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Ibrahim BE, El-Amin RO, Abdulla STA. Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit. Open Access Emerg Med 2023; 15:373-382. [PMID: 37872979 PMCID: PMC10590591 DOI: 10.2147/oaem.s433240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023] Open
Abstract
Background The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan. Methods A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators. Results Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau. Conclusion The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.
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Affiliation(s)
- Bayan E Ibrahim
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Shin S, Yoo HJ. Emergency nurses' communication experiences with patients and their families during the COVID-19 pandemic: A qualitative study. Int Emerg Nurs 2023; 66:101240. [PMID: 36584657 DOI: 10.1016/j.ienj.2022.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/22/2022] [Accepted: 11/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the emergency department, essential information is verified primarily through communication with patients and families. Thus, an in-depth understanding of emergency nurses' communication experiences with patients is required to facilitate the provision of effective therapeutic care. OBJECTIVE To analyze emergency nurses' communication experiences with patients and their families. METHODS A qualitative descriptive design was used. Interviews were conducted with 15 nurses between 2021 and 2022. Thematic analysis was carried out. This study was conducted in accordance with the consolidated criteria for reporting qualitative studies (COREQ). RESULTS Three themes were identified: transformation of communication approaches due to COVID-19, obstacles in therapeutic communication, and continuous endeavors for improved communication. CONCLUSION Emergency nurses experienced various barriers in communication with patients and their families, which were exacerbated by COVID-19. Nevertheless, nurses attempted to enhance their communication skills. Organizational support is pertinent to establish effective communication strategies.
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Cores D, Vila-Blanco N, Pérez-Alarcón M, Martínez-de-Alegría A, Mucientes M, Carreira MJ. A few-shot approach for COVID-19 screening in standard and portable chest X-ray images. Sci Rep 2022; 12:21511. [PMID: 36513713 DOI: 10.1038/s41598-022-25754-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
Reliable and effective diagnostic systems are of vital importance for COVID-19, specifically for triage and screening procedures. In this work, a fully automatic diagnostic system based on chest X-ray images (CXR) has been proposed. It relies on the few-shot paradigm, which allows to work with small databases. Furthermore, three components have been added to improve the diagnosis performance: (1) a region proposal network which makes the system focus on the lungs; (2) a novel cost function which adds expert knowledge by giving specific penalties to each misdiagnosis; and (3) an ensembling procedure integrating multiple image comparisons to produce more reliable diagnoses. Moreover, the COVID-SC dataset has been introduced, comprising almost 1100 AnteroPosterior CXR images, namely 439 negative and 653 positive according to the RT-PCR test. Expert radiologists divided the negative images into three categories (normal lungs, COVID-related diseases, and other diseases) and the positive images into four severity levels. This entails the most complete COVID-19 dataset in terms of patient diversity. The proposed system has been compared with state-of-the-art methods in the COVIDGR-1.0 public database, achieving the highest accuracy (81.13% ± 2.76%) and the most robust results. An ablation study proved that each system component contributes to improve the overall performance. The procedure has also been validated on the COVID-SC dataset under different scenarios, with accuracies ranging from 70.81 to 87.40%. In conclusion, our proposal provides a good accuracy appropriate for the early detection of COVID-19.
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Galo NR, Roriz Junior MP, Tóffano Pereira RP. A fuzzy approach to support decision-making in the triage process for suspected COVID-19 patients in Brazil. Appl Soft Comput 2022; 129:109626. [PMID: 36157968 PMCID: PMC9487152 DOI: 10.1016/j.asoc.2022.109626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/07/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022]
Abstract
Triage is a fundamental process in hospitals and emergency care units, as it allows for the classification and prioritization of patient care based on the severity of their clinical conditions. In Brazil, the triage of suspected COVID-19 cases is performed using a specific protocol, which involves manual steps, requiring the completion of four different forms, by four health care professionals. Aiming to investigate the possibility of improving the triage processes in Brazil, this article proposes the use of computational techniques for decision-making based on fuzzy inference systems. We argue that fuzzy set theory is appropriate to the problem because it allows the use of natural language to express the patient’s symptoms, making it easier for health care professionals. After modelling the problem in a fuzzy system we applied a pilot test. The model includes symptoms that health professionals currently use to analyse COVID-19 cases. The results suggest that the model presents convergence with the sample data, highlighting its potential application in supporting triage for the classification of the severity of COVID-19 cases. Among the benefits of the proposed model, we emphasize contributions as the reduction of the time and number of professionals required for triage as well as the reduction of exposure of health care professionals and other patients suspected of carrying the virus. In this context, this research provides an opportunity to obtain social contributions regarding the services in public hospitals improvement.
