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Wilcock AD, Zubizarreta JR, Wadhera RK, Yeh RW, Zachrison KS, Schwamm LH, Mehrotra A. Factors Underlying Reduced Hospitalizations for Myocardial Infarction During the COVID-19 Pandemic. JAMA Cardiol 2024:2821188. [PMID: 39083317 PMCID: PMC11292572 DOI: 10.1001/jamacardio.2024.2031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/28/2024] [Indexed: 08/03/2024]
Abstract
Importance The incidence of hospital encounters for acute myocardial infarction (AMI) decreased sharply early in the COVID-19 pandemic and has not returned to prepandemic levels. There has been an ongoing debate about what mechanism may underlie this decline, including patients avoiding the hospital for treatment, excess mortality from COVID-19 among patients who would otherwise have had an AMI, a reduction in the incidence or severity of AMIs due to pandemic-related changes in behavior, or a preexisting temporal trend of lower AMI incidence. Objective To describe drivers of changing incidence in AMI hospital encounters during the COVID-19 pandemic. Design, Setting, and Participants This cross-sectional study used traditional Medicare claims from all patients enrolled in traditional Medicare from January 2016 to June 2023 (total of 2.85 billion patient-months) to calculate the rate of AMI hospital encounters (emergency department visits, observation stays, or inpatient admissions) per capita at all short-term acute care and critical access hospitals in the United States overall and by patient characteristics. Observed rates were compared with expected rates that accounted for shifts in population characteristics and the prepandemic temporal trend (as estimated over 2016-2019). Data were analyzed in November 2023. Main Outcomes and Measures Hospital encounters for AMI. Results On average, the study sample included 31 623 928 patients each month from January 2016 through June 2023, for a total of 2 846 153 487 patient-months during the 90-month study period. In June 2023, there were 0.044 AMI hospital encounters per 100 patients, which was 20% lower than in June 2019 (0.055 encounters per 100 patients). Early in the pandemic, AMI rates moved inversely with COVID-19 death rates and tracked patterns seen for other painful acute conditions, such as nephrolithiasis, suggesting these changes were associated with care avoidance. Changes in patient characteristics driven by excess deaths during the pandemic explained little of the decline. Later in the pandemic, the decline may be explained by the long-standing downward trend in AMI incidence; by April 2022, the observed rate of encounters matched the expected rate that accounted for this trend. During the full pandemic period, from March 2020 to June 2023, there were an estimated 5% (95% prediction interval, 1%-9%) fewer AMI hospital encounters than expected. Conclusions and Relevance The early reduction in AMI encounters was likely driven by care avoidance, while ongoing reductions through June 2023 likely reflect long-standing temporal trends. During the pandemic, there were 5% fewer AMI encounters than expected.
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Affiliation(s)
- Andrew D. Wilcock
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jose R. Zubizarreta
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Statistics, Harvard University, Cambridge, Massachusetts
| | - Rishi K. Wadhera
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Robert W. Yeh
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Kori S. Zachrison
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Emergency Medicine, Massachusetts General Hospital, Boston
| | - Lee H. Schwamm
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
- Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut
| | - Ateev Mehrotra
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island
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Lim A, Rothwell PM, Li L, Coutts SB, Hill MD, Guarino M, Barone V, Rondelli F, Kleinig T, Cornell-Farrow R, Krause M, Wronski M, Singhal S, Ma H, Phan TG. Rapid outpatient transient ischemic attack clinic and stroke service activity during the SARS-CoV-2 pandemic: a multicenter time series analysis. Front Neurol 2024; 15:1351769. [PMID: 38385034 PMCID: PMC10879819 DOI: 10.3389/fneur.2024.1351769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 01/23/2024] [Indexed: 02/23/2024] Open
Abstract
Background and aim Rapid outpatient evaluation and treatment of TIA in structured clinics have been shown to reduce stroke recurrence. It is unclear whether short-term downtrends in TIA incidence and admissions have had enduring impact on TIA clinic activity. This study aims to measure the impact of the pandemic on hospitals with rapid TIA clinics. Methods Relevant services were identified by literature search and contacted. Three years of monthly data were requested - a baseline pre-COVID period (April 2018 to March 2020) and an intra-COVID period (April 2020 to March 2021). TIA presentations, ischemic stroke presentations, and reperfusion trends inclusive of IV thrombolysis (IVT) and endovascular thrombectomy (EVT) were recorded. Pandemic impact was measured with interrupted time series analysis, a segmented regression approach to test an effect of an intervention on a time-dependent outcome using a defined impact model. Results Six centers provided data for a total of 6,231 TIA and 13,191 ischemic stroke presentations from Australia (52.1%), Canada (35.0%), Italy (7.6%), and England (5.4%). TIA clinic volumes remained constant during the pandemic (2.9, 95% CI -1.8 to 7.6, p = 0.24), as did ischemic stroke (2.9, 95% CI -7.8 to 1.9, p = 0.25), IVT (-14.3, 95% CI -36.7, 6.1, p < 0.01), and EVT (0, 95% CI -16.9 to 16.9, p = 0.98) counts. Proportion of ischemic strokes requiring IVT decreased from 13.2 to 11.4% (p < 0.05), but those requiring EVT did not change (16.0 to 16.7%, p = 0.33). Conclusion This suggests that the pandemic has not had an enduring effect on TIA clinic or stroke service activity for these centers. Furthermore, the disproportionate decrease in IVT suggests that patients may be presenting outside the IVT window during the pandemic - delays in seeking treatment in this group could be the target for public health intervention.
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Affiliation(s)
- Andy Lim
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Peter M. Rothwell
- Wolfson Center for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Linxin Li
- Wolfson Center for the Prevention of Stroke and Dementia, Nuffield Department of Clinical Neuroscience, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Shelagh B. Coutts
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Michael D. Hill
- Departments of Clinical Neurosciences, Radiology and Community Health Sciences, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Maria Guarino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Valentina Barone
- Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | | | - Timothy Kleinig
- Department of Neurology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | | | - Martin Krause
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Miriam Wronski
- Department of Neurology, Royal North Shore Hospital and Kolling Institute, University of Sydney, St Leonards, NSW, Australia
| | - Shaloo Singhal
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Henry Ma
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
| | - Thanh G. Phan
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
- Department of Neurology, Monash Health, Melbourne, VIC, Australia
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Sakuma F, Yamamiya A, Abe Y, Nagashima K, Minaguchi T, Kashima K, Kunogi Y, Fukushi K, Inaba Y, Sugaya T, Tominaga K, Goda K, Irisawa A. Investigating COVID-19 Pandemic Effects on Acute Pancreatitis Development-From the Perspective of Alcohol Sales (Consumption) in a Japanese Regional Hospital. Healthcare (Basel) 2023; 11:2769. [PMID: 37893843 PMCID: PMC10606278 DOI: 10.3390/healthcare11202769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 09/29/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
[Aim and Background] People's lifestyles changed considerably due to the coronavirus disease 2019 (COVID-19) pandemic. The number of patients with acute pancreatitis (AP) can be expected to decrease as alcohol consumption decreases. This study was conducted to assess COVID-19 pandemic effects on AP patients in a Japanese regional hospital. [Methods] Based on the first and second states of emergency declarations in Tochigi Prefecture, the survey periods were set as follows: period A, 16 April-14 May; period B, 15 May-13 January; period C, 14 January-7 February; and period D, 8 February-15 April. Using data acquired in 2017, 2018, 2019, and 2020, we retrospectively reviewed the number of patients admitted to our hospital with a diagnosis of AP, and their clinical characteristics. [Results] According to a National Tax Agency survey, the average alcohol sales per adult in Tochigi Prefecture were 71.3 L in 2017 before the pandemic, and 64.0 L in 2021 under the pandemic. The number of AP patients in 2020 was 38% lower than in 2017. Comparing 2017 with 2020, the number of alcoholic AP patients was lower in 2020 (p = 0.007). [Conclusions] The findings suggest that COVID-19-pandemic-related lifestyle changes contributed to the decrease in AP patients.
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Affiliation(s)
| | - Akira Yamamiya
- Department of Gastroenterology, School of Medicine, Dokkyo Medical University, 880 Kitakobayashi Mibu, Tochigi 321-0293, Japan; (F.S.); (Y.A.); (K.N.); (T.M.); (K.K.); (Y.K.); (K.F.); (Y.I.); (T.S.); (K.T.); (K.G.); (A.I.)
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De Luca L, D'Errigo P, Rosato S, Badoni G, Giordani B, Mureddu GF, Tavilla A, Seccareccia F, Baglio G. Impact of COVID-19 Diagnosis on Mortality in Patients with Ischemic Stroke Admitted during the 2020 Pandemic in Italy. J Clin Med 2023; 12:4560. [PMID: 37510675 PMCID: PMC10380878 DOI: 10.3390/jcm12144560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 06/29/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
AIMS The impact of the COVID-19 pandemic on the event rate of patients with ischemic stroke has been poorly investigated. We sought to evaluate the impact of the COVID-19 infection on mortality in patients with ischemic stroke admitted during the 2020 pandemic in Italy. METHODS We analyzed a nationwide, comprehensive, and universal administrative database of patients who were admitted for ischemic stroke during and after the national lockdown for the COVID-19 infection in 2020, and the equivalent periods over the previous 5 years in Italy. The 2020 observed hospitalization and mortality rates of stroke patients with and without COVID-19 infection were compared with the expected rates, in accordance with the trend of the previous 5 years. RESULTS During the period of observation, 300,890 hospitalizations for ischemic stroke occurred in Italy. In 2020, 41,302 stroke patients (1102 with concomitant COVID-19 infection) were admitted at 771 centers. The rate of admissions for ischemic stroke during the 2020 pandemic was markedly reduced compared with previous years (percentage change vs. 2015: -23.5). Based on the 5 year trend, the 2020 expected 30 day and 1 year mortality rates were 9.8% and 23.9%, respectively, and the observed incidence of death rates were 12.2% and 26.7%, respectively (both p < 0.001). After multiple corrections, higher rates of mortality were observed among patients admitted for stroke with a concomitant COVID-19 diagnosis. CONCLUSIONS During the COVID-19 pandemic in 2020 in Italy, the rate of hospitalizations for ischemic stroke was dramatically reduced, although both the 30 day and 1 year mortality rates increased compared with the previous 5 year trend.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, 00152 Rome, Italy
- Faculty of Medicine and Dentistry, UniCamillus-Saint Camillus International University of Health Sciences, 00131 Rome, Italy
| | - Paola D'Errigo
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Gabriella Badoni
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Barbara Giordani
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
| | | | - Andrea Tavilla
- National Center for Disease Prevention and Health Promotion, Italian National Institute of Health, 00161 Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Italian National Institute of Health, 00161 Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, 00187 Rome, Italy
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Li G, Wang S, Wang C, Hao Y, Xiong Y, Ding Z, Zhao X. Intravenous thrombolysis for acute ischemic stroke during two COVID-19 outbreaks in China: Wuhan pandemic and Beijing pandemic. BMC Neurol 2023; 23:206. [PMID: 37231485 DOI: 10.1186/s12883-023-03211-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has had an impact on the emergency department (ED). Door-to-needle time (DNT) could be prolonged for intravenous thrombolysis (IVT) treatment. We aimed to investigate the impact of two COVID-19 pandemics on the workflow of IVT in our neurovascular ED. METHOD We performed a retrospective analysis of patients who received IVT treatment in the neurovascular ED of Beijing Tiantan Hospital, Beijing, from January 20, 2020, to October 30, 2020, covering two COVID-19 pandemics in China. The time-based performances of IVT treatment including onset-to-arrival time, arrival-to-CT time, CT-to-needle time, door-to-needle time, and onset-to-needle time were recorded. Data on clinical characteristics and imaging information were also collected. RESULTS Four hundred forty patients that received IVT were enrolled in this study. The number of patients admitted to our neurovascular ED began to decrease in December 2019 and was the lowest in April 2020 (n = 95). Longer DNT (Wuhan pandemic: 49.00 [35.00, 64.00] min; Beijing pandemic: 55.00 [45.50, 77.00] min) interval delays were observed during the two pandemics (p = .016). More patients admitted during the two pandemics had an 'unknown' subtype (Wuhan pandemic: 21.8%; Beijing pandemic: 31.4%. p = .008). The percentage of the cardiac embolism subtype was higher during the Wuhan pandemic (20.0%) than during other periods. The median admission NIHSS score increased during the Wuhan pandemic and the Beijing pandemic (8.00 [4.00, 12.00], 7.00 [4.50, 14.00], respectively, p < .001). CONCLUSION The number of patients who received IVT decreased during the Wuhan pandemic. Higher admission NIHSS scores and prolonged DNT intervals were also observed during the Wuhan pandemic and the Beijing pandemic.
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Affiliation(s)
- Guangshuo Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shang Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Fengtai District, No. 119 Nansihuanxilu, Beijing, 100070, China
| | - Chuanying Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yahui Hao
- China National Clinical Research Center for Neurological Diseases, Fengtai District, No. 119 Nansihuanxilu, Beijing, 100070, China
| | - Yunyun Xiong
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Fengtai District, No. 119 Nansihuanxilu, Beijing, 100070, China
| | - Zeyu Ding
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Xingquan Zhao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Fengtai District, No. 119 Nansihuanxilu, Beijing, 100070, China.
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Ngu NLY, Boyd DT, Morgan B, Surampudi A, Brown I, Bykersma C, Kennett G, Yesmin A, Peng Y, Bell S, Le S. Impact of increased alcohol consumption during the COVID-19-related lockdowns on admissions with liver disease, gastrointestinal bleeding and pancreatitis in Melbourne, Victoria. Intern Med J 2023; 53:830-834. [PMID: 37134235 DOI: 10.1111/imj.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 02/26/2023] [Indexed: 05/05/2023]
Abstract
This audit collates data on alcohol-related gastrointestinal (GI) admissions at Monash Health, Victoria, during the prolonged, coronavirus disease 2019 (COVID-19)-related lockdown July to October 2020 compared with the same periods in 2019 and 2021. We found a 58% increase in admissions in 2020 and a 16% increase in 2021, which also increased disproportionately to overall health service emergency presentations. Self-reported alcohol consumption increased by 2.5-fold and was greatest in 2020. Clinical severity was unchanged and cirrhosis was the only factor associated with severe disease. This study suggests an association between the pandemic-related lockdown, alcohol consumption and alcohol-related GI hospitalisation. Our study provides support for resourcing and adapting alcohol and other drug services during and beyond the COVID-19 lockdown.
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Affiliation(s)
- Natalie L Y Ngu
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - David T Boyd
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Beth Morgan
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
| | - Anusha Surampudi
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
| | - Imogen Brown
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
| | - Chloe Bykersma
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Grace Kennett
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Anika Yesmin
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Yuhong Peng
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Sally Bell
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Suong Le
- Department of Gastroenterology and Hepatology, Monash Health, Melbourne, Victoria, Australia
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Heidenreich A, Stachon P, Oettinger V, Hilgendorf I, Heidt T, Rilinger J, Zehender M, Westermann D, von Zur Mühlen C, Kaier K. Impact of the COVID-19 pandemic on aortic valve replacement procedures in Germany. BMC Cardiovasc Disord 2023; 23:187. [PMID: 37024779 PMCID: PMC10079149 DOI: 10.1186/s12872-023-03213-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND COVID-19 has caused the deferral of millions of elective procedures, likely resulting in a backlog of cases. We estimate the number of postponed surgical aortic valve replacement (sAVR) and transcatheter aortic valve replacement (TAVR) procedures during the first two waves of the COVID-19 pandemic in Germany. METHODS Using German national records, all isolated TAVR and sAVR procedures between 2007 and 2020 were identified. Using weekly TAVR and sAVR procedures between 2017 and 2019, we created a forecast for 2020 and compared it with the observed number of procedures in 2020. RESULTS In Germany, a total of 225,398 isolated sAVR and 159,638 isolated TAVR procedures were conducted between 2007 and 2020 that were included in our analysis. The reduction in all AVR procedures (sAVR and TAVR) for the entire year 2020 was 19.07% (95%CI: 15.19-22.95%). During the first wave of the pandemic (week 12-21), the mean weekly reduction was 32.06% (23.44-40.68%) and during the second wave of the pandemic (week 41-52), the mean weekly reduction was 25.58% (14.19-36.97%). The number of sAVR procedures decreased more than the number of TAVR procedures (24.63% vs. 16.42% for the entire year 2020). CONCLUSION The first year of the COVID-19 pandemic saw a substantial postponing of AVR procedures in Germany. Postponing was higher for sAVR than for TAVR procedures and less pronounced during the second wave of the COVID-19 pandemic.
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Affiliation(s)
- Adrian Heidenreich
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Timo Heidt
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute of Medical Biometry and Medical Informatics, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Freiburg, Germany.
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Katsouras CS, Papafaklis MI, Giannopoulos S, Karapanayiotides T, Tsivgoulis G, Michalis LK. Cerebro-/Cardiovascular Collateral Damage During the COVID-19 Pandemic: Fact or Fiction? J Clin Neurol 2023; 19:1-11. [PMID: 36606641 PMCID: PMC9833878 DOI: 10.3988/jcn.2023.19.1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 01/04/2023] Open
Abstract
Numerous observational studies have identified a decline in cerebro-/cardiovascular (CV) admissions during the initial phase of the COVID-19 pandemic. Recent studies and meta-analyses indicated that the overall decrease was smaller than that found in initial studies during the first months of 2020. Two years later we still do not have clear evidence about the potential causes and impacts of the reduction of CV hospitalizations during the COVID-19 pandemic. It has becoming increasingly evident that collateral damage (i.e., incidental damage to the public and patients) from the COVID-19 outbreak is the main underlying cause that at least somewhat reflects the effects of imposed measures such as social distancing and self-isolation. However, a smaller true decline in CV events in the community due to a lack of triggers associated with such acute syndromes cannot be excluded. There is currently indirect epidemiological evidence about the immediate impact that the collateral damage had on excess mortality, but possible late consequences including a rebound increase in CV events are yet to be observed. In the present narrative review, we present the reporting milestones in the literature of the rates of CV admissions and collateral damage during the last 2 years, and discuss all possible factors contributing to the decline in CV hospitalizations during the COVID-19 pandemic. Healthcare systems need to be prepared so that they can cope with the increased hospitalization rates for CV events in the near future.
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Affiliation(s)
- Christos S Katsouras
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Michail I Papafaklis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Sotirios Giannopoulos
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
| | - Theodoros Karapanayiotides
- 2nd Department of Neurology, Faculty of Health Sciences, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Tsivgoulis
- 2nd Department of Neurology, ATTIKON University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, University of Ioannina, Ioannina, Greece
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[Changes in number of emergency medical service deployments in an urban area during the first COVID-19 pandemic-related contact restriction phase]. Notf Rett Med 2023; 26:30-38. [PMID: 33935590 PMCID: PMC8063581 DOI: 10.1007/s10049-021-00875-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 02/06/2023]
Abstract
Background To contain the coronavirus disease (COVID-19) pandemic, public life was reduced through contact restriction measures (referred to as "lockdown" in the further course for reading simplicity), among other things to make health system resources available for the treatment of COVID-19 patients. In parallel, a decrease in emergency patients was observed in the public health system. Methods For two 10-week periods before and during the lockdown, ambulance service deployment rates were analysed in 6 ambulance service areas for 6 tracer diagnoses. Random effects were minimised by comparing the results with the corresponding 2018 and 2019 time periods and a calculated expected value. Results For emergency ambulance service calls, there was a reduction in call numbers (-16%) during the lockdown. A 20% reduction for the categories cardiac and cerebral ischaemia was found. In the urban area, the reduction in cardiac ischaemia was less pronounced at 14% than in the surrounding area at 23%. The deployment figures for intoxications decreased by 27% and for psychiatric emergencies by 16%. Conclusion The public ambulance service was not overwhelmed by the COVID-19 pandemic; there was a decrease in depolyments during the lockdown. For the reduction in cerebral or cardiac ischaemias, the explanatory models for the influence of the lockdown are missing. Further studies on the utilisation behaviour of the ambulance service during a lockdown appear necessary in order to detect potentially fatal reductions in utilisation for the patient outcome and to be able to counteract them through education.
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Sakibuzzaman M, Hassan A, Hayee S, Haque FA, Bushra SS, Maliha M, Tania MK, Sadat A, Akter F, Mazumder T, Razzaque J, Kapuria P, Jalal I, Shah-Riar P. Exacerbation of Pre-existing Neurological Symptoms With COVID-19 in Patients With Chronic Neurological Diseases: An Updated Systematic Review. Cureus 2022; 14:e29297. [PMID: 36277564 PMCID: PMC9578565 DOI: 10.7759/cureus.29297] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 01/08/2023] Open
Abstract
The neurotropism of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can potentially explain the worsening of symptoms in patients with a history of neurological conditions such as stroke, Parkinson's disease, Alzheimer's, and epilepsy. Several studies have reported that these pre-existing conditions may worsen with a higher frequency of flare-ups, thus resulting in a more significant risk of patient mortality. In this review, we sought to provide an overview of the relationship between pre-existing neurological disorders and COVID-19, focusing on whether the initial infection directly influenced the severity of symptoms. We systematically searched the electronic database PubMed (MEDLINE) and used specific keywords related to our aims from January 2020 to July 2022. All articles published on COVID-19 with keywords pertaining to pre-existing neurological diseases were retrieved and subsequently analyzed. After independent review, the data from 107 articles were selected and evaluated. After analyzing the data from selected articles reviewing the effect of COVID-19 on neurological conditions, we have documented the relationship between said pre-existing neurological diseases, showing an increased risk of hospitalization, admission length, worsening of symptoms, and even mortality in COVID-19 patients.
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11
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Pellegrino F, Carnevale A, Bisi R, Cavedagna D, Reverberi R, Uccelli L, Leprotti S, Giganti M. Best Practices on Radiology Department Workflow: Tips from the Impact of the COVID-19 Lockdown on an Italian University Hospital. Healthcare (Basel) 2022; 10:healthcare10091771. [PMID: 36141383 PMCID: PMC9498676 DOI: 10.3390/healthcare10091771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/11/2022] [Accepted: 09/12/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose: The workload of the radiology department (RD) of a university hospital in northern Italy dramatically changed during the COVID-19 outbreak. The restrictive measures of the COVID-19 pandemic lockdown influenced the use of radiological services and particularly in the emergency department (ED). Methods: Data on diagnostic services from March 2020 to May 2020 were retrospectively collected and analysed in aggregate form and compared with those of the same timeframe in the previous year. Data were sorted by patient type in the following categories: inpatients, outpatients, and ED patients; the latter divided in “traumatic” and “not traumatic” cases. Results: Compared to 2019, 6449 fewer patients (−32.6%) were assisted in the RD. This decrease was more pronounced for the emergency radiology unit (ERU) (−41%) compared to the general radiology unit (−25.7%). The proportion of investigations performed for trauma appeared to decrease significantly from 14.8% to 12.5% during the COVID-19 emergency (p < 0.001). Similarly, the proportion of assisted traumatic patients decreased from 16.6% to 12.5% (p < 0.001). The number of emergency patients assisted by the RD was significantly reduced from 45% during routine activity to 39.4% in the COVID-19 outbreak (p < 0.001). Conclusion: The COVID-19 outbreak had a tremendous impact on all radiology activities. We documented a drastic reduction in total imaging volume compared to 2019 because of both the pandemic and the lockdown. In this context, investigations performed for trauma showed a substantial decrease.
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Affiliation(s)
- Fabio Pellegrino
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
- Correspondence:
| | - Aldo Carnevale
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Riccardo Bisi
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Davide Cavedagna
- Department of Radiology, Sant’Anna University Hospital Ferrara, 44124 Ferrara, Italy
| | - Roberto Reverberi
- Blood Transfusion Service, Azienda Ospedaliera Universitaria di Ferrara, 44124 Ferrara, Italy
| | - Licia Uccelli
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
| | - Stefano Leprotti
- Department of Radiology, Sant’Anna University Hospital Ferrara, 44124 Ferrara, Italy
| | - Melchiore Giganti
- Department of Translational Medicine, University of Ferrara, 44124 Ferrara, Italy
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12
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Ng RWC, Emmerig D, Salter MD, Shetty A, Gunja N. Toxicology presentations to a tertiary unit in New South Wales during the COVID-19 pandemic first wave: A retrospective comparison study. Emerg Med Australas 2022; 35:105-111. [PMID: 36068925 PMCID: PMC9538971 DOI: 10.1111/1742-6723.14070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To compare presentation numbers, class of exposure, poison severity score (PSS) and drugs ingested by patients in a tertiary toxicology service during the first wave of the COVID-19 pandemic to the corresponding time periods in 2018 and 2019. METHODS A retrospective cohort observational study of patients admitted or consulted to the Western Sydney Toxicology Service (WSTS) from ED during February to May in 2018-2020. Patient age, sex, triage category, time and date of arrival, mode of arrival, type of poisoning, discharge location, length of stay and PSS were collected from WSTS database and electronic medical records. The total number of ED presentations, hospital admissions and toxicology admissions were gathered from hospital-based data services. RESULTS There was an overall increase in toxicology presentations in February to May 2020 (n = 441) compared to 2019 (n = 333) and 2018 (n = 255). The daily rate of presentations increased in March to May 2020 with an overall rate ratio of 1.42, 95% confidence interval 1.23-1.63, P < 0.001. There was an increase in presentations across all drug types. From March to April 2020, there was significantly higher number of daily presentations for recreational drugs use compared to 2018. CONCLUSION There was a relative increase in toxicology presentations during the COVID-19 pandemic compared to an overall decrease in presentations to ED. Recreational drug use increased significantly during the pandemic compared to 2018.
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Affiliation(s)
- Rachel WC Ng
- Department of Clinical Pharmacology and ToxicologyWestern Sydney HealthSydneyNew South WalesAustralia
| | - David Emmerig
- Department of Clinical Pharmacology and ToxicologyWestern Sydney HealthSydneyNew South WalesAustralia
| | - Mark Daniel Salter
- Department of Clinical Pharmacology and ToxicologyWestern Sydney HealthSydneyNew South WalesAustralia,Discipline of Emergency Medicine, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
| | - Amith Shetty
- The Westmead Institute for Medical ResearchThe University of SydneySydneyNew South WalesAustralia,Patient Experience and System Performance Support Division, NSW Ministry of HealthSydneyNew South WalesAustralia
| | - Naren Gunja
- Department of Clinical Pharmacology and ToxicologyWestern Sydney HealthSydneyNew South WalesAustralia,Discipline of Emergency Medicine, Sydney Medical SchoolThe University of SydneySydneyNew South WalesAustralia
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13
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Burton E, Aladkhen J, O’Donnell C, Masterson S, Merwick A, McCarthy VJC, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for adults with stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [PMID: 35859688 PMCID: PMC9266003 DOI: 10.12688/hrbopenres.13534.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results: Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions: This review will identify existing evidence reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Affiliation(s)
- Edel Burton
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Johnny Aladkhen
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Cathal O’Donnell
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - Siobhán Masterson
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- Discipline of General Practice, National University of Ireland, Galway, Ireland
| | - Aine Merwick
- Department of Neurology, Cork University Hospital, Cork City, Cork, Ireland
| | - Vera JC McCarthy
- School of Nursing and Midwifery, University College Cork, Cork City, Cork, Ireland
| | - Patricia M Kearney
- School of Public Health, University College Cork, Cork City, Cork, Ireland
| | - Claire M Buckley
- School of Public Health, University College Cork, Cork City, Cork, Ireland
- Office of the NCAGL for Chronic Disease, Health Service Executive South East, Lacken, Dublin Road, Kilkenny, R95 NV08, Ireland
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14
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Fyntanidou B, Stavrou G, Apostolopoulou A, Gkarmiri S, Kotzampassi K. Emergencies in the COVID-19 Era: Less Attendances, More Admissions. Cureus 2022; 14:e25971. [PMID: 35855234 PMCID: PMC9286014 DOI: 10.7759/cureus.25971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Healthcare systems suffered a significant hit by the COVID-19 pandemic since the spring of 2020, and a need for major reorganization emerged. Along with the constant increase in COVID-19 cases, a significant drop in emergency attendances for non-COVID-19-related conditions was noted worldwide. We decided to document attendances in our hospital's emergency department during the first lockdown period in order to monitor this trend, compare it to data from other countries, and start monitoring the effects of this reduction in the years to come. Materials and methods Emergency department attendances at AHEPA University Hospital, Thessaloniki, Greece, from March 10, 2020, to May 31, 2020, were documented and compared to the corresponding period in 2019. The data collected included the number of patients per specialty, severity upon admission, as well as the need for admission. Results We found a 58% reduction in emergency department attendance during the studied period compared to the corresponding period in 2019 (p<0.0001). The reduction was more noticeable in ears, nose, throat (ENT), and ophthalmology attendances (75.7% and 78.1% reductions, respectively, p<0.001), but other specialties, such as cardiology and general surgery, were also significantly affected (60% and 63% reductions, respectively, p<0.001). However, the percentage of attendances that required admission increased significantly by 25-33% (p<0.001) during the lockdown, reflecting the higher severity of cases reaching the hospital. Conclusion Despite the obvious reduction in attendances during the COVID-19 pandemic, patients still suffer from serious conditions that require hospital admission. Therefore, hospitals need to be supported to also care for these patients. The long-term effects of avoiding hospital attendance need to be closely monitored.
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15
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Alrasheed A, Shamou J, Rajendram R, Boqaeid A, Qasim S, Baharoon W, Layqah L, Baharoon S. Adequacy of physician clinical rounds and nursing care elements for non-COVID-19 infected patients admitted during the COVID-19 pandemic. J Infect Public Health 2022; 15:648-653. [PMID: 35617828 PMCID: PMC9045878 DOI: 10.1016/j.jiph.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/31/2022] [Accepted: 04/10/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic created many challenges for healthcare systems. Frontline workers and especially healthcare professionals were the most severely affected through increased working hours, burnout and major psychological distress. OBJECTIVES To evaluate the changes in standard care elements which occurred during the COVID-19 pandemic, specifically the physician clinical rounds and nursing care provided to non-COVID-19 infected patients. DESIGN Observational retrospective study. SETTINGS The study was conducted at King Abdulaziz Medical City, Riyadh Saudi Arabia. KAMC is a 1200 bed tertiary care referral academic medical center. PATIENTS (MATERIALS) AND METHODS We compared the physician clinical rounds and nursing care elements in all admissions due to non-COVID-19 pneumonia and ST elevation myocardial infarction during the lockdown period with similar admissions in a baseline period in the same weeks in the previous pre-lockdown. MAIN OUTCOME MEASURES To evaluates the changes occurring during the COVID-19 pandemic in terms of the standard care elements, such as the physician rounds and nursing care. SAMPLE SIZE Total of 113 patients records were analyzed. RESULTS During the lock down period, a total of 113 patients were admitted to the medical and cardiology wards, (95 patients with pneumonia and 18 patients with ST segment elevation myocardial infarction (STEMI)) compared to 89 patients in the pre lockdown period (74 patients with pneumonia and 15 patients with STEMI). Both groups were similar in age, gender, disposition, length of stay, goal of care planning and outcome. Chronic respiratory disease and Diabetes were more present in patients admitted on the pre lockdown time. Azithromycin was more frequently used as part of the initial antibiotic regimen for pneumonia during the pre-lockdown while doxycycline was significantly more during the lockdown. For the 95 patients admitted in the medical wards during the lockdown, there were a total of 820 physicians' clinical rounds opportunities for senior and junior physicians each. The residents missed 133 (16.2%) and consultant missed 252 (30.7%) of those clinical rounds opportunities. Missed clinical rounds opportunities during the pre-lock down period was higher for residents and consultants at 19.3% (P = 0.429 ) and 36.3% respectively (P = 0.027 ). Similarly, missed clinical rounds opportunities was less during the lockdown period from 35.2% to 25% (p 0.022) and from 38.8% to 30.6% (p = 1 ) for junior staff and consultant cardiology respectively compared to pre lockdown period. For nursing care elements, there was a decrease in missed opportunities in vital signs measurement (p 0.47 and p 0.226), pain assessment (p 0.088 and p 0,366) and skin care (p 0.249 and p 0.576) for patients admitted during the lockdown period in medical and cardiology wards. CONCLUSIONS Caring for patients admitted for non COVID 19 infection reasons, physicians' clinical rounds did marginally increase compared to pre lockdown period while nurses monitoring for those patients was significantly higher. No difference in mortality was observed for patients admitted pre and during lockdown. The number of missed opportunities to do clinical rounds by physicians remains high during both periods and measures to improve adherence of physicians to performed clinical rounds are needed.
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Affiliation(s)
- Abdullah Alrasheed
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Jinan Shamou
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Rajkumar Rajendram
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Abdulaziz Boqaeid
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Salman Qasim
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Waleed Baharoon
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Laila Layqah
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia; Research Offices, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Salim Baharoon
- Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia; Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdul-Aziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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16
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Usher MG, Tignanelli CJ, Hilliard B, Kaltenborn ZP, Lupei MI, Simon G, Shah S, Kirsch JD, Melton GB, Ingraham NE, Olson AP, Baum KD. Responding to COVID-19 Through Interhospital Resource Coordination: A Mixed-Methods Evaluation. J Patient Saf 2022; 18:287-294. [PMID: 34569998 PMCID: PMC8940726 DOI: 10.1097/pts.0000000000000916] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The COVID-19 pandemic stressed hospital operations, requiring rapid innovations to address rise in demand and specialized COVID-19 services while maintaining access to hospital-based care and facilitating expertise. We aimed to describe a novel hospital system approach to managing the COVID-19 pandemic, including multihospital coordination capability and transfer of COVID-19 patients to a single, dedicated hospital. METHODS We included patients who tested positive for SARS-CoV-2 by polymerase chain reaction admitted to a 12-hospital network including a dedicated COVID-19 hospital. Our primary outcome was adherence to local guidelines, including admission risk stratification, anticoagulation, and dexamethasone treatment assessed by differences-in-differences analysis after guideline dissemination. We evaluated outcomes and health care worker satisfaction. Finally, we assessed barriers to safe transfer including transfer across different electronic health record systems. RESULTS During the study, the system admitted a total of 1209 patients. Of these, 56.3% underwent transfer, supported by a physician-led System Operations Center. Patients who were transferred were older (P = 0.001) and had similar risk-adjusted mortality rates. Guideline adherence after dissemination was higher among patients who underwent transfer: admission risk stratification (P < 0.001), anticoagulation (P < 0.001), and dexamethasone administration (P = 0.003). Transfer across electronic health record systems was a perceived barrier to safety and reduced quality. Providers positively viewed our transfer approach. CONCLUSIONS With standardized communication, interhospital transfers can be a safe and effective method of cohorting COVID-19 patients, are well received by health care providers, and have the potential to improve care quality.
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Affiliation(s)
- Michael G. Usher
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Christopher J. Tignanelli
- Department of Surgery, University of Minnesota Medical School
- Institute for Health Informatics, University of Minnesota
| | - Brian Hilliard
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Zachary P. Kaltenborn
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | | | - Gyorgy Simon
- Institute for Health Informatics, University of Minnesota
| | - Surbhi Shah
- Division of Hematology and Oncology, Department of Medicine
| | - Jonathan D. Kirsch
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Genevieve B. Melton
- Department of Surgery, University of Minnesota Medical School
- Institute for Health Informatics, University of Minnesota
| | - Nicholas E. Ingraham
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Andrew P.J. Olson
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
| | - Karyn D. Baum
- From the Section of Hospital Medicine, Division of General Internal Medicine, Department of Medicine
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Choi H, Lee JH, Park HK, Lee E, Kim MS, Kim HJ, Park BE, Kim HN, Kim N, Jang SY, Bae MH, Yang DH, Park HS, Cho Y. Impact of the COVID-19 Pandemic on Patient Delay and Clinical Outcomes for Patients With Acute Myocardial Infarction. J Korean Med Sci 2022; 37:e167. [PMID: 35638194 PMCID: PMC9151994 DOI: 10.3346/jkms.2022.37.e167] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has been known that the fear of contagion during the coronavirus disease 2019 (COVID-19) creates time delays with subsequent impact on mortality in patients with acute myocardial infarction (AMI). However, difference of time delay and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) or non-STEMI between the COVID-19 pandemic and pre-pandemic era has not been fully investigated yet in Korea. The aim of this study was to investigate the impact of COVID-19 pandemic on time delays and clinical outcome in patients with STEMI or non-STEMI compared to the same period years prior. METHODS A total of 598 patients with STEMI (n = 195) or non-STEMI (n = 403) who underwent coronary angiography during the COVID-19 pandemic (February 1 to April 30, 2020) and pre-pandemic era (February 1 to April 30, 2017, 2018, and 2019) were analyzed in this study. Main outcomes were the incidence of time delay, cardiac arrest, and in-hospital death. RESULTS There was 13.5% reduction in the number of patients hospitalized with AMI during the pandemic compared to pre-pandemic era. In patients with STEMI, door to balloon time tended to be longer during the pandemic compared to pre-pandemic era (55.7 ± 12.6 minutes vs. 60.8 ± 13.0 minutes, P = 0.08). There were no significant differences in cardiac arrest (15.6% vs. 10.4%, P = 0.397) and in-hospital mortality (15.6% vs. 10.4%, P = 0.397) between pre-pandemic and the pandemic era. In patients with non-STEMI, symptom to door time was significantly longer (310.0 ± 346.2 minutes vs. 511.5 ± 635.7 minutes, P = 0.038) and the incidence of cardiac arrest (0.9% vs. 3.5%, P = 0.017) and in-hospital mortality (0.3% vs. 2.3%, P = 0.045) was significantly greater during the pandemic compared to pre-pandemic era. Among medications, angiotensin converting enzyme inhibitors/angiotensin type 2 receptor blockers (ACE-I/ARBs) were underused in STEMI (64.6% vs. 45.8%, P = 0.021) and non-STEMI (67.8% vs. 57.0%, P = 0.061) during the pandemic. CONCLUSION During the COVID-19 pandemic, there has been a considerable reduction in hospital admissions for AMI, time delay, and underuse of ACE-I/ARBs for the management of AMI, and this might be closely associated with the excess death in Korea.
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Affiliation(s)
- Hyohun Choi
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Hyuk Kyoon Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Eunkyu Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Myeong Seop Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hyeon Jeong Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Bo Eun Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Hong Nyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Namkyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
- School of Medicine, Kyungpook National University, Daegu, Korea
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Lin G, Xu X, Luan X, Qiu H, Shao S, Wu Q, Xu W, Huang G, He J, Feng L. A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic. Front Neurol 2022; 13:873061. [PMID: 35518200 PMCID: PMC9062182 DOI: 10.3389/fneur.2022.873061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH. Patients and Methods The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death. Results The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death. Conclusion During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.
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Affiliation(s)
- Gangqiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqian Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengfang Shao
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingsong Wu
- Medical Record Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Xu
- Outpatient Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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19
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Burton E, McCarthy VJC, Merwick A, Kearney PM, Buckley CM. Effects of the COVID-19 pandemic on prehospital emergency care for stroke and transient ischaemic attack: A protocol for a systematic review and meta-analysis. HRB Open Res 2022; 5:24. [DOI: 10.12688/hrbopenres.13534.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background The COVID-19 pandemic impacted on health service provision worldwide, including care for acute time sensitive conditions. Stroke and transient ischaemic attacks (TIA) are particularly vulnerable to pressures on healthcare delivery as they require immediate diagnosis and treatment. The global impact of the COVID-19 pandemic on prehospital emergency care for stroke/TIA is still largely unknown. Thus, the aim of this study is to conduct a systematic review and meta-analysis to investigate the impact of the COVID-19 pandemic on prehospital emergency care for stroke and TIA. Methods Following the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, the review is registered on PROSPERO (registration number CRD42022315260). Peer-reviewed quantitative studies comparing prehospital emergency care for adults with stroke/TIA before and during the COVID-19 pandemic will be considered for inclusion. The outcomes of interest are ambulance response times and emergency call volumes for stroke/TIA. A systematic search of databases including PubMed, Embase and Scopus will be conducted. Two authors will independently screen studies for inclusion based on predetermined inclusion and exclusion criteria. Data extraction and quality assessment will be conducted by two authors. Meta-analysis will be performed to calculate overall pooled estimates of ambulance response times (primary outcome) and stroke/TIA call volumes (secondary outcome), where appropriate. Where heterogeneity is low a fixed-effects model will be used and where heterogeneity is high a random-effects model will be used. Subgroup and sensitivity analyses will include location, stroke/TIA diagnosis and COVID-19 case numbers. Results Data on primary and secondary outcomes will be provided. Results of subgroup/sensitivity analyses and quality assessment will also be presented. Conclusions This review will identify existing literature reporting the impact of the COVID-19 pandemic on prehospital emergency care for adult patients with stroke/TIA and provide summary estimates of effects on ambulance response times.
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Carlos AF, Poloni TE, Caridi M, Pozzolini M, Vaccaro R, Rolandi E, Cirrincione A, Pettinato L, Vitali SF, Tronconi L, Ceroni M, Guaita A. Life during COVID-19 lockdown in Italy: the influence of cognitive state on psychosocial, behavioral and lifestyle profiles of older adults. Aging Ment Health 2022; 26:534-543. [PMID: 33445968 DOI: 10.1080/13607863.2020.1870210] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Few studies have examined lockdown effects on the way of living and well-being of older adults stratified by cognitive state. Since cognitive deficits are common in this population, we investigated how cognition influenced their understanding of the pandemic, socio-behavioral responses and lifestyle adaptations during lockdown, and how these factors affected their mood or memory. METHOD Telephone-based survey involving 204 older adults ≥65 y/o (median: 82) with previous assessments of cognitive state: 164 normal-old (NOLD), 24 mild-neurocognitive disorder (mild-NCD), 18 mild-moderate dementia. A structured questionnaire was developed to assess psychological and socio-behavioral variables. Logistic regression was used to ascertain their effects on mood and memory. RESULTS With increasing cognitive deficits, understanding of the pandemic and the ability to follow lockdown policies, adapt to lifestyle changes, and maintain remote interactions decreased. Participants with dementia were more depressed; NOLDs remained physically and mentally active but were more bored and anxious. Sleeping and health problems independently increased the likelihood of depression (OR: 2.29; CI: 1.06-4.93; p = 0.034 and OR: 2.45; CI: 1.16-5.16; p = 0.018, respectively); Regular exercise was protective (OR: 0.30; CI: 0.12-0.72; p = 0.007). Worsening subjective memory complaints were associated with dementia (p = 0.006) and depression (p = 0.004); New-onset sleeping problems raised their odds (OR: 10.26; CI: 1.13-93.41; p = 0.039). Finally, >40% with health problems avoided healthcare mainly due to fear of contagion. DISCUSSION NOLD and mild-NCD groups showed similar mood-behavioral profiles suggesting better tolerance of lockdown. Those with dementia were unable to adapt and suffered from depression and cognitive complaints. To counteract lockdown effects, physical and mental activities and digital literacy should be encouraged.
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Affiliation(s)
- Arenn Faye Carlos
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Tino Emanuele Poloni
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Martina Caridi
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Marco Pozzolini
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Roberta Vaccaro
- Department of Neuropsychology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Elena Rolandi
- Department of Neuropsychology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Alice Cirrincione
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
| | - Laura Pettinato
- Department of Neuropsychology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy.,Department of Dementia Care, ASP Golgi-Redaelli, Abbiategrasso, Milan, Italy
| | | | - Livio Tronconi
- Department of Public Health, Experimental and Forensic Medicine, IRCCS National Neurologic Institute C. Mondino Foundation, University of Pavia, Pavia, Italy
| | - Mauro Ceroni
- Department of Brain and Behavioral Disorders, IRCCS National Neurologic Institute C. Mondino Foundation, University of Pavia, Pavia, Italy
| | - Antonio Guaita
- Department of Neurology and Neuropathology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy.,Department of Neuropsychology, Golgi-Cenci Foundation, Abbiategrasso, Milan, Italy
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21
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Cuschieri S, Borg D, Agius S, Scherb H, Grech V. COVID-19 and vaccination induced changes in hospital activity in Malta, Q1 2020 to Q1 2021: a population-based study. JOURNAL OF THE EGYPTIAN PUBLIC HEALTH ASSOCIATION 2022; 97:7. [PMID: 35133544 PMCID: PMC8825920 DOI: 10.1186/s42506-021-00101-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
Background COVID-19 has severely impacted global healthcare services. Malta has only one acute state hospital, Mater Dei Hospital (MDH), and at the time of writing is the most vaccinated country in Europe. Malta thus provides an ideal setting to assess the impact of COVID-19 on healthcare services at population level, including the impact of vaccination on hospital admissions. Methods Hospital data was obtained as anonymised totals from MDH’s Clinical Performance Unit and the European Centre for Disease Prevention and Control. COVID-19-related data was obtained from the Ministry of Health dashboard. Comparative assessments were performed to explore associations between the COVID-19 situation, vaccination, and hospital activity. Poisson regression was used to model the counts of monthly accident and emergency (A&E), outpatient clinics attendances and hospital admissions. Results A&E, hospital admissions, and outpatient clinics attendances declined (31.88%; 23.89%; 29.57%; p < 0.01 respectively) with onset of COVID-19 till April 2021 when compared to pre-COVID years (2017–2019). Admissions due to COVID-19 initially increased in parallel to the population’s COVID positivity. Vaccination rollout led to a decline in COVID-19 admissions. Conclusions The drastic drop in admissions and outpatient attendees was expected but not for A&E attendees as acutely ill patients should still have attended. This is of public health concern since delayed or deferred medical management increases population morbidity, mortality and increases the eventual burden on the healthcare system. Mass vaccination saw the return to normality with an increase in A&E burden. Supplementary Information The online version contains supplementary material available at 10.1186/s42506-021-00101-1.
