TRANSTORNOS MENTAIS EM PROFISSIONAIS DA SAÚDE: UM PROBLEMA A MAIS DURANTE A PANDEMIA POR COVID-19

Within the pandemic scenario, healthcare professionals are vulnerable. Thus, the present study sought to score the main causes of disorders. The review method used the following Descriptors in Health Sciences (DeCS): Mental Health, Coronavirus Infections and Health Personnel, in the following databases: Google Scholar, Virtual Health Library (BVS), SciELO, PubMed and LILACS. 2,758 articles were found and 21 were chosen for analysis. The inclusion criterion used was articles addressing the causes in Portuguese and English. Articles that did not address the increase of mental disorders in health professionals were excluded. According to the searches, psychological disorders in the pandemic scenario were caused by inadequate working conditions (31.25%); fear of infection and contamination of family members (25%); mental exhaustion and stressful events (43.75%); social changes (18.75%); insecurity about conduct updates (25%) and ethical and moral suffering (12.5%), these causes were prevalent in the 21 articles analyzed. We conclude that, during the pandemic, some causes such as inadequate working conditions, fear of getting infected and infecting family members, mental exhaustion and stressful events, social changes, insecurity about behavioral updates, and ethical and mental suffering collaborated to the emergence or worsening of the pandemic. However, the current literature lacks these and other works for a better understanding of the theme.En el escenario de la pandemia, los profesionales sanitarios son vulnerables. Así, el presente estudio pretendía puntuar las principales causas de los trastornos. Como método de revisión se utilizaron los siguientes Descriptores en Ciencias de la Salud (DeCS): Salud Mental, Infecciones por Coronavirus y Personal de Salud, en conjunto con las siguientes bases de datos: Google Académico, Biblioteca Virtual de Salud (BVS), SciELO, PubMed y LILACS. Se encontraron 2.758 artículos y se eligieron 21 para el análisis.  Según las búsquedas, los trastornos psicológicos en el escenario de la pandemia fueron causados por las condiciones de trabajo inadecuadas (31,25%); el miedo al contagio y a la contaminación de los miembros de la familia (25%); el agotamiento mental y los acontecimientos estresantes (43,75%); los cambios sociales (18,75%); la inseguridad sobre las actualizaciones de la conducta (25%) y el sufrimiento ético y moral (12,5%), estas causas fueron prevalentes en los 21 artículos analizados. Concluimos que, durante la pandemia, algunas causas como las condiciones de trabajo inadecuadas, el miedo a infectarse y contaminar a los miembros de la familia, el agotamiento mental y los acontecimientos estresantes, los cambios sociales, la inseguridad sobre las actualizaciones de la conducta y el sufrimiento ético y mental colaboraron a la aparición o al empeoramiento. Sin embargo, la literatura actual carece de estos y otros trabajos para una mejor comprensión del tema.Dentro do cenário pandêmico, os profissionais da saúde são vulneráveis. Assim, o presente estudo buscou pontuar as principais causas de transtornos. Utilizou-se o método de revisão os seguintes Descritores em Ciências da Saúde (DeCS): Saúde Mental, Infecções por Coronavírus e Pessoal de Saúde, em conjunto nas seguintes bases de dados: Google Acadêmico, Biblioteca Virtual em Saúde (BVS), SciELO, PubMed e LILACS. Foram encontrados 2.758 artigos e escolhidos 21 para análise. Utilizou-se como critério de inclusão artigos com abordagem nas causas, nas línguas portuguesa e inglesa. Foram excluídos artigos que não abordam o aumento dos transtornos mentais em profissionais de saúde. De acordo com as buscas, os transtornos psicológicos no cenário pandêmico foram causados por condições de trabalho inadequadas (31,25%); medo de se infectar e contaminar os familiares (25%); esgotamento mental e eventos estressores (43,75%); mudanças sociais (18,75%); insegurança sobre atualizações de conduta (25%) e sofrimento ético e moral (12,5%), essas causas se apresentaram prevalentes nos 21 artigos analisados. Conclui-se que, durante a pandemia, algumas causas como condições de trabalho inadequadas, medo de se infectar e contaminar os familiares, esgotamento mental e eventos estressores, mudanças sociais, insegurança sobre atualizações de conduta e sofrimento ético e mental colaboraram para o surgimento ou piora. Porém, a atual literatura carece desses e de outros trabalhos para maior compreensão da temática.Dentro do cenário pandêmico, os profissionais da saúde são vulneráveis. Assim, o presente estudo buscou pontuar as principais causas de transtornos. Utilizou-se o método de revisão os seguintes Descritores em Ciências da Saúde (DeCS): Saúde Mental, Infecções por Coronavírus e Pessoal de Saúde, em conjunto nas seguintes bases de dados: Google Acadêmico, Biblioteca Virtual em Saúde (BVS), SciELO, PubMed e LILACS. Foram encontrados 2.758 artigos e escolhidos 21 para análise. Utilizou-se como critério de inclusão artigos com abordagem nas causas, nas línguas portuguesa e inglesa. Foram excluídos artigos que não abordam o aumento dos transtornos mentais em profissionais de saúde. De acordo com as buscas, os transtornos psicológicos no cenário pandêmico foram causados por condições de trabalho inadequadas (31,25%); medo de se infectar e contaminar os familiares (25%); esgotamento mental e eventos estressores (43,75%); mudanças sociais (18,75%); insegurança sobre atualizações de conduta (25%) e sofrimento ético e moral (12,5%), essas causas se apresentaram prevalentes nos 21 artigos analisados. Conclui-se que, durante a pandemia, algumas causas como condições de trabalho inadequadas, medo de se infectar e contaminar os familiares, esgotamento mental e eventos estressores, mudanças sociais, insegurança sobre atualizações de conduta e sofrimento ético e mental colaboraram para o surgimento ou piora. Porém, a atual literatura carece desses e de outros trabalhos para maior compreensão da temática

A922 Sequential measurement of 1 hour creatinine clearance (1-CRCL) in critically ill patients at risk of acute kidney injury (AKI)

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Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p&lt;0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p&lt;0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake