Articles: pandemics.
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Review
Rethinking Traditional Emergency Department Care Models in a Post-Coronavirus Disease-2019 World.
As the nursing shortage in United States emergency departments has drastically worsened since the coronavirus disease-2019 (COVID-19) pandemic, emergency departments have experienced increased rates of inpatient onboarding, higher rates of patients leaving without being seen, and declining patient satisfaction scores. This paper reviews the impacts of the coronavirus disease-2019 pandemic on the current nursing shortage and considers how various medical personnel (emergency nurse-extenders) can ameliorate operational challenges by redesigning emergency department systems. ⋯ Health care workers who can be trained to augment the existing emergency department workforce include paramedics, Emergency Medical Technicians, emergency department technicians, ancillary staff, scribes, and motivated health sciences students. Utilizing non-nurse providers to fulfill tasks traditionally assigned to emergency nurses can improve emergency department flow and care delivery in a post-coronavirus disease-2019 world.
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Palliative medicine · Jul 2023
Deaths at home, area-based deprivation and the effect of the Covid-19 pandemic: An analysis of mortality data across four nations.
The number and proportion of home deaths in the UK increased during the Covid-19 pandemic. It is not known whether these changes were experienced disproportionately by people from different socioeconomic groups. ⋯ The Covid-19 pandemic exacerbated a previously described socioeconomic inequality in place of death in the UK. Further research to understand the reasons for this change and if this inequality has been sustained is needed.
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Stress on the healthcare system requires careful allocation of resources such as renal replacement therapy (RRT). The COVID-19 pandemic generated difficulty securing access to RRT for trauma patients. We sought to develop a renal replacement after trauma (RAT) scoring tool to help identify trauma patients who may require RRT during their hospitalization. ⋯ RAT is a novel and validated scoring tool to help predict the need for RRT in trauma patients. With future improvements including baseline renal function and other variables, the RAT tool may help prepare for the allocation of RRT machines/staff during times of limited resources.
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Background: Goals-of-care conversations (GoCCs) are essential for individualized end-of-life care. Shared decision-making (SDM) that elicits patients' goals and values to collaboratively make life sustaining treatment (LST) decisions is best practice. However, it is unknown how the COVID-19 pandemic onset and associated changes to care delivery, stress on providers, and clinical uncertainty affected SDM and recommendation-making during GoCCs. ⋯ In adjusted regression models, being a physician and discussing patients' goals and values were positively associated with giving an LST recommendation (B = 0.380, p = 0.031 and B = 0.400, p < 0.001, respectively) at peak-COVID-19. Conclusion: Providers who discuss patients' preferences and values are more likely to report giving a recommendation; both behaviors are markers of SDM during GoCCs. Our findings suggest potential areas for training in conducting patient-centered GoCCs.
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The objective is to determine how the COVID-19 pandemic affected care for patients undergoing thoracic surgery for cancer. ⋯ Telemedicine enabled cancer care to continue during the COVID-19 pandemic without delays in surgery, cancer progression, or worsened postoperative morbidity and was generally well received.