Challenges In Care Of Patients Research Articles

Forgotten frontline workers: Environmental health service employees' perspectives on working during the COVID-19 pandemic.

BackgroundEnvironmental Health Service employees (EVS) sanitize healthcare facilities and are critical to preventing infection, but are under‐resourced during the COVID‐19 pandemic and at risk of burnout.ObjectiveUnderstand demands on EVS’ work and strain on resources during COVID‐19.DesignQualitative descriptive study conducted in winter 2020–2021.SettingOne quaternary care academic medical center in Colorado.ParticipantsA convenience sample of 16 EVS out of 305 eligible at the medical center. Fifty percent identified as Black, 31% as Hispanic, 6% as Asian, and 6% as White (another 6% identified as mixed race). Sixty‐nine percent were female, and half were born in a country outside the United States.MeasuresSemistructured telephone interviews. Interviews were audio‐recorded and transcribed, and thematic analysis was used to identify key themes.ResultsFour themes illustrate EVS experiences with job strain and support during COVID‐19: (1) Needs for ongoing training/education, (2) Emotional challenges of patient care, (3) Resource/staffing barriers, and (4) Lack of recognition as frontline responders. Despite feeling unrecognized during the pandemic, EVS identified structural supports with potential to mitigate job strain, including opportunities for increased communication with interdisciplinary colleagues, intentional acknowledgment, and education for those who speak languages other than English. Strategies that can increase physical and emotional resources and reduce job demands have potential to combat EVS burnout.ConclusionsAs the surge of COVID‐19 cases continues to overwhelm healthcare facilities, healthcare systems and interdisciplinary colleagues can adopt policies and practices that ensure lower‐wage healthcare workers have access to resources, education, and emotional support.

Frequency of A2 Blood Group among A Blood Group

Background: Transfusion medicine is an important branch in the field of medicine and patient care. Prior knowledge and identification of subgroups of ABO blood group system is important in blood transfusion, inheritance pattern, genetics and disease susceptibility. Getting right donor in right time in right place is sometime a challenge in patient care. So proper blood typing is mandatory. Still now there is no data on frequency of rare A2 blood group in Bangladesh Armed Forces as well as in Bangladesh. Aim: To see the frequency of A2 blood group among ABO blood groups in Bangladesh Armed forces and Bangladesh. Materials and Methods: A total of 200 patients with blood group A irrespective of age and sex were included in this retrospective study and the study was carried out in the Department of Transfusion Medicine Armed Forces Institute of Pathology (AFIP), Dhaka Cantonment, Dhaka, Bangladesh from 01 June 2021 to 30 June 2021. Blood grouping was performed by slide method and Anti-A1 reagent is used to differentiate blood group A1 from blood group A2. Results: Among 200 A blood group individual 198 were typed as A1 (99%) and 02 were typed as A2 (01%). Among those two one had anti A1 antibody while other didn’t have. Conclusion: A2 is a rare subtype of A blood group. Care should be taken during routine ABO grouping especially in cases of discrepancies or mix-field or weak positive reactions in A blood group.

Postgraduate nursing students' experiences in providing frontline and backstage care during the Covid-19 pandemic: A qualitative study.

BackgroundSafety measures due to the Covid-19 pandemic necessitated universities to reorganise teaching to accommodate the students' needs, including nursing students who had been called back into clinical practice to support front-line nursing.PurposeTo describe the experiences of post-graduate students in nursing sciences (experienced in clinical nursing) during the Covid-19 pandemic.MethodThis qualitative descriptive study took place at a Swiss University delivering masters and doctoral programmes in nursing sciences. Participants were post-graduate students enrolled in masters and doctoral programmes. All current students were invited by email to participate in three focus groups, which were recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis.ResultsThirteen students participated, with a majority who had been called back into clinical practice. Four themes were identified: Challenges of caring for patients during the coronavirus pandemic, Challenges of being a student during the pandemic, Resilience amid the difficulties, and Recognition of the Clinical Nurse Specialist competencies.ConclusionsOur results showed that amid the challenges, post-graduate nursing students demonstrated high leadership skills, resilience, and a tremendous sense of professional duty, where patients' and families' best interest remained their main concerns. Educators and nurse administrators need to acknowledge the impact of the COVID-19 pandemic on post-graduate nurses, caught in the tension between their academic career aspirations and duty of care to patients, families, and the healthcare system.