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Affiliation(s)
- Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, RM425 Biomedical Building, Msida, MSD2080, Malta.
| | - David Borg
- Clinical Performance Unit, Mater Dei Hospital, Msida, Malta
| | - Steve Agius
- Administration, Mater Dei Hospital, Msida, Malta
| | - Hagen Scherb
- German Research Center for Environmental Health, Institute of Computational Biology, Ingolstädter Landstr. 1, D-85764, Neuherberg, Germany
| | - Victor Grech
- Department of Paediatrics, Mater Dei Hospital, Msida, Malta
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22
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Usta NC, Kartal S, Gunay BO, Boz C. Neurological manifestations and etiological risk factors in patients hospitalized with COVID-19 in Turkey. ASIAN BIOMED 2022; 16:23-30. [PMID: 37551396 PMCID: PMC10321161 DOI: 10.2478/abm-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) can affect the neurological as well as the respiratory system. Neurological manifestations may involve the central or peripheral nervous systems, or musculoskeletal system. Findings can range from mild presentations, such as headache and anosmia, to severe complications, such as stroke and seizure. Objectives To evaluate the neurological findings and to determine etiological risk factors for mortality in patients hospitalized for COVID-19. Methods Medical records of patients with COVID-19 who were hospitalized and sought neurological consultation between March 2020 and March 2021 at a reference pandemic hospital in Turkey were reviewed retrospectively in a cross-sectional study design. Result We included data from 150 (94 male) patients. Their mean age ± standard deviation was 68.56 ± 16.02 (range 21-97) years. The patients were categorized into 2 groups according to any acute neurological event or progression of neurological disease. Ischemic cerebrovascular events, seizures, and encephalopathy were the most common acute neurological events, while deterioration in consciousness, epileptic seizures, and Parkinson disease were observed in those with progression of neurological disease. Abnormal neurological findings were found at a mean of 7.8 ± 9.7 days following COVID-19 diagnosis and 50 (a third of) patients died. A logistic regression model found that advanced age, increased Modified Charlson Comorbidity Index (MCCI) score, and prolonged duration of hospitalization were factors significantly associated with increased mortality; however, sex and day of abnormal neurological findings after COVID-19 diagnosis were not. Common conditions accompanying neurological events were hypertension, coronary artery disease-heart failure, and diabetes mellitus. Conclusion COVID-19 may present with neurological symptoms in our Turkish patients and comorbidities are often present.
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Affiliation(s)
- Nuray Can Usta
- Department of Neurology, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Seyfi Kartal
- Department of Anaesthesiology and Reanimation, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Betul Onal Gunay
- Department of Ophthalmology, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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23
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Bull Iversen A, Paaske Johnsen S, Christensen B, Bondo Christensen M, Andersen G. The impact of a Danish stroke campaign: A cross-sectional study. Acta Neurol Scand 2022; 145:102-110. [PMID: 34523120 DOI: 10.1111/ane.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
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24
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Vissio E, Falco EC, Scozzari G, Scarmozzino A, Trinh DAA, Morino M, Papotti M, Bertero L, Cassoni P. The Adverse Impact of the COVID-19 Pandemic on Abdominal Emergencies: A Retrospective Clinico-Pathological Analysis. J Clin Med 2021; 10:jcm10225254. [PMID: 34830534 PMCID: PMC8618829 DOI: 10.3390/jcm10225254] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/30/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023] Open
Abstract
The COVID-19 pandemic has caused a worldwide significant drop of admissions to the emergency department (ED). The aim of the study was to retrospectively investigate the pandemic impact on ED admissions, management, and severity of three abdominal emergencies (appendicitis, diverticulitis, and cholecystitis) during the COVID-19 pandemic using 2017–2019 data as a control. The difference in clinical and pathological disease severity was the primary outcome measure while differences in (i) ED admissions, (ii) triage urgency codes, and (iii) surgical rates were the second ones. Overall, ED admissions for the selected conditions decreased by 34.9% during the pandemic (control: 996, 2020: 648) and lower triage urgency codes were assigned for cholecystitis (control: 170/556, 2020: 66/356, p < 0.001) and appendicitis (control: 40/178, 2020: 21/157, p = 0.031). Less surgical procedures were performed in 2020 (control: 447, 2020: 309), but the surgical rate was stable (47.7% in 2020 vs. 44.8% in 2017–2019). Considering the clinical and pathological assessments, a higher percentage of severe cases was observed in the four pandemic peak months of 2020 (control: 98/192, 2020: 87/109; p < 0.001 and control: 105/192, 2020: 87/109; p < 0.001). For the first time in this study, pathological findings objectively demonstrated an increased disease severity of the analyzed conditions during the early COVID-19 pandemic.
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Affiliation(s)
- Elena Vissio
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Enrico Costantino Falco
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Gitana Scozzari
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Antonio Scarmozzino
- Hospital Medical Direction, Molinette Hospital, “Città della Salute e della Scienza di Torino” University Hospital, 10126 Turin, Italy; (G.S.); (A.S.)
| | - Do An Andrea Trinh
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
| | - Mario Morino
- General Surgery 1U, Department of Surgical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Mauro Papotti
- Pathology Unit, Department of Oncology, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy;
| | - Luca Bertero
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
- Correspondence: ; Tel.: +39-0116336181
| | - Paola Cassoni
- Pathology Unit, Department of Medical Sciences, “Città della Salute e della Scienza di Torino” University Hospital, University of Turin, 10126 Turin, Italy; (E.V.); (E.C.F.); (D.A.A.T.); (P.C.)
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25
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Dandena F, Teklewold B, Anteneh D. Impact of COVID-19 and mitigation plans on essential health services: institutional experience of a hospital in Ethiopia. BMC Health Serv Res 2021; 21:1105. [PMID: 34654411 PMCID: PMC8519745 DOI: 10.1186/s12913-021-07106-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 09/10/2021] [Indexed: 12/12/2022] Open
Abstract
Background Health systems around the world are being challenged by an on-going COVID-19 pandemic. The COVID-19 pandemic and associated response can have a significant downstream effect on access to routine health care services, and indirectly cause morbidity and mortality from causes other than the disease itself, especially in resource-poor countries such as Ethiopia. This study aimed to explore the impact of the pandemic on these services and measures taken to combat the effect. Methods The study was conducted at St. Paul’s hospital millennium medical college (SPHMMC) from December 15, 2020 to January 15, 2021 using a comparative cross-sectional study design. We collected data on the number of clients getting different essential health care services from May to October 2019 (Pre COVID) and the same period in 2020 (during a COVID-19 pandemic) from the patient registry book. The analysis was done with SPSS version 24 software. Result Overall, the essential services of SPHMMC were affected by the COVID-19 pandemic. The most affected service is inpatient admission, which showed a 73.3% (2044 to 682) reduction from the pre-COVID period and the least affected is maternal service, which only decreased by 13% (3671 to 3177). During the 6 months after the COVID-19 pandemic, there was a progressive increment in the number of clients getting essential health services. Conclusion and recommendation The establishment of a triple setup for fighting against COVID-19, which encompasses non-COVID services, an isolation center and a COVID-19 treatment center, played a vital role in preserving essential health services.
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Affiliation(s)
- Firaol Dandena
- Department of Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Berhanetsehay Teklewold
- Department of Surgery, Saint Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Dagmawi Anteneh
- Saint Paul Hospital Millennium Medical College, Quality Improvement and Clinical Governance Directorate, Addis Ababa, Ethiopia
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Ding Y, Zhou Y, Ling P, Feng X, Luo S, Zheng X, Little PJ, Xu S, Weng J. Metformin in cardiovascular diabetology: a focused review of its impact on endothelial function. Am J Cancer Res 2021; 11:9376-9396. [PMID: 34646376 PMCID: PMC8490502 DOI: 10.7150/thno.64706] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 08/30/2021] [Indexed: 02/07/2023] Open
Abstract
As a first-line treatment for diabetes, the insulin-sensitizing biguanide, metformin, regulates glucose levels and positively affects cardiovascular function in patients with diabetes and cardiovascular complications. Endothelial dysfunction (ED) represents the primary pathological change of multiple vascular diseases, because it causes decreased arterial plasticity, increased vascular resistance, reduced tissue perfusion and atherosclerosis. Caused by “biochemical injury”, ED is also an independent predictor of cardiovascular events. Accumulating evidence shows that metformin improves ED through liver kinase B1 (LKB1)/5'-adenosine monophosphat-activated protein kinase (AMPK) and AMPK-independent targets, including nuclear factor-kappa B (NF-κB), phosphatidylinositol 3 kinase-protein kinase B (PI3K-Akt), endothelial nitric oxide synthase (eNOS), sirtuin 1 (SIRT1), forkhead box O1 (FOXO1), krüppel-like factor 4 (KLF4) and krüppel-like factor 2 (KLF2). Evaluating the effects of metformin on endothelial cell functions would facilitate our understanding of the therapeutic potential of metformin in cardiovascular diabetology (including diabetes and its cardiovascular complications). This article reviews the physiological and pathological functions of endothelial cells and the intact endothelium, reviews the latest research of metformin in the treatment of diabetes and related cardiovascular complications, and focuses on the mechanism of action of metformin in regulating endothelial cell functions.
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27
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Myasthenia gravis and telemedicine: a lesson from COVID-19 pandemic. Neurol Sci 2021; 42:4889-4892. [PMID: 34436726 PMCID: PMC8390022 DOI: 10.1007/s10072-021-05566-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 01/09/2023]
Abstract
COVID-19 pandemic has induced an urgent reorganization of the healthcare system to ensure continuity of care for patients affected by chronic neurological diseases including myasthenia gravis (MG). Due to the fluctuating nature of the disease, early detection of disease worsening, adverse events, and possibly life-threatening complications is mandatory. This work analyzes the main unresolved issues in the management of the myasthenic patient, the possibilities offered so far by digital technologies, and proposes an online evaluation protocol based on 4 simple tests to improve MG management. Telemedicine and Digital Technology might help neurologists in the clinical decision-making process of MG management, avoiding unnecessary in presence consultations and allowing a rational use of the time and space reduced by the pandemic.
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28
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Böjti PP, Szilágyi G, Dobi B, Stang R, Szikora I, Kis B, Kornfeld Á, Óváry C, Erőss L, Banczerowski P, Kuczyński W, Bereczki D. Impact of COVID-19 on ischemic stroke care in Hungary. GeroScience 2021; 43:2231-2248. [PMID: 34406562 PMCID: PMC8371604 DOI: 10.1007/s11357-021-00424-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Data about the coronavirus disease 2019 (COVID-19) pandemic’s collateral damage on ischemic stroke (IS) care during the second epidemic wave in Central Europe are limited. We sought to evaluate the impact of the COVID-19 outbreak on Hungarian IS care during the two epidemic waves. This retrospective observational study was based on a nationwide reimbursement database that encompasses all IS admissions and all reperfusion interventions, i.e., intravenous thrombolysis (IVT) and endovascular therapy (EVT) from 2 January 2017 to 31 December 2020 in Hungary. COVID-19 pandemic’s effect on the number of IS admissions and reperfusion interventions were analyzed using different statistics: means, medians, trends, relative rates, and linear relationships. The mean and median values of IS admissions and reperfusion interventions decreased only in some measure during the COVID-periods. However, trend analysis demonstrated a significant decline from the trends. The decline’s dynamic and amplitude have differed for each variable. In contrast to IVT, the number of IS admissions and EVTs negatively correlated with the epidemic waves’ amplitude. Besides, the decrease in the number of IS admissions was more pronounced than the decrease in the number of reperfusion interventions. Our study demonstrated a significant disruption in IS care during the COVID-19 epidemic in Hungary, in which multiple different factors might play a role. The disproportionate reduction of IS admission numbers could partially be explained by the effect of health emergency operative measures and changes in patients’ social behavior. Further studies are needed to evaluate the causes of our observations.
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Affiliation(s)
- Péter Pál Böjti
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary. .,National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.
| | - Géza Szilágyi
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,Department of Neurology, Medical Centre, Hungarian Defence Forces, Budapest, Hungary
| | - Balázs Dobi
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary.,Neuroepidemiology Research Group ELKH, MTA-SE, Budapest, Hungary
| | - Rita Stang
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - István Szikora
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Neurosurgery, Semmelweis University, Budapest, Hungary
| | - Balázs Kis
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Ákos Kornfeld
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Csaba Óváry
- National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Lóránd Erőss
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Neurosurgery, Semmelweis University, Budapest, Hungary
| | - Péter Banczerowski
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Neurosurgery, Semmelweis University, Budapest, Hungary
| | - Wojciech Kuczyński
- Department of Sleep Medicine and Metabolic Disorders, Medical University of Lodz, Lodz, Poland
| | - Dániel Bereczki
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Balassa utca 6., Budapest, 1083, Hungary.,Neuroepidemiology Research Group ELKH, MTA-SE, Budapest, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary.,European Academy of Neurology, EANcore COVID-19 Task Force, Vienna, Austria
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Sedova P, Brown Jr. RD, Bryndziar T, Jarkovsky J, Tomek A, Sramek M, Skoda O, Sramkova T, Littnerova S, Mikulik R. Treat COVID-19, but Not Only COVID-19: Stroke Matters as Well. Cerebrovasc Dis 2021; 51:52-59. [PMID: 34515067 PMCID: PMC8450853 DOI: 10.1159/000517968] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/16/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, studies reported less number of hospitalizations for acute stroke and reduction in the use of recanalization treatments. This study analyzes nationwide data on stroke admissions and management in the Czech Republic during the first wave of the COVID-19 pandemic. METHODS We compared the early COVID-19 pandemic (March-May 2020) with the pre-pandemic period (January-February 2020 and March-May 2019): (a) the National Register of Reimbursed Health Services provided volume of all admissions for subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and ischemic stroke (IS), and volume of recanalization treatments (intravenous thrombolysis [IVT] and mechanical thrombectomy [MT]); (b) Registry of Stroke Care Quality provided door-to-needle time (DNT), onset-to-door time (ODT), and stroke severity at admission (National Institutes of Health Stroke Scale, NIHSS) for IS. RESULTS During the pandemic (March-May 2020), the peak number of COVID-19 patients treated in Czech hospitals was 39 per million. In March-May 2020 versus March-May 2019, hospital admissions decreased as follows: stroke overall by 14% (p < 0.001), IS by 14% (p < 0.001), SAH by 15% (p = 0.07), and ICH by 7% (p = 0.17). The mean age was 74 years versus 74 years (p = 0.33), and 52% versus 51% were men (p = 0.34). The volumes of IVT and MT decreased by 14% (p = 0.001) and 19% (p = 0.01), respectively. The proportions of all IS patients receiving IVT or MT remained unchanged, with, respectively, 17% versus 17% receiving IVT (p = 0.86) and 5% versus 5% receiving MT (p = 0.48). DNT and ODT were 24 versus 25 min (p = 0.58) and 168 versus 156 min (p = 0.23), respectively. NIHSS at admission did not differ (6 vs. 6; p = 0.54). CONCLUSION Even with a low burden of COVID-19 during the first wave and no change in organization and logistics of stroke services, stroke admissions and volume of recanalization treatments decreased. Public health communication campaigns should encourage people to seek emergency medical care for stroke symptoms during the COVID-19 pandemic.
