Articles: pandemics.
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Engaging frontline clinicians and staff in quality improvement is a promising bottom-up approach to transforming primary care practices. This may be especially true in federally qualified health centers (FQHCs) and similar safety-net settings where large-scale, top-down transformation efforts are often associated with declining worker morale and increasing burnout. Innovation contests, which decentralize problem-solving, can be used to involve frontline workers in idea generation and selection. ⋯ Innovation contests generated numerous ideas for improvement from the frontline. It is likely that the issues described in this study have become even more salient today, as the COVID-19 pandemic has had devastating impacts on work environments and health/social needs of patients living in low-resourced communities. Continued work is needed to promote learning and information exchange about opportunities to improve and transform practices between policymakers, managers, and providers and staff at the frontlines.
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Ulus Travma Acil Cerrahi Derg · Oct 2023
What has changed? The impact of the COVID-19 pandemic on the management of acute biliary pancreatitis.
The COVID-19 pandemic thoroughly changed the daily practices of medicine. We retrospectively evaluated the impact of the COVID-19 pandemic on our management strategies for patients with acute biliary pancreatitis (ABP). ⋯ COVID strikingly reduced the admissions of ABP patients in the early stages of the disease to hospitals, leading to inevitable admissions in advanced severity. Moreover, a significant increase was detected in the recurrence rates of ABP. This can be explained by the reduction in cholecystectomy performed.
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Am. J. Respir. Crit. Care Med. · Oct 2023
Randomized Controlled Trial Multicenter StudyConservative versus Liberal Oxygenation Targets in Intensive Care Unit Patients (ICONIC): A Randomized Clinical Trial.
Rationale: Supplemental oxygen is widely administered to ICU patients, but appropriate oxygenation targets remain unclear. Objectives: This study aimed to determine whether a low-oxygenation strategy would lower 28-day mortality compared with a high-oxygenation strategy. Methods: This randomized multicenter trial included mechanically ventilated ICU patients with an expected ventilation duration of at least 24 hours. ⋯ At least one serious adverse event was reported in 12 (3.6%) and 17 (5.2%) patients in the low- and high-oxygenation groups, respectively. Conclusions: Among mechanically ventilated ICU patients with an expected mechanical ventilation duration of at least 24 hours, using a low-oxygenation strategy did not result in a reduction of 28-day mortality compared with a high-oxygenation strategy. Clinical trial registered with the National Trial Register and the International Clinical Trials Registry Platform (NTR7376).
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J Neurosurg Anesthesiol · Oct 2023
Ethical Management of COVID-19 Pandemic at a Neurological Hospital: The Ethicovid report.
During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of COVID-19 patients. ⋯ Our ethical consulting unit allowed for collegial ethical decision-making in line with international recommendations. This model could be easily transferred to other triage situations, provided it is adapted to the local context.
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The COVID-19 pandemic significantly impacted and continues to impact the health and well-being of Australian adults. However, there has been no instrument validated to comprehensively measure how the COVID-19 pandemic impacted adults in Australia across several domains (e.g. fear of COVID-19, attitudes towards vaccination, psychosocial impact of lockdowns).The current study conducted a rigorous psychometric process to develop and validate an instrument to measure the impact of the COVID-19 pandemic in Australia, the COVID-19 Impact Scale (CIS). ⋯ The instrument is available to be used by Australian researchers and implemented to evaluate public policies, adapted for future pandemics, or used internationally.