1
|
Hyder S, Tang R, Huang R, Ludwig A, Scott K, Nadig N. Implementation of an Interdisciplinary Transfer Huddle Intervention for Prolonged Wait Times During Inter-ICU Transfer. Jt Comm J Qual Patient Saf 2024; 50:371-376. [PMID: 38378394 DOI: 10.1016/j.jcjq.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND ICU transfers from a regional to a tertiary-level hospital are initiated typically for a higher level of care. Extended transfer wait times can negatively affect survival, length of stay (LOS), and cost. METHODS In this prospective single-center study, the subjects were adult ICU patients admitted to regional hospitals between January and October 2022, for whom a request was made to transfer to a tertiary-level medical ICU. The authors developed and implemented an interdisciplinary transfer huddle intervention (THI) with the goal of reducing wait times by providing a consistent channel of communication between key stakeholders. The primary outcome was the number of hours elapsed between transfer request and the time of transfer to the tertiary hospital. Secondary outcomes included in-hospital mortality, discharge to home, ICU LOS, and hospital LOS. Data were abstracted from electronic health records and periods before (January to June 2022) and after (June to October 2022) the intervention were compared. Data were analyzed using logistic regression or negative binomial regression, adjusting for patient demographic and clinical characteristics. ICU fellows also completed a daily survey about barriers they perceived to the THI application. RESULTS During the study period, 76 patients were transferred. The THI was completed 75.0% of the time. There were no statistically significant differences in the primary and secondary outcomes before and after the intervention. The top perceived barriers to transfer were lack of physical beds (50.0%) and staffing limitations (37.5%). CONCLUSION The authors successfully developed and implemented a transfer huddle to ensure consistent interdisciplinary communication for patients being transferred between ICUs and identified barriers to such transfer. However, transfer times and patient outcomes were not significantly different after the change. Future studies should consider staffing challenges, hospital capacity, and the role of dedicated transfer teams in in decreasing inter-ICU transfer wait times.
Collapse
|
2
|
Burke B, Boyd S, McNamara K, O'Donoghue K. Barriers to attendance at a tertiary hospital's perinatal mortality meeting. Ir J Med Sci 2023; 192:1265-1270. [PMID: 36053388 PMCID: PMC9438871 DOI: 10.1007/s11845-022-03137-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 08/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Perinatal mortality multi-disciplinary team meetings (PM-MDTMs) offer a forum for multi-disciplinary discussion of poor perinatal outcomes. They ensure a thorough understanding of individual cases and present an important learning opportunity for healthcare professionals (HCPs). Attendance at PM-MDTMs in this tertiary maternity hospital has been low. AIMS We aimed to identify barriers which may be targeted to improve attendance and engagement. METHODS An anonymous questionnaire was developed, and all HCPs invited to participate. Demographic data on respondents was collected, as was knowledge of PM-MDTMs, their purpose and relevance to clinical practice, and barriers to attendance at meetings. A total of 78 responses were obtained and analysed. RESULTS Self-reported understanding of the purpose and format PM-MDTMs was high (84.6% (66/78) and 65.4% (51/78), respectively), while only 50% (39/78) of respondents provided an accurate description of either. Only 50% (39/78) reported having attended a meeting in the hospital, of whom 61.5% (24/39) described the correct meeting. Of these, 37.5% (9/24) reported attending regularly and 70.8% (17/24) found the meeting relevant to their clinical practice. Of the 33.33% (26/78) who reported attending a PM-MDTM in another hospital, 73.1% (19/26) accurately described the meeting, 63.1% (12/19) of these attended regularly, and 100% (19/19) found it relevant. Three main qualitative themes emerged as barriers to attendance and were areas for suggested improvements: workload and staffing levels, meeting logistics, and lack of communication and education regarding PM-MDTMs. CONCLUSIONS Communication regarding PM-MDTMs and their learning opportunities needs to improve. Lack of engagement is likely compounded by high workloads and staffing levels, but these issues should be surmountable.
Collapse
Affiliation(s)
- Barbara Burke
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.
| | - Sophie Boyd
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
| | - Karen McNamara
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
- The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
| |
Collapse
|
3
|
Jeong H, Choi JW, Kim DK, Lee SH, Lee SY. Implementation and Outcomes of a Difficult Airway Code Team Composed of Anesthesiologists in a Korean Tertiary Hospital: A Retrospective Analysis of a Prospective Registry. J Korean Med Sci 2022; 37:e21. [PMID: 35040296 PMCID: PMC8763879 DOI: 10.3346/jkms.2022.37.e21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/21/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2017, we established an airway call (AC) team composed of anesthesiologists to improve emergency airway management outside the operating room. In this retrospective analysis of prospectively collected data from the airway registry, we describe the characteristics of patients attended to and practices by the AC team during the first 4 years of implementation. METHODS All AC team activations in which an airway intervention was performed by the AC team between June 2017 and May 2021 were analyzed. RESULTS In all, 359 events were analyzed. Activation was more common outside of working hours (62.1%) and from the intensive care unit (85.0%); 36.2% of AC activations were due to known or anticipated difficult airway, most commonly because of acquired airway anomalies (n = 49), followed by airway edema or bleeding (n = 32) and very young age (≤ 1 years; n = 30). In 71.3% of the cases, successful intubation was performed by the AC team at the first attempt. However, three or more attempts were performed in 33 cases. The most common device used for successful intubation was the videolaryngoscope (59.7%). Tracheal intubation by the AC team failed in nine patients, who then required surgical airway insertion by otolaryngologists. However, there were no airway-related deaths. CONCLUSIONS When coupled with appropriate assistance from an otolaryngologist AC system, an AC team composed of anesthesiologists could be an efficient way to provide safe airway management outside the operating room. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0006643.
Collapse
Affiliation(s)
- Heejoon Jeong
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Won Choi
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Duk Kyung Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sang Hyun Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo Yeon Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
4
|
Anane-Fenin B, Agbeno EK, Osarfo J, Opoku Anning DA, Boateng AS, Ken-Amoah S, Amanfo AO, Derkyi-Kwarteng L, Mouhajer M, Amoo SA, Ashong J, Jeffery E. A ten-year review of indications and outcomes of obstetric admissions to an intensive care unit in a low-resource country. PLoS One 2022; 16:e0261974. [PMID: 34972184 PMCID: PMC8719704 DOI: 10.1371/journal.pone.0261974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction Obstetric intensive care unit admission (ICU) suggests severe morbidity. However, there is no available data on the subject in Ghana. This retrospective review was conducted to determine the indications for obstetric ICU admission, their outcomes and factors influencing these outcomes to aid continuous quality improvement in obstetric care. Methods This was a retrospective review conducted in a tertiary hospital in Ghana. Data on participant characteristics including age and whether participant was intubated were collected from patient records for all obstetric ICU admissions from 1st January 2010 to 31st December 2019. Descriptive statistics were presented as frequencies, proportions and charts. Hazard ratios were generated for relations between obstetric ICU admission outcome and participant characteristics. A p-value <0.05 was deemed statistically significant. Results There were 443 obstetric ICU admissions over the review period making up 25.7% of all ICU admissions. The commonest indications for obstetric ICU admissions were hypertensive disorders of pregnancy (70.4%, n = 312/443), hemorrhage (14.4%, n = 64/443) and sepsis (9.3%, n = 41/443). The case fatality rates for hypertension, hemorrhage, and sepsis were 17.6%, 37.5%, and 63.4% respectively. The obstetric ICU mortality rate was 26% (115/443) over the review period. Age ≥25 years and a need for mechanical ventilation carried increased mortality risks following ICU admission while surgery in the index pregnancy was associated with a reduced risk of death. Conclusion Hypertension, haemorrhage and sepsis are the leading indications for obstetric ICU admissions. Thus, preeclampsia screening and prevention, as well as intensifying antenatal education on the danger signs of pregnancy can minimize obstetric complications. The establishment of an obstetric HDU in CCTH and the strengthening of communication between specialists and the healthcare providers in the lower facilities, are also essential for improved pregnancy outcomes. Further studies are needed to better appreciate the wider issues underlying obstetric ICU admission outcomes. Plain language summary This was a review of the reasons for admitting severely-ill pregnant women and women who had delivered within the past 42 days to the intensive care unit (ICU), the admission outcomes and risk factors associated with ICU mortality in a tertiary hospital in a low-resource country. High blood pressure and its complications, bleeding and severe infections were observed as the three most significant reasons for ICU admissions in decreasing order of significance. Pre-existing medical conditions and those arising as a result of, or aggravated by pregnancy; obstructed labour and post-operative monitoring were the other reasons for ICU admission over the study period. Overall, 26% of the admitted patients died at the ICU and maternal age of at least 25 years and the need for intubation were identified as risk factors for ICU deaths. Attention must be paid to high blood pressure during pregnancy.
Collapse
Affiliation(s)
- Betty Anane-Fenin
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
- * E-mail:
| | - Evans Kofi Agbeno
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Joseph Osarfo
- Department of Community Medicine, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | | | - Abigail Serwaa Boateng
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Sebastian Ken-Amoah
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Anthony Ofori Amanfo
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Leonard Derkyi-Kwarteng
- Department of Pathology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Mohammed Mouhajer
- Department of Obstetrics and Gynaecology, University of Cape Coast School of Medical Sciences, Cape Coast, Ghana
| | - Sarah Ama Amoo
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Joycelyn Ashong
- Department of Obstetrics and Gynaecology, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Ernestina Jeffery
- Intensive Care Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
| |
Collapse
|
5
|
Vranas KC, Golden SE, Mathews KS, Schutz A, Valley TS, Duggal A, Seitz KP, Chang SY, Nugent S, Slatore CG, Sullivan DR, Hough CL. The Influence of the COVID-19 Pandemic on ICU Organization, Care Processes, and Frontline Clinician Experiences: A Qualitative Study. Chest 2021; 160:1714-1728. [PMID: 34062115 PMCID: PMC8164514 DOI: 10.1016/j.chest.2021.05.041] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic resulted in unprecedented adjustments to ICU organization and care processes globally. RESEARCH QUESTIONS Did hospital emergency responses to the COVID-19 pandemic differ depending on hospital setting? Which strategies worked well to mitigate strain as perceived by intensivists? STUDY DESIGN AND METHODS Between August and November 2020, we carried out semistructured interviews of intensivists from tertiary and community hospitals across six regions in the United States that experienced early or large surges of COVID-19 patients, or both. We identified themes of hospital emergency responses using the four S framework of acute surge planning: space, staff, stuff, system. RESULTS Thirty-three intensivists from seven tertiary and six community hospitals participated. Clinicians across both settings believed that canceling elective surgeries was helpful to increase ICU capabilities and that hospitals should establish clearly defined thresholds at which surgeries are limited during future surge events. ICU staff was the most limited resource; staff shortages were improved by the use of tiered staffing models, just-in-time training for non-ICU clinicians, designated treatment teams, and deployment of trainees. Personal protective equipment (PPE) shortages and reuse were widespread, causing substantial distress among clinicians; hands-on PPE training was helpful to reduce clinicians' anxiety. Transparency and involvement of frontline clinicians as stakeholders were important components of effective emergency responses and helped to maintain trust among staff. INTERPRETATION We identified several strategies potentially to mitigate strain as perceived by intensivists working in both tertiary and community hospital settings. Our study also demonstrated the importance of trust and transparency between frontline staff and hospital leadership as key components of effective emergency responses during public health crises.
Collapse
Affiliation(s)
- Kelly C Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Palliative and Advanced Illness Research (PAIR) Center, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sara E Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR
| | - Kusum S Mathews
- Division of Pulmonary, Critical Care, & Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Amanda Schutz
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| | - Thomas S Valley
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI
| | - Abhijit Duggal
- Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH
| | - Kevin P Seitz
- Division of Pulmonary, Allergy, and Critical Care Medicine, Vanderbilt University, Nashville, TN
| | - Steven Y Chang
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at UCLA, Ronald Reagan-UCLA Medical Center, Los Angeles, CA
| | - Shannon Nugent
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Christopher G Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| | - Donald R Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR; Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR; Knight Cancer Institute, Oregon Health & Science University, Portland, OR
| | - Catherine L Hough
- Division of Pulmonary and Critical Care, Oregon Health & Science University, Portland, OR
| |
Collapse
|
6
|
Ferreira JA, Baptista RM, Monteiro SR, Gonçalves FM, Monteiro PF, Gonçalves LM. Admission hyperglycemia and all-cause mortality in diabetic and non-diabetic patients with acute myocardial infarction: a tertiary center analysis. Intern Emerg Med 2021; 16:2109-2119. [PMID: 33713285 DOI: 10.1007/s11739-021-02693-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 03/01/2021] [Indexed: 01/08/2023]
Abstract
Admission hyperglycemia (AH) is associated with worse prognosis in patients with acute myocardial infarction (AMI). Controversy remains whether the impact of AH differs among patients previously diagnosed with diabetes mellitus (DM). We retrospectively evaluated consecutive patients admitted in a coronary care unit with AMI, from 2006 to 2014. Patients were divided into 4 groups: patients without known DM with admission glycemia (AG) ≤ 143 mg/dL (group 1), patients without known DM with AG > 143 mg/dL (group 2), known DM with AG ≤ 213 mg/dL (group 3), and known DM with AG > 213 mg/dL (group 4). Primary outcome was defined as all-cause mortality during follow-up. A total of 2768 patients were included: 1425 in group 1, 426 in group 2, 593 in group 3, and 325 in group 4. After a median follow-up of 5.6 years, 1047 (37.8%) patients reached primary outcome. After multivariate analysis, group 4 was associated with the worst prognosis (HR 3.103, p < 0.001) followed by group 3 (HR 1.639, p = 0.002) and group 2 (HR 1.557, p = 0.039), when compared to group 1. When groups were stratified by type of AMI, patients in group 2 had a worse prognosis than patients in group 3 in the case of non-ST-segment elevation AMI. AH is associated with higher all-cause mortality in patients with AMI, irrespective of previous diabetic status.