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Affiliation(s)
- Petra Sedova
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Internal Medicine, Hematology and Oncology, University Hospital Brno, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | | | - Tomas Bryndziar
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Jiri Jarkovsky
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Ales Tomek
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Martin Sramek
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Ondrej Skoda
- Neurological Department and Stroke Unit, Jihlava Hospital, Jihlava, Czechia
- Department of Neurology, University Hospital Kralovske Vinohrady and Charles University in Prague, Prague, Czechia
| | - Tereza Sramkova
- Department of Neurology, Charles University in Prague, 2nd Faculty of Medicine and Motol University Hospital, Prague, Czechia
| | - Simona Littnerova
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czechia
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czechia
| | - Robert Mikulik
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
- Department of Neurology, St. Anne's University Hospital, Brno, Czechia
- Faculty of Medicine, Masaryk University, Brno, Czechia
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30
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Decrease in intravenous thrombolysis and poor short-term functional prognosis for acute ischemic stroke during the COVID-19 pandemic. J Neurol 2021; 269:597-602. [PMID: 34379199 PMCID: PMC8355571 DOI: 10.1007/s00415-021-10740-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 01/17/2023]
Abstract
Background and purpose Since the outbreak of the coronavirus pandemic in 2019 (COVID-19), healthcare systems around the world have been hit to varying degrees. As a neurologist team, for patients with acute ischemic stroke (AIS), we compared the situations of intravenous thrombolysis (IVT) treatment from 2019 to 2020 to investigate the influence of COVID-19 pandemic on the attendance and prognosis of the IVT patients. Methods We collected the messages of objects who had received IVT (Bridging surgery was ruled out) during 2019–2020. We analyzed differences in age, gender, time from onset to start IVT, door to needle time (DNT), pretreatment NIHSS score, postoperative NIHSS score, and so on. Statistical tests were also performed to respectively compare the discharged modified Rankin score (mRS) and discharged NIHSS score between two years. Results Since the onset of COVID-19 restrictions in Wenzhou, we observed a significant reduction of 24.7% (p = 0.023) from 267(2019) to 201(2020) of received IVT on hospital admission. We compared the DNT between two years and it reflected that the DNT (min) in 2020 was obviously longer than in 2019 (51.60 ± 23.80 vs 46.80 ± 21.90, p = 0.026). We also compared the discharged mRS, which reflected much more IVT patients in 2020 during the COVID-19 pandemic had a poor short-term functional prognosis (38.2% vs 29.2%, p = 0.043). Conclusions The COVID-19 pandemic caused the decrease of admissions and prolonged the time of the green channel for stroke, which led to the worse short-term prognosis of AIS patients during the pandemic. It’s necessary to ensure an effective green channel and provide adequate medical resources during the pandemic period to reduce the damage caused by COVID-19.
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31
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Usher MG, Tourani R, Simon G, Tignanelli C, Jarabek B, Strauss CE, Waring SC, Klyn NAM, Kealey BT, Tambyraja R, Pandita D, Baum KD. Overcoming gaps: regional collaborative to optimize capacity management and predict length of stay of patients admitted with COVID-19. JAMIA Open 2021; 4:ooab055. [PMID: 34350391 PMCID: PMC8327377 DOI: 10.1093/jamiaopen/ooab055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/12/2021] [Accepted: 07/06/2021] [Indexed: 11/21/2022] Open
Abstract
Objective Ensuring an efficient response to COVID-19 requires a degree of inter-system coordination and capacity management coupled with an accurate assessment of hospital utilization including length of stay (LOS). We aimed to establish optimal practices in inter-system data sharing and LOS modeling to support patient care and regional hospital operations. Materials and Methods We completed a retrospective observational study of patients admitted with COVID-19 followed by 12-week prospective validation, involving 36 hospitals covering the upper Midwest. We developed a method for sharing de-identified patient data across systems for analysis. From this, we compared 3 approaches, generalized linear model (GLM) and random forest (RF), and aggregated system level averages to identify features associated with LOS. We compared model performance by area under the ROC curve (AUROC). Results A total of 2068 patients were included and used for model derivation and 597 patients for validation. LOS overall had a median of 5.0 days and mean of 8.2 days. Consistent predictors of LOS included age, critical illness, oxygen requirement, weight loss, and nursing home admission. In the validation cohort, the RF model (AUROC 0.890) and GLM model (AUROC 0.864) achieved good to excellent prediction of LOS, but only marginally better than system averages in practice. Conclusion Regional sharing of patient data allowed for effective prediction of LOS across systems; however, this only provided marginal improvement over hospital averages at the aggregate level. A federated approach of sharing aggregated system capacity and average LOS will likely allow for effective capacity management at the regional level.
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Affiliation(s)
- Michael G Usher
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Roshan Tourani
- Department of Medicine, Institute for Health Informatics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Gyorgy Simon
- Department of Medicine, Institute for Health Informatics, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Christopher Tignanelli
- Department of Medicine, Institute for Health Informatics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.,Division of Acute Care Surgery, Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Bryan Jarabek
- Department of Informatics, M Health Fairview, Minneapolis, Minnesota, USA
| | - Craig E Strauss
- Minneapolis Heart Institute Center for Healthcare Delivery Innovation, Minneapolis Heart Institute, Allina Health, Minneapolis, Minnesota, USA
| | - Stephen C Waring
- Essentia Institute of Rural Health, Essential Health, Duluth, Minnesota, USA
| | - Niall A M Klyn
- Information Services, Essentia Health, Duluth, Minnesota, USA
| | - Burke T Kealey
- Internal Medicine, HealthPartners, St. Paul, Minnesota, USA
| | - Rabindra Tambyraja
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, USA
| | - Deepti Pandita
- Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
| | - Karyn D Baum
- Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Lu Y, Zhao JJ, Ye MF, Li HM, Yao FR, Kong Y, Xu Z. The relationship between COVID-19's severity and ischemic stroke: a systematic review and meta-analysis. Neurol Sci 2021; 42:2645-2651. [PMID: 33954827 PMCID: PMC8098783 DOI: 10.1007/s10072-021-05299-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE We aim to determine the risk of acute ischemic stroke in patients with severe and non-severe coronavirus disease 2019 (COVID-19). METHODS A literature search was conducted in the PubMed, Embase, Web of Science, and Cochrane Library databases until October 28, 2020. Studies covering COVID-19's severity classification data and COVID-19 patients with acute ischemic stroke were included. Two independent evaluators extracted data, and the random effects model was used to calculate the risk ratios (RR) and 95% confidence interval (95% CI) of acute ischemic stroke associated with COVID-19's severity. RESULTS A total of 8 studies were included, involving 5266 patients. Among all COVID-19 patients, the total incidence of ischemic stroke was 1.76% (95% CI: 0.82-3.01). Severe patients have an increased risk of acute ischemic stroke compared with non-severe patients (RR = 3.53, 95% CI: 2.06-6.07, P < 0.0001; I2 = 12%). This association was also observed when COVID-19's severity was defined by clinical parameters (RR 2.91, 95% CI: 1.17-7.26, P = 0.02; I2 = 29%) and the need for intensive care (RR 4.47, 95% CI: 2.40-8.31, P < 0.0001; I2 = 0%). CONCLUSIONS This meta-analysis shows that the severe course of COVID-19 is associated with an increased risk of acute ischemic stroke.
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Affiliation(s)
- Yue Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jie-ji Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng-fan Ye
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hong-mei Li
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fei-rong Yao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yan Kong
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Zhuan Xu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, China
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Mann E, Swedien D, Hansen J, Peterson S, Saheed M, Klein E, Munjuluru A, Scheulen J, Kelen G. Reduction in Emergency Department Presentations in a Regional Health System during the Covid-19 Pandemic. West J Emerg Med 2021; 22:842-850. [PMID: 35354014 PMCID: PMC8328168 DOI: 10.5811/westjem.2020.10.49759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/27/2020] [Accepted: 11/10/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Nationally, there has been more than a 40% decrease in Emergency Department (ED) patient volume during the coronavirus disease 2019 (Covid-19) crisis, with reports of decreases in presentations of time-sensitive acute illnesses. We analyzed ED clinical presentations in a Maryland/District of Columbia regional hospital system while health mitigation measures were instituted. METHODS We conducted a retrospective observational cohort study of all adult ED patients presenting to five Johns Hopkins Health System (JHHS) hospitals comparing visits from March 16 through May 15, in 2019 and 2020. We analyzed de-identified demographic information, clinical conditions, and ICD-10 diagnosis codes for year-over-year comparisons. RESULTS There were 36.7% fewer JHHS ED visits in 2020 compared to 2019 (43,088 vs. 27,293, P<.001). Patients 75+ had the greatest decline in visits (-44.00%, P<.001). Both genders had significant decreases in volume (-41.9%, P<.001 females vs -30.6%, P<.001 males). Influenza like illness (ILI) symptoms increased year-over-year including fever (640 to 1253, 95.8%, P<.001) and shortness of breath (2504 to 2726, 8.9%, P=.002). ICD-10 diagnoses for a number of time-sensitive illnesses decreased including deep vein thrombosis (101 to 39, -61%, P<.001), acute myocardial infarction (157 to 105, -33%, P=.002), gastrointestinal bleeding (290 to 179, -38.3%, P<.001), and strokes (284 to 234, -17.6%, P=0.03). CONCLUSION ED visits declined significantly among JHHS hospitals despite offsetting increases in ILI complaints. Decreases in presentations of time-sensitive illnesses were of particular concern. Efforts should be taken to inform patients that EDs are safe, otherwise preventable morbidity and mortality will remain a problem.
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Affiliation(s)
- Edana Mann
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Daniel Swedien
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Jonathan Hansen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Susan Peterson
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
| | - Mustapha Saheed
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Eili Klein
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Ajit Munjuluru
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - James Scheulen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
| | - Gabor Kelen
- Johns Hopkins University School of Medicine, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins Office of Critical Care Event Preparedness and Response, Department of Emergency Medicine, Baltimore, Maryland
- Johns Hopkins University School of Medicine, Armstrong Institute for Patient Safety and Quality, Baltimore, Maryland
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Padrick MM, Sangha N, Paletz L, Mirocha J, Figueroa S, Manoukian V, Schlick K, Lyden PD, Liebeskind DS, Chatfield FK, Tarpley JW, Burgos A, Tenser M, Gaffney D, Pech MA, Nazareth E, Jackson R, Kauffman H, Arnold L, Cox J, Joyce T, Nakamura C, Fitzgerald D, Ogami K, Steiner N, Wolber N, Robertson B, Izzo R, Gorski S, Manuel H, Valdez K, Reyes L, Sharma LK, Song SS. COVID-19 Impact on Acute Ischemic Stroke Treatment at 9 Comprehensive Stroke Centers across Los Angeles. Cerebrovasc Dis 2021; 50:707-714. [PMID: 34175851 PMCID: PMC8339042 DOI: 10.1159/000516908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To describe the impact of COVID-19 on acute cerebrovascular disease care across 9 comprehensive stroke centers throughout Los Angeles County (LAC). Methods Volume of emergency stroke code activations, patient characteristics, stroke severity, reperfusion rates, treatment times, and outcomes from February 1 to April 30, 2020, were compared against the same time period in 2019. Demographic data were provided by each participating institution. Results There was a 17.3% decrease in stroke code activations across LAC in 2020 compared to 2019 (1,786 vs. 2,159, respectively, χ<sup>2</sup> goodness of fit test p < 0.0001) across 9 participating comprehensive stroke centers. Patients who did not receive any reperfusion therapy decreased by 16.6% in 2020 (1,527) compared to 2019 (1,832). Patients who received only intravenous thrombolytic (IVT) therapy decreased by 31.8% (107 vs. 157). Patients who received only mechanical thrombectomy (MT) increased by 3% (102 vs. 99). Patients who received both IVT and MT decreased by 31.8% (45 vs. 66). Recanalization treatment times in 2020 were comparable to 2019. CSCs serving a higher proportion of Latinx populations in the eastern parts of LAC experienced a higher incidence of MT in 2020 compared to 2019. Mild increase in stroke severity was seen in 2020 compared to 2019 (8.95 vs. 8.23, p = 0.046). A higher percentage of patients were discharged home in 2020 compared to 2019 (59.5 vs. 56.1%, p = 0.034), a lower percentage of patients were discharged to skilled nursing facility (16.1 vs. 20.7%, p = 0.0004), and a higher percentage of patients expired (8.6 vs. 6.3%, p = 0.008). Conclusion LAC saw a decrease in overall stroke code activations in 2020 compared to 2019. Reperfusion treatment times remained comparable to prepandemic metrics. There has been an increase in severe stroke incidence and higher volume of thrombectomy treatments in Latinx communities within LAC during the pandemic of 2020. More patients were discharged home, less patients discharged to skilled nursing facilities, and more patients expired in 2020, compared to the same time frame in 2019.
