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Cernega A, Nicolescu DN, Meleșcanu Imre M, Ripszky Totan A, Arsene AL, Șerban RS, Perpelea AC, Nedea MI(I, Pițuru SM. Volatility, Uncertainty, Complexity, and Ambiguity (VUCA) in Healthcare. Healthcare (Basel) 2024; 12:773. [PMID: 38610195 PMCID: PMC11011466 DOI: 10.3390/healthcare12070773] [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: 02/29/2024] [Revised: 03/26/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
Our professional activity is constantly under pressure from a multitude of elements and factors that can be classified into the four components of the VUCA phenomenon-volatility, uncertainty, complexity, and ambiguity-components that define the turbulence and challenges of the external environment. Considering the general elements of this phenomenon, we designed a new VUCA dimension specific to the healthcare field within which we have identified and analyzed all the factors that can influence the main actors of the doctor-patient relationship and the effects that can occur within the healthcare system in which this relationship is born. In this context, we generated the VUCA treatment in healthcare capable of mitigating the impact of this phenomenon; this treatment involves essential elements in overcoming possible crises and vulnerabilities of the medical profession. The VUCA treatment in healthcare requires combating volatility, uncertainty, complexity, and ambiguity through vision, understanding, clarity, and agility, which are grounded in the doctor's need to acquire cross-functional competencies (soft skills). These competencies are applicable by using functional mechanisms and techniques that support the doctor in developing adaptability and anticipation skills, understanding the patient's needs and addressing them, and ensuring the functionality and efficiency of the healthcare system by transferring these elements from micro-management to macro-management levels.
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Affiliation(s)
- Ana Cernega
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Dragoș Nicolae Nicolescu
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina Meleșcanu Imre
- Department of Prosthodontics, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Calea Plevnei, 010221 Bucharest, Romania;
| | - Alexandra Ripszky Totan
- Department of Biochemistry, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania;
| | - Andreea Letiția Arsene
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Robert Sabiniu Șerban
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Anca-Cristina Perpelea
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
| | - Marina-Ionela (Ilie) Nedea
- Departament of General and Pharmaceutical Microbiology, Faculty of Pharmacy, “Carol Davila” University of Medicine and Pharmacy, 6 Traian Vuia Street, 020956 Bucharest, Romania; (A.L.A.); (M.-I.N.)
| | - Silviu-Mirel Pițuru
- Department of Organization, Professional Legislation and Management of the Dental Office, Faculty of Dental Medicine, “Carol Davila” University of Medicine and Pharmacy, 17-23 Plevnei Street, 020021 Bucharest, Romania; (R.S.Ș.); (A.-C.P.); (S.-M.P.)
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Thielmann B, Meyer F, Böckelmann I. [Against the mental stress-Resilient work in surgery]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:135-147. [PMID: 37987763 PMCID: PMC10834595 DOI: 10.1007/s00104-023-01977-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Surgery represents a challenging medical discipline. AIM This article focuses on psychological stress in surgery and explains resilience as a protective factor against the consequences of psychological stress, based on selected literature references and own relevant clinical experiences. In this context, the sense of coherence, social support and self-efficacy expectation are discussed in more detail as resilience factors. METHOD Narrative review. RESULTS (CORNER POINTS) Surgery is classified as a challenging medical subspecialty with a high reputation but associated with diverse and varied physical and psychological stress factors. Stress factors differ individually in terms of requirements (can be overdemanding or underdemanding but also stimulating, relevant to learning and meaningful, thus positively or negatively stressful) and resources (potentially beneficial working conditions, experience, or behavior, e.g., social support, scope for action). Fluctuations within surgical specialties and a high dropout rate during residency training are well known and the causes include high psychological stress. In the case of persistent and at the same time insufficient compensation of work stress caused by a lack of or insufficient resources, these can be associated with mental illnesses. Nonetheless, many physicians spend their entire lives working in hospital or private surgical settings and remain healthy, a strong sense of resilience to mental illness may be fundamental to this. Resilience can be present as a personal characteristic or it can be learnt through a process or adapted through positive or negative influences, thus strengthening the personal characteristics. Overall, data on surgeon resilience or interventional studies in resilience research in the surgical setting are limited and provide another research gap. Resilience training (directed at a sense of coherence, social support, strengthening knowledge of coping skills, positive emotions, optimism, hope, self-efficacy expectations, control beliefs or robustness), also clearly indicated in the "robust" medical specialty of surgery, is always individual and should not be generalized. If the surgeon cannot retrieve sufficient resources due to the stressful situation, stress management with its methods is helpful to reduce the psychological stress and to be able to maintain the performance and health of this person. CONCLUSION The consolidation of resilience as a notable aspect of employee management. In collegial interactions, resilience must be based on workplace-based approaches to strengthen coping mechanisms in the face of work stress. Workplace-related stress should also be perceived, addressed and counteracted within the organization, certainly also as an elementary management task.
