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Ouyang H, Jiang H, Huang J, Liu Z. COVID-19 Pandemic Brings Challenges to the Management of Stroke-The Differences Between Stroke Cases Admitted to a Tertiary Hospital Before and During COVID-19 Pandemic in China. Risk Manag Healthc Policy 2023; 16:2893-2905. [PMID: 38155847 PMCID: PMC10752818 DOI: 10.2147/rmhp.s435094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023] Open
Abstract
Background An international public health emergency has resulted from the emergence of the new coronavirus-2. Both direct and indirect influences have been felt on the treatment of acute stroke. However, no conclusive link between COVID-19 and the alleged decline in admissions for stroke-related reasons has been established, and the findings of recent studies are contentious. Most of those researches are not made use of authentic data. Therefore, the goal of this study is to examine how the COVID-19 pandemic has affected hospital admissions for stroke patients, to provide a basis for managing stroke patients in hospitals during COVID-19 pandemic. Methods This retrospective study took place at the People's Hospital of Peking University in Beijing, China. For each patient, interventions such as the application of tissue plasminogen activator (tPA) were examined. We recorded each patient's outcomes. The stroke patients' hospital admissions were compared to the average of the prior year. As the time span of interest, we selected the epidemic period (January 2020 to December 2020). Results When compared to the previous year in the pre-COVID period, mean monthly stroke hospitalizations decreased during the pandemic by 54.42% (P<0.001); average lengths of stay (ALOS) increased; and non-emergency admissions decreased by 78.8% (P<0.001). The monthly volume of stroke patients exceeding the intravenous thrombolysis (IVT) window decreased by 25% and 59.73%, respectively (P <0.001). There was a 5.3% increase in the percentage of IVT or within IVT time window in male stroke patients (p=0.019; p=0.049). During COVID-19, the proportion of non-local patients among male stroke patients decreased by 10% compared with the previous year (p=0.006). Conclusion The COVID-19 epidemic has had a negative impact on stroke management in China, healthcare systems must work to assess and adapt to the new reality.
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Affiliation(s)
- Hui Ouyang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Hong Jiang
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Jin Huang
- Department of Emergency, Yiyang Central Hospital, Yiyang, Hunan, People’s Republic of China
| | - Zunjing Liu
- Department of Neuromedicine, Peking University People’s Hospital, Beijing, People’s Republic of China
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Banfield WH, Elghawy O, Dewanjee A, Brady WJ. Impact of COVID-19 on emergency department management of stroke and STEMI. A narrative review. Am J Emerg Med 2022; 57:91-97. [PMID: 35526406 PMCID: PMC9057561 DOI: 10.1016/j.ajem.2022.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 03/20/2022] [Accepted: 04/11/2022] [Indexed: 10/28/2022] Open
Abstract
The novel coronavirus of 2019 (COVID-19) has resulted in a global pandemic; COVID-19 has resulted in significant challenges in the delivery of healthcare, including emergency management of multiple diagnoses, such as stroke and ST-segment myocardial infarction (STEMI). The aim of this study was to identify the impacts of the COVID-19 pandemic on emergency department care of stroke and STEMI patients. In this study a review of the available literature was performed using pre-defined search terms, inclusion criteria, and exclusion criteria. Our analysis, using a narrative review format, indicates that there was not a significant change in time required for key interventions for stroke and STEMI emergent management, including imaging (door-to-CT), tPA administration (door-to-needle), angiographic reperfusion (door-to-puncture), and percutaneous coronary intervention (door-to-balloon). Potential future areas of investigation include how emergency department (ED) stroke and STEMI care has adapted in response to different COVID-19 variants and stages of the pandemic, as well as identifying strategies used by EDs that were successful in providing effective emergency care in the face of the pandemic.
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Affiliation(s)
- W H Banfield
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - O Elghawy
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - A Dewanjee
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - W J Brady
- Department of Emergency Medicine University of Virginia Health Systems, Charlottesville, VA, United States.
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Alanazi TNM, McKenna L, Buck M, Alharbi RJ. Reported effects of the COVID-19 pandemic on the psychological status of emergency healthcare workers: A scoping review. Australas Emerg Care 2021; 25:197-212. [PMID: 34802977 PMCID: PMC8585598 DOI: 10.1016/j.auec.2021.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/29/2021] [Accepted: 10/27/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND While literature on psychological consequences among frontline healthcare workers (HCWs) flourishes, understanding the psychological burden on this group is particularly crucial, as their exposure to COVID-19 makes them especially at high risk. We explored what is known about psychological effects of the COVID-19 pandemic on emergency HCWs. METHODS We used a scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. RESULTS The search identified 5432 articles, from which a total of 21 were included in the final review. Anxiety, burnout, depression, inadequate sleep, post-traumatic stress disorder (PTSD) symptoms, distress/stress and secondary trauma, were all reportedly experienced by emergency HCWs. Anxiety, burnout, depression and stress levels were higher among physicians and nurses compared to others. Post-traumatic stress disorder symptoms were higher among reserve medics, while Red Cross volunteers developed similar reactions of psychological stress and secondary trauma to other healthcare workers. Male HCWs reported more post-traumatic stress disorder symptoms than females, while stress was higher among females than male HCWs. CONCLUSIONS Emergency HCWs providing care during the COVID-19 pandemic are at risk from specific psychological impacts, including anxiety, burnout, depression, inadequate sleep, PTSD symptoms, psychological distress/stress and secondary trauma, and stress TWEETABLE ABSTRACT: Emergency healthcare workers are at direct risk of psychological impacts from the COVID-19 pandemic.
