Articles: pandemics.
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The COVID-19 pandemic has markedly increased delays in oncologic surgeries because of the virus's impact on traditional anesthetic management. Novel protocols, developed to protect patients and medical professionals, have altered the ways and instances in which general anesthesia (GA) can be safely performed. To reduce virus exposure related to aerosol-generating procedures, it is now recommended to avoid GA when feasible and promote regional anesthesia instead. At our institution, we observed faster postoperative recovery in patients who received paravertebral blocks for breast cancer surgery instead of GA. This led us to formally evaluate whether regional anesthesia instead of GA helped improve time to hospital discharge. ⋯ Patients who received paravertebral blocks for breast cancer surgery in the intrapandemic group were ready for hospital discharge earlier, spent less time in the PACU, and experienced less PONV than those who received GA in the prepandemic group. With growing surgical wait times, concerns related to aerosol-generating procedures, and recommendations to avoid GA when feasible, paravertebral blocks as the principal anesthetic modality for breast cancer surgery offered benefits for patients and medical teams.
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To evaluate the impact of the COVID-19 pandemic on Canadian intensive care unit (ICU) workers. ⋯ This survey study shows that ICU workers have been impacted by the COVID-19 pandemic with high levels of stress and psychological burden. Respondents endorsed communication, protocols, and appreciation from leadership as helpful mitigating strategies.
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Emerg Med Australas · Apr 2022
COVID-19 and involuntary detention - An emergency medicine or emergency management responsibility?
The COVID-19 pandemic has thrown up innumerable challenges throughout the world, especially evident in the healthcare system. In emergency medicine, there is a new urgency around the clinical and ethical dilemmas clinicians face as they make decisions that impact upon the lives of their patients. Emergency clinicians are accustomed to upholding duty of care and acting in the best interests of patients. ⋯ What is particularly fraught for clinicians is the lack of clarity around this potential duty of care to the community, and navigating the potential conflict with duty of care to the patient. How much danger does the community need to be in, and how definable, imminent and specific does that risk need to be? An attempt to protect the community may well constitute either a breach of confidentiality or a breach of duty of care. This paper will explore the complex issues of respect for autonomy and the principle of non-maleficence, in the setting of COVID-19 and public health orders and illustrate the uncomfortable uncertainty that exists surrounding care of some of the most vulnerable patients in the community when their actions are contrary to public health recommendations.
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Semin Respir Crit Care Med · Apr 2022
New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses.
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. ⋯ Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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The coronavirus disease 2019 (COVID-19) pandemic created shortages of operating room (OR) supplies, forcing healthcare systems to make concessions regarding "standard" OR attire. At our institution, we were required to reduce shoe covers, reuse face masks, and allow washable head coverings. We determined if these changes affected surgical site infection (SSI) rates. ⋯ This analysis has practical applications as we emerge from the pandemic and make decisions regarding OR attire. These data suggest that disposable head covers and shoe covers and frequent changes of face masks are unnecessary, and discontinuation of these practices will have significant cost and environmental implications. These data also reinforce the importance of good hand hygiene for infection prevention.