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Affiliation(s)
- Beatrice Thielmann
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - Frank Meyer
- Universitätsklinik für Allgemein-, Viszeral-, Gefäß- und Transplantationschirurgie, Otto-von-Guericke-Universität Magdeburg mit Universitätsklinikum Magdeburg A. ö. R., Magdeburg, Deutschland.
| | - Irina Böckelmann
- Bereich Arbeitsmedizin, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
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Adami T, Ries M. The scientific chaos phase of the great pandemic: A longitudinal analysis and systematic review of the first surge of clinical research concerning COVID-19. PLoS One 2023; 18:e0289193. [PMID: 38033112 PMCID: PMC10688862 DOI: 10.1371/journal.pone.0289193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Early stages of catastrophes like COVID-19 are often led by chaos and panic. To characterize the initial chaos phase of clinical research in such situations, we analyzed the first surge of more than 1000 clinical trials about the new disease at baseline and after two years follow-up. Our 3 main objectives were: (1) Assessment of spatial and temporal evolution of clinical research of COVID-19 across the globe, (2) Assessment of transparency and quality-trial registration, (3) Assessment of research waste and redundancies. METHODS By entering the keyword "COVID-19" we screened the International Clinical Trials Registry Platform of the WHO and downloaded the search output when our goal of 1000 trials was reached on the 1st of April 2020. Additionally, we verified the integrity of the downloaded data from the meta registry by comparing the data with each individual registration record on their source register. Also, we conducted a follow-up after two years to track their progress. RESULTS (1) The spatial evolution followed the geographical spread of the disease as expected, however, the temporal development suggested that panic was the main driver for clinical research activities. (2) Trial registrations and registers showed a huge lack of transparency by allowing retrospective registrations and not keeping their registration records up to date. Quality of trial registration seems to have improved over the last decade, yet crucial information still was missing. (3) Research waste and redundancies were present as suggested by discontinuation of trials, preventable flaws in study design, and similar but uncoordinated research topics operationally fragmented in isolated silo-structures. CONCLUSION The scientific response mechanism across the globe was intact during the chaos phase. However, supervision, leadership, and accountability are urgently needed to prevent research waste, to ensure effective structure, quality, and validity to ultimately break the "panic-then-forget" cycle in future catastrophes.
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Affiliation(s)
- Till Adami
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Heidelberg University, Heidelberg, Germany
- Thoracic Oncology, Thoraxklinik Heidelberg, University Hospital Heidelberg, Heidelberg, Germany
| | - Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, Faculty of Medicine, Heidelberg University, Heidelberg, Germany
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Thielmann B, Schwarze R, Böckelmann I. A Systematic Review of Associations and Predictors for Job Satisfaction and Work Engagement in Prehospital Emergency Medical Services-Challenges for the Future. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4578. [PMID: 36901586 PMCID: PMC10002026 DOI: 10.3390/ijerph20054578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/22/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
Ambulance services are changing, and the SARS-CoV-2 pandemic has been a major challenge in the past three years. Job satisfaction and work engagement are important characteristics for a healthy organization and success in one's profession. The purpose of the current systematic review was to evaluate the predictors of job satisfaction and work engagement in prehospital emergency medical service personnel. Electronic databases, such as PubMed, Ovid Medline, Cochrane Library, Scopus, Web of Science, PsycINFO, PSYNDEX, and Embase, were utilized in this review. Predictors (ß coefficient, odds ratio, rho) of higher job satisfaction and work engagement were examined. Only prehospital emergency medical service personnel were considered. The review included 10 studies worldwide with 8358 prehospital emergency medical service personnel (24.9% female). The main predictor for job satisfaction was supervisors' support. Other predictors were younger or middle age and work experience. Emotional exhaustion and depersonalization, as burnout dimensions, were negative predictors for higher job satisfaction or work engagement. Quality demands for health care systems are a significant challenge for future emergency medical services. The psychological and physical strengthening of employees is necessary and includes constant supervision of managers or facilitators.
