scholarly journals ECT in the time of the COVID-19 pandemic

2020 ◽  
Vol 28 (5) ◽  
pp. 527-529
Author(s):  
Venkata Subramanian Ramakrishnan ◽  
Young Kwang Kim ◽  
Wanda Yung ◽  
Prashanth Mayur
Keyword(s):  
Mental Health ◽  
Electroconvulsive Therapy ◽  
Personal Protective Equipment ◽  
Tertiary Care ◽  
Healthcare Systems ◽  
Protective Equipment ◽  
Anaesthetic Induction ◽  
Policy Makers ◽  
Anaesthetic Procedure ◽  
Narrative Account

Objective: The recent and ongoing COVID-19 pandemic outbreak has placed a huge burden on healthcare systems worldwide. This emergent situation applies invariably to mental health services, and policy makers have issued new directives to adequately deal with this crisis. The COVID-19 outbreak poses special challenges to the administration of electroconvulsive therapy (ECT) since the anaesthetic induction is an aerosol-generating process. The report provides a narrative account of modifications to the ECT practice at a tertiary care psychiatric hospital to mitigate the risk of COVID-19 transmission. Conclusion: We emphasise two main modifications: use of personal protective equipment (PPE) during the ECT and modifications in the anaesthetic procedure to mitigate potential transmission.

scholarly journals Use of Personal Protective Equipment and Operating Room Behaviors in Four Surgical Subspecialties: Personal Protective Equipment and Behaviors in Surgery

1999 ◽  
Vol 20 (02) ◽  
pp. 110-114 ◽  
Author(s):  
Deniz Akduman ◽  
Lynn E. Kim ◽  
Rodney L. Parks ◽  
Paul B. L'Ecuyer ◽  
Sunita Mutha ◽  
...  
Keyword(s):  
Operating Room ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Tertiary Care ◽  
Hand Surgery ◽  
Occupational Exposures ◽  
Protective Equipment ◽  
Care Hospital ◽  
Exposure Rate ◽  
Total Exposure

AbstractObjective:To evaluate Universal Precautions (UP) compliance in the operating room (OR).Design:Prospective observational cohort. Trained observers recorded information about (1) personal protective equipment used by OR staff; (2) eyewear, glove, or gown breaks; (3) the nature of sharps transfers; (4) risk-taking behaviors of the OR staff; and (5) needlestick injuries and other blood and body-fluid exposures.Setting:Barnes-Jewish Hospital, a 1,000-bed, tertiary-care hospital affiliated with Washington University School of Medicine, St Louis, Missouri.Participants:OR personnel in four surgical specialties (gynecologic, orthopedic, cardiothoracic, and general). Procedures eligible for the study were selected randomly. Hand surgery and procedures requiring no or a very small incision (eg, arthroscopy, laparoscopy) were excluded.Results:A total of 597 healthcare workers' procedures were observed in 76 surgical cases (200 hours). Of the 597 healthcare workers, 32% wore regular glasses, and 24% used no eye protection. Scrub nurses and medical students were more likely than other healthcare workers to wear goggles. Only 28% of healthcare workers double gloved, with orthopedic surgery personnel being the most compliant. Sharps passages were not announced in 91% of the surgical procedures. In 65 cases (86%), sharps were adjusted manually. Three percutaneous and 14 cutaneous exposures occurred, for a total exposure rate of 22%.Conclusion:OR personnel had poor compliance with UP. Although there was significant variation in use of personal protective equipment between groups, the total exposure rate was high (22%), indicating the need for further training and reinforcement of UP to reduce occupational exposures.

scholarly journals Are Australian medical interns adequately prepared for the optimal use of personal protective equipment?

2020 ◽  
Author(s):  
Ruth Barratt
Keyword(s):  
Personal Protective Equipment ◽  
Best Practice ◽  
Tertiary Care ◽  
Medical Student Education ◽  
Protective Equipment ◽  
Practical Training ◽  
New Graduates ◽  
Medical Interns ◽  
Training Programmes ◽  
Hospital Orientation

Abstract BackgroundThe current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore new graduates’ experiences of the use of PPE and identify opportunities for improvement in medical student education and training programmes, to improve occupational and patient safety. MethodsThis study was undertaken in 2018 in a large tertiary-care teaching hospital in XXXX, Australia, to explore medical interns’ self-reported experiences of PPE use, at the beginning of their first postgraduate year. Focus groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. Results 80% of 90 eligible interns participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. ConclusionsUndergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.

scholarly journals Nurses on the Frontline against the COVID-19 Pandemic: An Integrative Review

2020 ◽  
Vol 3 (3) ◽  
pp. 87-92
Author(s):  
Abdullelah Al Thobaity ◽  
Farhan Alshammari
Keyword(s):  
Nursing Staff ◽  
Personal Protective Equipment ◽  
Critical Line ◽  
Healthcare Providers ◽  
Healthcare Systems ◽  
Integrative Review ◽  
Protective Equipment ◽  
Crisis Plans ◽  
Medical Supplies ◽  
The World