Collapse
Affiliation(s)
- João André Ferreira
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal.
| | - Rui Miguel Baptista
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
| | - Sílvia Reis Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Francisco Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
| | - Pedro Filipe Monteiro
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
| | - Lino Manuel Gonçalves
- Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta, R. Professor Mota Pinto, 3004-561, Coimbra, Portugal
- Faculty of Medicine, iCBR, University of Coimbra, Coimbra, Portugal
| |
Collapse
|
7
|
Navarro-Pérez MP, Ballesta-Martínez S, Rodríguez-Montolio J, Bellosta-Diago E, García-Noaín JA, Santos-Lasaosa S. Acute migraine management in the emergency department: experience from a large Spanish tertiary hospital. Intern Emerg Med 2021; 16:2243-2249. [PMID: 33712966 DOI: 10.1007/s11739-021-02698-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
To assess the characteristics of the management of patients with migraine who present to the emergency department (ED) with a migraine attack. Retrospective, observational study analyzing demographic, clinical, diagnostic and therapeutic characteristics of patients with migraine diagnosis presenting to ED for a migraine attack between 2016 and 2019. We reviewed the clinical records of 847 cases. 82.2% were women with mean age of 34.9 years. 87.2% had episodic migraine and 12.2% chronic migraine. 62.3% (528/847) had taken analgesics before visiting the ED [non-steroidal-anti-inflammatory drugs (NSAIDs) (300/528; 56.9%) and triptans (261/528; 49.5%)]. 25.4% (215/847) received blood testing and 6.4% (55/847) received cranial CT. Medication was administered in 77.2% cases (654/847). The median time-to-treatment was 70 min (IQR 42-120). NSAIDs (81%, 530/654), antiemetics (43.1%, 282/654) and metamizole (39% 255/654) were the most used. Triptans were administered in 7 cases (1.1%) and opioids in 84 (12.8%). At discharge, preventive treatment was prescribed or modified in 8.2% of cases (69/839) and triptans were prescribed in 129 cases (15.3%). 70.5% (592/839) were instructed to follow-up with their primary care provider (PCP), 21.5% (181/839) with a general neurologist and 7.9% (66/839) with a headache specialist. The majority of migraine patients were not receiving the recommended acute migraine-specific medication, both in the outpatient and in the ED setting, being especially remarkable the rare use of triptans in the ED. Furthermore, we found an elevated use of urgent complementary tests, mainly blood tests.
Collapse
Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain.
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain.
| | - Sara Ballesta-Martínez
- Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Joana Rodríguez-Montolio
- Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain
| | - Elena Bellosta-Diago
- Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| | | | - Sonia Santos-Lasaosa
- Neurology department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Zaragoza, Spain
- Aragon Institute for Health Research (IIS Aragón), Zaragoza, Spain
| |
Collapse
|
8
|
Smit JM, Haaksma ME, Winkler MH, Heldeweg MLA, Arts L, Lust EJ, Elbers PWG, Meijboom LJ, Girbes ARJ, Heunks LMA, Tuinman PR. Lung ultrasound in a tertiary intensive care unit population: a diagnostic accuracy study. Crit Care 2021; 25:339. [PMID: 34535169 PMCID: PMC8447620 DOI: 10.1186/s13054-021-03759-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 09/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Evidence from previous studies comparing lung ultrasound to thoracic computed tomography (CT) in intensive care unit (ICU) patients is limited due to multiple methodologic weaknesses. While addressing methodologic weaknesses of previous studies, the primary aim of this study is to investigate the diagnostic accuracy of lung ultrasound in a tertiary ICU population. METHODS This is a single-center, prospective diagnostic accuracy study conducted at a tertiary ICU in the Netherlands. Critically ill patients undergoing thoracic CT for any clinical indication were included. Patients were excluded if time between the index and reference test was over eight hours. Index test and reference test consisted of 6-zone lung ultrasound and thoracic CT, respectively. Hemithoraces were classified by the index and reference test as follows: consolidation, interstitial syndrome, pneumothorax and pleural effusion. Sensitivity, specificity, positive and negative likelihood ratio were estimated. RESULTS In total, 87 patients were included of which eight exceeded the time limit and were subsequently excluded. In total, there were 147 respiratory conditions in 79 patients. The estimated sensitivity and specificity to detect consolidation were 0.76 (95%CI: 0.68 to 0.82) and 0.92 (0.87 to 0.96), respectively. For interstitial syndrome they were 0.60 (95%CI: 0.48 to 0.71) and 0.69 (95%CI: 0.58 to 0.79). For pneumothorax they were 0.59 (95%CI: 0.33 to 0.82) and 0.97 (95%CI: 0.93 to 0.99). For pleural effusion they were 0.85 (95%CI: 0.77 to 0.91) and 0.77 (95%CI: 0.62 to 0.88). CONCLUSIONS In conclusion, lung ultrasound is an adequate diagnostic modality in a tertiary ICU population to detect consolidations, interstitial syndrome, pneumothorax and pleural effusion. Moreover, one should be careful not to interpret lung ultrasound results in deterministic fashion as multiple respiratory conditions can be present in one patient. Trial registration This study was retrospectively registered at Netherlands Trial Register on March 17, 2021, with registration number NL9344.
Collapse
Affiliation(s)
- Jasper M Smit
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands.
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands.
| | - Mark E Haaksma
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Michiel H Winkler
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Micah L A Heldeweg
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| | - Luca Arts
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Erik J Lust
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - Armand R J Girbes
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Leo M A Heunks
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Research VUmc Intensive Care (REVIVE) and Amsterdam Cardiovascular Sciences (ACS), Amsterdam UMC, Location VU University Medical Center, de Boelelaan 11171007MB, Postbox 7505, Amsterdam, The Netherlands
- Amsterdam Leiden Intensive Care Focused Echography (ALIFE), Amsterdam, The Netherlands
| |
Collapse
|
9
|
Koch C, Koca E, Filmann N, Husmann G, Bojunga J. Time from first tumor manifestation to diagnosis in patients with GEP-NET: Results from a large German tertiary referral center. Medicine (Baltimore) 2021; 100:e27276. [PMID: 34664885 PMCID: PMC8448036 DOI: 10.1097/md.0000000000027276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 09/01/2021] [Indexed: 11/26/2022] Open
Abstract
Patients with neuroendocrine tumors (NET) often go through a long phase between onset of symptoms and initial diagnosis.Assessment of time to diagnosis and pre-clinical pathway in patients with gastroenteropancreatic NET (GEP-NET) with regard to metastases and symptoms.Retrospective analysis of patients with GEP-NET at a tertiary referral center from 1984 to 2019; inclusion criteria: Patients ≥18 years, diagnosis of GEP-NET; statistical analysis using non-parametrical methods.Four hundred eighty-six patients with 488 tumors were identified; median age at first diagnosis (478/486, 8 unknown) was 59 years; 52.9% male patients. Pancreatic NET: 143/488 tumors; 29.3%; small intestinal NET: 145/488 tumors, 29.7%. 128/303 patients (42.2%) showed NET specific and 122/486 (25%) patients other tumor-specific symptoms. 222/279 patients had distant metastases at initial diagnosis (187/222 liver metastases). 154/488 (31.6%) of GEP-NET were incidental findings. Median time from tumor manifestation (e.g., symptoms related to NET) to initial diagnosis across all entities was 19.5 (95% CI: 12-28) days. No significant difference in patients with or without distant metastases (median 73 vs 105 days, P = .42).A large proportion of GEP-NET are incidental findings and only about half of all patients are symptomatic at the time of diagnosis. We did not find a significant influence of the presence of metastases on time to diagnosis, which shows a large variability with a median of <30 days.
Collapse
Affiliation(s)
- Christine Koch
- Goethe University Frankfurt, University Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Frankfurt, Germany
| | - Esra Koca
- Goethe University Frankfurt, University Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Frankfurt, Germany
| | - Natalie Filmann
- Goethe University Frankfurt, Department of Biostatistics and Mathematical Modeling, Frankfurt, Germany
| | - Gabriele Husmann
- Goethe University Frankfurt, University Hospital, University Cancer Center, Tumor Documentation, Frankfurt, Germany
| | - Jörg Bojunga
- Goethe University Frankfurt, University Hospital, Department of Gastroenterology, Hepatology and Endocrinology, Frankfurt, Germany
| |
Collapse
|
10
|
Fei Y, Wen J, Li X, Wang N, Chen M, Jiang X. Uterine adhesion: Is luteal phase prior to follicular phase in uterine adhesiolysis? Medicine (Baltimore) 2021; 100:e27194. [PMID: 34664846 PMCID: PMC8448072 DOI: 10.1097/md.0000000000027194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
To compare the patients' outcomes of Asherman syndrome who underwent uterine adhesiolysis in luteal phase or follicular phase.A retrospective cohort study.A tertiary hospital in China.Four hundred sixty-four women suffered intrauterine adhesion who underwent monopolar adhesiolysis from March 2014 to March 2017 were analyzed. One hundred seventy-eight patients underwent operations in follicular phase (OFP) and 286 underwent operations in luteal phase (OLP).Hormone therapy was accompanied with an intrauterine device and a second-look hysteroscopy was performed postoperatively.Endometrial thickness in women was analyzed by a transvaginal 3-dimensional ultrasound examination. Re-adhesion was confirmed by a second-look hysteroscopy 3 months after hysteroscopic adhesiolysis. Pregnancy rate was acquired by questionnaires 3 months after a second-look hysteroscopy.OLP has advantages with thicker luteal endometrium (P = .001), higher pregnancy rates (P < .001), and lower re-adhesion rates (P = 0015) compared to these values of OFP.For Asherman syndrome, our study showed that OLP is more feasible than OFP in intrauterine adhesiolysis.
Collapse
|
11
|
Gendler Y, Seguier-Lipszyc E, Silbermintz A, Hain M, Stern Y, Kravarusic D, Politi K, Amir G, Katz J, Zeitlin Y, Grozovski S, Nitzan Y, Eshel Y, Shimoni A, Fischer Y, Serfaty D, Shnayderman T, Assi K, Barbash L, Stafler P. Aerodigestive Clinics as Emerging Pediatric Care Model: The First 100 Patients in Israel. Isr Med Assoc J 2021; 23:569-575. [PMID: 34472232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Aerodigestive clinics are run by interdisciplinary medical and surgical teams, and provide complex care coordination and combined endoscopies. OBJECTIVES To describe the design and patient population of the first pediatric aerodigestive center in Israel. METHODS A retrospective single-center cohort study was conducted describing patients followed in the aerodigestive clinic of Schneider Children's Medical Center of Israel, a tertiary pediatric hospital, between its inception in January 2017 and June 2020. RESULTS During the study period, 100 patients were seen at the combined respiratory and digestive (NoAM) clinic, with a total of 271 visits. Median age at first assessment was 29.5 months (range 3-216). Fifty-six patients (56%) had esophageal atresia and tracheoesophageal fistula. Thirty-nine patients had an identified genetic disorder, 28 had a primary airway abnormality, 28 were oxygen dependent, and 21 were born premature. Fifty-two patients underwent triple endoscopy, consisting of flexible bronchoscopy, rigid bronchoscopy, and gastroscopy. In 33 patients, esophageal dilatation was necessary. Six patients underwent posterior tracheopexy at a median of 6 months of age (range 5 days to 8 years) all with ensuing symptom improvement. The total mean parental satisfaction score on a Likert-type scale of 1-5 (5 = highest satisfaction) was 4.5. CONCLUSIONS A coordinated approach is required to provide effective care to the growing population of children with aerodigestive disorders. The cross fertilization between multiple disciplines offers a unique opportunity to develop high quality and innovative care. Outcome measures must be defined to objectively measure clinical benefit.
Collapse
Affiliation(s)
- Yulia Gendler
- Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Emmanuelle Seguier-Lipszyc
- Department of Pediatric Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Silbermintz
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Moshe Hain
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yoram Stern
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dragan Kravarusic
- Department of Pediatric Surgery, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gabriel Amir
- Pediatric Cardiac Surgery Unit, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jacob Katz
- Department of Anesthesia, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yelena Zeitlin
- Department of Anesthesia, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sylvia Grozovski
- Department of Radiology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yifat Nitzan
- Department of Pediatric Otolaryngology, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yuliana Eshel
- Department of Occupational Therapy, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Adi Shimoni
- Department of Occupational Therapy, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Yifat Fischer
- Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
- Nutrition and Dietary Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Dana Serfaty
- Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
- Nutrition and Dietary Unit, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Tami Shnayderman
- Department of Physical Therapy, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Kian Assi
- Department of Social Services, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Lior Barbash
- Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
| | - Patrick Stafler
- Pulmonary Institute, Schneider Children's Medical Center, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
Qin S, Ding Y. Who is willing to participate in and provide Family Doctor Contract Service?: A cross-sectional study based on the medical staff's perspective in China. Medicine (Baltimore) 2021; 100:e26887. [PMID: 34397909 PMCID: PMC8360403 DOI: 10.1097/md.0000000000026887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 07/20/2021] [Indexed: 12/03/2022] Open
Abstract
China encourages medical staff from non-primary hospitals (higher-level hospitals) to participate in and provide Family Doctor Contract Service (FDCS) due to a lack of primary medical resources in community health service centers. This study aims to explore the factors affecting the willingness of family doctor contracting from the tertiary hospital medical staff's perspective. An anonymous self-administered survey was conducted among the medical staff from tertiary hospitals in Hangzhou, Zhejiang Province. Information of the socio-demographic characteristics, the willingness of participating in FDCS and its related reasons, and factors that might affect willingness were investigated. A multivariate logistic regression was used to identify the statistically significant variables associated with willingness. A total of 346 medical staff were recruited in the survey, and 37.86% of them were willing to participate in and provide FDCS. Medical staff with the following characteristics had stronger will: (1).. with higher education level; (2).. having better knowledge with family doctor; (3).. being more attracted by the national policy of FDCS; (4).. thinking it help for income increase. The majority of willing doctors (25.95%) believed that participating in FDCS could help them achieve their personal value, and the reason chosen most for unwilling reason was “low income and unrealized personal value (32.21%).” It is necessary for the government to establish the essential matching mechanisms to guarantee the development of the family doctor, including increasing the final financial support for primary health facilities, and developing the national incentive mechanism for family doctors.
