Seven Epidemic Waves of COVID-19 in a Hospital in Madrid. Analysis of Severity and Associated Factors (preprint)

(1) Background: Since the onset of the SARS-CoV-2 pandemic, seven epidemic waves have been described in Spain. Our objective was to study mortality and severity, and associated factors in our hospitalized patients; (2) Method: Retrospective cohort study was conducted on COVID-19 patients admitted to the Hospital de Fuenlabrada (Madrid, Spain) from the beginning of the pandemic until December 31, 2022; (3) Results: A total of 5,510 admissions for COVID-19 were recorded. First wave accounted for 1,823 (33%) and exhibited the highest proportion of severe patients (lowest mean oxygen saturation, 88.2%; elevated levels of CRP, IL-6, D-dimer and ferri-tin), but a below-average percentage of intubated patients (5% vs. 6.5%). Overall mortality rate was 10.3%, higher during the first wave (11.5%) and the two winter waves (third: 11.3%, sixth: 12%), although the first wave represented 39% of the total. Variables associated with mortality were age (OR 1.08,1.07-1.09), need for high-flow oxygen (OR 6.10,4.94-7.52), oncological disease (OR 1.88,1.53-2.60), dementia (OR 1.82,1.2-2.75), Charlson index (OR 1.38,1.31-1.47), and maxi-mum IL-6 levels (OR 1.001,1.000-1.001); (4) Conclusions: Variables associated with mortality in-cluded age, comorbidity, respiratory failure, and inflammation. Differences on baseline charac-teristics of patients admitted explained differences on mortality in each wave

Nurses with workplace violence in pneumology settings during Covid-19

Background: Workplace violence (WPV) has consequences both for healthcare workers and healthcare organizations. Nurses are the most exposed healthcare workers to vertical WPV. Aims and Objectives: Describe the Italian WPV and identify its predictive factors. Method(s): This is a secondary analysis conducted in hospital pneumology settings from a larger study between January and April 2021. Data were collected through the Practice Environment Scale of the Nursing Work Index (PES-NWI;Likert scale 1 to 4) and the Violence in Emergency Nursing and Triage (VENT) Questionnaire. Result(s): The analysis was conducted on 484 pulmonary nurses (72.9% female;mean age 38.9 years, SD 9.8). Thirty-four per cent (n=164) of them have had an experience of WPV in last year and/or their last week and 16.7% (n=81) only in their last week. Comparing main results between nurses with WPV vs no WPV the number of patients was higher for nurses with WPV (MD +4.8;p<.001). The PES-NWI results were significantly worse for nurses with WPV: global mean scores (MD +0.2;p<.001);nurse participation in hospital affairs (MD +0.3;p<.001);nurse manager ability leadership, and support of nurses (MD +0.2;p<.001);physician-nurse relationship (MD +0.2;p<.001). Conclusion(s): Public health companies should reduce WPV by investing in resources for the management and prevention of the phenomenon. Integrated and multimodal programs of prevention and management of WPV are useful to combat it. Improving the work environment and job satisfaction should reduce WPV.

Nursing Students' Perceptions of Virtual Simulation in Nursing Education During the COVID-19 Pandemic: A Proposal for a Validation Protocol and Cross-Sectional Study

There is no evidence with regard to the effectiveness of the use of simulation in video conferences to facilitate the learning experiences of nursing student. Aims. To describe the research protocol 1) to validate instruments measuring student satisfaction, self-confidence, and perceptions of good planning and best practice in the use of virtual simulation in the Italian con- text on the basis of Jeffries and Rizzolo's theoretical model in the Italian context and 2) to analyse student satisfaction, self-confidence, and perceptions of good planning and best practice in virtual simulation during the COVID-19 pandemic. Methods. First, we will perform a validation study and then use a descriptive cross-sectional study design. Third year nursing students in a bachelor's degree course in nursing in central Italy, who participated in virtual simulation-based learning during the COVID-19 pandemic will be included. We will consider translation and cultural adaptation, the content and face validity, the construct validity, the criterion validity, the reliability, and the responsiveness to changes in the instruments. Then we will consider means and standard deviations for evaluating the score of the instruments. Discussion. This study will provide us with the opportunity to determine the effectiveness of virtual simulation for nursing students. The intent is not only to evaluate students' perceptions of virtual simulation but also to create a continuous monitoring system. The future intention is to evaluate the effectiveness of virtual simulation for developing students' skills during their internship. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Comparative Study of Vaccinated and Unvaccinated Hospitalised Patients: A Retrospective Population Study of 500 Hospitalised Patients with SARS-CoV-2 Infection in a Spanish Population of 220,000 Inhabitants.