COVID-19 has affected the life and health of more than 1 million people across the world. This overwhelms many countries’ healthcare systems, and, of course, affects healthcare providers such as nurses fighting on the frontlines to safeguard the lives of everyone affected. Exploring the issues that nurses face during their battle will help support them and develop protocols and plans to improve their preparedness. Thus, this integrative review will explore the issues facing nurses during their response to the COVID-19 crisis. The major issues facing nurses in this situation are the critical shortage of nurses, beds, and medical supplies, including personal protective equipment and, as reviews indicate, psychological changes and fears of infection among nursing staff. The implications of these findings might help to provide support and identify the needs of nurses in all affected countries to ensure that they can work and respond to this crisis with more confidence. Moreover, this will help enhance preparedness for pandemics and consider issues when drawing up crisis plans. The recommendation is to support the nurses, since they are a critical line of defense. Indeed, more research must be conducted in the field of pandemics regarding nursing.

scholarly journals Medical interns’ reflections on their training in use of personal protective equipment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Ruth Barratt ◽  
Mary Wyer ◽  
Su-yin Hor ◽  
Gwendolyn L. Gilbert
Keyword(s):  
Personal Protective Equipment ◽  
Best Practice ◽  
Tertiary Care ◽  
Undergraduate Teaching ◽  
Protective Equipment ◽  
Practical Training ◽  
Medical Graduates ◽  
Medical Interns ◽  
Training Programmes ◽  
Hospital Orientation

Abstract Background The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates’ experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety. Methods This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns’ self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. Results 80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. Conclusions Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.

scholarly journals Severe Acute Respiratory Syndrome Coronavirus 2 Surveillance and Exposure in the Perioperative Setting With Universal Testing and Personal Protective Equipment Policies

2020 ◽  
Author(s):  
Anoshe Aslam ◽  
Jessica Singh ◽  
Elizabeth Robilotti ◽  
Karin Chow ◽  
Tarun Bist ◽  
...  
Keyword(s):  
New York ◽  
Severe Acute Respiratory Syndrome ◽  
Personal Protective Equipment ◽  
Tertiary Care ◽  
Contact Tracing ◽  
Cancer Center ◽  
Protective Equipment ◽  
Diagnostic Strategies ◽  
Asymptomatic Patients ◽  
Polymerase Chain

Abstract Background New York City (NYC) experienced a surge of coronavirus disease 2019 (COVID-19) cases in March and April 2020. Since then, universal polymerase chain reaction (PCR)–based surveillance testing and personal protective equipment (PPE) measures are in wide use in procedural settings. There is limited published experience on the utility and sustainability of PCR-based surveillance testing in areas with receding and consistently low community COVID-19 rates. Methods The study was conducted at a tertiary care cancer center in NYC from 22 March to 22 August 2020. Asymptomatic patients underwent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing before surgeries, interventional radiology procedures, and endoscopy. Contact tracing in procedural areas was done if a patient with an initial negative screen retested positive within 48 hours of the procedure. Results From March 22 until August 22, 2020, 11 540 unique patients underwent 14 233 tests before surgeries or procedures at Memorial Sloan Kettering Cancer Center. Overall, 65 patients were positive, with a peak rate of 4.3% that fell below 0.3% after April 2020. Among the 65 positive cases, 3 were presymptomatic and 38 were asymptomatic. Among asymptomatic test-positive patients, 76% had PCR cycle threshold >30 at first detection. Five patients tested newly positive in the immediate postoperative period, exposing 82 employees with 1 case of probable transmission (1.2%). Conclusions The prevalence of SARS-CoV-2 infection identified on preprocedural surveillance was low in our study, which was conducted in an area with limited community spread at the later stage of the study. Universal PPE is protective in procedural settings. Optimal and flexible diagnostic strategies are needed to accomplish and sustain the goals of comprehensive preprocedure surveillance testing.

scholarly journals An illustrated step-by-step guide to establish a disinfection facility for reuse of personal protective equipment

2020 ◽  
Author(s):  
Vikram Saini ◽  
Priya Kalra
Keyword(s):  
Health Care ◽  
Personal Protective Equipment ◽  
Tertiary Care ◽  
Scale Up ◽  
Protective Equipment ◽  
New Delhi ◽  
Medical Sciences ◽  
Care Workers ◽  
Public Health Challenges ◽  
Immense Potential

Abstract COVID-19 pandemic has created unforeseen public health challenges including the disruption of a steady supply of personal protective equipment (PPE) for health care workers (HCWs). Several approaches have been evaluated for safe disinfection of used PPEs to allow their selective reuse. We have recently shown that Vaporized Hydrogen Peroxide (VHP) is a safe, easy-to-scale up, economical and environment friendly method to disinfect PPE (coveralls, N-95 masks and face-shields) without compromising their quality and integrity even after repeated cycles of disinfection (Saini et al., 2020). Based on this method, we have operationalized a PPE disinfection research facility at All India Institute of Medical Sciences (AIIMS), New Delhi, a tertiary care medical centre in India. Considering the immense potential of this approach, we have been repeatedly approached by various hospitals to provide a detailed standard operating guideline to run such a facility. Herein, we present a step-by-step illustrative guide that we believe would be helpful to operationalize a PPE disinfection facility at health care settings. This guide incorporates elements and steps of biosafety necessary to handle used PPE during COVID-19 settings and can be adapted for various methods of PPE disinfection, and various pathogens.

scholarly journals Medical interns’ reflections on their training in use of personal protective equipment.