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Affiliation(s)
- Nadya Regina Galo
- Federal University of Goiás, Faculty of Sciences and Technology, Mucuri Street s/n, Setor Conde dos Arcos, Aparecida de Goiânia, Goiás, Brazil
| | - Marcos Paulino Roriz Junior
- Federal University of Goiás, Faculty of Sciences and Technology, Mucuri Street s/n, Setor Conde dos Arcos, Aparecida de Goiânia, Goiás, Brazil
| | - Rodrigo Pinheiro Tóffano Pereira
- Federal University of Goiás, Faculty of Sciences and Technology, Mucuri Street s/n, Setor Conde dos Arcos, Aparecida de Goiânia, Goiás, Brazil
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5
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Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med 2022; 12:1295. [PMID: 36013244 PMCID: PMC9409667 DOI: 10.3390/jpm12081295] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/21/2022] [Accepted: 08/05/2022] [Indexed: 12/15/2022] Open
Abstract
Beginning in December 2019, the world faced a critical new public health stressor with the emergence of SARS-CoV-2. Its spread was extraordinarily rapid, and in a matter of weeks countries across the world were affected, notably in their ability to manage health care needs. While many sectors of public structures were impacted by the pandemic, it particularly highlighted shortcomings in medical care infrastructures around the world that underscored the need to reorganize medical systems, as they were vastly unprepared and ill-equipped to manage a pandemic and simultaneously provide general and specialized medical care. This paper presents modalities in approaches to the pandemic by various countries, and the triaged reorganization of medical sections not considered first-line in the pandemic that was in many cases transformed into wards for treating COVID-19 cases. As new viruses and structural variants emerge, it is important to find solutions to streamline medical care in hospitals, which includes the expansion of digital network medicine (i.e., telemedicine and mobile health apps) for patients to continue to receive appropriate care without risking exposure to contagions. Mobile health app development continues to evolve with specialized diagnostics capabilities via external attachments that can provide rapid information sharing between patients and care providers while eliminating the need for office visits. Telemedicine, still in the early stages of adoption, especially in the developing world, can ensure access to medical information and contact with care providers, with the potential to release emergency rooms from excessive cases, and offer multidisciplinary access for patients and care providers that can also be a means to avoid contact during a pandemic. As this pandemic illustrated, an overhaul to streamline health care is essential, and a move towards greater use of mobile health and telemedicine will greatly benefit public health to control the spread of new variants and future outbreaks.
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Affiliation(s)
- Roxana Filip
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- BK Laboratory, SuceavaCounty Emergency Hospital, 720224 Suceava, Romania
| | - Roxana Gheorghita Puscaselu
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Liliana Anchidin-Norocel
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Mihai Dimian
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Department of Computers, Electronics and Automation, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
| | - Wesley K. Savage
- Faculty of Medicine and Biological Sciences, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
- Integrated Center for Research, Development and Innovation in Advanced Materials, Nanotechnologies, and Distributed Systems for Fabrication and Control, Stefan cel Mare University of Suceava, 720229 Suceava, Romania
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White MJ, Birkness JE, Salimian KJ, Meiss AE, Butcher M, Davis K, Ware AD, Zarella MD, Lecksell K, Rooper LM, Cimino-Mathews A, VandenBussche CJ, Halushka MK, Thompson ED. Continuing Undergraduate Pathology Medical Education in the Coronavirus Disease 2019 (COVID-19) Global Pandemic: The Johns Hopkins Virtual Surgical Pathology Clinical Elective. Arch Pathol Lab Med 2021; 145:814-820. [PMID: 33740819 DOI: 10.5858/arpa.2020-0652-sa] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In the early months of the response to the coronavirus disease 2019 (COVID-19) pandemic, the Johns Hopkins University School of Medicine (JHUSOM) (Baltimore, Maryland) leadership reached out to faculty to develop and implement virtual clinical clerkships after all in-person medical student clinical experiences were suspended. OBJECTIVE.— To develop and implement a digital slide-based virtual surgical pathology (VSP) clinical elective to meet the demand for meaningful and robust virtual clinical electives in response to the temporary suspension of in-person clinical rotations at JHUSOM. DESIGN.— The VSP elective was modeled after the in-person surgical pathology elective to include virtual previewing and sign-out with standardized cases supplemented by synchronous and asynchronous pathology educational content. RESULTS.— Validation of existing Web communications technology and slide-scanning systems was performed by feasibility testing. Curriculum development included drafting of course objectives and syllabus, Blackboard course site design, electronic-lecture creation, communications with JHUSOM leadership, scheduling, and slide curation. Subjectively, the weekly schedule averaged 35 to 40 hours of asynchronous, synchronous, and independent content, approximately 10 to 11 hours of which were synchronous. As of February 2021, VSP has hosted 35 JHUSOM and 8 non-JHUSOM students, who have provided positive subjective and objective course feedback. CONCLUSIONS.— The Johns Hopkins VSP elective provided meaningful clinical experience to 43 students in a time of immense online education need. Added benefits of implementing VSP included increased medical student exposure to pathology as a medical specialty and demonstration of how digital slides have the potential to improve standardization of the pathology clerkship curriculum.
