ENTO Research UnitCollege of Medicine and Health, University College CorkCorkIreland
- Department of SurgeryUniversity College CorkCorkIreland
| | - Deirdre O'Brien
- Department of MicrobiologySouth Infirmary Victoria University HospitalCorkIreland
| | - Patrick Sheahan
- Department of Otolaryngology, Head and Neck SurgerySouth Infirmary Victoria University HospitalCorkIreland
- ENTO Research UnitCollege of Medicine and Health, University College CorkCorkIreland
- Department of SurgeryUniversity College CorkCorkIreland
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Farsi S, Noaman N, Bukhary A, Bahaziq W, Sabbahi A, Abushoshah I, Boker A. Anaesthesia and Critical Care Department at a Major Academic Centre's Adaptation to Face the COVID-19 Pandemic. Int J Gen Med 2021; 14:3539-3552. [PMID: 34290525 PMCID: PMC8289458 DOI: 10.2147/ijgm.s318336] [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] [Received: 05/01/2021] [Accepted: 06/04/2021] [Indexed: 01/08/2023] Open
Abstract
The new novel coronavirus is having a major impact on healthcare systems internationally. Hospitals are struggling to manage the sudden influx of critical patients. Anaesthesiologists and critical care physicians are front liners in the fight against COVID-19 and carry the highest risk of getting infected. Due to the rapid response of the Saudi government to the WHO's early warning, we were fortunate at our hospital to see a slower rise in COVID-19 cases allowing us some time to prepare. We had to make room for the expected rise in highly infectious and critical patients, while at the same time protecting non-COVID-19 patients, staff and trainees. Additionally, the team continued to provide essential and specialized care to all patients in the hospital and maintain its academic and non-clinical services within the university. This review presents the different protocols, challenges and lessons learned during the development of a COVID-19 anaesthesia and critical care department plan in a major teaching hospital in Jeddah, Saudi Arabia. Our ultimate aim is to share our experience with other similar institutions.
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Affiliation(s)
- Sara Farsi
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nada Noaman
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Auhood Bukhary
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wadeeah Bahaziq
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Alaa Sabbahi
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ibrahim Abushoshah
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulaziz Boker
- Anesthesia and Critical Care Department, King Abdulaziz University Hospital, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Centre, King Abdulaziz University, Jeddah, Saudi Arabia
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Jan R, Uddin M, Ullah I, Bibi M, Nawaz S, Rehmani M, Meherali S. Developing COVID-19 emergency response centres in geographically challenged areas of Pakistan: A case study of the Aga Khan Development Network. Int J Health Plann Manage 2021; 36:1990-1997. [PMID: 34247416 PMCID: PMC8426727 DOI: 10.1002/hpm.3286] [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] [Received: 12/31/2020] [Revised: 06/22/2021] [Accepted: 07/01/2021] [Indexed: 11/11/2022] Open
Abstract
The inevitable COVID‐19 global pandemic has severely affected Pakistan’s fragile healthcare system. The system was already facing a significant burden of noncommunicable and other infectious diseases, and the pandemic further exacerbated the disease and the healthcare burden in Pakistan. In such a situation, people who live in geographically challenged areas with limited healthcare infrastructure and resources are more vulnerable to the impacts of a pandemic. The authors share the experience of the development of emergency response centres (ERCs) in the rural remote mountainous regions of Pakistan–Chitral, an initiative that the Government of Pakistan and Aga Khan Health Service Pakistan (AKHSP) implemented to manage the increasing rates of COVID‐19 cases in these areas. The authors outline the processes that need to be undertaken to develop such healthcare facilities in a short period of time and discusses the challenges of establishing and operating these centres and the lessons learnt during and after the development of these centres in the remote mountainous regions of Pakistan.
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Affiliation(s)
- Rafat Jan
- Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
| | | | | | | | | | - Mehnaz Rehmani
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Salima Meherali
- Department of Nursing, University of Alberta, Edmonton, Canada
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