Taking on the elephant in the room-postoperative atrial fibrillation: a clinical program management perspective

Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery, yet there is no consistent cardiothoracic professional society-based definition of new-onset POAF, nor a broadly accepted consensus on how to prevent or treat it. Importantly, there is an ever-growing body of evidence that new-onset POAF is associated with worse patient outcomes. Given the lack of evidence-based guidelines, detection and treatment of POAF, in addition to understanding how POAF is related to these worse outcomes, represents an unaddressed quality of care concern. In the United States, the annual cardiac surgical POAF patient costs are estimated at ~$1 billion. The entire US Medicare annual budget has been reported at ~$141.2 billion for all hospital-related care; thus, the administrative challenges uniquely posed by POAF have been exposed for the first time. Mapping future tactics, this Vessel Plus special atrial fibrillation publication, swings the pendulum from impromptu observations towards action. A new strategic framework is proposed to begin the tedious but necessary task of taking on this elephant in the room. With ideal collaboration between clinical providers, health care systems, professional societies and insurers, a five-step approach is proposed to overcome these POAF patient care challenges.

Frontline connect: Evaluating a virtual technology program to enhance patient and provider communication during COVID‐19

Since the beginning of the COVID-19 pandemic, many hospitals have reduced in-hospital visitation. In these situations, virtual communication tools have helped maintain interaction between parties. The Frontline Connect program was designed to address communication and patient care challenges by providing data-enabled devices to clinical staff in hospitals. This study aimed to identify areas of improvement for the Frontline Connect program by: (a) evaluating communication needs, user experience, and program satisfaction; and (b) identifying potential barriers to device access or use. We administered pre-implementation needs assessment, post-use, and exit surveys to healthcare staff at a pilot hospital site in Ontario. Recruitment was through email lists and site champions using convenience sampling. We descriptively analysed survey responses and compared the initial need statements to post-implementation use-cases identified by users. We received 139 needs assessments, 31 user experience assessments, and 47 exit survey responses. Most device use occurred in the emergency department and intensive care units and was facilitated by social workers, nurses, and physicians to connect patients, families, and care providers. Pre-implementation concerns were related to infection control, data security, and device privacy. In the exit survey, these were replaced by other concerns including Internet connectivity and time-intensiveness. Device utility and ease-of-use were rated 9.7/10 and 9.6/10 respectively in the user experience survey, though overall experience was rated 7.2/10 in the exit survey. Overall, respondents viewed the devices as useful and we agree with participants who suggested increased program promotion and training would likely improve adoption. We found that our virtual technology program for facilitating communication was positively perceived. Survey feedback indicates that a rapid rollout in response to urgent pandemic-related needs was feasible, though program logistics could be improved. The current work supports the need to improve, standardize, and sustain virtual communication programs in hospitals.

Clinical Practice Experiences Using a Professional Diabetes Management Ecosystem During COVID.

Challenges of patient care in diabetes were exacerbated by COVID, undermining the ability of patients to engage in-person with health care professionals (HCPs). To combat this, there has been accelerated adoption of telemedicine to support patient and provider connectivity. We collated survey information regarding telemedicine from 21 European clinical institutions. Health care professionals joined virtual meetings focusing on the OneTouch Reveal (OTR) ecosystem and its utility for conducting telemedicine. Selected HCPs provided clinical case studies to explain how the OTR ecosystem supported patient care. Remote consultations increased by nearly 50% in 21 European clinics during the pandemic (Belgium [24%], Iberia [65%], Germany [34%], Italy [54%]). In all, 52% of people with diabetes using OTR app to connect remotely with HCPs had type 1 diabetes and 48% had type 2 diabetes. Remote connection methods included telephone (60%), email (19%), video chat (10%), text only (3%), or a mix of these methods (8%). Health care professionals usually reviewed patient data during consultations (45%) rather than before consultations (25%). Fifty-five percent of HCPs indicated digital ecosystems like OTR ecosystem would become their standard of care for diabetes management. In-depth conversations with HCPs provided a deeper understanding of how a digital ecosystem integrated into clinical practice and population management. In addition, five patient case studies using OTR ecosystem were provided by a selection of our HCPs. Diabetes management solutions, such as OTR ecosystem, supported telemedicine during the pandemic and will continue to play a valuable role in patient care beyond the pandemic.