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Affiliation(s)
- Marissa J White
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jacqueline E Birkness
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kevan J Salimian
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alice E Meiss
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Monica Butcher
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katelynn Davis
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alisha D Ware
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark D Zarella
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristen Lecksell
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa M Rooper
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ashley Cimino-Mathews
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Marc K Halushka
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Elizabeth D Thompson
- From the Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Tay YX, Kothan S, Kada S, Cai S, Lai CWK. Challenges and optimization strategies in medical imaging service delivery during COVID-19. World J Radiol 2021; 13:102-121. [PMID: 34141091 PMCID: PMC8188837 DOI: 10.4329/wjr.v13.i5.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/10/2021] [Accepted: 05/10/2021] [Indexed: 02/06/2023] Open
Abstract
In coronavirus disease 2019 (COVID-19), medical imaging plays an essential role in the diagnosis, management and disease progression surveillance. Chest radiography and computed tomography are commonly used imaging techniques globally during this pandemic. As the pandemic continues to unfold, many healthcare systems worldwide struggle to balance the heavy strain due to overwhelming demand for healthcare resources. Changes are required across the entire healthcare system and medical imaging departments are no exception. The COVID-19 pandemic had a devastating impact on medical imaging practices. It is now time to pay further attention to the profound challenges of COVID-19 on medical imaging services and develop effective strategies to get ahead of the crisis. Additionally, preparation for operations and survival in the post-pandemic future are necessary considerations. This review aims to comprehensively examine the challenges and optimization of delivering medical imaging services in relation to the current COVID-19 global pandemic, including the role of medical imaging during these challenging times and potential future directions post-COVID-19.
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Affiliation(s)
- Yi Xiang Tay
- Radiography Department, Singapore General Hospital, Singapore 169608, Singapore
| | - Suchart Kothan
- Center of Radiation Research and Medical Imaging, Department of Radiologic Technology, Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai 50000, Thailand
| | - Sundaran Kada
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen Postbox 7030, 5020 Bergen, Norway
| | - Sihui Cai
- Radiography Department, Singapore General Hospital, Singapore 169608, Singapore
| | - Christopher Wai Keung Lai
- Department of Health and Social Sciences, Singapore Institute of Technology, Singapore 138683, Singapore
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Margherita A, Elia G, Klein M. Managing the COVID-19 emergency: A coordination framework to enhance response practices and actions. Technol Forecast Soc Change 2021; 166:120656. [PMID: 33551496 PMCID: PMC7849534 DOI: 10.1016/j.techfore.2021.120656] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/26/2021] [Accepted: 01/28/2021] [Indexed: 05/28/2023]
Abstract
The global outbreak of the coronavirus pneumonia (COVID-19) showed how epidemics today can spread very rapidly, with potentially ruinous impact on economies and societies. Whereas medical research is crucial to define effective treatment protocols, technology innovation and social research can contribute by defining effective approaches to emergency management, especially to optimize the complex dynamics arising within actors and systems during the outbreak. The purpose of this article is to define a framework for modeling activities, actors and resources coordination in the epidemic management scenario, and to reflect on its use to enhance response practices and actions. We identify 25 types of resources and 8 activities involved in the management of epidemic, and study 29 "flow", "fit", and "share" dependencies among those resources and activities, along with purposeful management criteria. Next, we use a coordination framework to conceptualize an emergency management system encompassing practices and response actions. This study has the potential to impact a broad audience, and can opens avenues for follow up works at the intersection between technology and innovation management and societal challenges. The outcomes can have immediate applicability to an ongoing societal problem, as well as be generalized for application in future (possible although undesired) events.
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Affiliation(s)
- Alessandro Margherita
- Department of Engineering for Innovation, University of Salento, Campus Ecotekne, Via Monteroni s.n., 73100 Lecce, Italy
| | - Gianluca Elia
- Department of Engineering for Innovation, University of Salento, Campus Ecotekne, Via Monteroni s.n., 73100 Lecce, Italy
| | - Mark Klein
- Center for Collective Intelligence, MIT Massachusetts Institute of Technology, 77 Massachusetts Avenue, E94-1505, Cambridge, MA 02139, USA
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Abstract
In response to the COVID-19 pandemic medical students in different countries were mobilized to support healthcare systems during the emergency. This study presents the experience of 580 students of a single medical university in Poland who served as volunteers at different healthcare units during the first six months of the first case being recorded in the country (March-September 2020). The mean ± SD hours and days spent on volunteering in the studied group were 52 ± 36 h and 144 ± 126 d, respectively, the collective number of worked hours amounted to 83,460 h. Compared to other fields of study students of medicine engaged in volunteering for more hours and for more days. The main tasks performed by the surveyed group included triage, servicing call-centers for patients and working at the admission ward, hospital clinics, emergency departments and diagnostic labs. The level of fear at the beginning of volunteering was relatively low in the studied group and did not increase over the course. The majority of students received positive feedback from families, friends, patients and healthcare workers, revealed a high level of satisfaction from volunteering (also when experiencing COVID-19-related prejudice), while gaining professional experience and a sense of giving real aid were among the most frequently indicated benefits. The results of the present study demonstrate that although medical students are not essential workers in response to the COVID-19 pandemic, they can be of real assistance to healthcare systems during times of emergency, and should be considered as such in the future in case such a need arises again.