Collapse
Affiliation(s)
- Shangren Qin
- School of Public Health, Hangzhou Normal University
| | - Ye Ding
- School of Public Health, Hangzhou Medical College, Hangzhou, Zhejiang, China
| |
Collapse
|
13
|
Melazzini F, Colaneri M, Fumoso F, Freddi G, Lenti MV, Pieri TC, Piloni D, Noris P, Pieresca C, Preti PS, Russo M, Corsico A, Tavazzi G, Baldanti F, Triarico A, Mojoli F, Bruno R, Di Sabatino A. Venous thromboembolism and COVID-19: a single center experience from an academic tertiary referral hospital of Northern Italy. Intern Emerg Med 2021; 16:1141-1152. [PMID: 33161478 PMCID: PMC7648897 DOI: 10.1007/s11739-020-02550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/22/2020] [Indexed: 01/08/2023]
Abstract
Preliminary evidence supports the notion that COVID-19 patients may have an increased susceptibility to develop venous thromboembolism (VTE). However, the magnitude of this association still needs to be defined. Furthermore, clinical predictors of thrombogenesis, and the relationship with the inflammatory status are currently unknown. On this basis, we conducted a retrospective, observational study on 259 consecutive COVID-19 patients admitted to an academic tertiary referral hospital in Northern Italy between March 19th and April 6th, 2020. Records of COVID-19 patients with a definite VTE event were reviewed for demographic information, co-morbidities, risk factors for VTE, laboratory tests, and anticoagulation treatment. Twenty-five cases among 259 COVID-19 patients developed VTE (9.6%), all of them having a Padua score > 4, although being under standard anticoagulation prophylaxis since hospital admission. In the VTE subcohort, we found a significant positive correlation between platelet count (PLT) and either C reactive protein (CRP) (p < 0.0001) or lactate dehydrogenase (LDH) (p = 0.0013), while a significant inverse correlation was observed between PLT and mean platelet volume (p < 0.0001). Platelet-to-lymphocyte ratio significantly correlated with CRP (p < 0.0001). The majority of VTE patients was male and younger compared to non-VTE patients (p = 0.002 and p = 0.005, respectively). No significant difference was found in D-dimer levels between VTE and non VTE patients, while significantly higher levels of LDH (p = 0.04) and IL-6 (p = 0.04) were observed in VTE patients in comparison to non-VTE patients. In conclusion, our findings showed a quite high prevalence of VTE in COVID-19 patients. Raised inflammatory indexes and increased serum levels of pro-inflammatory cytokines should raise the clinical suspicion of VTE.
Collapse
Affiliation(s)
- Federica Melazzini
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marta Colaneri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Federica Fumoso
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Giulia Freddi
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Teresa Chiara Pieri
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Patrizia Noris
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Carla Pieresca
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Paola Stefania Preti
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Mariaconcetta Russo
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Department of Respiratory Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Guido Tavazzi
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Triarico
- Chief Medical Direction, San Matteo Hospital Foundation, Pavia, Italy
| | - Francesco Mojoli
- Department of Intensive Care, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Raffaele Bruno
- Department of Infectious Disease, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| |
Collapse
|
14
|
Oo HM, Htun YM, Win TT, Han ZM, Zaw T, Tun KM. Information and communication technology literacy, knowledge and readiness for electronic medical record system adoption among health professionals in a tertiary hospital, Myanmar: A cross-sectional study. PLoS One 2021; 16:e0253691. [PMID: 34197506 PMCID: PMC8248629 DOI: 10.1371/journal.pone.0253691] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/11/2021] [Indexed: 11/18/2022] Open
Abstract
Some developing countries are currently introducing and implementing an electronic medical record system (EMRs) for improvement in healthcare delivery services. Availability of information and communication technology (ICT), technical skillful staff, and strong resistance to change by the health professionals impacted the successful adoption of EMRs. This study aimed to assess the ICT literacy, knowledge, and readiness for EMRs adoption among health professionals in a tertiary hospital, Myanmar. A cross-sectional study was conducted among 118 health professionals involving in a tertiary hospital at Nay Pyi Taw, Myanmar from February to April 2020 using a stratified sampling method. The data were collected through face-to-face interviews using a pretested structured questionnaire after getting informed consent. Data were analyzed by using SPSS version 23.0. Chi-square test, Fisher's exact test, and logistic regression analysis were performed to assess the associated factors of ICT literacy, knowledge, and overall readiness for EMRs adoption. The prevalence of high ICT literacy and knowledge on EMRs among health professionals were 20.3% and 24.6% respectively. The factors associated with ICT literacy were professional, education, duration of service, and reported English language skills. Duration of service was associated with knowledge on EMRs. The overall readiness was 54.2% (core readiness 59.3% and engagement readiness 61.9%), and postgraduate [Adjusted Odds Ratio (AOR): 7.32, 95% Confidence Interval (CI): 2.26-23.68] and knowledge on EMRs (AOR: 1.27, 95% CI: 1.13-1.43) were the factors associated with overall readiness for EMRs adoption. Expanding infrastructure and provision of ICT development training are crucial for the improvement of ICT literacy. EMRs training program enabling hands-on experience should be implemented for improvement of knowledge on EMRs. In general, the overall readiness for EMRs adoption was found to be moderate. Enhancing the establishment of comprehensive on-the-job training and contextualization of curriculum in EMRs training program are recommended to improve the health professionals' readiness for EMRs adoption.
Collapse
Affiliation(s)
- Hlaing Min Oo
- Outpatient Department, Defence Services Liver Hospital, Yangon, Myanmar
| | - Ye Minn Htun
- Department of Prevention and Research Development of Hepatitis, AIDS and Other Viral Diseases, Health and Disease Control Unit, Nay Pyi Taw, Myanmar
- * E-mail:
| | - Tun Tun Win
- Department of Preventive and Social Medicine, Defence Services Medical Academy, Yangon, Myanmar
| | - Zaw Myo Han
- Outpatient Department, Defence Services Liver Hospital, Yangon, Myanmar
| | - Thein Zaw
- Special Operation Medical Research Department, Defence Services Medical Research Centre, Nay Pyi Taw, Myanmar
| | - Kyaw Myo Tun
- Department of Preventive and Social Medicine, Defence Services Medical Academy, Yangon, Myanmar
| |
Collapse
|
15
|
Oztek Celebi FZ, Senel S. Patients with chronic conditions and their complex care needs in a tertiary care hospital. Arch Pediatr 2021; 28:470-474. [PMID: 34140218 DOI: 10.1016/j.arcped.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 02/04/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Health care for children with complex chronic conditions (CCC) constitutes an evolving and a challenging part of practices in pediatrics. These children need end-of-life services such as palliative care. The aim of this study was to identify the frequency of patients with CCC among all hospitalized children at our general pediatrics services and to describe the demographics, diagnosis, clinical spectrum, long-term care needs, and mortality data of patients with CCC. PATIENTS AND METHODS All hospitalizations in 2018 at the general pediatric services were screened retrospectively. Patients' hospitalization diagnoses, gender, age, comorbid conditions, number of emergency admissions in 2018, intensive care unit needs, mortality rates, and the number of hospitalizations in 2018 were investigated. RESULTS A total of 1591 patients were hospitalized for 2083 times in 2018. Overall, 145 of 1591 patients (9%) had CCC. Patients with CCC were hospitalized for 472 times (23% of all hospitalizations). The number of emergency admissions, the number of hospitalizations in 2018 and the need for intensive care, and the mortality rate during hospitalization for patients with CCC were significantly higher than those for patients without CCC. The median length of hospitalization in patients with CCC was significantly longer. CONCLUSION Patients with CCC were hospitalized frequently and longer, had increased emergency and PICU admissions, and special long-term care needs. Pediatricians who pioneer care for children with CCC need education, training, and coordinated support to ensure qualified long-term care for these patients.
Collapse
Affiliation(s)
- F Z Oztek Celebi
- University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Department of Pediatrics, Babür Caddesi No:41, Altındağ, Ankara, Turkey.
| | - S Senel
- University of Health Sciences, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, Department of Pediatrics, Babür Caddesi No:41, Altındağ, Ankara, Turkey
| |
Collapse
|
16
|
Bogler O, Liu J, Cadesky B, Bell CM. Quality of care and outcomes in internal medicine patients bedspaced to noninternal medicine units. Medicine (Baltimore) 2021; 100:e25737. [PMID: 33950957 PMCID: PMC8104304 DOI: 10.1097/md.0000000000025737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/25/2021] [Indexed: 01/04/2023] Open
Abstract
Hospital overcrowding has led to a practice known as bedspacing (in which admitted patients are placed on a different specialty's inpatient ward), yet little is known about the impact of this practice on healthcare quality.We investigated whether hospital outcome measures differ between bedspaced general internal medicine (GIM) patients vs nonbedspaced patients.Our retrospective study included patients admitted to GIM wards at 2 academic hospitals (2012-2014), comparing bedspaced to nonbedspaced patients, and identifying adverse events from the hospital's Electronic Patient Record.We compared these groups with respect to actual length of stay vs the expected length of stay (% ELOS), which is defined as length of stay (LOS) divided by expected length of stay (ELOS), 30-day readmission, adverse events (falls, medication-related incidents, equipment-related incidents, first treatment related incidents, laboratory-related incidents, and operative/invasive events), and in-hospital mortality.There were 22,519 patients analyzed with 15,985 (71%) discharged from a medical ward and 6534 (29%) discharged from a non-medical ward. Bedspaced patients had shorter lengths of stay (4.1 vs 6.2 days, P < .001) and expected lengths of stay (ELOS) (6.1 vs 6.4 days, P < .001). Bedspaced patients had a lower percentage of ELOS (% ELOS) than nonbedspaced patients (70% vs 91%, P < .001), similar readmission rates (9.8 vs 10.3 events per 100 patients, P = .24), lower in-hospital mortality rates (2.6 vs 3.3 events per 100 patients, P = .003) and fewer adverse events (0.20 vs 0.60 events per 100 patient days, P < .01).Bedspacing of patients is common. Patients who are bedspaced to off-service wards have better outcomes. This may relate to preferential allocation practices.
Collapse
Affiliation(s)
- Orly Bogler
- Department of Medicine, University of Toronto
| | - Jessica Liu
- Department of Medicine, University of Toronto
- Toronto General Hospital, Division of Internal Medicine, Sinai Health Systems and University Health Network, Toronto
| | - Ben Cadesky
- Department of Medicine, Lakeridge Health, Oshawa
- Department of Medicine, Queen's University, Kingston, Ontario
| | - Chaim M. Bell
- Toronto General Hospital, Division of Internal Medicine, Sinai Health Systems and University Health Network, Toronto
- Institute for Clinical Evaluative Sciences
- Institute for Health Policy, Management, and Evaluation, University of Toronto
- Department of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada
| |
Collapse
|
17
|
Turner NA, Wrenn R, Sarubbi C, Kleris R, Lugar PL, Radojicic C, Moehring RW, Anderson DJ. Evaluation of a Pharmacist-Led Penicillin Allergy Assessment Program and Allergy Delabeling in a Tertiary Care Hospital. JAMA Netw Open 2021; 4:e219820. [PMID: 33983399 PMCID: PMC8120333 DOI: 10.1001/jamanetworkopen.2021.9820] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Penicillin allergies are frequently mislabeled, which may contribute to use of less-preferred alternative antibiotics. OBJECTIVE To evaluate a pharmacist-led allergy assessment program's association with antimicrobial use and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS A pharmacist-led allergy assessment program was launched in 2 phases (June 1, 2015, and November 2, 2016) at a single-center tertiary referral hospital. The longitudinal cross-sectional study included all study period adult admissions; hospitalwide outcomes were assessed by segmented regression. Individual outcomes were assessed within an embedded propensity score-matched case-control study of inpatients undergoing comprehensive allergy assessment following self-report of penicillin allergy. Analysis occurred from March 1, 2020, to February 29, 2020. EXPOSURES The longitudinal study analyzed hospital-level outcomes over 3 periods: preintervention (15 months), phase 1 (structured allergy history alone, 16 months), and phase 2 (comprehensive assessment including penicillin skin testing, 52 months). The case-control study defined cases as individuals undergoing comprehensive allergy assessment. MAIN OUTCOMES AND MEASURES Hospital-level outcomes included antibiotic days of therapy per 1000 patient-days and hospital-acquired Clostridioides difficile infection (CDI) incidence per 10 000 patient-days. Individual outcomes included antibiotic selection, overall survival, and CDI-free survival. RESULTS Longitudinal analysis spanned 2014-2020 (median admissions, 46 416 per year; interquartile range [IQR], 46 001-50 091 per year). Hospitalwide, allergy histories were temporally associated with decreased use of nonpenicillin alternative antibiotics (rate ratio, 0.87; 95% CI, 0.79-0.97) and high-CDI-risk antibiotics (rate ratio, 0.91; 95% CI, 0.85-0.98). Penicillin skin testing was temporally associated with lower hospital-acquired CDI rates (rate ratio, 0.61; 95% CI, 0.43-0.86). The embedded case-control study included 272 cases and 819 controls. Median age was 63 years (interquartile range, 51-73 years), 553 (50.7%) patients were women, and 229 (21.0%) patients were Black. Allergy-assessed patients were less likely to receive high-CDI-risk antibiotics at discharge (odds ratio, 0.66; 95% CI, 0.44-0.98). Estimated reductions in mortality (hazard ratio, 0.77; 95% CI, 0.55-1.07) and hospital-acquired CDI risk (hazard ratio, 0.53; 95% CI, 0.18-1.55) were not statistically significant. CONCLUSIONS AND RELEVANCE Pharmacist-led allergy assessments may be associated with reduced high-CDI-risk antibiotic use at both hospitalwide and individual levels. Although individual reductions in mortality and CDI risk did not achieve significance, divergence of survival curves suggest longer-term benefits of allergy delabeling warrant future study.