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Affiliation(s)
- Tariq Noman M Alanazi
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia; General Directorate of Health Affairs, The Northern Border Region, Ministry of Health, Ar'Ar 73311, Saudi Arabia.
| | - Lisa McKenna
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Miranda Buck
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia.
| | - Rayan Jafnan Alharbi
- School of Nursing & Midwifery, LaTrobe University, Kingsbury Drive, Bundoora, VIC 3086, Australia; Department of Emergency Medical Service, Jazan University, Jazan 45142, Saudi Arabia.
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4
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Welsh M, Chimowitz H, Nanavati JD, Huff NR, Isbell LM. A qualitative investigation of the impact of coronavirus disease 2019 (COVID-19) on emergency physicians' emotional experiences and coping strategies. J Am Coll Emerg Physicians Open 2021; 2:e12578. [PMID: 34746921 PMCID: PMC8549858 DOI: 10.1002/emp2.12578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY OBJECTIVE Throughout the coronavirus disease 2019 (COVID-19) pandemic, emergency physicians in the United States have faced unprecedented challenges, risks, and uncertainty while caring for patients in an already vulnerable healthcare system. As such, the pandemic has exacerbated high levels of negative emotions and burnout among emergency physicians, but little systematic qualitative work has documented these phenomena. The purpose of this qualitative investigation was to study emergency physicians' emotional experiences in response to COVID-19 and the coping strategies that they employed to navigate the pandemic. METHODS From September 2020 to February 2021, we conducted semistructured interviews with 26 emergency physicians recruited from 2 early COVID-19 epicenters: New York City and the Metro Boston region. Interviews, coding, and analyses were conducted using a grounded theory approach. RESULTS Emergency physicians reported heightened anxiety, empathy, sadness, frustration, and anger during the pandemic. Physicians frequently attributed feelings of anxiety to medical uncertainty around the COVID-19 virus, personal risk of contracting the virus and transmitting it to family members, the emergency environment, and resource availability. Emergency physicians also discussed the emotional effects of policies prohibiting patients' family members from entering the emergency department (ED), both on themselves and patients. Sources of physician anger and frustration included changing policies and rules, hospital leadership and administration, and pay cuts. Some physicians described an evolving, ongoing coping process in response to the pandemic, and most identified collective discussion and processing within the emergency medicine community as an effective coping strategy. CONCLUSIONS Our findings underscore the need to investigate the effects of physicians' pandemic-related emotional stress and burnout on patient care. Evidence-based interventions to support emergency physicians in coping with pandemic-related trauma are needed.
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Affiliation(s)
- Margaux Welsh
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Hannah Chimowitz
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Janvi D. Nanavati
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Nathan R. Huff
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
| | - Linda M. Isbell
- Department of Psychological and Brain SciencesUniversity of Massachusetts AmherstAmherstMassachusettsUSA
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Fiest KM, Parsons Leigh J, Krewulak KD, Plotnikoff KM, Kemp LG, Ng-Kamstra J, Stelfox HT. Experiences and management of physician psychological symptoms during infectious disease outbreaks: a rapid review. BMC Psychiatry 2021; 21:91. [PMID: 33568141 PMCID: PMC7875435 DOI: 10.1186/s12888-021-03090-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/02/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Prior to the COVID-19 pandemic, physicians experienced unprecedented levels of burnout. The uncertainty of the ongoing COVID-19 pandemic along with increased workload and difficult medical triage decisions may lead to a further decline in physician psychological health. METHODS We searched Medline, EMBASE, and PsycINFO for primary research from database inception (Medline [1946], EMBASE [1974], PsycINFO [1806]) to November 17, 2020. Titles and abstracts were screened by one of three reviewers and full-text article screening and data abstraction were conducted independently, and in duplicate, by three reviewers. RESULTS From 6223 unique citations, 480 articles were reviewed in full-text, with 193 studies (of 90,499 physicians) included in the final review. Studies reported on physician psychological symptoms and management during seven infectious disease outbreaks (severe acute respiratory syndrome [SARS], three strains of Influenza A virus [H1N1, H5N1, H7N9], Ebola, Middle East respiratory syndrome [MERS], and COVID-19) in 57 countries. Psychological symptoms of anxiety (14.3-92.3%), stress (11.9-93.7%), depression (17-80.5%), post-traumatic stress disorder (13.2-75.2%) and burnout (14.7-76%) were commonly reported among physicians, regardless of infectious disease outbreak or country. Younger, female (vs. male), single (vs. married), early career physicians, and those providing direct care to infected patients were associated with worse psychological symptoms. INTERPRETATION Physicians should be aware that psychological symptoms of anxiety, depression, fear and distress are common, manifest differently and self-management strategies to improve psychological well-being exist. Health systems should implement short and long-term psychological supports for physicians caring for patients with COVID-19.
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Affiliation(s)
- Kirsten M Fiest
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada.
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada.
| | - Jeanna Parsons Leigh
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
- School of Health Administration, Faculty of Health and Department of Critical Care Medicine, Faculty of Medicine, Dalhousie University, 5850 College Street, Halifax, Nova Scotia, B3H4R2, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Kara M Plotnikoff
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Laryssa G Kemp
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Joshua Ng-Kamstra
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary & Alberta Health Services, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, T2N4Z6, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, 3134 Hospital Drive NW, Calgary, Alberta, T2N4Z6, Canada
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