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Lee JM, Jansen R, Sanderson KE, Guerra F, Keller-Olaman S, Murti M, O'Sullivan TL, Law MP, Schwartz B, Bourns LE, Khan Y. Public health emergency preparedness for infectious disease emergencies: a scoping review of recent evidence. BMC Public Health 2023; 23:420. [PMID: 36864415 PMCID: PMC9979131 DOI: 10.1186/s12889-023-15313-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/23/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic continues to demonstrate the risks and profound health impacts that result from infectious disease emergencies. Emergency preparedness has been defined as the knowledge, capacity and organizational systems that governments, response and recovery organizations, communities and individuals develop to anticipate, respond to, or recover from emergencies. This scoping review explored recent literature on priority areas and indicators for public health emergency preparedness (PHEP) with a focus on infectious disease emergencies. METHODS Using scoping review methodology, a comprehensive search was conducted for indexed and grey literature with a focus on records published from 2017 to 2020 onward, respectively. Records were included if they: (a) described PHEP, (b) focused on an infectious emergency, and (c) were published in an Organization for Economic Co-operation and Development country. An evidence-based all-hazards Resilience Framework for PHEP consisting of 11 elements was used as a reference point to identify additional areas of preparedness that have emerged in recent publications. The findings were analyzed deductively and summarized thematically. RESULTS The included publications largely aligned with the 11 elements of the all-hazards Resilience Framework for PHEP. In particular, the elements related to collaborative networks, community engagement, risk analysis and communication were frequently observed across the publications included in this review. Ten emergent themes were identified that expand on the Resilience Framework for PHEP specific to infectious diseases. Planning to mitigate inequities was a key finding of this review, it was the most frequently identified emergent theme. Additional emergent themes were: research and evidence-informed decision making, building vaccination capacity, building laboratory and diagnostic system capacity, building infection prevention and control capacity, financial investment in infrastructure, health system capacity, climate and environmental health, public health legislation and phases of preparedness. CONCLUSION The themes from this review contribute to the evolving understanding of critical public health emergency preparedness actions. The themes expand on the 11 elements outlined in the Resilience Framework for PHEP, specifically relevant to pandemics and infectious disease emergencies. Further research will be important to validate these findings, and expand understanding of how refinements to PHEP frameworks and indicators can support public health practice.
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Affiliation(s)
- Jessica M Lee
- Public Health Ontario, 480 University Avenue, Suite 300, M5G 1V2, Toronto, ON, Canada
| | - Rachel Jansen
- Public Health Ontario, 480 University Avenue, Suite 300, M5G 1V2, Toronto, ON, Canada
| | - Kate E Sanderson
- Public Health Ontario, 480 University Avenue, Suite 300, M5G 1V2, Toronto, ON, Canada
| | - Fiona Guerra
- Public Health Ontario, 661 University Avenue, Suite 1701, M5G 1M1, Toronto, ON, Canada
| | - Sue Keller-Olaman
- Public Health Ontario, 480 University Avenue, Suite 300, M5G 1V2, Toronto, ON, Canada
| | - Michelle Murti
- Office of the Chief Medical Officer of Health, Government of Ontario, 393 University Avenue, Suite 2100, M5G 2M2, Toronto, ON, Canada
| | | | - Madelyn P Law
- Brock University, 1812 Sir Isaac Brock Way, L2S 3A1, St. Catharines, ON, Canada
| | - Brian Schwartz
- Public Health Ontario, 661 University Avenue, Suite 1701, M5G 1M1, Toronto, ON, Canada
| | - Laura E Bourns
- Public Health Ontario, 661 University Avenue, Suite 1701, M5G 1M1, Toronto, ON, Canada
| | - Yasmin Khan
- Public Health Ontario, 480 University Avenue, Suite 300, M5G 1V2, Toronto, ON, Canada.