Collapse
Affiliation(s)
- Nicholas A. Turner
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Rebekah Wrenn
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | | | - Renee Kleris
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina
| | - Patricia L. Lugar
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina
| | - Christine Radojicic
- Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina
| | - Rebekah W. Moehring
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Deverick J. Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| |
Collapse
|
18
|
Khan SA, Khalid S, Khan AA, Javed Z, Hussain J, Khan Afridi EA, Haroon MZ, Aurangzeb A. Level Of Pre-Tertiary Care Hospital Management Of Traumatic Spinal Cord Injured Patients; Where Do We Stand? J Ayub Med Coll Abbottabad 2021; 33:305-310. [PMID: 34137550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Traumatic spinal cord injury is a debilitating condition that may cause long term disabilities with tremendous socioeconomic impact on affected individuals and their families. Secondary injuries can best prevent or minimized by appropriate pre hospital management and proper referral and transfer. This study was conducted to assess the clinical profile of traumatic spinal cord injuries and level of pre-hospital care provided to patients either at the site of injury or at other healthcare facilities. METHODS This prospective study was conducted in the Department of Neurosurgery Ayub Teaching Hospital Abbottabad, from January 2012 to January 2017. All patients with suspected spinal injury were included in the study. Age, gender, mode of injuries and the pre-tertiary care provided were recorded. RESULTS Out of 4464 patients with suspected spinal cord injury, 3685 (82.5%) were male, 779 (17.4%) were female. Age ranged from 10-70 years. 1685 (37.8%) were diagnosed as having spinal injury. Cervical spine was the most common affected level 743 (44.09%), followed by thoracic spine 135 (8.01%). 1441 (85.5%) were incomplete while 224(14.5%) were complete spinal cord injuries. Road traffic accident was the most common mechanism of injury 884 (52.4%). Only 4 (0.23%) patients directly received in our unit were properly transported, 66 (3.91%) were brought after proper spinal immobilization, intravenous line was maintained in 584 (34.66%) patients, 410 (24.3%) patients received some fluid resuscitation, parenteral analgesia was given to 441 (26.17%) patients while urinary catheterization was done in 195 (11.75%) patients. Those received from other healthcare facilities only 4 (0.23%) were brought by properly equipped ambulance, intravenous access was maintained in 438 (25.99%),320 (18.99%) received some fluid resuscitation, urinary catheterization was done in 229(13.59%) while proper parenteral analgesia was given to 988 (58.63%) patients. CONCLUSIONS There is a complete lack of proper transport and referral of trauma patients in our area which reflects almost non-existent emergency medical (rescue) services, deficient health care facilities.
Collapse
Affiliation(s)
- Shahbaz Ali Khan
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Shah Khalid
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Abdul Aziz Khan
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Zanib Javed
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| | - Jawwad Hussain
- Department of Neurology, Ayub Medical College Abbottabad, Pakistan
| | | | | | - Ahsan Aurangzeb
- Department of Neurosurgery, Ayub Medical College Abbottabad, Pakistan
| |
Collapse
|
19
|
Fujihara N, Fujihara Y, Hamada S, Yoshida M, Tsukushi S. Current practice patterns of osteoporosis treatment in cancer patients and effects of therapeutic interventions in a tertiary center. PLoS One 2021; 16:e0248188. [PMID: 33705450 PMCID: PMC7951835 DOI: 10.1371/journal.pone.0248188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/22/2021] [Indexed: 11/22/2022] Open
Abstract
Cancer and osteoporosis have high incidence rates in older populations. However, the treatment of osteoporosis among cancer patients has not been adequately described. Our purpose was to clarify the current practice patterns of osteoporosis treatment among cancer patients in an academic cancer center, and to analyze the efficacy of treatment interventions. Patient records from April 2009 to March 2018 were retrospectively reviewed, and the study included a total of 316 cancer patients with osteoporosis. After patients’ data extraction, the patients were divided into two groups, with (n = 144) or without treatment (n = 172), and compared the outcomes of these groups to evaluate the medication effect. The primary outcome was new radiographic fragility fractures during the study period. The related factors associated with fracture injuries and the rate of adverse events, such as osteonecrosis in the jaw and atypical femoral fractures, were analyzed. The rate of treatment intervention was 45.6% among the patient groups. Among patients in the study group, breast cancer patients (n = 107) were mostly treated (n = 79, 73.8%) with oral bisphosphonate. A significant difference in new fracture rate was observed between the two groups (treatment group, 30.6%; non-treatment group, 54.7%), and the risk of fracture was 42% lower in the treatment group (hazard ratio, 0.58; 95% confidence interval, 0.39–0.86; p<0.05). Previous chemotherapy, steroid use, and older age were significantly associated with increased rate of new fragility fractures. The adverse event rate was 3.5% (presented in five cases). Older cancer patients who receive chemotherapy or steroids are strongly recommended undergo bone quality assessment and appropriate osteoporosis treatment to improve their prognosis.
Collapse
Affiliation(s)
- Nasa Fujihara
- Section of Orthopedic Surgery, Aichi Cancer Center, Nagoya, Japan
- * E-mail:
| | - Yuki Fujihara
- Section of Orthopedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
| | - Shunsuke Hamada
- Section of Orthopedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Masahiro Yoshida
- Section of Orthopedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Satoshi Tsukushi
- Section of Orthopedic Surgery, Aichi Cancer Center, Nagoya, Japan
| |
Collapse
|
20
|
Dutta U, Sachan A, Premkumar M, Gupta T, Sahoo S, Grover S, Sharma S, Lakshmi PVM, Talati S, Biswal M, Suri V, Singh MP, Ghai B, Chhabra R, Bharti B, Samanta J, Arora P, Mohindra R, Malhotra S, Singh G, Guru RR, Pandey N, Koushal V, Kumar A, Bhogal RS, Aggarwal AK, Goel K, Malhotra P, Yaddanapudi N, Mahajan P, Thakur JS, Sehgal R, Ghosh A, Sehgal IS, Agarwal R, Jayashree M, Bhalla A, Jain S, Kochhar R, Chakrabarti A, Puri GD, Ram J. Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study. BMJ Open 2021; 11:e043837. [PMID: 33619195 PMCID: PMC7902325 DOI: 10.1136/bmjopen-2020-043837] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Healthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty. SETTING Our tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless. PARTICIPANTS We recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone. RESULTS Between 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment. CONCLUSION A multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.
Collapse
Affiliation(s)
- Usha Dutta
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Anurag Sachan
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | - Madhumita Premkumar
- Department of Gastroenterology, PGIMER, Chandigarh, India
- Department of Hepatology, PGIMER, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, PGIMER, Chandigarh, India
| | | | | | - Sugandhi Sharma
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - P V M Lakshmi
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Shweta Talati
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Vikas Suri
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Mini P Singh
- Department of Virology, PGIMER, Chandigarh, India
| | - Babita Ghai
- Department of Anesthesia, PGIMER, Chandigarh, India
| | | | | | | | - Pankaj Arora
- Department of Hospital Administration, PGIMER, Chandigarh, India
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Ritin Mohindra
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | | | - Gurmeet Singh
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | - Navin Pandey
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - Ashok Kumar
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Arun K Aggarwal
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Kapil Goel
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | | | | | - Pranay Mahajan
- Department of Hospital Administration, PGIMER, Chandigarh, India
| | - J S Thakur
- Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
| | - Rakesh Sehgal
- Department of Parasitology, PGIMER, Chandigarh, India
| | - Arnab Ghosh
- Department of Virology, PGIMER, Chandigarh, India
| | | | | | | | - Ashish Bhalla
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Sanjay Jain
- Department of Internal Medicine, PGIMER, Chandigarh, India
| | - Rakesh Kochhar
- Department of Gastroenterology, PGIMER, Chandigarh, India
| | | | | | - Jagat Ram
- Department of Ophthalmology, PGIMER, Chandigarh, India
| |
Collapse
|
21
|
Kumar D, Saghir T, Ali G, Yasin U, Furnaz S, Karim M, Hussain M, Kumari R, Bai R, Kumar H. Psychosocial Impact of COVID-19 on Healthcare Workers at a Tertiary Care Cardiac Center of Karachi Pakistan. J Occup Environ Med 2021; 63:e59-e62. [PMID: 33234873 PMCID: PMC7864597 DOI: 10.1097/jom.0000000000002094] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic. METHODS This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used. RESULTS A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress. CONCLUSION A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.
Collapse
Affiliation(s)
- Dileep Kumar
- National Institute of Cardiovascular Diseases (Dr Kumar, Dr Saghir, Dr Ali, Dr Yasin, Ms Furnaz, Mr Karim, Dr Hussain); Dow Medical College (Dr Bai), Karachi; Medical officer of Government of Sindh (Dr Kumari, Dr Kumar), Pakistan
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Özdirik B, Jann H, Bischoff P, Fehrenbach U, Tacke F, Roderburg C, Wiedenmann B. PD-L1 - inhibitors in neuroendocrine neoplasia: Results from a real-life study. Medicine (Baltimore) 2021; 100:e23835. [PMID: 33429744 PMCID: PMC7793325 DOI: 10.1097/md.0000000000023835] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023] Open
Abstract
Immune check-point inhibitors (ICIs) have changed our view on how to treat cancer. Despite their approval in treatment of many different cancers, efficacy of immune check-point inhibitors (ICI) in neuroendocrine neoplasia is limited and poorly understood. Established treatment options of neuroendocrine tumors (NET) and neuroendocrine carcinomas (NECs) are based on surgery, tumor-targeted medical treatments, Peptide Receptor Radionuclide Therapy (PRRT), and locoregional therapies. However, in many patients these treatments lose efficacy over time, and novel therapies are urgently needed. We report on 8 patients diagnosed with neuroendocrine neoplasms (NEN) that were treated with ICI (pembrolizumab, avelumab, nivolumab plus ipilimumab) as salvage therapy. In this cohort, we observed tumor response with partial remission in 3 patients and stable disease in 1 patient. Four patients showed progressive disease. Of note, responses were observed both in PD-L1 positive and PD-L1 negative patients. Here, we discuss clinical courses of these patients in the context of available literature to highlight limitations and drawbacks currently preventing the use of ICI in routine management of patients with NEN.
Collapse
Affiliation(s)
- Burcin Özdirik
- Charité – University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Henning Jann
- Charité – University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Philip Bischoff
- Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Pathology
| | - Uli Fehrenbach
- Charité – University Medicine Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Radiology, Berlin, Germany
| | - Frank Tacke
- Charité – University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Christoph Roderburg
- Charité – University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| | - Bertram Wiedenmann
- Charité – University Medicine Berlin, Department of Hepatology & Gastroenterology, Campus Virchow Klinikum and Charité Campus Mitte
| |
Collapse
|
23
|
Ong CSH, Lu J, Tan YQ, Tan LGL, Tiong HY. Implementation of a Ureteric Colic Telemedicine Service: A Mixed Methods Quality Improvement Study. Urology 2021; 147:14-20. [PMID: 33091386 PMCID: PMC7573635 DOI: 10.1016/j.urology.2020.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of a telemedicine service for ureteric colic patients in reducing the number of unnecessary face-to-face consultations and shortening waiting time for appointments. METHODS A telemedicine workflow was implemented as a quality improvement study using the Plan-Do-Study-Act method. All patients presenting with ureteric colic without high-risk features of fever, severe pain, and hydronephrosis, were recruited, and face-to-face appointments to review scan results were replaced with phone consultations. Data were prospectively collected over 3 years (January 2017 to December 2019). Patient outcomes including the reduction in face-to-face review visits, time to review, reattendance and intervention rates, were tracked in an interrupted time-series analysis, and qualitative feedback was obtained from patients and clinicians. RESULTS Around 53.2% of patients presenting with ureteric colic were recruited into the telemedicine workflow. A total of 465 patients (46.2%) had normal scan results and 250 patients (24.9%) did not attend their scan appointments, hence reducing the number of face-to-face consultations by 71.1%. A total of 230 patients (22.9%) required subsequent follow-up with urology, while 61 patients (6.1%) were referred to other specialties. Mean (SD) time to review was 30.0 (6.2) days, 6-month intervention rate was 3.4% (n = 34) and unplanned reattendance rate was 3.2% (n = 32). Around 93.1% of patients reported satisfaction with the service. CONCLUSION The ureteric colic telemedicine service successfully and sustainably reduced the number of face-to-face consultations and time to review without compromising on patient safety. The availability of this telemedicine service has become even more important in helping us provide care to patients with ureteric colic in the current COVID-19 pandemic.