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Affiliation(s)
| | - Navdeep Sangha
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Laurie Paletz
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - James Mirocha
- Cedars-Sinai Medical Center, Biostatistics and Bioinformatics Research Center, Los Angeles, California, USA
| | - Sonia Figueroa
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vicki Manoukian
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Konrad Schlick
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Patrick D Lyden
- Zilka Neurogenetic Institute at Keck School of Medicine of USC, Los Angeles, California, USA
| | - David S Liebeskind
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Fiona K Chatfield
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Jason W Tarpley
- Providence Saint John's Health Center, Santa Monica, California, USA.,Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Adrian Burgos
- PIH Health Whittier Hospital, Whittier, California, USA
| | - Matthew Tenser
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA.,PIH Health Good Samaritan Hospital, Los Angeles, California, USA
| | - Denise Gaffney
- Kaiser Permanente, Los Angeles Medical Center, Los Angeles, California, USA
| | - Marco A Pech
- Torrance Memorial Medical Center, Torrance, California, USA
| | | | - Robert Jackson
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Helaine Kauffman
- Providence Saint John's Health Center, Santa Monica, California, USA.,Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA.,Torrance Memorial Medical Center, Torrance, California, USA
| | - Lisa Arnold
- Providence Saint John's Health Center, Santa Monica, California, USA
| | - Jennifer Cox
- Providence Saint Joseph Medical Center, Burbank, California, USA
| | - Treasure Joyce
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Catrice Nakamura
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Darcie Fitzgerald
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA
| | - Kyle Ogami
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nili Steiner
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicole Wolber
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Betty Robertson
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Rachel Izzo
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | | | - Krystal Valdez
- Providence Little Company of Mary Medical Center- Torrance, Torrance, California, USA.,Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Liliana Reyes
- Department of Neurosurgery, University of Southern California, Los Angeles, California, USA
| | - Latisha K Sharma
- Zilka Neurogenetic Institute at Keck School of Medicine of USC, Los Angeles, California, USA
| | - Shlee S Song
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Goel V, Chan RK, Smibert OC, Holmes NE, Marhoon N, Bach CAT, Trubiano JA, Jones NR. Identifying patterns in unplanned hospital admissions during the COVID-19 pandemic: a single-centre retrospective study. Intern Med J 2021; 51:868-872. [PMID: 34155754 PMCID: PMC8444750 DOI: 10.1111/imj.15075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 12/03/2022]
Abstract
Background Countries with a high prevalence of COVID‐19 have identified a reduction in crude hospital admission rates for non‐COVID‐19 conditions during the pandemic. There remains a paucity of such data from lower prevalence countries, including Australia. Aims To describe the patterns of unplanned hospital daily admission rates during the COVID‐19 pandemic in a major Australian metropolitan hospital, with a focus on acute medical presentations including acute coronary syndrome (ACS), stroke and falls. Methods This single‐centre retrospective analysis analysed hospital admission episodes between 1 March and 30 April 2020 (COVID‐19‐era) and compared this to a historical cohort during the same period between 2017 and 2019 (pre‐COVID‐19). Information collected included total admission rates and patient characteristics for ACS, stroke and falls patients. Results A total of 12 278 unplanned admissions was identified across the study period. The daily admission rate was lower in the COVID‐19‐era compared with pre‐COVID‐19 (46.59 vs 51.56 days, P < 0.001). There was also a reduced average daily admission rate for falls (7.79 vs 9.95 days, P < 0.001); however, similar admission rates for ACS (1.52 vs 1.49 days, P = 0.83) and stroke (1.56 vs 1.76 days, P = 0.33). Conclusions Public health interventions have been effective in reducing domestic cases of COVID‐19 in Australia. At our tertiary metropolitan hospital, we have observed a significant reduction in unplanned hospital admission rates during the COVID‐19‐era, particularly for falls. Public health messaging needs to focus on educating the public how to seek medical care safely and promptly in the context of the ongoing COVID‐19 crisis.
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Affiliation(s)
- Vishal Goel
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - R Kimberley Chan
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Olivia C Smibert
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Melbourne, Melbourne, Victoria, Australia
| | - Natasha E Holmes
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia
| | - Nada Marhoon
- Data Analytics Research and Evaluation (DARE) Centre, Austin Health, Melbourne, Victoria, Australia
| | - Cindy-Anne T Bach
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia
| | - Jason A Trubiano
- Department of Infectious Diseases, Austin Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia.,National Centre for Infections in Cancer, Peter MacCallum Cancer Centre Melbourne, Melbourne, Victoria, Australia
| | - Nicholas R Jones
- Department of General Medicine, Austin Health, Melbourne, Victoria, Australia.,School of Medicine, University of Melbourne, Melbourne, Victoria, Australia
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Gambazza S, Galazzi A, Binda F, Passeri O, Bosco P, Costantino G, Laquintana D. Pattern of Visits in a Metropolitan Emergency Department in Lombardia (Italy): January 2019-December 2020. Healthcare (Basel) 2021; 9:791. [PMID: 34202591 PMCID: PMC8304284 DOI: 10.3390/healthcare9070791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/11/2021] [Accepted: 06/21/2021] [Indexed: 11/16/2022] Open
Abstract
During the Coronavirus disease 2019 (COVID-19), a general decrease in the presentations to emergency departments (ED) was reported. However, we suspect that there was a lower number but an unchanged pattern of ED visits for urgent conditions in 2020 compared to 2019. This retrospective study assessed the change in the number of presentations in the ED of a tertiary level university hospital in Milano (Lombardia, Italy). Compared to 2019, a significant drop in ED presentations occurred (-46.4%), and we recorded a -15.7% difference in the proportion of patients admitted with white codes. The pattern of hourly presentations to the ED was unchanged, with overcrowding during the working daytime. COVID-19 changed ED flows, likely causing an overall reduction in the number of deferrable conditions. However, the pattern associated with urgent conditions did not change abruptly in 2020.
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Affiliation(s)
- Simone Gambazza
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Alessandro Galazzi
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Filippo Binda
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Onorina Passeri
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
| | - Paola Bosco
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, Via Francesco Sforza 35, 20122 Milano, Italy
| | - Dario Laquintana
- Healthcare Professions Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122 Milano, Italy; (S.G.); (A.G.); (O.P.); (P.B.); (D.L.)
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Presentation of Infectious Keratitis to ED during COVID-19 Lockdown. J Ophthalmol 2021; 2021:5514055. [PMID: 34150337 PMCID: PMC8197668 DOI: 10.1155/2021/5514055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/22/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022] Open
Abstract
Objectives To compare presentation of infectious keratitis during COVID-19 lockdown with previous years, assess relative severity, and compare outcomes between COVID-19 and pre-COVID-19 era groups. Methods Acute presentations of infectious keratitis during a strict government-mandated COVID-19 lockdown period were analysed retrospectively (March–May 2020). Data were compared with the same periods in 2018-2019. The clinical notes of patients undergoing corneal scrapes were reviewed, and data were collected on treatment, culture growth, surgical interventions, visual outcomes, admission rates, and risk factors. Results There were 37% fewer presentations of infectious keratitis to the ED in 2020 (N = 29, 47, and 45, respectively). Risk factor profiles and microbial data were similar across all periods. Admission rates and use of fortified antibiotics were lower in 2020. COVID-19 era cases recovered less vision (LogMAR 0.26, 0.67, and 0.45, respectively; p = 0.04) and were more likely to require surgical intervention (10%, 4%, and 2%, respectively; OR 3.4 (CI 0.7–17.9, p = 0.1)). Conclusion A concerning fall in presentations of infectious keratitis to ED during the pandemic lockdown was observed. Though societal behaviour changed during the lockdown, our data suggest it is unlikely that the incidence of infectious keratitis fell significantly. It is unclear how and where these patients were treated. We postulate that lower levels of visual recovery and higher rates of surgical intervention may have been caused by delays in accessing care. To minimise avoidable ocular morbidity as COVID-19 resurges, we must communicate clearly with patients and health professionals on how to access available emergency eye care services.
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Succi MD, Chang K, An T, Rosman DA, Raja AS, Gee MS, Lev MH, Liu R, Saini S, Brink JA. Increased per-patient imaging utilization in an emergency department setting during COVID-19. Clin Imaging 2021; 80:77-82. [PMID: 34274685 PMCID: PMC8183018 DOI: 10.1016/j.clinimag.2021.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/24/2021] [Accepted: 06/03/2021] [Indexed: 12/29/2022]
Abstract
Introduction COVID-19 has resulted in decreases in absolute imaging volumes, however imaging utilization on a per-patient basis has not been reported. Here we compare per-patient imaging utilization, characterized by imaging studies and work relative value units (wRVUs), in an emergency department (ED) during a COVID-19 surge to the same period in 2019. Methods This retrospective study included patients presenting to the ED from April 1–May 1, 2020 and 2019. Patients were stratified into three primary subgroups: all patients (n = 9580, n = 5686), patients presenting with respiratory complaints (n = 1373, n = 2193), and patients presenting without respiratory complaints (n = 8207, n = 3493). The primary outcome was imaging studies/patient and wRVU/patient. Secondary analysis was by disposition and COVID status. Comparisons were via the Wilcoxon rank-sum or Chi-squared tests. Results The total patients, imaging exams, and wRVUs during the 2020 and 2019 periods were 5686 and 9580 (−41%), 6624 and 8765 (−24%), and 4988 and 7818 (−36%), respectively, and the percentage patients receiving any imaging was 67% and 51%, respectively (p < .0001). In 2020 there was a 170% relative increase in patients presenting with respiratory complaints. In 2020, patients without respiratory complaints generated 24% more wRVU/patient (p < .0001) and 33% more studies/patient (p < .0001), highlighted by 38% more CTs/patient. Conclusion We report increased per-patient imaging utilization in an emergency department during COVID-19, particularly in patients without respiratory complaints.
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Affiliation(s)
- Marc D Succi
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Ken Chang
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Thomas An
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - David A Rosman
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Ali S Raja
- Harvard Medical School, Boston, MA, United States of America; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, United States of America
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Michael H Lev
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Ray Liu
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Sanjay Saini
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - James A Brink
- Department of Radiology, Massachusetts General Hospital, Boston, MA, United States of America; Medically Engineered Solutions in Healthcare Incubator, Innovation in Operations Research Center (MESH IO), Massachusetts General Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
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Allen MT, Thompson BC, Atkinson B, Fyfe CE, Scanlan MJ, Stephen RE, Thomas SI, Welsh GN, Wrigley R, McLeay A, Beck S, Dockerty JD. Emergency department presentations in the Southern District of New Zealand during the 2020 COVID-19 pandemic lockdown. Emerg Med Australas 2021; 33:534-540. [PMID: 33586331 PMCID: PMC8013615 DOI: 10.1111/1742-6723.13749] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess changes in presentations to EDs during the COVID-19 pandemic lockdown in the Southern Region of New Zealand. METHODS We conducted a retrospective audit of patients attending EDs in the Southern District Health Board (SDHB), from 1 March to 13 May 2020. We made comparisons with attendances during the same period in 2019. The 2020 study period included 'pre-lockdown' (1 March-25 March), 'level 4 (strict) lockdown' (26 March-27 April) and 'level 3 (eased) lockdown' (28 April-13 May). RESULTS Patient volumes reduced in all SDHB EDs during levels 4 and 3, mostly representing a loss of low acuity patients (Australasian Triage Scale 3, 4 and 5), although high-acuity presentations also declined. Average patient age increased by 5 years; however, the proportions of sexes and ethnicities did not change. Presentations of cerebrovascular accidents and appendicitis did not change significantly. Trauma, mental health, acute coronary syndrome and infectious respiratory presentations decreased significantly during level 4, and infectious respiratory presentations decreased further in level 3. CONCLUSIONS Within the SDHB, patient volumes reduced during levels 4 and 3 of our lockdown, with reduced low-acuity presentations. High-acuity patient numbers also declined. Trauma, mental health, alcohol-related, infectious respiratory and acute coronary syndrome presentations declined while cerebrovascular accident and appendicitis numbers showed little to no change.
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Affiliation(s)
- Manurereau T Allen
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Brianna C Thompson
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Brad Atkinson
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Christie E Fyfe
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Meghan J Scanlan
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Rachel E Stephen
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Sophie I Thomas
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Grace N Welsh
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Rebekah Wrigley
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
| | - Adam McLeay
- Emergency DepartmentSouthern District Health BoardDunedinNew Zealand
| | - Sierra Beck
- Emergency DepartmentSouthern District Health BoardDunedinNew Zealand
- Department of MedicineUniversity of OtagoDunedinNew Zealand
| | - John D Dockerty
- Department of Preventive and Social MedicineUniversity of OtagoDunedinNew Zealand
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Kreutz R, Dobrowolski P, Prejbisz A, Algharably EAEH, Bilo G, Creutzig F, Grassi G, Kotsis V, Lovic D, Lurbe E, Modesti PA, Pappaccogli M, Parati G, Persu A, Polonia J, Rajzer M, de Timary P, Weber T, Weisser B, Tsioufis K, Mancia G, Januszewicz A. Lifestyle, psychological, socioeconomic and environmental factors and their impact on hypertension during the coronavirus disease 2019 pandemic. J Hypertens 2021; 39:1077-1089. [PMID: 33395152 DOI: 10.1097/hjh.0000000000002770] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
SUMMARY The coronavirus disease 2019 (COVID-19) pandemic considerably affects health, wellbeing, social, economic and other aspects of daily life. The impact of COVID-19 on blood pressure (BP) control and hypertension remains insufficiently explored. We therefore provide a comprehensive review of the potential changes in lifestyle factors and behaviours as well as environmental changes likely to influence BP control and cardiovascular risk during the pandemic. This includes the impact on physical activity, dietary patterns, alcohol consumption and the resulting consequences, for example increases in body weight. Other risk factors for increases in BP and cardiovascular risk such as smoking, emotional/psychologic stress, changes in sleep patterns and diurnal rhythms may also exhibit significant changes in addition to novel factors such as air pollution and environmental noise. We also highlight potential preventive measures to improve BP control because hypertension is the leading preventable risk factor for worldwide health during and beyond the COVID-19 pandemic.