Preventing moral conflicts in patient care: Insights from a mixed-methods study with clinical experts

Background and aim Healthcare professionals are regularly exposed to moral challenges in patient care potentially compromising quality of care and safety of patients. Preventive clinical ethics support aims to identify and address moral problems in patient care at an early stage of their development. This study investigates the occurrence, risk factors, early indicators, decision parameters, consequences and preventive measures of moral problems. Method Semi-structured expert interviews were conducted with 20 interprofessional healthcare professionals from 2 university hospitals in Basel, Switzerland. A Likert scale questionnaire was completed by the interviewees and analysed using descriptive and inferential statistics. Results Healthcare professionals are frequently exposed to a variety of moral problems, such as end-of-life decisions, resource allocation and assessing the patient's will or decisional capacity. Thirty-four different risk factors for moral problems are identified, e.g. patient vulnerability, divergent values or world views, inadequate resources or poor ethical climate. Twenty-one early indicators are recognised such as disagreement between healthcare professionals, patients and relatives, emotional disturbances, gut feeling or conflict of conscience. A variety of preventive measures are suggested and presented in a preventive clinical ethics support process model. The most helpful measures are early ethical conversations with colleagues, early team-internal ethical case discussions and an ethics-trained contact person on the ward. Ethics training, kerbside consultations, proactive ethics consultations, ethics screening and rounds are also considered helpful. Conclusions Clinical ethics support services should not only offer reactive and complex, but also proactive and low-threshold support for healthcare professionals, patients and relatives.

Managing agitation secondary to hyperactive delirium in deteriorating patients.

Delirium is an under-recognised condition which adversely affects deteriorating patients. Delirium can be an acute or long-term condition and is associated with increased morbidity and mortality, and extended length of hospital stay. The management of delirium is often reactive rather than proactive, which can lead to the inappropriate use of chemical and physical restraint to control agitation secondary to hyperactive delirium. Caring for patients with delirium presents physical and emotional challenges for nurses, who are sometimes inclined to use restraint, which should be a last resort. This article describes the challenges of caring for patients with delirium, presents the risk factors for and assessment of delirium, and describes the management of agitation secondary to hyperactive delirium. Support and education for nurses caring for patients with delirium is essential to ensure optimal patient care and avoid staff burnout.

Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines

Breaking Barriers Amid the Pandemic: The Status of Telehealth in Southeast Asia and its Potential as a Mode of Healthcare Delivery in the Philippines

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Extracorporeal Membrane Oxygenation: Opportunities for Expanding Nurses' Roles.

Innovative radiation oncology Together\xa0\u2013 Precise,\xa0Personalized,\xa0Human

PurposeScientific and clinical achievements in radiation, medical, and surgical oncology are changing the landscape of interdisciplinary oncology. The German Society for Radiation Oncology (DEGRO) working group of young clinicians and scientists (yDEGRO) and the DEGRO representation of associate and full professors (AKRO) are aware of the essential role of radiation oncology in multidisciplinary treatment approaches. Together, yDEGRO and AKRO endorsed developing a German radiotherapy & radiation oncology vision 2030 to address future challenges in patient care, research, and education. The vision 2030 aims to identify priorities and goals for the next decade in the field of radiation oncology.MethodsThe vision development comprised three phases. During the first phase, areas of interest, objectives, and the process of vision development were defined jointly by the yDEGRO, AKRO, and the DEGRO board. In the second phase, a one-day strategy retreat was held to develop AKRO and yDEGRO representatives’ final vision from medicine, biology, and physics. The third phase was dedicated to vision interpretation and program development by yDEGRO representatives.ResultsThe strategy retreat’s development process resulted in conception of the final vision “Innovative radiation oncology Together – Precise, Personalized, Human.” The first term “Innovative radiation oncology” comprises the promotion of preclinical research and clinical trials and highlights the development of a national committee for strategic development in radiation oncology research. The term “together” underpins collaborations within radiation oncology departments as well as with other partners in the clinical and scientific setting. “Precise” mainly covers technological precision in radiotherapy as well as targeted oncologic therapeutics. “Personalized” emphasizes biology-directed individualization of radiation treatment. Finally, “Human” underlines the patient-centered approach and points towards the need for individual longer-term career curricula for clinicians and researchers in the field.ConclusionThe vision 2030 balances the ambition of physical, technological, and biological innovation as well as a comprehensive, patient-centered, and collaborative approach towards radiotherapy & radiation oncology in Germany.

Latest developments in glaucoma

Glaucoma is a leading cause of irreversible blindness in the world affecting 12.5% of blind population. In addition to that, it is the cause of morbidity for 64.3 million of people among 40-80 years of age. World statistical predictions estimate it to be 118 million in 2040. Unpublished data in Sri Lanka reveals 6-9% of prevalence among people over 40 years with more predilections to Northern Province.Glaucoma is a disease of optic nerve head with progressive ganglion cell loss resulting in loss of neuro-retinal rim and retinal nerve fiber layer. It is characterized by structural changes in optic nerve head and retinal nerve fiber layer and functional loss depicted as visual field loss.Asymptomatic nature of the disease causes a delay in diagnosis. On the other hand, the early diagnosis and treatment will minimize the physical, psychological and social impact of the illness. The diagnosis of glaucoma is a complicated and expensive effort that is heavily dependent on the experience and expertise of a clinician. Therefore, the awareness on latest discoveries on pathophysiology, diagnostic evaluations and therapeutic interventions in the field of glaucoma will help to face the challenges in patient care.

Teleoncology: Assessing online communication skills of millennial medical students.

e13616 Background: COVID-19 posed new challenges in patient care and led to an increase in teleoncology. This paper analyzes telemedicine communication skills of millennial medical students of the postgraduate program of Clinical Oncology at Universidad del Salvador, Buenos Aires. Methods: Student assessment was based on a video call interaction with simulated patients in two stations (30 minutes each) of the Virtual Observational Standard Clinical Examination (V-OSCE), implemented in November 2020. Students received virtual communication guidelines and participated in training sessions to use the video call platform. All interactions were recorded. Assessment items (Table). Results: A total of 25 students were evaluated: 1 (4%) was ineligible due to network connection issues; 24 (96%) participated in both interactions. We analyzed 48 interactions in total. Opening: 6/48 interactions completed all five required items. Most recurring problems: not checking for patient’s previous experience with teleoncology (37/48) and not providing an alternative communication channel in case of technical difficulties (40/48). Middle: the results were similar to in-person interaction observed in previous exams, 35/48 interactions completed all required items. End: 16/48 interactions completed both items. In 32/48 the student did not check for patient understanding of the information provided. Only 3/48 interactions completed all 12 items. Conclusions: A) The V-OSCE is a useful tool to practice and evaluate teleoncology communication skills. B) The Middle Moment of the interactions was similar to an in-person interaction. However, the Opening and End of the interview were more challenging. The most critical struggles being: checking for patient’s previous experience in teleoncology, providing an alternative communication channel in case of technical difficulties and checking for patient understanding. C) COVID-19 established new forms of communication that are likely to remain even after the pandemic has ended. It is important to address this demand for online communication skills in medical education curricula.[Table: see text]

Child Protective Services Referral in a Cleft Lip and/or Palate Population: Assessment of Prevalence, Indications, and Outcomes.

To determine the prevalence of, reasons for, and outcomes related to Child Protective Services (CPS) referral in an isolated and syndromic cleft lip/palate population. Retrospective cohort study. Tertiary Children's Hospital. Any patient <18 years of age attending the multidisciplinary cleft team for care at our institution with a history of referral to CPS by the cleft team during the study period 2009 to 2014. The number of children with CPS referrals, reasons for CPS referrals, outcomes of CPS referrals, associated psychosocial risk factors potentially predictive of CPS referral; demographics and cleft-related surgical history was also reviewed for each patient. Of 1392 patients, 25 (1.8%) were identified with a history of referral to CPS. Average age at referral was 11 months; 76.0% of patients were <1 year of age. Most referrals (64.0%) were directly associated with issues related to cleft care. Identified psychosocial risk factors included financial strain, mental illness/cognitive disability, transportation issues, and inadequate social support. Nine families ultimately lost custody of their children temporarily (n = 5) or permanently (n = 4). Cleft team family referral to CPS involves long-term patient care challenges requiring maximal medical and social support. Families are most commonly referred for issues related to medical neglect, which can lead to failure to thrive, delays in care, and ultimate removal from the home. Identifying families with known psychosocial risk factors and providing increased support may potentially help avoid referrals to CPS.