Collapse
Affiliation(s)
- Chloe Shu Hui Ong
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Jirong Lu
- Department of Urology, National University Hospital, National University Health System, Singapore.
| | - Yi Quan Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Lincoln Guan Lim Tan
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore
| |
Collapse
|
24
|
Bugaev N, Hojman HM, Breeze JL, Nasraway SA, Arabian SS, Holewinski S, Johnson BP. Acute Care Surgery Service Is Essential During a Nonsurgical Catastrophic Event, the COVID-19 Pandemic. Am Surg 2020; 86:1629-1635. [PMID: 33231486 PMCID: PMC7688435 DOI: 10.1177/0003134820972084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The role of an acute care surgery (ACS) service during the COVID-19 pandemic is not well established. METHODS A retrospective review of the ACS service performance in an urban tertiary academic medical center. The study was performed between January and May 2020. The demographics, clinical characteristics, and outcomes of patients treated by the ACS service 2 months prior to the COVID surge (pre-COVID group) and during the first 2 months of the COVID-19 pandemic (surge group) were compared. RESULTS Trauma and emergency general surgery volumes decreased during the surge by 38% and 57%, respectively; but there was a 64% increase in critically ill patients. The proportion of patients in the Department of Surgery treated by the ACS service increased from 40% pre-COVID to 67% during the surge. The ACS service performed 32% and 57% of all surgical cases in the Department of Surgery during the pre-COVID and surge periods, respectively. The ACS service managed 23% of all critically ill patients in the institution during the surge. Critically ill patients with and without confirmed COVID-19 infection treated by ACS and non-ACS intensive care units during the surge did not differ in demographics, indicators of clinical severity, or hospital mortality:13.4% vs. 13.5% (P = .99) for all critically ill patients; and 13.9% vs. 27.4% (P = .12) for COVID-19 critically ill patients. CONCLUSION Acute care surgery is an "essential" service during the COVID-19 pandemic, capable of managing critically ill nonsurgical patients while maintaining the provision of trauma and emergent surgical services. LEVEL OF EVIDENCE III. STUDY TYPE Therapeutic.
Collapse
Affiliation(s)
- Nikolay Bugaev
- Division of Trauma & Acute Care
Surgery, Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| | - Horacio M. Hojman
- Division of Trauma & Acute Care
Surgery, Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| | - Janis L. Breeze
- Tufts Clinical and Translational Science
Institute, Tufts University, and Institute for Clinical Research and
Health Policy Studies, Tufts Medical
Center, Boston, MA, USA
| | - Stanley A. Nasraway
- Department of Surgery,
Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| | - Sandra S. Arabian
- Division of Trauma & Acute Care
Surgery, Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| | - Sharon Holewinski
- Department of Surgery,
Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| | - Benjamin P. Johnson
- Division of Trauma & Acute Care
Surgery, Tufts
University School of Medicine, Tufts Medical
Center, Boston, MA, USA
| |
Collapse
|
25
|
Kwan SY, Lancaster E, Dixit A, Inglis-Arkell C, Manuel S, Suh I, Shen WT, Seib CD. Reducing Opioid Use in Endocrine Surgery Through Patient Education and Provider Prescribing Patterns. J Surg Res 2020; 256:303-310. [PMID: 32712445 PMCID: PMC7855097 DOI: 10.1016/j.jss.2020.06.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/31/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Postoperative opioid use can lead to dependence, contributing to the opioid epidemic in the United States. New persistent opioid use after minor surgeries occurs in 5.9% of patients. With increased documentation of persistent opioid use postoperatively, surgeons must pursue interventions to reduce opioid use perioperatively. METHODS We performed a prospective cohort study to assess the feasibility of a preoperative intervention via patient education or counseling and changes in provider prescribing patterns to reduce postoperative opioid use. We included adult patients undergoing thyroidectomy and parathyroidectomy from January 22, 2019 to February 28, 2019 at a tertiary referral, academic endocrine surgery practice. Surveys were administered to assess pain and patient satisfaction postoperatively. Prescription, demographic, and comorbidity data were collected from the electronic health record. RESULTS Sixty six patients (74.2% women, mean age 58.6 [SD 14.9] y) underwent thyroidectomy (n = 35), parathyroidectomy (n = 24), and other cervical endocrine operations (n = 7). All patients received a preoperative educational intervention in the form of a paper handout. 90.9% of patients were discharged with prescriptions for nonopioid pain medications, and 7.6% were given an opioid prescription on discharge. Among those who received an opioid prescription, the median quantity of opioids prescribed was 135 (IQR 120-150) oral morphine equivalents. On survey, four patients (6.1%) reported any postoperative opioid use, and 94.6% of patients expressed satisfaction with their preoperative education and postoperative pain management. CONCLUSIONS Clear and standardized education regarding postoperative pain management is feasible and associated with high patient satisfaction. Initiation of such education may support efforts to minimize unnecessary opioid prescriptions in the population undergoing endocrine surgery.
Collapse
Affiliation(s)
- Stephanie Y. Kwan
- University of California- San Francisco, School of Medicine, 513 Parnassus Ave, San Francisco, CA, USA 94143
| | - Elizabeth Lancaster
- University of California- San Francisco, Department of Surgery, 513 Parnassus Ave, Room S-321, San Francisco, CA, USA 94143
| | - Anjali Dixit
- University of California- San Francisco, Department of Anesthesia and Perioperative Care, 513 Parnassus Ave, San Francisco, CA, USA 94143
| | - Christina Inglis-Arkell
- University of California- San Francisco, Department of Anesthesia and Perioperative Care, 513 Parnassus Ave, San Francisco, CA, USA 94143
| | - Solmaz Manuel
- University of California- San Francisco, Department of Anesthesia and Perioperative Care, 513 Parnassus Ave, San Francisco, CA, USA 94143
| | - Insoo Suh
- University of California- San Francisco, Department of Surgery, Section of Endocrine Surgery, 1600 Divisadero St, 4 Floor, San Francisco, CA, USA 94115
| | - Wen T. Shen
- University of California- San Francisco, Department of Surgery, Section of Endocrine Surgery, 1600 Divisadero St, 4 Floor, San Francisco, CA, USA 94115
| | - Carolyn D. Seib
- Stanford University, Department of Surgery, 300 Pasteur Drive, H3680, Stanford, CA 94305
| |
Collapse
|
26
|
Hoesseini A, Offerman MPJ, van de Wall-Neecke BJ, Sewnaik A, Wieringa MH, Baatenburg de Jong RJ. Physicians' clinical prediction of survival in head and neck cancer patients in the palliative phase. BMC Palliat Care 2020; 19:176. [PMID: 33234115 PMCID: PMC7687732 DOI: 10.1186/s12904-020-00682-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 11/09/2020] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The prognosis of patients with incurable head and neck cancer (HNC) is a relevant topic. The mean survival of these patients is 5 months but may vary from weeks to more than 3 years. Discussing the prognosis early in the disease trajectory enables patients to make well-considered end-of-life choices, and contributes to a better quality of life and death. However, physicians often are reluctant to discuss prognosis, partly because of the concern to be inaccurate. This study investigated the accuracy of physicians' clinical prediction of survival of palliative HNC patients. METHODS This study was part of a prospective cohort study in a tertiary cancer center. Patients with incurable HNC diagnosed between 2008 and 2011 (n = 191), and their treating physician were included. Analyses were conducted between July 2018 and February 2019. Patients' survival was clinically predicted by their physician ≤3 weeks after disclosure of the palliative diagnosis. The clinical prediction of survival in weeks (CPS) was based on physicians' clinical assessment of the patient during the outpatient visits. More than 25% difference between the actual survival (AS) and the CPS was regarded as a prediction error. In addition, when the difference between the AS and CPS was 2 weeks or less, this was always considered as correct. RESULTS In 59% (n = 112) of cases survival was overestimated. These patients lived shorter than predicted by their physician (median AS 6 weeks, median CPS 20 weeks). In 18% (n = 35) of the cases survival was correctly predicted. The remaining 23% was underestimated (median AS 35 weeks, median CPS 20 weeks). Besides the differences in AS and CPS, no other significant differences were found between the three groups. There was worse accuracy when predicting survival closer to death: out of the 66 patients who survived 6 weeks or shorter, survival was correctly predicted in only eight (12%). CONCLUSION Physicians tend to overestimate the survival of palliative HNC patients. This optimism can result in suboptimal use of palliative and end-of-life care. The future development of a prognostic model that provides more accurate estimates, could help physicians with personalized prognostic counseling.
Collapse
Affiliation(s)
- Arta Hoesseini
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Marinella P J Offerman
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Bojou J van de Wall-Neecke
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Aniel Sewnaik
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Marjan H Wieringa
- Department of Education and Research, Elisabeth TweeSteden Hospital, Tilburg, The Netherlands
| | - Robert J Baatenburg de Jong
- Department of Otorhinolaryngology and Head and Neck Surgery, Erasmus MC Cancer Institute, Erasmus University Medical Center, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| |
Collapse
|
27
|
Govender I, Masilo KM, Maphasha OM, Matjila S. A description of events surrounding the index COVID-19 diagnosis in a staff member at Kalafong Provincial Tertiary Hospital in Gauteng, South Africa. S Afr Fam Pract (2004) 2020; 62:e1-e6. [PMID: 33314945 PMCID: PMC8377803 DOI: 10.4102/safp.v62i1.5196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 11/01/2022] Open
Affiliation(s)
- Indiran Govender
- Department of Family Medicine, University of Pretoria and Kalafong Provincial Tertiary Hospital, Pretoria.
| | | | | | | |
Collapse
|
28
|
Fernandes S, Petiz C, Abecasis M, Duarte L, Da Costa FM, Paulino A, Ormonde L. [Preparing For the COVID-19 Pandemic: The Perspective of a Department of Anesthesiology in a Tertiary Hospital in Portugal]. ACTA MEDICA PORT 2020; 33:768-774. [PMID: 32692649 DOI: 10.20344/amp.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/19/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022]
Abstract
Since the detection of the first cases of COVID-19, reported by the People's Republic of China on the 31st December 2019, up to the confirmation of the first cases in Portugal, on the 2nd March, countries like Italy and Spain faced the collapse of their healthcare systems. Anticipating this possibility, the Portuguese National Health Service carried out measures to prepare for this reality. This paper describes the changes implemented in the Anesthesiology department of a tertiary hospital center in Portugal, aiming to ensure the safety of both patients and healthcare professionals. The measures implemented had to do mostly with scientific preparation and team reorganization; management of personal protective equipment; redesigning the department's clinical common areas, separation of patient circuits with creation of a designated COVID Operating Room, Post-Anesthetic Care Unit; rescheduling of elective surgery and testing all patients before anesthesia procedures and consulting other hospital departments. The reported data covers the period between the 2nd March and the 30th April of 2020. In this period, 64 cases with COVID-19 or with high clinical suspicion were approached. To date, there have been no cases of in-hospital spread to other patients or to professionals in this department. With this paper we intend to start a reflection that will end up with the optimization of strategies that allows health systems to deal better with COVID-19, keeping patients and health providers safe.
Collapse
Affiliation(s)
- Sofia Fernandes
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Catarina Petiz
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Manuel Abecasis
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Luís Duarte
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | | | - Ana Paulino
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Lucindo Ormonde
- Serviço de Anestesiologia. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| |
Collapse
|
29
|
Ferretti S, Gatto A, Pansini V, Curatola A, Capossela L, Currò V, Chiaretti A. Telephone consultation during Coronavirus outbreak in a Pediatric Emergency Department: methodological approach of a tertiary care center in a COVID-19 hospital setting. Eur Rev Med Pharmacol Sci 2020; 24:11440-11444. [PMID: 33215467 DOI: 10.26355/eurrev_202011_23638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVE A computerized system of telephone consultation has been experimented at the Pediatric Emergency Department (ED) of Policlinico Gemelli Hospital in Rome during the outbreak of Coronavirus Disease 2019 (COVID-19). MATERIALS AND METHODS Twenty monothematic items with a series of questions to evaluate child's clinical conditions have been set up in order to evaluate the different situations according to their severity. All items were highlighted according to conventional scores corresponding to the different answers (yes/no) given by the child's parents. This system has been implemented with large diffusion of computer programs and applications by the availability of a computer station in every ED room. RESULTS The system allows healthcare workers to establish the medical check-up urgency which may be immediate, within the next 24 hours or scheduled in the pediatric ward. Therefore, it has been implemented a telephone triage consultation with a standardized method. CONCLUSIONS Telephone consultation during outbreaks, considering the risks of contagion, allows healthcare workers to decrease the concern of families and to reduce indiscriminate access to ED. The remote approach will not solve logistic and setting problems related to COVID-19 outbreak17, but it would be a valid tool to improve medical evaluation without deep change in infrastructure and clinical organization.
Collapse
Affiliation(s)
- S Ferretti
- Department of Woman and Child Health and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
30
|
Sim WY, Chen RC, Aw LP, Abu Bakar R, Tan CC, Heng AL, Ooi CC. How to safely and sustainably reorganise a large general radiography service facing the COVID-19 pandemic. Radiography (Lond) 2020; 26:e303-e311. [PMID: 32419769 PMCID: PMC7225715 DOI: 10.1016/j.radi.2020.05.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/30/2020] [Accepted: 05/07/2020] [Indexed: 12/14/2022]
Abstract
Objectives This paper aims to share our experience in reorganising our general radiography service during the coronavirus disease (COVID-19) pandemic from the viewpoint of a large tertiary referral medical centre. Key findings Re-organization of the radiography workforce, patient segregation, and modification of routine radiographic practices are key measures to help radiographic services deal with the COVID-19 pandemic. Specific emphasis on deploying more mobile radiographic units, segregating equipment, developing consistent image acquisition workflows, and strict adherence to infection control protocols are paramount to minimize the possibility of in-hospital transmission and ensure a safe environment for both patients and staff. Streamlining communication channels between leadership and ground staff allows quick dissemination of information to ultimately facilitate safe provision of services. Conclusion COVID-19 has drastically altered the way general radiography teams provide services. The institution of several key measures will allow hospitals to safely and sustainably provide radiographic services. To date, there have been zero incidences of radiographer healthcare worker transmission within our institution during the course of work. Implication for practice Radiographers are facing the challenge of providing high-quality services while simultaneously minimizing pathogen exposure to staff and patients. Our experience may lend support to other radiographic services responding to the COVID-19 outbreak and serve as a blueprint for future infectious disease outbreak contingency plans.