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Ries M. Global key concepts of civil-military cooperation for disaster management in the COVID-19 pandemic-A qualitative phenomenological scoping review. Front Public Health 2022; 10:975667. [PMID: 36187698 PMCID: PMC9521329 DOI: 10.3389/fpubh.2022.975667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/15/2022] [Indexed: 01/25/2023] Open
Abstract
Background In the context of a holistic and comprehensive disaster response effort to the COVID-19 pandemic, many countries across the globe mobilized their military forces in order to cope with sudden and exponential surges of critically ill patients with COVID-19 in stretched healthcare systems. Objective The purpose of this work is to identify, map, and render world-wide key concepts of civil-military cooperation (CIMIC) in disaster management during the COVID-19 crisis visible. Material and methods Literature was systematically searched in three databases (PubMed, Web of Science, Cochrane Library) on 26 January 2022, and analyzed with qualitative, mixed narrative-phenomenological methods in compliance with PRISM-ScR and SRQR. Results Forty-five publications were included in the analysis; pertinent authors were from 22 countries covering five continents. We identified three key thematic clusters in the published literature: Cluster (1) Medico-scientific contributions with the participation of military medical personnel or institutions: members of the military acted as subject matter experts, clinical and experimental (co-) investigators as well as co-founders for enabling COVID-19 relevant research. Areas covered were relevant to the COVID-19 patient's clinical journey from prevention, exposure, diagnostics, and treatment and included pertinent fields such as digital health and telemedicine, global and public health, critical care, emergency and disaster medicine, radiology, neurology, as well as other medical specialties, i.e., respiratory care, pulmonology, burn medicine, and transfusion medicine, in addition to environmental and occupational sciences as well as materials science. Cluster (2) CIMIC field experiences or analyses included areas such as political framework, strategy, structure, nature of civil-military interaction, and concrete mission reports in selected countries. Themes covered a broad spectrum of pandemic disaster management subjects such as capacity and surge capacity building, medical and pharmaceutical logistics, patient care under austere circumstances, SARS-CoV-2 testing support, intelligent and innovative information management, vaccination support, and disaster communication. Cluster (3) The military as a role model for crisis management. Conclusion Civil-military cooperation made a significant contribution to the level of resilience in crisis management on a global scale, positively impacting a broad spectrum of core abilities during the COVID-19 pandemic.
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Affiliation(s)
- Markus Ries
- Pediatric Neurology and Metabolic Medicine, Center for Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Center for Virtual Patients, Medical Faculty, University of Heidelberg, Heidelberg, Germany
- CIMIC District Liaison Command Heidelberg, 3rd Medical Regiment, German Federal Armed Forces, Dornstadt, Germany
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Haier J, Mayer M, Schaefers J, Geyer S, Feldner D. A pyramid model to describe changing decision making under high uncertainty during the COVID-19 pandemic. BMJ Glob Health 2022; 7:bmjgh-2022-008854. [PMID: 35940628 PMCID: PMC9364040 DOI: 10.1136/bmjgh-2022-008854] [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: 04/19/2022] [Accepted: 07/18/2022] [Indexed: 11/15/2022] Open
Abstract
The COVID-19 pandemic put healthcare systems, hospitals and medical personal under great pressure. Based on observations in Germany, we theorise a general model of rapid decision-making that makes sense of the growing complexity, risks and impact of missing evidence. While adapting decision-making algorithms, management, physicians, nurses and other healthcare professionals had to move into uncharted territory while addressing practical challenges and resolving normative (legal and ethical) conflicts. During the pandemic, this resulted in decisional uncertainties for healthcare professionals. We propose an idealised risk-based model that anticipates these shifts in decision-making procedures and underlying value frameworks. The double pyramid model visualises foreseeable procedural adaptations. This does not only help practitioners to secure operational continuity in a crisis but also contributes to improving the conceptual underpinnings of the resilience of healthcare during the next pandemic or similar future crises situations.