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Affiliation(s)
- Dominika Bazan
- Department of Promotion and Careers, Poznan University of Medical Sciences, 61-701, Poznań, Poland
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland
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Bazan D, Nowicki M, Rzymski P. Medical students as the volunteer workforce during the COVID-19 pandemic: Polish experience. Int J Disaster Risk Reduct 2021; 55:102109. [PMID: 33585172 PMCID: PMC7871109 DOI: 10.1016/j.ijdrr.2021.102109] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/29/2021] [Accepted: 01/30/2021] [Indexed: 05/24/2023]
Abstract
In response to the COVID-19 pandemic medical students in different countries were mobilized to support healthcare systems during the emergency. This study presents the experience of 580 students of a single medical university in Poland who served as volunteers at different healthcare units during the first six months of the first case being recorded in the country (March-September 2020). The mean ± SD hours and days spent on volunteering in the studied group were 52 ± 36 h and 144 ± 126 d, respectively, the collective number of worked hours amounted to 83,460 h. Compared to other fields of study students of medicine engaged in volunteering for more hours and for more days. The main tasks performed by the surveyed group included triage, servicing call-centers for patients and working at the admission ward, hospital clinics, emergency departments and diagnostic labs. The level of fear at the beginning of volunteering was relatively low in the studied group and did not increase over the course. The majority of students received positive feedback from families, friends, patients and healthcare workers, revealed a high level of satisfaction from volunteering (also when experiencing COVID-19-related prejudice), while gaining professional experience and a sense of giving real aid were among the most frequently indicated benefits. The results of the present study demonstrate that although medical students are not essential workers in response to the COVID-19 pandemic, they can be of real assistance to healthcare systems during times of emergency, and should be considered as such in the future in case such a need arises again.
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Affiliation(s)
- Dominika Bazan
- Department of Promotion and Careers, Poznan University of Medical Sciences, 61-701, Poznań, Poland
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, 60-781, Poznań, Poland
| | - Piotr Rzymski
- Department of Environmental Medicine, Poznan University of Medical Sciences, 60-806, Poznań, Poland
- Integrated Science Association (ISA), Universal Scientific Education and Research Network (USERN), 60-806, Poznań, Poland
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Mauro A, Improda N, Zenzeri L, Valitutti F, Vecchione E, Esposito S, Tipo V. Infection control strategy and primary care assistance in Campania region during the national lockdown due to COVID-19 outbreak: the experience of two tertiary emergency centers. Ital J Pediatr 2021; 47:19. [PMID: 33514406 PMCID: PMC7844775 DOI: 10.1186/s13052-021-00963-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/04/2021] [Indexed: 12/15/2022] Open
Abstract
Background COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8–April 30), as well as the outcomes of our infection control strategy. Results Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days. Conclusion Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.
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Affiliation(s)
- Angela Mauro
- Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy. .,EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy.
| | - Nicola Improda
- Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy.,Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Letizia Zenzeri
- Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy
| | - Francesco Valitutti
- EBRIS (European Biomedical Research Institute of Salerno), Salerno, Italy.,Pediatric Unit, AOU San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Erica Vecchione
- Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy
| | - Sara Esposito
- Pediatric Section, Department of Translational Medical Sciences, Federico II University of Naples, Naples, Italy
| | - Vincenzo Tipo
- Emergency Pediatric Department, Pediatric Emergency Unit, AORN Santobono-Pausilipon Children's Hospital, Via Mario Fiore 6, 80131, Naples, Italy
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12
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Duggal M, Dahiya N, Kankaria A, Chaudhary M, Bachani D. Restructuring the Healthcare System to Protect Healthcare Personnel Amidst the COVID-19 Pandemic. Front Public Health 2020; 8:588203. [PMID: 33363085 PMCID: PMC7759646 DOI: 10.3389/fpubh.2020.588203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/23/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Mona Duggal
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Neha Dahiya
- Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ankita Kankaria
- All India Institute of Medical Sciences, Bathinda (AIIMS Bathinda), Bhatinda, India
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