Collapse
Affiliation(s)
- W Y Sim
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore.
| | - R C Chen
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| | - L P Aw
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| | - R Abu Bakar
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| | - C C Tan
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| | - A L Heng
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| | - C C Ooi
- Division of Radiological Sciences, Singapore General Hospital, Outram Road, 169608, Singapore
| |
Collapse
|
31
|
Ghio S, Baldi E, Vicentini A, Lenti MV, Di Sabatino A, Di Matteo A, Zuccaro V, Piloni D, Corsico A, Gnecchi M, Speciale F, Sabena A, Oltrona Visconti L, Perlini S. Cardiac involvement at presentation in patients hospitalized with COVID-19 and their outcome in a tertiary referral hospital in Northern Italy. Intern Emerg Med 2020; 15:1457-1465. [PMID: 32960429 PMCID: PMC7505942 DOI: 10.1007/s11739-020-02493-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 09/04/2020] [Indexed: 12/15/2022]
Abstract
The correlation between myocardial injury and clinical outcome in COVID-19 patients is gaining attention in the literature. The aim of the present study was to evaluate the role of cardiac involvement and of respiratory failure in a cohort of COVID-19 patients hospitalized in an academic hospital in Lombardy, one of the most affected Italian (and worldwide) regions by the epidemic. The study included 405 consecutive patients with confirmed COVID-19 admitted to a medical ward from February 25th to March 31st, 2020. Follow-up of surviving patients ended either at hospital discharge or by July 30th, 2020. Myocardial injury was defined on the basis of the presence of blood levels of hs-TnI above the 99th percentile upper reference limit. Respiratory function was assessed as PaO2/FiO2 (P/F) ratio. The primary end-point was death for any cause. During hospitalization, 124 patients died. Death rate increased from 7.9% in patients with normal hs-TnI plasma levels and no cardiac comorbidity to 61.5% in patients with elevated hs-TnI and cardiac involvement (p < 0.001). At multivariable analysis, older age, P/F ratio < 200 (both p < 0.001) and hs-TnI plasma levels were independent predictors of death. However, it must be emphasized that the median values of hs-TnI were within normal range in non-survivors. Cardiac involvement at presentation was associated with poor prognosis in COVID-19 patients, but, even in a population of COVID-19 patients who did not require invasive ventilation at hospital admission, mortality was mainly driven by older age and respiratory failure.
Collapse
Affiliation(s)
- Stefano Ghio
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Enrico Baldi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Alessandro Vicentini
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marco Vincenzo Lenti
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- Department of Internal Medicine, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Angela Di Matteo
- Division of Infectious Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Valentina Zuccaro
- Division of Infectious Disease, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Davide Piloni
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Angelo Corsico
- Division of Respiratory Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, University of Pavia, Pavia, Italy
| | - Massimiliano Gnecchi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology, Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Cardiology Unit, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Francesco Speciale
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Anna Sabena
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy
| | - Stefano Perlini
- Emergency Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Pavia, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
32
|
Jia H, Chen R, Wei L, Zhang G, Jiao M, Liu C, Sha Z, Zhou S, Wang Y, Li J, Jia X, Ismael OY, Mao J, Wu Q. What is the impact of restricted access policy on workplace violence in general hospital? A before-after study in a CHINESE tertiary hospital. BMC Health Serv Res 2020; 20:936. [PMID: 33046067 PMCID: PMC7549238 DOI: 10.1186/s12913-020-05757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To evaluate the impact of a restricted access policy on workplace violence in a healthcare setting. METHODS We surveyed healthcare workers before and after the implementation of a restricted-access policy at a tertiary hospital in north-eastern China. Data were collected in April 2017 and January 2019. Fisher's exact test were used to compare the difference in workplace violence prevalence between responses to two surveys. Survey 1 (S1) collected data from 345 healthcare professionals who had worked in the inpatient ward for at least 12 months. Survey 2 (S2) included 338 healthcare workers from the same ward who had been employed for more than two years. The effective response rates for the two studies was 79.31 and 83.25%, respectively. All 18 female security guards were included in the investigation in S2. RESULTS The prevalence of psychological violence was 62.03% in S1 and 34.62% in S2, the difference in prevalence showing statistical significance (P = 0.000), while the prevalence of physical violence was 3.77 and 4.73% respectively, showing no statistical significance (P = 0.573). The change in the rate of injury caused by physical violence was also statistically significant at 76.92 and 31.25% (P = 0.025), respectively. Security guards were at high risk of workplace violence under the policy. Most healthcare professionals thought this policy ameliorated treatment order, the sense of security, anxiety about workplace violence, and so forth, but one-third of the respondents thought that it caused patient dissatisfaction. CONCLUSION While the restricted access policy may be effective for healthcare professionals in avoiding or dealing with violence, such policy could contribute to new problems regarding the safety of security guards and the potential dissatisfaction of patients. The policy should be further developed to alleviate this phenomenon.
Collapse
Affiliation(s)
- Haonan Jia
- Department of Medical Affairs, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
| | - Ruohui Chen
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Department of Human Resources, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Lifeng Wei
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Gangyu Zhang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Mingli Jiao
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China.
- Institute of Quantitative& Technical Economics, Chinese Academy of Social Science, Beijing, China.
| | - Chao Liu
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Zhuowa Sha
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Shuang Zhou
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Yameng Wang
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Jingqun Li
- Department of Cardiology, No.1 People's Hospital of Heihe, Heihe, China
| | - Xiaowen Jia
- Department of General Surgery, No.1 People's Hospital of Heihe, Heihe, China
| | - Omar Yacouba Ismael
- Department of Health Policy and Hospital Management, School of Public Health, Harbin Medical University, No.157 Baojian Road, Nangang District, Harbin, 150086, Heilongjiang, China
- Heilongjiang Infectious Disease Prevention and Control Hospital, Harbin, China
| | - Jingfu Mao
- Department of Human Resource Management, School of Public Health, Harbin Medical University, Harbin, China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, China
| |
Collapse
|
33
|
Asakrh N, Abu Farha R, Abu Hammour K, Al-Hashar A. Evaluation of the completeness of information sources used to prepare the best possible medication histories at a tertiary teaching hospital in Jordan. Int J Clin Pract 2020; 74:e13597. [PMID: 32593206 DOI: 10.1111/ijcp.13597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES In this study we aimed to evaluate the completeness of three different medication information sources that are commonly used to collect and obtain the Best Possible Medication History (BPMH). METHODS This is an observational study which was held at Jordan University Hospital. After identifying eligible patients, the BPMH was obtained from three different sources separately. These sources include medical file, pharmacy database, and patients' interview. Information from all of these sources was compiled to create the BPMH. The BPMH was used as the standard against which every other information source was compared and given a "completeness score" according to a systematic scoring system. RESULTS Among the 196 participating patients who were included in the study, 113 (57.7%) were recruited from internal medicine and 83 (42.3%) from surgical department. Patients' interview showed the highest median completeness score (71.4%) among the three used sources followed by pharmacy database (35.3%), and medical files (28.2%). The median completeness score for the compiled BPMH obtained by the pharmacist was 93.0%. The compiled BPMH completeness score was inversely proportional to the numbers of medications in the compiled BPMH (R = -.392, P value < .001). Moreover, patients with lower income showed better median BPMH completeness score compared with those with higher income (95.2% (IQR = 16.7%) vs 88.9% (IQR = 15.7%), respectively, P value = .042). CONCLUSION The results show that pharmacist's interview with the patients scored the highest percentage of completeness compared with hospital pharmacy database and medical file and is, therefore, considered more comprehensive in obtaining the BPMH.
Collapse
Affiliation(s)
- Nadeen Asakrh
- Faculty of Pharmacy, Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman, Jordan
| | - Rana Abu Farha
- Faculty of Pharmacy, Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Amman, Jordan
| | - Khawla Abu Hammour
- Faculty of Pharmacy, Department Biopharmaceutics and Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Amna Al-Hashar
- Department of Pharmacy, Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| |
Collapse
|
34
|
Yang Y, Guo L, Shen Z. Psychometric properties of the modified breastfeeding self-efficacy scale-short form (BSES-SF) among Chinese mothers of preterm infants. Midwifery 2020; 91:102834. [PMID: 32956984 DOI: 10.1016/j.midw.2020.102834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 05/05/2020] [Accepted: 08/28/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Preterm mother-infant dyads face more challenges than healthy term infants in breastfeeding initiation and continuation due to maternal health status, preterm infant's immaturity or comorbidities, and breastfeeding policy of the neonatal units. Breastfeeding self-efficacy affects breastfeeding outcomes in preterm infants. No specific instrument in Chinese is available to assess maternal breastfeeding self-efficacy of preterm infants. This study aims to assess the psychometric characteristics of the modified Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) among Chinese mothers of preterm infants. DESIGN A cross-sectional study was conducted. SETTING Two tertiary hospitals in China. PARTICIPANTS A total of 153 women who gave birth before 37 weeks of gestation. MEASUREMENTS The instrument was translated and back translated. The internal consistency reliability was investigated using Cronbach's alpha coefficient. The content validity, construct validity, and criterion validity were conducted to evaluate the validity of the scale. Exploratory factor analysis was used to investigate the factor structure. FINDINGS The scale had good reliability with Cronbach´s alpha above the acceptable level of 0.7. The Item-Content Validity Index (I-CVI) ranged from 0.800 to 1.000, and the Scale-Content Validity Index (S-CVI) is 0.950. The principal component analysis revealed the presence of two factors with eigenvalues greater than 1, explaining a total variance of 74.665%. The modified BSES-SF scores were correlated with women's parity, breastfeeding knowledge, previous breastfeeding experience, perceived support from the spouse and health professionals, and amounts of expressed milk. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The Chinese version of modified BSES-SF is a reliable, valid screening instrument to evaluate the maternal breastfeeding self-efficacy of preterm infants. It is recommended to provide interactive, face-to-face breasting education and support to help mothers of preterm infants maintain high level of breastfeeding self-efficacy and further to achieve satisfactory breastfeeding outcomes.
Collapse
Affiliation(s)
- Yuanyuan Yang
- Peking University School of Nursing, 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Litao Guo
- Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
| | - Zhijuan Shen
- Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Hubei, China.
| |
Collapse
|
35
|
Meyer C, Winters J, Brady RG, Riddick JB, Folsom C, Jardine D. Postoperative Analgesia Protocol: A Resident-Led Effort to Standardize Opioid Prescribing Patterns. Laryngoscope 2020; 131:982-988. [PMID: 32894598 DOI: 10.1002/lary.29087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/07/2020] [Accepted: 08/18/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The combined impact of variable surgeon prescribing preferences and low resident prescribing comfort level can lead to significant disparity in opioid prescribing patterns for the same surgery in the same academic surgical practice. We report the results of a resident led initiative to standardize postoperative prescription practices within the Department of Otolaryngology at a single tertiary-care academic hospital in order to reduce overall opioid distribution. STUDY DESIGN Retrospective cohort study. METHODS Following approval by the Institutional Review Board, performed a retrospective review of 12 months before (July 2016-June 2017) and after (July 2017-June 2018) implementation of the Postoperative Analgesia Protocol, which included all adults undergoing tonsillectomy, septoplasty, thyroidectomy, parathyroidectomy, tympanoplasty, middle ear exploration, stapedectomy, and ossicular chain reconstruction. RESULTS Seven hundred and thirty eight procedures met inclusion criteria. Following implementation, total morphine milligram equivalents decreased by 26% (P < .0001). The number of patients requiring opioid refills decreased by 49%, and morphine milligram equivalents received as refills decreased by 16% (P < .001). Thyroid and parathyroid surgery had the greatest reduction in morphine milligram equivalents prescribed (84%, P < .001), followed by septoplasty (30%, P = .001) and tonsillectomy (18%, P < .001). The number of patients receiving refills of opioid medications decreased for all procedures (tonsillectomy 54%; septoplasty 67%; thyroid/parathyroid surgery 80%, middle ear surgery 100%). CONCLUSIONS While every patient and surgery must be treated individually, this study demonstrates that a resident led standardization of pain control regimes can result in significant reductions in total quantity of opioids prescribed. LEVEL OF EVIDENCE IV Laryngoscope, 131:982-988, 2021.
Collapse
Affiliation(s)
- Charles Meyer
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Jessica Winters
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Rebecca G Brady
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, U.S.A
| | - Jeanelle B Riddick
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Craig Folsom
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| | - Dinchen Jardine
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia, U.S.A
| |
Collapse
|
36
|
Co COC, Yu JRT, Macrohon-Valdez MC, Laxamana LC, De Guzman VPE, Berroya-Moreno RMM, Mariano MM, Rivera PPDP, Racpan-Cauntay JLM, Ilano KCS, Trias EC, Domingo AMC, Marcelo AVDB, Pineda-Franks MCC. Acute stroke care algorithm in a private tertiary hospital in the Philippines during the COVID-19 pandemic: A third world country experience. J Stroke Cerebrovasc Dis 2020; 29:105059. [PMID: 32807464 PMCID: PMC7305875 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE Since the declaration of the Novel Coronavirus Disease (COVID-19) pandemic, ensuring the safety of our medical team while delivering timely management has been a challenge. Acute stroke patients continue to present to the emergency department and they may not have the usual symptoms of COVID-19 infection. Stroke team response and management must be done within the shortest possible time to minimize worsening of the functional outcome without compromising safety of the medical team. METHODS Infection control recommendations, emergency department protocols and stroke response pathways utilized prior to the COVID 19 pandemic within our institution were evaluated by our stroke team in collaboration with the multidisciplinary healthcare services. Challenges during the COVID-19 scenario were identified, from which a revised acute stroke care algorithm was formulated to adapt to this pandemic. RESULTS We formulated an algorithm that incorporates practices from internationally devised protocols while tailoring certain aspects to suit the available resources in our system locally. We highlighted the significance of the following: team role designation, coordination among different subspecialties and departments, proper use of personal protective equipment and resources, and telemedicine use during this pandemic. CONCLUSIONS This pandemic has shaped the stroke team's approach in the management of acute stroke patients. Our algorithm ensures proper resource management while optimizing acute stroke care during the COVID-19 pandemic in our local setting. This algorithm may be utilized and adapted for local practice and other third world countries who face similar constraints.