OBJECTIVES: This study aimed to compare the characteristics of fully and partially vaccinated or unvaccinated coronavirus disease 2019 (COVID-19) patients who were hospitalised in a population of 220,000 habitants. METHODS: Retrospective, observational, and population studies were conducted on patients who were hospitalised due to COVID-19 from March to October 2021. We assessed the impact of vaccination and other risk factors through Cox multivariate analysis. RESULTS: A total of 500 patients were hospitalised, among whom 77 (15.4%) were fully vaccinated, 86 (17.2%) were partially vaccinated, and 337 (67.4%) were unvaccinated. Fully vaccinated (FV) patients were older and had a higher Charlson index than those of partially vaccinated and unvaccinated patients (NFV). Bilateral pneumonia was more frequent among NFV (259/376 (68.9%)) than among FV patients (32/75 (42.7%)). The former had more intensive care unit admissions (63/423) than the latter (4/77); OR: 2.80; CI (1.07-9.47). Increasing age HZ: 1.1 (1.06-1.14)) and haematological disease at admission HZ: 2.99 (1.26-7.11)) were independent risk factors for higher mortality during the first 30 days of hospitalisation. The probability of an earlier discharge in the subgroup of 440 patients who did not die during the first 30 days of hospitalisation was related to age (older to younger: HZ: 0.98 (0.97-0.99)) and vaccination status. CONCLUSIONS: Among the patients hospitalised because of COVID-19, complete vaccination was associated with less severe forms of COVID-19, with an earlier discharge date. Age and haematological disease were related to a higher mortality rate during the first 30 days of hospitalisation.

ACUTE PERICARDITIS in TIMES of COVID

Background: The most common etiology of acute pericarditis is usually infectious, especially viral. When its cause is infammatory (up to 7% of cases), it can be presented as an isolated process or be a clinical manifestation in the context of multiple systemic autoimmune diseases (SAD), therefore it is necessary to make a broad differential diagnosis. Nowadays, an increased incidence has been described in relation to SARS-CoV-2 infection, and especially in global vaccination against this one. This represents a clinical challenge when we have to identify the cause of this pathology with a not insignifcant comorbidity. Objectives: To describe the characteristics of a series of patients with acute pericarditis and its association with SAD. Methods: Retrospective and descriptive observational study. Digitalised records of patients with acute pericarditis evaluated in the Rheumatology unit of a tertiary hospital in Seville during 2021 were reviewed. Demographic, epidemiological, clinical and therapeutic variables were analysed. Results: Eight cases of acute pericarditis were detected. The average age of the patients was 51.50 ± 18.601 years. 62.5% were women. 50% had previous rheumatological pathology: two rheumatoid arthritis (RA), one systemic lupus erythematosus (SLE) and one limited systemic sclerosis (LSS);with an average disease duration of 8.63 ± 2.387 months. Of these, 3 were on treatment with steroids and DMARDs (lefunomide or hydroxychloroquine) and 1 had previously received rituximab. Pericardial effusion was moderate in 50% of cases, severe in 33.3% and mild in 16.7%. One patient had cardiac tamponade. Five patients had pleural effusion, which was moderate in 80%, and in one case associated with pneumonia. As complications, one patient developed heart failure and the patient with ESL was diagnosed with pulmonary arterial hypertension. Two patients had previous COVID19 and 7 were vaccinated against Sars-CoV2. Treatment was colchicine in 57.15% of cases, steroids in 85.7%, DMARDsc in 85.8% (3 hydroxychloroquine and 3 azathioprine) and DMARDsb in 42.9% (1 anakinra, 1 tocilizumab and 1 rituximab). Pericarditis resolved in all patients. Table 1. Conclusion: In the previous year, an increase in consultations from other departments for acute pericarditis with suspected infammatory origin was observed. The possibility of a correlation with COVID19 or vaccination against COVID was initially considered, but it could not be demonstrated, since vaccination was later in vaccinated patients, and in those who had been infected, the time interval until the development of pericarditis was too long for it in order to be attributed to COVID19. Finally, in 5 of the 8 patients, pericarditis was related to SAD, in particular with the rheumatic pathologies most associated with this clinical manifestation (RA and SLE). Therefore, in the middle of the COVID pandemic, in addition to considering COVID19 or its vaccine in the differential diagnosis of acute pericarditis, we must not forget to include SAD in this diagnosis.