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Affiliation(s)
- Joerg Haier
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Maximilian Mayer
- Center for Advanced Security, Strategic and Integration Studies, University of Bonn, Bonn, Germany
| | - Juergen Schaefers
- Comprehensive Cancer Center Hannover, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Institute for Sociology, Hannover Medical School, Hannover, Germany
| | - Denise Feldner
- Bridgehead Advisors, Strategic Advisory Think Tank, Berlin, Germany
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Ramazanu S, Bautista C, Green T, Rhudy LM, Rogado MIC, Baby P, Woon C, Martinez RCKP, von Gaudecker JR, Nydahl P, Mbakaya BC, Said NB, Hayek MF, Sila F, Rahn AC, Minagawa T, Olson DM. Challenges and Opportunities in Stroke Nursing Research: Global Views From a Panel of Nurse Researchers. J Neurosci Nurs 2022; 54:111-115. [PMID: 35532329 DOI: 10.1097/jnn.0000000000000643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT INTRODUCTION: A diverse group of neuroscience nurse experts discussed stroke nursing research at the 5th International Neuroscience Nursing Research Symposium. Panel experts from Singapore, India, Australia, New Zealand, the Philippines, Malawi, Germany, Palestine, Kenya, Japan, and the United States collaborated to examine similarities and differences in nurse-led stroke research conducted in their home countries. This article reflects panel insights on challenges and opportunities for nurse-led stroke research. DISCUSSION: The research challenges discussed include nursing independence, the processes of informed consent and randomization process, obtaining adequate independent funding, recruiting research subjects, and working with vulnerable groups. The major opportunities to leverage and improve stroke nursing research include facilitating the nurse investigator role, information digitalization, improving health literacy, and collaboration between nurse researchers. SUMMARY: We are living in a volatile, uncertain, complex, and ambiguous world, and the COVID-19 pandemic has accentuated many challenges. There is a need to allow for creativity around recruitment and conducting stroke research. The use of technology reduces travel needs and mitigates many safety, financial, and transportation-related problems. Although the pandemic has highlighted the challenges faced when conducting stroke-related research, there are remarkable similarities in opportunities to improve outcomes.
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The COVID-19 Infodemic: Mechanism, Impact, and Counter-Measures—A Review of Reviews. SUSTAINABILITY 2022. [DOI: 10.3390/su14052605] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The acceptability of appropriate SARS-CoV-2 pandemic measures including vaccinations is currently being hampered due to significant misinformation all over the globe, also known as the “infodemic” within the pandemic. We asked the following two research questions: (1) What is the current extent of the global infodemic preventing populations from receiving adequate healthcare including COVID-vaccinations? (2) Which are appropriate countermeasures to manage the infodemic in order to guarantee adequate healthcare in the SARS-CoV-2 pandemic? Pubmed and Cochrane Library were accessed on 29 October 2021 and searched for reviews and systematic reviews on “COVID-19” and “infodemic”. The literature identified was analyzed with methods of qualitative research focusing on (1) mechanism, (2) impact, and (3) countermeasures to confront the infodemic. The world-wide infodemic is being recognized as a multifaceted problem beyond health and human rights, extending into global political spheres such as societal cohesion and security. The mechanism of the COVID-19 infodemic involves specific factors related to the situation, sender, instrument, and recipient. Although freedom of expression and the right to seek, receive, and impart information through any media is a fundamental human right, the infodemic has a substantial impact on health, another fundamental human right, by causing stress, deception, violence, and harm. Mixed-synergistic pre-impact, trans-impact, and post-impact countermeasures can be taken; the most important is building and maintaining trust.
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