Collapse
Affiliation(s)
- Christian Oliver C Co
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Jeryl Ritzi T Yu
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Ma Cristina Macrohon-Valdez
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Lina C Laxamana
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Vincent Paul E De Guzman
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | | | - Manuel M Mariano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Peter Paul Dela Paz Rivera
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Joana Lyn M Racpan-Cauntay
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Karen Czarina S Ilano
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | - Evita C Trias
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines
| | - Alyssa Mae C Domingo
- Institute for Neurosciences, St. Luke's Medical Center- Global City, 5th Ave, Taguig, Manila 1634, Philippines.
| | | | | |
Collapse
|
37
|
Katsaras D, Chalil S, Abozguia K. Coronovirus Disease-2019 (COVID-19) Pandemic and Cardiac Electrophysiology: Guidance Protocol From a UK Tertiary Cardiac Center. Crit Pathw Cardiol 2020; 19:112-114. [PMID: 32349045 PMCID: PMC7188062 DOI: 10.1097/hpc.0000000000000226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/15/2022]
Abstract
Since December 2019, the coronovirus disease-2019 (COVID-19) pandemic has resulted in more than 2,160,000 positive cases and more than 145,000 deaths until April 18, 2020. The pressure to the health services worldwide has been unprecedented. The redeployment of staff and resources to treat more efficiently COVID-19 cases along with the need to reduce disease transmission has affected the field of electrophysiology among many others. Amendments to clinical pathways are obligatory in this perspective to continue to provide the necessary health services to the people who need them, although at the same time, infection control and prevention are not compromised by inadvertent disease transmission or unnecessary use of resources. We aim to provide a guide of the logistic aspects of electrophysiology procedures derived from our tertiary cardiac center during the current COVID-19 pandemic.
Collapse
Affiliation(s)
- Dimitrios Katsaras
- From the Cardiology Department, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Shajil Chalil
- From the Cardiology Department, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| | - Khalid Abozguia
- From the Cardiology Department, Lancashire Cardiac Centre, Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, United Kingdom
| |
Collapse
|
38
|
McAllister M. Weathering Pandemic Turbulence: It's All about Relationships. Nurs Leadersh (Tor Ont) 2020; 33:9-14. [PMID: 33097100 DOI: 10.12927/cjnl.2020.26324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
During my career, I have had many mantras, including "I love to wonder what will happen tomorrow" and "It's all about relationships." Well, I have been rewarded in spades because nothing has been predictable or stable about our professional practice environments since COVID-19 infiltrated our organizations. I have been challenged to develop and implement changes at The Hospital for Sick Children - a 300-bed tertiary pediatric academic health sciences centre in Toronto, ON - that we had never contemplated before. I believe that staying true to my leadership values and core principles has been essential when taking on such challenges and staying afloat during these tumultuous times.
Collapse
Affiliation(s)
- Mary McAllister
- Associate Chief, Nursing Practice, The Hospital for Sick Children, Editor, Practice, Canadian Journal of Nursing Leadership, Toronto, ON
| |
Collapse
|
39
|
Vilallonga R, Garcia Ruiz de Gordejuela A, Cossio-Gil Y, Domínguez González JM, Martín Sánchez R, Armengol Carrasco M. Transforming a surgical department during the outbreak of new coronavirus pandemic. Clinical implications. Langenbecks Arch Surg 2020; 405:867-875. [PMID: 32761374 PMCID: PMC7408973 DOI: 10.1007/s00423-020-01931-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The 2019 novel coronavirus (2019-nCoV) has caused an outbreak of the disease now officially named coronavirus disease 2019 (COVID-19). Since then, all hospitals have required a complete restructuring of their usual facilities and the treatments provided. Our goal was to detail the remodeling of a tertiary hospital during the COVID-19 outbreak and analyze pitfalls to avoid increasing surgical department burdens. METHODS This was a retrospective analysis of data affecting patients during their admission in our institution during March 2020. Data from general admission, intensive care units, and elective and emergency surgeries were collected and analyzed. All patients who underwent a surgical procedure were reviewed to elucidate limitations in the deployment of the hospital transformation to a COVID-19 hospital. RESULTS A total of 688 patients have been treated in our institution. Of those, 186 required intensive care. More than 120 new intensive care beds have been created during this period, and a decrease in elective surgeries of more than 75% was observed. Inadvertent COVID-19 patients accounted for 70%. Thirty percent of the patients who underwent surgery while infected with COVID-19 died in our institution. CONCLUSIONS The complete reorganization of surgical departments will be requested during the outbreak and adaptive solutions are needed in order to avoid increased mortality rates and infection among patients and to promote maximal optimization of surgical spaces. Timing, governmental decisions, and scientific society's recommendations may be limitations in the efficient deployment of hospital transformations to COVID-19 facilities.
Collapse
Affiliation(s)
- Ramon Vilallonga
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Amador Garcia Ruiz de Gordejuela
- Endocrine, Metabolic and Bariatric Unit, Center of Excellence for the EAC-BC, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Yolima Cossio-Gil
- Department of information Systems and decision support, Hospital Universitari Vall d'Hebron, Barcelona, Spain
- Healthcare Systems Research Group, VHIR, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - José Manuel Domínguez González
- Vascular Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Rocio Martín Sánchez
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| | - Manel Armengol Carrasco
- General Surgery Department, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035, Barcelona, Spain
| |
Collapse
|
40
|
Sota J, Rigante D, Emmi G, Lopalco G, Orlando I, Tosi GM, Frediani B, Vitale A, Guerriero S, Iannone F, Vannozzi L, Fabiani C, Cantarini L. Behçet's syndrome in Italy: a detailed retrospective analysis of 396 cases seen in 3 tertiary referral clinics. Intern Emerg Med 2020; 15:1031-1039. [PMID: 32006221 DOI: 10.1007/s11739-019-02248-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 11/25/2019] [Indexed: 12/17/2022]
Abstract
Behçet's syndrome (BS) is a multisystemic disorder displaying a marked variability across different geographic areas. The main aim of this study was to analyze demographic and clinical features of a cohort of BS patients diagnosed in three tertiary referral centers in Italy and detect potential associations between the different manifestations. Medical records of 396 patients (218 females, 178 males) were retrospectively analyzed. Mean age at onset was 30.00 ± 18.75 years with a female-to-male ratio of 1.22:1. Mucocutaneous features were the most frequent starting manifestations of BS, followed by eye inflammation. Erythema nodosum (p = 0.007), arthritis/arthralgias (p = 0.0115), and central nervous system (CNS) signs (p = 0.014) were significantly over-represented in female patients, whereas male gender was associated with lower mean age at onset (p = 0.031), higher frequency of pseudofollicular lesions, and uveitis (p = 0.00134 and p < 0.0001 respectively), particularly for posterior segment involvement and panuveitis (p < 0.0001). Regarding the association between disease features, genital ulcers were negatively associated with uveitis (p < 0.0001) and vascular involvement (p < 0.0001). Other negative associations were detected between uveitis and gastrointestinal involvement (p = 0.008), pseudofolliculitis and CNS signs (p = 0.031), vascular involvement (p = 0.002) and erythema nodosum (p = 0.013). Logistic regression identified male gender and genital ulcers, respectively, with a higher (OR 2.199 [1.397-3.461], p < 0.001) and lower risk (OR 0.157 [0.090-0.273], p < 0.0001) of developing major organ involvement. Our evaluations found that the disease had started mostly in the second and third decade with most severe features in the male gender, and that patients presenting with mucocutaneous manifestations were less prone to develop major organ involvement.
Collapse
Affiliation(s)
- Jurgen Sota
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica Sacro Cuore, Rome, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Ida Orlando
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Gian Marco Tosi
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Bruno Frediani
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Antonio Vitale
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy
| | - Silvana Guerriero
- Department of Ophthalmology and Otolaryngology, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), University of Bari, Bari, Italy
| | - Lorenzo Vannozzi
- Department of Surgery and Translational Medicine, Eye Clinic, University of Florence, Florence, Italy
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Luca Cantarini
- Research Center of Systemic Autoinflammatory Diseases, Behçet's Disease and Rheumatology-Ophthalmology Collaborative Uveitis Center, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Rheumatology Unit, Policlinico "Le Scotte", viale Bracci 16, 53100, Siena, Italy.
| |
Collapse
|
41
|
Wang J, Zong L, Zhang J, Sun H, Harold Walline J, Sun P, Xu S, Li Y, Wang C, Liu J, Li F, Xu J, Li Y, Yu X, Zhu H. Identifying the effects of an upgraded 'fever clinic' on COVID-19 control and the workload of emergency department: retrospective study in a tertiary hospital in China. BMJ Open 2020; 10:e039177. [PMID: 32819955 PMCID: PMC7440187 DOI: 10.1136/bmjopen-2020-039177] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE COVID-19 started spreading widely in China in January 2020. Outpatient fever clinics (FCs), instituted during the SARS epidemic in 2003, were upgraded to serve for COVID-19 screening and prevention of disease transmission in large tertiary hospitals in China. FCs were hoped to relieve some of the healthcare burden from emergency departments (EDs). We aimed to evaluate the effect of upgrading the FC system on rates of nosocomial COVID-19 infection and ED patient attendance at Peking Union Medical College Hospital (PUMCH). DESIGN A retrospective cohort study. PARTICIPANTS A total of 6365 patients were screened in the FC. METHODS The FC of PUMCH was upgraded on 20 January 2020. We performed a retrospective study of patients presenting to the FC between 12 December 2019 and 29 February 2020. The date when COVID-19 was declared an outbreak in Beijing was 20 January 2020. Two groups of data were collected and subsequently compared with each other: the first group of data was collected within 40 days before 20 January 2020; the second group of data was collected within 40 days after 20 January 2020. All necessary data, including patient baseline information, diagnosis, follow-up conditions and the transfer records between the FC and ED, were collected and analysed. RESULTS 6365 patients were screened in the FC, among whom 2912 patients were screened before 21 January 2020, while 3453 were screened afterward. Screening results showed that upper respiratory infection was the major disease associated with fever. After the outbreak of COVID-19, the number of patients who were transferred from the FC to the ED decreased significantly (39.21% vs 15.75%, p<0.001), and patients generally spent more time in the FC (55 vs 203 min, p<0.001), compared with before the outbreak. For critically ill patients waiting for their screening results, the total length of stay in the FC was 22 min before the outbreak, compared with 442 min after the outbreak (p<0.001). The number of in-hospital deaths of critically ill patients in the FC was 9 out of 29 patients before the outbreak and 21 out of 38 after the outbreak (p<0.05). Nineteen cases of COVID-19 were confirmed in the FC during the period of this study. However, no other patients nor any healthcare providers were cross-infected. CONCLUSION The workload of the FC increased significantly after the COVID-19 outbreak. New protocols regarding the use of FC likely helped prevent the spread of COVID-19 within the hospital. The upgraded FC also reduced the burden on the ED.
Collapse
Affiliation(s)
- Jiangshan Wang
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Liang Zong
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jinghong Zhang
- School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Han Sun
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Joseph Harold Walline
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Pengxia Sun
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shengyong Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chunting Wang
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jihai Liu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jun Xu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yi Li
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuezhong Yu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Huadong Zhu
- Department of Emergency Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
42
|
Thomas T, Laher AE, Mahomed A, Stacey S, Motara F, Mer M. Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement. S Afr Med J 2020; 110:964-967. [PMID: 33205721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 06/11/2023] Open
Abstract
SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic.
Collapse
Affiliation(s)
- T Thomas
- Infection Control Services Laboratory, Charlotte Maxeke Johannesburg Academic Hospital, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Disease, University of the Witwatersrand, Johannesburg, South Africa.
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
This study characterizes the prevalence of antibodies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among hospital staff of a Belgian tertiary care center tested over 1 week in April 2020, and risk factors for seropositivity.
Collapse
Affiliation(s)
| | - Els Oris
- Ziekenhuis Oost-Limburg, Genk, Belgium
| | | | | | | | | | - Line Heylen
- Ziekenhuis Oost-Limburg, Genk, Belgium
- Hasselt University, Hasselt, Belgium
| |
Collapse
|
44
|
Charlton OA, Harris V, Phan K, Mewton E, Jackson C, Cooper A. Toxic Epidermal Necrolysis and Steven-Johnson Syndrome: A Comprehensive Review. Adv Wound Care (New Rochelle) 2020; 9:426-439. [PMID: 32520664 PMCID: PMC7307670 DOI: 10.1089/wound.2019.0977] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 09/21/2019] [Indexed: 12/13/2022] Open
Abstract
Significance: Toxic epidermal necrolysis (TEN) and Steven-Johnson syndrome (SJS) are potentially fatal acute mucocutaneous vesiculobullous disorders. Evidence to date suggests that outcomes for patients with both TEN and SJS are largely dependent on stopping the causative agent, followed by supportive care and appropriate wound management in a specialized burns unit. These are life-threatening conditions characterized by widespread full-thickness cutaneous and mucosal necrosis. This article outlines the approach to holistic management of such patients, in a specialized unit, highlighting various practical aspects of wound care to prevent complications such as infection, mucosal and adhesions, and ocular scaring. Recent Advances: There is improved understanding of pain and morbidity with regard to the type and frequency of dressing changes. More modern dressings, such as nanocrystalline, are currently favored as they may be kept in situ for longer periods. The most recent evidence on systemic agents, such as corticosteroids and cyclosporine, and novel treatments, are also discussed. Critical Issues: Following cessation of the culprit trigger, management in a specialized burns unit is the most important management step. It is now understood that a multidisciplinary team is essential in the care of these patients. Following admission of such patients, dermatology, ear, nose, and throat surgery, ophthalmology, urology, colorectal surgery, and gynecology should all be consulted to prevent disease sequelae. Future Directions: Looking forward, research is aimed at achieving prospective data on the efficacy of systemic immunomodulating agents and dressing types. Tertiary centers with burns units should develop policies for such patients to ensure that the relevant teams are consulted promptly to avoid mucocutaneous complications.