Psychiatry Has Opened Its Eyes and Seen Our Environmental Issues

Psychiatry Has Opened Its Eyes and Seen Our Environmental Issues

Paediatric primary care in Germany during the early COVID-19 pandemic: the calm before the storm

ObjectivesGlobally, the COVID-19 pandemic has a major impact on healthcare provision. The effects in primary care are understudied. This study aimed to explore changes in consultation numbers and patient management...

Oculoplastic Surgeons’ Surgical, Clinical, and Management Experiences During the COVID-19 Crisis

During the COVID-19 crisis, the American Society of Ophthalmic Plastic and Reconstructive Surgeons (ASOPRS) recommended cessation of all nonurgent oculofacial services, imparting unprecedented challenges in patient care and practice management. An anonymous survey was performed to assess surgeons’ surgical, clinical, and financial experiences during the COVID-19 restrictions. Results were collected from April 20 to May 1, 2020 and analyzed. A total 112 ASOPRS members participated. A significant majority (81.52%) performed surgeries during the COVID-19 restrictions. Fourteen percent did not allow trainee participation. While operating, 34.41% always wore an N-95 mask. Preoperative patient COVID-19 testing was mandated in 37.21% of practices. Fewer than half of surgeons were required to leave the operating room during intubation. A large majority (88.76%) of ASOPRS members used telemedicine, with most finding the virtual platform to function moderately well (62.92%) for oculofacial evaluations. Senior ASOPRS members were less interested in continuing virtual patient encounters in the future ( P = .0130). Nearly all private practice surgeons (95.38%) had applied for federal funding and 83.51% expressed concern about the long-term financial well-being of their practice. ASOPRS surgeons have provided emergency oculofacial patient care during COVID-19, though often without proper safety precautions. New virtual patient evaluation platforms and financial practice hardships have posed additional challenges.

Rapid implementation of Inpatient eConsult Programme addresses new challenges for patient care during COVID-19 pandemic

IntroductionAt the early epicentre of the COVID-19 crisis in the USA, our institution saw a surge in the demand for inpatient consultations for areas impacted by COVID-19 (eg, infectious diseases,...

The impact of COVID-19 on obstetrics and gynaecology trainees; how do we move on?

Obstetrics and Gynaecology (O&G) is an evolving specialty that encompasses women's health at its core. The COVID-19 pandemic has caused significant patient care challenges, however simultaneously it has resulted in the interruption of clinical training and cessation of all elective work. Our primary aim was to assess the impact of the pandemic on the experiences of O&G trainees. An email invite was sent to all 127 O&G trainees in Kent, Surrey and Sussex (KSS), inviting them to participate in an anonymous 33-question survey. The survey data was collected and analysed over a 4-week period. Of the 127 trainees sent the survey, 87 responded (69%). 39% and 75% of trainees agreed that the pandemic had a negative impact on their overall physical and mental wellbeing respectively. 43% agreed that the COVID-19 pandemic had adversely affected their obstetric training experience whilst almost all trainees stated a significant negative impact on benign gynaecology surgical training. Reassuringly, over 80% were positive they would recover from the negative impacts of COVID-19. It is evident that COVID-19 has impacted O&G trainees in several ways. Whilst we face uncertain times, we must firstly ensure the physical and mental well-being of all trainees. It is encouraging that non-emergency consultations and benign surgery are being restarted nationwide and whilst this will inevitably help with re-booting surgical training, we must also think "outside" the box and utilise other modes of teaching and training to safeguard learning whilst mitigating against the negative impacts of subsequent waves.

Physical human–robot interaction for clinical care in infectious environments

The COVID-19 pandemic has highlighted key challenges for patient care and health provider safety. Adaptable robotic systems, with enhanced sensing, manipulation and autonomy capabilities could help address these challenges in future infectious disease outbreaks.