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Affiliation(s)
- Reinhold Kreutz
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Piotr Dobrowolski
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Aleksander Prejbisz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
| | - Engi A E-H Algharably
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Klinische Pharmakologie und Toxikologie, Berlin, Germany
| | - Grzegorz Bilo
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Felix Creutzig
- Mercator Research Institute on Global Commons and Climate Change
- Technical University Berlin, Berlin, Germany
| | - Guido Grassi
- Clinica Medica, University Milano Bicocca, Milan, Italy
| | - Vasilios Kotsis
- 3rd Department of Internal Medicine Aristotle University Thessaloniki, Hypertension-24 h Ambulatory Blood Pressure Monitoring Center, Papageorgiou Hospital, Thessaloniki, Greece
| | - Dragan Lovic
- Cardiology Department, Clinic for Internal Disease Intermedica, Singidunum University, School of Medicine, Nis, Serbia
| | - Empar Lurbe
- Pediatric Department, Consorcio Hospital General, University of Valencia
- CIBER Fisiopatología Obesidad y Nutrición (CB06/03), Instituto de Salud Carlos III, Valencia, Spain
| | - Pietro A Modesti
- Department of Experimental and Clinical Medicine, Universita' degli Studi di Firenze, School of Medicine, Azienda Ospedaliero Universitaria Careggi, Firenze
| | - Marco Pappaccogli
- Hypertension Unit, Division of Internal Medicine, Department of Medical Sciences, University of Turin, Turin, Italy
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, IRCCS Istituto Auxologico Italiano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alexandre Persu
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Jorge Polonia
- Department of Medicine and CINTESIS, Faculty of Medicine, Porto University, Porto, Portugal
| | - Marek Rajzer
- 1st Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension Jagiellonian University Medical College, Kraków, Poland
| | - Philippe de Timary
- Department of Adult Psychiatry, Cliniques Universitaires Saint-Luc and Institute of Neuroscience, Université Catholique de Louvain, Brussels, Belgium
| | - Thomas Weber
- Cardiology Department, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Konstantinos Tsioufis
- First Cardiology Clinic, Medical School, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece
| | - Giuseppe Mancia
- Università Milano-Bicocca, Milan
- Policlinico di Monza, Monza, Italy
| | - Andrzej Januszewicz
- Department of Hypertension, National Institute of Cardiology, Warsaw, Poland
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Loh HC, Neoh KK, Tang ASN, Chin CJ, Suppiah PD, Looi I, Goh KW, Tan CS, Ming LC. Stroke Patients' Characteristics and Clinical Outcomes: A Pre-Post COVID-19 Comparison Study. ACTA ACUST UNITED AC 2021; 57:medicina57050507. [PMID: 34069433 PMCID: PMC8159102 DOI: 10.3390/medicina57050507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/12/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: The Coronavirus disease 2019 (COVID-19) pandemic caused significant disruption to established medical care systems globally. Thus, this study was aimed to compare the admission and outcome variables such as number of patient and its severity, acute recanalisation therapy given pre-post COVID-19 at a primary stroke centre located in Malaysia. Methods: This cross-sectional hospital-based study included adult ischaemic stroke patients. Variables of the study included the number of ischaemic stroke patients, the proportions of recanalisation therapies, stroke severity during admission based on the National Institutes of Health Stroke Scale, functional outcome at discharge based on the modified Rankin Scale, and relevant workflow metrics. We compared the outcome between two six-month periods, namely the pre-COVID-19 period (March 2019 to September 2019) and the COVID-19 period (March 2020 to September 2020). Results: There were 131 and 156 patients, respectively, from the pre-COVID-19 period and the COVID-19 period. The median door-to-scan time and the median door-to-reperfusion time were both significantly shorter in the COVID-19 period (24.5 min versus 12.0 min, p = 0.047) and (93.5 min versus 60.0 min, p = 0.015), respectively. There were also significantly more patients who received intravenous thrombolysis (7.6% versus 17.3%, p = 0.015) and mechanical thrombectomy (0.8% versus 6.4%, p = 0.013) in the COVID-19 period, respectively. Conclusions: The COVID-19 pandemic may not have caused disruptions of acute stroke care in our primary stroke centre. Our data indicated that the number of ischaemic stroke events remained stable, with a significant increase of recanalisation therapies and better in-hospital workflow metrics during the COVID-19 pandemic period. However, we would like to highlight that the burden of COVID-19 cases in the study area was very low. Therefore, the study may not have captured the true burden (and relevant delays in stroke patient management) during the COVID-19 pandemic. The effect of the pandemic crisis is ongoing and both pre-hospital and in-hospital care systems must continue to provide optimal, highly time-dependent stroke care services.
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Affiliation(s)
- Hong Chuan Loh
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
- Correspondence: (H.C.L.); (L.C.M.)
| | - Kar Keong Neoh
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Angelina Siing Ngi Tang
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Chen Joo Chin
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
| | - Purnima Devi Suppiah
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
| | - Irene Looi
- Clinical Research Centre, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (C.J.C.); (P.D.S.); (I.L.)
- Department of Internal Medicine, Hospital Seberang Jaya, Ministry of Health Malaysia, Seberang Jaya 13700, Malaysia; (K.K.N.); (A.S.N.T.)
| | - Khang Wen Goh
- Faculty of Computing and Engineering, Quest International University Perak, Ipoh 30250, Malaysia;
| | - Ching Siang Tan
- School of Pharmacy, KPJ Healthcare University College, Nilai 71800, Malaysia;
| | - Long Chiau Ming
- Pengiran Anak Puteri Rashidah Sa’adatul Bolkiah Institute of Health Sciences, Universiti Brunei Darussalam, Gadong BE1410, Brunei
- Correspondence: (H.C.L.); (L.C.M.)
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Hameed S, Khan M, Fatmi Z, Wasay M. Exploring the Relationship Between Air Quality and Ischemic Stroke Admissions During the COVID-19 Pandemic. J Stroke Cerebrovasc Dis 2021; 30:105860. [PMID: 34029889 PMCID: PMC8106888 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105860] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 12/02/2022] Open
Abstract
Objectives Amongst all the global catastrophe due to Coronavirus disease 2019, a significant bright spot is a reduction in air pollution as countries undergo lockdowns to limit the spread of infection. Another reduction that has been reported is in the number of strokes presenting to hospitals, despite the virus implicated in causing a hypercoagulable state. Acute exposure to air pollution has been linked to increase in stroke incidence and the improvement in air quality may be responsible for the decrease in stroke presentations. Materials and Methods To explore this hypothesis, we compared the air quality index (AQI) of Karachi, the largest cosmopolitan city of Pakistan, during the lockdown period in 2020 to the same period in the previous year. Results We found a significant drop in AQI depicting an improvement in air quality. Simultaneously, we identified a drop in number of stroke admissions to less than half from 2019 to 2020 at one of the largest tertiary care hospitals of the city, during this period of interest. Conclusion: We hypothesize that one important reason for this drop in stroke admissions, may be an actual reduction in stroke incidence brought about by an improvement in air quality.
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Affiliation(s)
- Sajid Hameed
- Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Maria Khan
- Department of Neurology, Rashid Hospital, Dubai, UAE
| | - Zafar Fatmi
- Section of Environmental-Occupational Health & Injuries, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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de Havenon A, Ney JP, Callaghan B, Hohmann S, Shippey E, Yaghi S, Anadani M, Majersik JJ. Characteristics and Outcomes Among US Patients Hospitalized for Ischemic Stroke Before vs During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e2110314. [PMID: 33999162 PMCID: PMC8129817 DOI: 10.1001/jamanetworkopen.2021.10314] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE After the emergence of COVID-19, studies reported a decrease in hospitalizations of patients with ischemic stroke (IS), but there are little to no data regarding hospitalizations for the remainder of 2020, including outcome data from a large cohort of patients with IS and comorbid COVID-19. OBJECTIVE To assess hospital discharge rates, demographic factors, and outcomes of hospitalization associated with the COVID-19 pandemic among US patients with IS before vs during the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used data from the Vizient Clinical Data Base on 324 013 patients with IS at 478 nonfederal hospitals in 43 US states between January 1, 2019, and December 31, 2020. Patients were eligible if they were admitted to the hospital on a nonelective basis and were not receiving hospice care at the time of admission. A total of 41 166 discharged between January and March 2020 were excluded from the analysis because they had unreliable data on COVID-19 status, leaving 282 847 patients for the study. EXPOSURE Ischemic stroke and laboratory-confirmed COVID-19. MAIN OUTCOMES AND MEASURES Monthly counts of discharges among patients with IS in 2020. Demographic characteristics and outcomes, including in-hospital death, among patients with IS who were discharged in 2019 (control group) were compared with those of patients with IS with or without comorbid COVID-19 (COVID-19 and non-COVID-19 groups, respectively) who were discharged between April and December 2020. RESULTS Of the 282 847 patients included in the study, 165 912 (50.7% male; 63.4% White; 26.3% aged ≥80 years) were allocated to the control group; 111 418 of 116 935 patients (95.3%; 51.9% male; 62.8% White; 24.6% aged ≥80 years) were allocated to the non-COVID-19 group and 5517 of 116 935 patients (4.7%; 58.0% male; 42.5% White; 21.3% aged ≥80 years) to the COVID-19 group. A mean (SD) of 13 846 (553) discharges per month among patients with IS was reported in 2019. Discharges began decreasing in February 2020, reaching a low of 10 846 patients in April 2020 before returning to a prepandemic level of 13 639 patients by July 2020. A mean (SD) of 13 492 (554) discharges per month was recorded for the remainder of 2020. Black and Hispanic patients accounted for 21.4% and 7.0% of IS discharges in 2019, respectively, but accounted for 27.5% and 16.0% of those discharged with IS and comorbid COVID-19 in 2020. Compared with patients in the control and non-COVID-19 groups, those in the COVID-19 group were less likely to smoke (16.0% vs 17.2% vs 6.4%, respectively) and to have hypertension (73.0% vs 73.1% vs 68.2%) or dyslipidemia (61.2% vs 63.2% vs 56.6%) but were more likely to have diabetes (39.8% vs 40.5% vs 53.0%), obesity (16.2% vs 18.4% vs 24.5%), acute coronary syndrome (8.0% vs 9.2% vs 15.8%), or pulmonary embolus (1.9% vs 2.4% vs 6.8%) and to require intubation (11.3% vs 12.3% vs 37.6%). After adjusting for baseline factors, patients with IS and COVID-19 were more likely to die in the hospital than were patients with IS in 2019 (adjusted odds ratio, 5.17; 95% CI, 4.83-5.53; National Institutes of Health Stroke Scale adjusted odds ratio, 3.57; 95% CI, 3.15-4.05). CONCLUSIONS AND RELEVANCE In this cohort study, after the emergence of COVID-19, hospital discharges of patients with IS decreased in the US but returned to prepandemic levels by July 2020. Among patients with IS between April and December 2020, comorbid COVID-19 was relatively common, particularly among Black and Hispanic populations, and morbidity was high.
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Affiliation(s)
| | - John P. Ney
- Department of Neurology, Boston University, Boston, Massachusetts
| | | | | | | | - Shadi Yaghi
- Department of Neurology, New York University, New York
| | - Mohammad Anadani
- Department of Neurology, Washington University in St Louis, St Louis, Missouri
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Gaspardone A, Versaci F, Tomai F, Biondi-Zoccai G, Sgueglia GA, Gioffré G, Romagnoli E, Mancone M, Calcagno S, Proietti I, Sciahbasi A, DI Pietro R, Tanzilli G, Mariano E, Romeo F. Reduction in emergency access for acute myocardial infarction during the COVID-19 pandemic: a survey from the greater area of Rome, Italy. Minerva Cardiol Angiol 2021; 70:421-427. [PMID: 33823575 DOI: 10.23736/s2724-5683.21.05516-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND On March 9, 2020, the Italian government imposed a national lockdown to tackle the COronaVIrus Disease 19 (COVID-19) pandemic, including stay at home recommendations. The precise impact of COVID-19 scare and lockdown on emergency access for acute myocardial infarction (MI) is still subject to debate. METHODS Data on all patients undergoing invasive coronary angiography at 9 hospitals in the greater area of Rome, Italy, between February 19, 2020 and March 29, 2020, 9, 2020, were retrospectively collected. Incidence of ST-elevation MI (STEMI), and non-ST-elevation MI (NSTEMI), as well as corresponding percutaneous coronary intervention (PCI), was compared distinguishing two different 20-day time periods (before vs on or after March 10, 2020). RESULTS During the study period, 1,068 patients underwent coronary angiography, 142 (13%) with STEMI and 169 (16%) with NSTEMI. The average daily number of STEMI decreased from 4.3 before the lockdown to 2.9 after the lockdown (p=0.021). Similarly, the average daily number of NSTEMI changed from 5.0 to 3.5 (p=0.028). The average daily number of primary PCI changed from 4.2 to 2.9 (p=0.030), while the average daily number of PCI for NSTEMI changed from 3.5 to 2.5 (p=0.087). For STEMI patients, the time from symptom onset to hospital arrival (onset-to-door time less than three hours) showed a significant increase after the lockdown (p=0.018), whereas door-to-balloon time did not change significantly from before to after the lockdown (p=0.609). CONCLUSIONS The present study, originally reporting on the trends in STEMI and NSTEMI in the Rome area, highlights that significant decreases in the incidence of both acute coronary syndromes occurred between February 19, 2020 and March 29, 2020, together with increases in time from symptom onset to hospital arrival, luckily without changes in door-to-balloon time.
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Affiliation(s)
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti, Latina, Italy -
| | | | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | | | - Enrico Romagnoli
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Simone Calcagno
- Division of Cardiology, Ospedale Santa Maria Goretti, Latina, Italy
| | - Igino Proietti
- Division of Cardiology, Ospedale M.G. Vannini, Rome, Italy
| | | | | | - Gaetano Tanzilli
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Sapienza University of Rome, Rome, Italy
| | - Enrica Mariano
- Division of Cardiology, Department of Medical Sciences, Università Tor Vergata, Rome, Italy
| | - Francesco Romeo
- Division of Cardiology, Department of Medical Sciences, Università Tor Vergata, Rome, Italy
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Narasimhalu K, Woon FP, Ng SC, De Silva DA. Attendance for ischaemic stroke before and during COVID-19 lockdown in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:359-361. [PMID: 33990828 DOI: 10.47102/annals-acadmedsg.2020433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Kaavya Narasimhalu
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Singapore
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Page EM, Ariëns RAS. Mechanisms of thrombosis and cardiovascular complications in COVID-19. Thromb Res 2021; 200:1-8. [PMID: 33493983 PMCID: PMC7813504 DOI: 10.1016/j.thromres.2021.01.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/16/2020] [Accepted: 01/08/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND The novel coronavirus SARS-CoV-2, responsible for the 2019-2020 global (COVID-19) pandemic, is a respiratory virus associated with the development of thromboembolic complications and respiratory failure in severe cases. Increased risk of pulmonary embolism and thrombosis has been identified in COVID-19 patients, alongside accompanying elevations in potential prognostic biomarkers, including D-dimer, IL-6 and cardiac specific troponins. Our aim was to provide a scoping review of the available literature regarding thrombosis risk, other cardiovascular implications, and their biomarkers in COVID-19 to highlight potential disease mechanisms. METHODS Authors conducted a literature search in PubMed using MeSH headings "disseminated intravascular coagulation", "pulmonary embolism", "thromb*", "stroke", "myocardial infarction" and "acute lung injury", as well as terms "COVID-19", "SARS-CoV-2", "2019 novel coronavirus" and "2019-nCoV". RESULTS AND CONCLUSIONS COVID-19 disease is characterised by the interactions between hyperactive coagulation and complement systems - induced by hyper-inflammatory conditions, resulting in a pro-thrombotic state and diffuse tissue injury. There are several promising prognostic markers of disease severity, with D-dimer the most significant. The presence of thrombocytopenia appears to be a key indicator of patient deterioration. Further research is required to understand the underlying pathophysiology in COVID-19 and its implications in disease progression and patient management. Randomised trials are urgently needed to determine the safety of proposed therapeutic anticoagulation with heparin and the role for anti-platelet agents, such as Ticagrelor, in patient management.
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Affiliation(s)
- Eden M Page
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Robert A S Ariëns
- Discovery and Translational Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK.
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Balestrino M, Coccia A, Boffa AS, Furgani A, Bermano F, Finocchi C, Bandettini di Poggio ML, Malfatto L, Farinini D, Schenone A. Request of hospital care dropped for TIA but remained stable for stroke during COVID-19 pandemic at a large Italian university hospital. Intern Emerg Med 2021; 16:735-739. [PMID: 33063236 PMCID: PMC7561243 DOI: 10.1007/s11739-020-02522-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/28/2020] [Indexed: 11/04/2022]
Abstract
Reduced incidence of stroke during COVID-19 pandemic was sometimes reported. While decrease in stroke incidence and fear of patients to go to the hospitals were sometimes invoked to explain this decrease, reduction in urban pollution was also hypothesized as a possible cause. We investigated statistically the incidence of ischemic and hemorrhagic stroke, and of transient ischemic attacks, at a large Italian tertiary stroke center during the pandemic. We analyzed statistically the number of transient ischemic attacks (TIA), ischemic strokes (IS) and hemorrhagic strokes (HS) between March 8 and May 2, 2020, the peak of the COVID-19 epidemic in Italy, and compared them with the identical period of 2019. We also analyzed the concentration of small particulate matter (PM10) in 2019 and 2020, to see if it could account for modified incidence of strokes or TIA. We found a large, significant drop in TIA (- 51%) during the pandemic compared to the same period of 2019. By contrast, the number of HS was identical, and IS showed a not significant - 24% decrease. PM10 concentration, already low in 2019, did not further decrease in 2020. Patients kept seeking hospital care when experiencing permanent neurological symptoms (stroke), but they tended not go to the hospital when their symptoms were transient (TIA). The fact that we did not observe a significant decrease in strokes may be explained by the fact that in our city the concentration of small particulate matter did not change compared to 2019.