Collapse
Affiliation(s)
- Olivia A. Charlton
- Department of Dermatology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Victoria Harris
- Department of Dermatology, Prince of Wales Hospital, Sydney, Australia
| | - Kevin Phan
- Department of Dermatology, Liverpool Hospital, Sydney, Australia
| | - Erin Mewton
- Department of Dermatology, Royal North Shore Hospital, Sydney, Australia
| | - Chris Jackson
- Northern Clinical School, University of Sydney, Sydney, Australia
- Kolling Institute of Medical Research, Sydney, Australia
| | - Alan Cooper
- Department of Dermatology, Royal North Shore Hospital, Sydney, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| |
Collapse
|
45
|
Inzitari M, Udina C, Len O, Ars J, Arnal C, Badani H, Davey V, Risco E, Ayats P, de Andrés AM, Mayordomo C, Ros FJ, Morandi A, Cesari M. How a Barcelona Post-Acute Facility became a Referral Center for Comprehensive Management of Subacute Patients With COVID-19. J Am Med Dir Assoc 2020; 21:954-957. [PMID: 32674827 PMCID: PMC7287444 DOI: 10.1016/j.jamda.2020.06.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
The COVID-19 pandemic's greatest impact is among older adults. Management of the situation requires a systemic response, and post-acute care (PAC) can provide an adequate mix of active treatment, management of associated geriatric syndromes and palliative care, both in the acute phase, and in post-COVID-19 recovery. In the region of Catalonia, Spain, selected PAC centers have become sites to treat older patients with COVID-19. Referrals come from the emergency department or COVID-19 wards of the acute reference hospitals, nursing homes, or private homes. We critically review the actions taken by Parc Sanitari Pere Virgili, a PAC facility in Barcelona, to manage the pandemic, including its administration, health care, communication, psychological support, and ethical frameworks. We believe that the strategies we used and the lessons we learned can be useful for other sites and countries where similar adaptation of existing facilities may be implemented.
Collapse
Affiliation(s)
- Marco Inzitari
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Cristina Udina
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Joan Ars
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Cristina Arnal
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Hugo Badani
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Vanessa Davey
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ester Risco
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Pere Ayats
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Ana M de Andrés
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Cristina Mayordomo
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Francisco J Ros
- Medical Oncology Department, Vall d'Hebron University Hospital and, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Alessandro Morandi
- Research Group on Aging, Frailty and Care Transitions in Barcelona, Parc Sanitari Pere Virgili and Vall d'Hebron Research Institute (VHIR), Barcelona, Spain; Ospedale Le Ancelle, Fondazione Teresa Camplani, Cremona, Italy
| | - Matteo Cesari
- Università Statale and Policlinico Maggiore, Milan, Italy
| |
Collapse
|
46
|
Pignatti M, Pinto V, Miralles MEL, Giorgini FA, Cannamela G, Cipriani R. How the COVID-19 pandemic changed the Plastic Surgery activity in a regional referral center in Northern Italy. J Plast Reconstr Aesthet Surg 2020; 73:1348-1356. [PMID: 32499187 PMCID: PMC7255253 DOI: 10.1016/j.bjps.2020.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/09/2020] [Indexed: 11/17/2022]
Abstract
The Covid 19 epidemic has modified the way that plastic surgeons can treat their patients. At our hospital all elective surgery was canceled and only the more severe cases were admitted. The outpatient department activity has been reduced also. We present the number and diagnoses of patients, treated as in- and out-patients, during seven weeks from the onset of the epidemic, comparing our activity from the lockdown of elective surgery with the numbers and diagnoses observed during the same weeks of last year. Finally we underline the importance of using telemedicine and web-based tools to transmit images of lesions that need the surgeon's evaluation, and can be used by the patient to keep in touch with a doctor during the distressing time of delay of the expected procedure.
Collapse
Affiliation(s)
- Marco Pignatti
- Plastic Surgery, Policlinico di Sant'Orsola - DIMES, University of Bologna, Via Massarenti, 9, 40138 Bologna, Italy.
| | | | - Maria Elisa Lozano Miralles
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy; Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | - Federico A Giorgini
- Plastic Surgery, Policlinico di Sant'Orsola, Bologna, Italy; Plastic Surgery, Policlinico di Modena, University of Modena and Reggio Emilia, Italy
| | | | | |
Collapse
|
47
|
Zhou J, Luo J, Lin J, Zeng Y, Qiu X, Zhu W, Liu G. Perinatal risk factors for congenital hypothyroidism: A retrospective cohort study performed at a tertiary hospital in China. Medicine (Baltimore) 2020; 99:e20838. [PMID: 32590776 PMCID: PMC7328952 DOI: 10.1097/md.0000000000020838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023] Open
Abstract
Congenital hypothyroidism (CH) is one of the most common neonatal endocrine diseases. This retrospective cohort study aimed to identify the potential perinatal risk factors for CH and to differentiate between transient and permanent CH (TCH and PCH, respectively) as well as determine their prevalence in a southeastern Chinese population.This study was based on an 18-year surveillance of a neonatal CH screening program in a large tertiary hospital. A retrospective review of the maternal and neonatal perinatal exposures was conducted.Of the 205,834 newborns screened between 2000 and 2018, 189 were diagnosed with CH (1/1089). Among the 131 CH patients who again underwent thyroid function testing (TFT) after discontinuation of levothyroxine at the age of 3 years, 61 (46.6%) were diagnosed with PCH and 70 (53.4%) were diagnosed with TCH. In the maternal characteristics model, women aged 35 years or older and those who had thyroid disease and/or diabetes mellitus during pregnancy had increased risk of having an offspring with CH (P = .001, .000, and .001, respectively). Significant associations were found with regard to parity and the risk of CH in the offspring (P = .000). In the neonatal characteristics model, infants with female sex, preterm birth, post-term birth, low birth weight, other birth defects, and those born as part of multiple births (P = .011, .034, .001, .000, .000, and .003, respectively) had increased risk of CH. The rate of newborns with other birth defects was higher in the PCH group than that in the TCH group (P = .008), whereas the rate of maternal thyroid disease, newborns with low birth weight, and newborns with preterm birth was higher in the TCH group than that in the PCH group (P = .041, .020, and .013, respectively). The levothyroxine dose (μg/kg/day) at 1 year, 2 years, and 3 years old was significantly lower in the TCH group than that in the PCH group (P = .000, .000, and .000, respectively).Perinatal factors should be considered during the diagnosis and treatment of CH.
Collapse
Affiliation(s)
| | - Jinying Luo
- Department of Gynaecology and Obstetrics, Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical Universitya
| | - Junyu Lin
- The First Affiliated Hospital of Fujian Medical University
| | | | | | | | - Guanghua Liu
- Department of Pediatrics, Fujian Provincial Maternity and Child Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian Province, China
| |
Collapse
|
48
|
Marano L, Marrelli D, Roviello F. Cancer care under the outbreak of COVID-19: A perspective from Italian tertiary referral center for surgical oncology. Eur J Surg Oncol 2020; 46:1184-1185. [PMID: 32312591 PMCID: PMC7158818 DOI: 10.1016/j.ejso.2020.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 03/30/2020] [Accepted: 04/08/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Luigi Marano
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy.
| | - Daniele Marrelli
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| | - Franco Roviello
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, Siena, Italy
| |
Collapse
|
49
|
Chen WT, Sun C, Zhou YB, Liu DH, Peng ZL, Chen J, Xu N, Lei YY, He J, Tang CZ, Lin XF, Xu NG, Xian SX, Lu LM. Evaluation on the effect of acupuncture on patients with sepsis-induced myopathy (ACU-SIM pilot study): A single center, propensity-score stratified, assessor-blinded, prospective pragmatic controlled trial. Medicine (Baltimore) 2020; 99:e20233. [PMID: 32481297 PMCID: PMC7249879 DOI: 10.1097/md.0000000000020233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Sepsis-induced myopathy (SIM) is a disease that causes motor dysfunction in patients with sepsis. There is currently no targeted treatment for this disease. Acupuncture has shown considerable efficacy in the treatment of sepsis and muscle weakness. Therefore, our research aims to explore the effects of acupuncture on the improvement of muscle structure and function in SIM patients and on activities of daily living. METHODS The ACU-SIM pilot study is a single-center, propensity-score stratified, assessor-blinded, prospective pragmatic controlled trial (pCT) with a 1-year follow-up period. This study will be deployed in a multi-professional critical care department at a tertiary teaching hospital in Guangzhou, China. Ninety-eight intensive care unit subjects will be recruited and assigned to either the control group or the acupuncture group. Both groups will receive basic treatment for sepsis, and the acupuncture group will additionally receive acupuncture treatment. The primary outcomes will be the rectus femoris cross-sectional area, the Medical Research Council sum-score and time-to-event (defined as all-cause mortality or unplanned readmission to the intensive care unit due to invasive ventilation). The activities of daily living will be accessed by the motor item of the Functional Independence Measure. Recruitment will last for 2 years, and each patient will have a 1-year follow-up after the intervention. DISCUSSION There is currently no research on the therapeutic effects of acupuncture on SIM. The results of this study may contribute to new knowledge regarding early muscle atrophy and the treatment effect of acupuncture in SIM patients, and the results may also direct new approaches and interventions in these patients. This trial will serve as a pilot study for an upcoming multicenter real-world study. TRIAL REGISTRATION Chinese Clinical Trials Registry: ChiCTR-1900026308, registered on September 29th, 2019.
Collapse
Affiliation(s)
- Wei-Tao Chen
- Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- Ling-Nan Medical Research Center, Guangzhou University of Chinese Medicine
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou
| | - Ce Sun
- Meizhou Hospital of Traditional Chinese Medicine, Meizhou
| | - Ying-Bin Zhou
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou
| | - Dong-Hua Liu
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou
| | - Zhi-Long Peng
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou
| | - Jing Chen
- Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- Ling-Nan Medical Research Center, Guangzhou University of Chinese Medicine
- The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou
| | - Nuo Xu
- The university of Alabama at Birmingham, Birmingham, USA
| | - Yan-Yan Lei
- Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
- School of economics and management, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jun He
- Department of Acupuncture and Rehabilitation, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | | | - Xin-Feng Lin
- Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | | | - Shao-Xiang Xian
- Ling-Nan Medical Research Center, Guangzhou University of Chinese Medicine
- The First Affiliated Hospital of Guangzhou University of Chinese Medicine
| | - Li-Ming Lu
- Medical College of Acupuncture and Rehabilitation
| |
Collapse
|
50
|
Garnier A, Vaucher J, Bianchi C, Kraege V, Méan M, Castioni J, Bart PA, Champier V, Eggimann P, Gachoud D, Jovanovic M, Lamy O, Marques-Vidal P, Monti M, Perier A, Robert S, Roulet G, Sartori C, Waeber G, Vollenweider P. [Organizational Impacts and Clinical Challenges of the COVID-19 Pandemic on a Swiss Tertiary Internal Medicine Department]. Rev Med Suisse 2020; 16:869-874. [PMID: 32348056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The rapid progression of COVID-19 is an organizational challenge for all hospitals. To secure the patient overflow, the Department internal medicine of the University Hospital of Lausanne increased nurse and medical workforces as well as bed capacity by 65 %, with extraordinary help from other departments. The implemented crisis management stood upon three pillars : a crisis management team, steering documents and internal communication. In this new form, the Department had already taken care of 442 COVID-19 admissions by April 16, 2020. Alongside organizational challenges, clinical issues such as rapid respiratory distress, clinical suspicions with negative PCR and treatment uncertainties in the absence of sufficient evidence were overcome. Despite the peak of the pandemic appearing to have passed, the next phase could be just as complicated.
Collapse
Affiliation(s)
- Antoine Garnier
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
- Direction médicale, CHUV, 1011 Lausanne
| | - Julien Vaucher
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | | | | | - Marie Méan
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Julien Castioni
- Service de médecine interne, CHUV, 1011 Lausanne
- Direction des ressources humaines, CHUV, 1011 Lausanne
| | - Pierre-Alexandre Bart
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | | | - Philippe Eggimann
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
- Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - David Gachoud
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | | | - Olivier Lamy
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
- Département de l'appareil locomoteur, CHUV, 1011 Lausanne
| | - Pedro Marques-Vidal
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Matteo Monti
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Anne Perier
- Service de médecine interne, CHUV, 1011 Lausanne
| | | | | | - Claudio Sartori
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| | - Gérard Waeber
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
- Département de médecine, CHUV, 1011 Lausanne
| | - Peter Vollenweider
- Service de médecine interne, CHUV, 1011 Lausanne
- Faculté de biologie et de médecine, Université de Lausanne, 1011 Lausanne
| |
Collapse
|