2020 ◽  
Author(s):  
Ruth Barratt ◽  
Mary Wyer ◽  
Su-yin Hor ◽  
Gwendolyn L Gilbert
Keyword(s):  
Personal Protective Equipment ◽  
Best Practice ◽  
Tertiary Care ◽  
Undergraduate Teaching ◽  
Protective Equipment ◽  
Practical Training ◽  
Medical Graduates ◽  
Medical Interns ◽  
Training Programmes ◽  
Hospital Orientation

Abstract Background The current COVID-19 pandemic has demonstrated that personal protective equipment (PPE) is essential, to prevent the acquisition and transmission of infectious diseases, yet its use is often sub-optimal in the clinical setting. Training and education are important to ensure and sustain the safe and effective use of PPE by medical interns, but current methods are often inadequate in providing the relevant knowledge and skills. The purpose of this study was to explore medical graduates’ experiences of the use of PPE and identify opportunities for improvement in education and training programmes, to improve occupational and patient safety.Methods This study was undertaken in 2018 in a large tertiary-care teaching hospital in Sydney, Australia, to explore medical interns’ self-reported experiences of PPE use, at the beginning of their internship. Reflexive groups were conducted immediately after theoretical and practical PPE training, during hospital orientation. Transcripts of recorded discussions were analysed, using a thematic approach that drew on the COM-B (capability, opportunity, motivation - behaviour) framework for behaviour. Results 80% of 90 eligible graduates participated. Many interns had not previously received formal training in the specific skills required for optimal PPE use and had developed potentially unsafe habits. Their experiences as medical students in clinical areas contrasted sharply with recommended practice taught at hospital orientation and impacted on their ability to cultivate correct PPE use. Conclusions Undergraduate teaching should be consistent with best practice PPE use, and include practical training that embeds correct and safe practices.

scholarly journals Chart review of electroconvulsive therapy practice from a tertiary care geriatric mental health set up

2017 ◽  
Vol 4 (2) ◽  
pp. 135
Author(s):  
Akanksha Sonal ◽  
Shrikant Srivastava ◽  
SC Tiwari ◽  
PrateekKumar Chaubey
Keyword(s):  
Mental Health ◽  
Electroconvulsive Therapy ◽  
Chart Review ◽  
Tertiary Care ◽  
Geriatric Mental Health ◽  
Set Up

scholarly journals Neurosurgical education during COVID-19: challenges and lessons learned in Egypt

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Ahmed Hamdy Ashry ◽  
Hussein Mohammed Soffar ◽  
Mohamed Fathalla Alsawy
Keyword(s):  
Mental Health ◽  
Online Education ◽  
Personal Protective Equipment ◽  
Training Programs ◽  
Well Being ◽  
Lessons Learned ◽  
Protective Equipment ◽  
Primary Concern ◽  
The Impact ◽  
Neurosurgical Education

Abstract Background The coronavirus pandemic (COVID-19) has disrupted the routine neurosurgical education and practice worldwide and so more in developing countries. Continuing the neurosurgical training while maintaining the well-being of our residents should be the primary concern of leaders of training programs. Objectives The aim of this cross-sectional study was the evaluation of the impact of COVID-19 on neurosurgical residency programs and neurosurgical practice in five tertiary medical centers in our country. We also aimed at detecting the shortcomings in training programs and provide solutions. Methods An online questionnaire-based survey was prepared and sent to 73 neurosurgery residents in 5 tertiary centers in 4 governorates by social networks. The questions focused on the evaluation of clinical and surgical activities before and after the pandemic. Safety precautions, education, and residents’ mental health were also evaluated. Results Fifty residents responded to our survey. We identified a significant reduction in surgical cases, inpatient services, and working hours per week during the pandemic comparing to the pre-pandemic era. We also identified a significant increase in research hours and changes in educational methods from in-person methods to virtual ones. Seventy-four percent reported that personal protective equipment was not adequate for their duties. Sixty-eight percent experienced burnout symptoms. Unavailability of personal protective equipment, negative concerns regarding the surgical career, and financial strains significantly affected the mental health of residents. Conclusions The survey highlighted the negative impact of COVID-19 on neurosurgical practice and education. Being in a developing country, this negative effect was amplified due to financial reasons and weak infrastructure. Inadequate personal protective equipment increased the risk of infection and work-related stress among neurosurgery residents. We lacked telemedicine services in our country. Online education gained more visibility and awareness.

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