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Affiliation(s)
- Maurizio Balestrino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
| | - Alberto Coccia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessandra Silvia Boffa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | - Andrea Furgani
- Dipartimento Regionale di Emergenza Sanitaria Territoriale 118, Genoa, Italy
| | - Francesco Bermano
- Dipartimento Regionale di Emergenza Sanitaria Territoriale 118, Genoa, Italy
| | - Cinzia Finocchi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Monica Laura Bandettini di Poggio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Mother and Child Sciences (DINOGMI), University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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Jansen R, Lee JI, Turowski B, Kaschner M, Caspers J, Bernhard M, Hartung HP, Jander S, Ruck T, Meuth SG, Gliem M. Consequences of COVID-19 pandemic lockdown on emergency and stroke care in a German tertiary stroke center. Neurol Res Pract 2021; 3:21. [PMID: 33789760 PMCID: PMC8011045 DOI: 10.1186/s42466-021-00118-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND COVID-19 pandemic caused a decline in stroke care in several countries. The objective was to describe lockdown stroke care in a tertiary stroke center in Düsseldorf, Germany near Heinsberg, a German hot spot for COVID-19 in spring 2020. METHODS In a retrospective, observational, single-center study, we compared all patients treated in our emergency department (ED), patients seen by a neurologist in the ED, ED patients suffering from ischemic and hemorrhagic strokes and transient ischemic attacks (TIAs) as well as stroke patients admitted to our stroke unit during lockdown in spring 2020 (16 March 2020-12 April 2020) to those cared for during the same period in 2019 and lockdown light in fall 2020 (2 November - 29 November 2020). RESULTS In spring 2020 lockdown the mean number of patients admitted to our ED dropped by 37.4%, seen by a neurologist by 35.6%, ED stroke patients by 19.2% and number of patients admitted to our stroke unit by 10% compared to the same period in 2019. In fall lockdown light 2020 effects were comparable but less pronounced. Thrombolysis rate was stable during spring and fall lockdown, however, endovascular treatment (EVT) rate declined by 58% in spring lockdown and by 51% in fall lockdown compared to the period in 2019. CONCLUSIONS Our study indicates a profound reduction of overall ED patients, neurological ED patients and EVT during COVID-19 pandemic caused lockdowns. Planning for pandemic scenarios should include access to effective emergency therapies.
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Affiliation(s)
- Robin Jansen
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - John-Ih Lee
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany.
| | - Bernd Turowski
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marius Kaschner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
- Brain and Mind Centre, University of Sydney, Sydney, Australia
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Sebastian Jander
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Michael Gliem
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, Moorenstr. 5, 40225, Düsseldorf, Germany
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Nechuta S, Wallace H. Screening and Diagnostic Mammography Utilization During the COVID-19 Pandemic: Public Health Implications and Future Research Needs. J Natl Cancer Inst 2021; 113:1115-1117. [PMID: 33778893 PMCID: PMC8083614 DOI: 10.1093/jnci/djab046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 01/28/2023] Open
Affiliation(s)
- Sarah Nechuta
- Department of Public Health, Grand Valley State University, College of Health Professions, Grand Rapids, MI, USA
| | - Heather Wallace
- Department of Public Health, Grand Valley State University, College of Health Professions, Grand Rapids, MI, USA
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Nogueira RG, Abdalkader M, Qureshi MM, Frankel MR, Mansour OY, Yamagami H, Qiu Z, Farhoudi M, Siegler JE, Yaghi S, Raz E, Sakai N, Ohara N, Piotin M, Mechtouff L, Eker O, Chalumeau V, Kleinig TJ, Pop R, Liu J, Winters HS, Shang X, Vasquez AR, Blasco J, Arenillas JF, Martinez-Galdamez M, Brehm A, Psychogios MN, Lylyk P, Haussen DC, Al-Bayati AR, Mohammaden MH, Fonseca L, Luís Silva M, Montalverne F, Renieri L, Mangiafico S, Fischer U, Gralla J, Frei D, Chugh C, Mehta BP, Nagel S, Mohlenbruch M, Ortega-Gutierrez S, Farooqui M, Hassan AE, Taylor A, Lapergue B, Consoli A, Campbell BC, Sharma M, Walker M, Van Horn N, Fiehler J, Nguyen HT, Nguyen QT, Watanabe D, Zhang H, Le HV, Nguyen VQ, Shah R, Devlin T, Khandelwal P, Linfante I, Izzath W, Lavados PM, Olavarría VV, Sampaio Silva G, de Carvalho Sousa AV, Kirmani J, Bendszus M, Amano T, Yamamoto R, Doijiri R, Tokuda N, Yamada T, Terasaki T, Yazawa Y, Morris JG, Griffin E, Thornton J, Lavoie P, Matouk C, Hill MD, Demchuk AM, Killer-Oberpfalzer M, Nahab F, Altschul D, Ramos-Pachón A, Pérez de la Ossa N, Kikano R, Boisseau W, Walker G, Cordina SM, Puri A, Luisa Kuhn A, Gandhi D, Ramakrishnan P, Novakovic-White R, Chebl A, Kargiotis O, Czap A, Zha A, Masoud HE, Lopez C, Ozretic D, Al-Mufti F, Zie W, Duan Z, Yuan Z, Huang W, Hao Y, Luo J, Kalousek V, Bourcier R, Guile R, Hetts S, Al-Jehani HM, AlHazzani A, Sadeghi-Hokmabadi E, Teleb M, Payne J, Lee JS, Hong JM, Sohn SI, Hwang YH, Shin DH, Roh HG, Edgell R, Khatri R, Smith A, Malik A, Liebeskind D, Herial N, Jabbour P, Magalhaes P, Ozdemir AO, Aykac O, Uwatoko T, Dembo T, Shimizu H, Sugiura Y, Miyashita F, Fukuda H, Miyake K, Shimbo J, Sugimura Y, Beer-Furlan A, Joshi K, Catanese L, Abud DG, Neto OG, Mehrpour M, Al Hashmi A, Saqqur M, Mostafa A, Fifi JT, Hussain S, John S, Gupta R, Sivan-Hoffmann R, Reznik A, Sani AF, Geyik S, Akıl E, Churojana A, Ghoreishi A, Saadatnia M, Sharifipour E, Ma A, Faulder K, Wu T, Leung L, Malek A, Voetsch B, Wakhloo A, Rivera R, Barrientos Iman DM, Pikula A, Lioutas VA, Thomalla G, Birnbaum L, Machi P, Bernava G, McDermott M, Kleindorfer D, Wong K, Patterson MS, Fiorot JA, Huded V, Mack W, Tenser M, Eskey C, Multani S, Kelly M, Janardhan V, Cornett O, Singh V, Murayama Y, Mokin M, Yang P, Zhang X, Yin C, Han H, Peng Y, Chen W, Crosa R, Frudit ME, Pandian JD, Kulkarni A, Yagita Y, Takenobu Y, Matsumaru Y, Yamada S, Kono R, Kanamaru T, Yamazaki H, Sakaguchi M, Todo K, Yamamoto N, Sonoda K, Yoshida T, Hashimoto H, Nakahara I, Cora E, Volders D, Ducroux C, Shoamanesh A, Ospel J, Kaliaev A, Ahmed S, Rashid U, Rebello LC, Pereira VM, Fahed R, Chen M, Sheth SA, Palaiodimou L, Tsivgoulis G, Chandra R, Koyfman F, Leung T, Khosravani H, Dharmadhikari S, Frisullo G, Calabresi P, Tsiskaridze A, Lobjanidze N, Grigoryan M, Czlonkowska A, de Sousa DA, Demeestere J, Liang C, Sangha N, Lutsep HL, Ayo-Martín Ó, Cruz-Culebras A, Tran AD, Young CY, Cordonnier C, Caparros F, De Lecinana MA, Fuentes B, Yavagal D, Jovin T, Spelle L, Moret J, Khatri P, Zaidat O, Raymond J, Martins S, Nguyen T. Global impact of COVID-19 on stroke care. Int J Stroke 2021; 16:573-584. [PMID: 33459583 PMCID: PMC8010375 DOI: 10.1177/1747493021991652] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The COVID-19 pandemic led to profound changes in the organization of health care systems worldwide. Aims We sought to measure the global impact of the COVID-19 pandemic on the volumes for mechanical thrombectomy, stroke, and intracranial hemorrhage hospitalizations over a three-month period at the height of the pandemic (1 March–31 May 2020) compared with two control three-month periods (immediately preceding and one year prior). Methods Retrospective, observational, international study, across 6 continents, 40 countries, and 187 comprehensive stroke centers. The diagnoses were identified by their ICD-10 codes and/or classifications in stroke databases at participating centers. Results The hospitalization volumes for any stroke, intracranial hemorrhage, and mechanical thrombectomy were 26,699, 4002, and 5191 in the three months immediately before versus 21,576, 3540, and 4533 during the first three pandemic months, representing declines of 19.2% (95%CI, −19.7 to −18.7), 11.5% (95%CI, −12.6 to −10.6), and 12.7% (95%CI, −13.6 to −11.8), respectively. The decreases were noted across centers with high, mid, and low COVID-19 hospitalization burden, and also across high, mid, and low volume stroke/mechanical thrombectomy centers. High-volume COVID-19 centers (−20.5%) had greater declines in mechanical thrombectomy volumes than mid- (−10.1%) and low-volume (−8.7%) centers (p < 0.0001). There was a 1.5% stroke rate across 54,366 COVID-19 hospitalizations. SARS-CoV-2 infection was noted in 3.9% (784/20,250) of all stroke admissions. Conclusion The COVID-19 pandemic was associated with a global decline in the volume of overall stroke hospitalizations, mechanical thrombectomy procedures, and intracranial hemorrhage admission volumes. Despite geographic variations, these volume reductions were observed regardless of COVID-19 hospitalization burden and pre-pandemic stroke/mechanical thrombectomy volumes.
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Affiliation(s)
- Raul G Nogueira
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Mohamad Abdalkader
- Radiology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Muhammed M Qureshi
- Radiology, Radiation Oncology, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Michael R Frankel
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | - Ossama Yassin Mansour
- Neurology Department, Stroke and Neurointervention Division, Alexandria University Hospital, Alexandria University, Egypt
| | - Hiroshi Yamagami
- Stroke Neurology, National Hospital Organization, Osaka National Hospital, Japan
| | - Zhongming Qiu
- Neurology, Xinqiao Hospital of the Army Medical University, Chongqing, China
| | | | - James E Siegler
- Neurology, Cooper Neurological Institute, Cooper University Hospital, Camden, New Jersey, USA
| | - Shadi Yaghi
- Neurology, Radiology, New York University School of Medicine, New York, USA
| | - Eytan Raz
- Radiology, Neurology, New York University School of Medicine, New York, USA
| | - Nobuyuki Sakai
- Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Nobuyuki Ohara
- Neurology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Michel Piotin
- Fondation Ophtalmologique Adolphe de Rothschild, France
| | | | - Omer Eker
- Neuroradiologie, Hospices Civils de Lyon, France
| | | | | | - Raoul Pop
- Hôpitaux Universitaires de Strasbourg, France
| | | | | | | | | | - Jordi Blasco
- Interventional Neuroradiology, Hospital Clinic de Barcelona, Spain
| | | | | | | | | | - Pedro Lylyk
- Clínica Sagrada Familia, Buenos Aires, Argentina
| | - Diogo C Haussen
- Neurology, Grady Memorial Hospital, Emory University, Atlanta, Georgia, USA
| | | | | | - Luísa Fonseca
- Stroke, Centro Hospitalar Universitário de São João, Portugal
| | - M Luís Silva
- Neuroradiology, Centro Hospitalar Universitário de São João, Portugal
| | | | | | | | - Urs Fischer
- Neurology, University Hospital Bern, Switzerland
| | - Jan Gralla
- Interventional Neuroradiology, University Hospital Bern, Switzerland
| | | | | | | | - Simon Nagel
- Neurology, University Hospital Heidelberg, Germany
| | | | | | | | - Ameer E Hassan
- Neurosciences, Valley Baptist Medical Center, Harlingen, Texas, USA
| | - Allan Taylor
- Neurosurgery, University of Cape Town, South Africa
| | | | | | | | | | | | - Noel Van Horn
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | - Jens Fiehler
- Interventional Neuroradiology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | - Hao Zhang
- Affiliated Hangzhou First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Naoki Tokuda
- Japanese Red Cross Kyoto Daiichi Hospital, Japan
| | | | | | | | | | | | | | | | | | | | | | | | - Fadi Nahab
- Emory University School of Medicine, USA
| | | | | | | | | | | | | | | | - Ajit Puri
- University of Massachusetts Medical Center, USA
| | | | | | | | | | | | | | | | - Alicia Zha
- UTHealth McGovern Medical School, Houston, USA
| | | | | | | | | | - Wenjie Zie
- Xinqiao Hospital of the Army Medical University, China
| | | | - Zhengzhou Yuan
- Affiliated Hospital of Southwest Medical University, China
| | - Wenguo Huang
- Maoming Traditional Chinese Medicine Hospital, China
| | | | - Jun Luo
- Mianyang 404 Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Alice Ma
- Royal North Shore Hospital, Australia
| | | | - Teddy Wu
- Christchurch Hospital, Christchurch , New Zealand
| | | | | | | | - Ajay Wakhloo
- Interventional Neuroradiology, Beth Israel Lahey Health, USA
| | - Rodrigo Rivera
- Neuroradiology, Instituto de Neurocirugia Dr. Asengo, Chile
| | | | | | | | - Gotz Thomalla
- Neurology, Universitätsklinikum Hamburg-Eppendorf, Germany
| | | | | | | | | | | | - Ken Wong
- Royal London Hospital, United Kingdom
| | | | | | | | | | | | - Clifford Eskey
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | | | | | | | | | | | | | | | | | - Congguo Yin
- Affiliated Hangzhou First People's Hospital, China
| | | | - Ya Peng
- First People's Hospital, China
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenichi Todo
- Osaka University Graduate School of Medicine, Japan
| | - Nobuaki Yamamoto
- Tokushima University Graduate School of Biomedical Sciences, Japan
| | | | | | | | | | - Elena Cora
- Dalhousie University, Nova Scotia, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Conrad Liang
- Neurointerventional Radiology, Kaiser Permanente, California, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thanh Nguyen
- Radiology, Neurology, Boston Medical Center, USA
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