Urinary tubular biomarkers as predictors of death in critically ill patients with COVID-19.

Aim: To evaluate the prediction capacity of urinary biomarkers for death in critically ill patients with COVID-19. Methods: This is a prospective study with critically ill patients due to COVID-19 infection. The urinary biomarkers NGAL, KIM-1, MCP-1 and nephrin were quantified on ICU admission. Results: There was 40% of death. Urinary nephrin and MCP-1 had no association with death. Tubular biomarkers (proteinuria, NGAL and KIM-1) were predictors of death and cut-off values of them for death were useful in stratify patients with worse prognosis. In a multivariate cox regression analysis, only NGAL remains associated with a two-mount survival chance. Conclusion: Kidney tubular biomarkers, mostly urinary NGAL, had useful capacity to predict death in critically ill COVID-19 patients.

Prognostic factors and combined use of tocilizumab and corticosteroids in a Spanish cohort of elderly COVID-19 patients.

Coronavirus disease 2019 (COVID-19) infection in elderly patients is more aggressive and treatments have shown limited efficacy. Our objective is to describe the clinical course and to analyze the prognostic factors associated with a higher risk of mortality of a cohort of patients older than 80 years. In addition, we assess the efficacy of immunosuppressive treatments in this population. We analyzed the data from 163 patients older than 80 years admitted to our institution for COVID-19, during March and April 2020. A Lasso regression model and subsequent multivariate Cox regression were performed to select variables predictive of death. We evaluated the efficacy of immunomodulatory therapy in three cohorts using adjusted survival analysis. The mortality rate was 43%. The mean age was 85.2 years. The disease was considered severe in 76.1% of the cases. Lasso regression and multivariate Cox regression indicated that factors correlated with hospital mortality were: age (hazard ratio [HR] 1.12, 95% confidence interval [CI]: 1.03-1.22), alcohol consumption (HR 3.15, 95% CI: 1.27-7.84), CRP > 10 mg/dL (HR 2.67, 95% CI: 1.36-5.24), and oxygen support with Venturi Mask (HR 6.37, 95% CI: 2.18-18.62) or reservoir (HR 7.87, 95% CI: 3.37-18.38). Previous treatment with antiplatelets was the only protective factor (HR 0.47, 95% CI: 0.23-0.96). In the adjusted treatment efficacy analysis, we found benefit in the combined use of tocilizumab (TCZ) and corticosteroids (CS) (HR 0.09, 95% CI: 0.01-0.74) compared to standard treatment, with no benefit of CS alone (HR 0.95, 95% CI: 0.53-1.71). Hospitalized elderly patients suffer from a severe and often fatal form of COVID-19 disease. In this regard, several parameters might identify high-risk patients upon admission. Combined use of TCZ and CS could improve survival.

Smartphone screen testing, a novel pre-diagnostic method to identify SARS-CoV-2 infectious individuals.

The COVID-19 pandemic will likely take years to control globally, and constant epidemic surveillance will be required to limit the spread of SARS-CoV-2, especially considering the emergence of new variants that could hamper the effect of vaccination efforts. We developed a simple and robust - Phone Screen Testing (PoST) - method to detect SARS-CoV-2-positive individuals by RT-PCR testing of smartphone screen swab samples. We show that 81.3-100% of individuals with high-viral-load SARS-CoV-2 nasopharyngeal-positive samples also test positive for PoST, suggesting this method is effective in identifying COVID-19 contagious individuals. Furthermore, we successfully identified polymorphisms associated with SARS-CoV-2 Alpha, Beta, and Gamma variants, in SARS-CoV-2-positive PoST samples. Overall, we report that PoST is a new non-invasive, cost-effective, and easy-to-implement smartphone-based smart alternative for SARS-CoV-2 testing, which could help to contain COVID-19 outbreaks and identification of variants of concern in the years to come.

Description of the method used by tor vergata university of rome for the electronic final exam of the degree course in physiotherapy

On 11 March 2020, the Director General of the World Health Organisation (WHO) officially declared the outbreak of the coronavirus (COVID-19) as a pandemic. Much of the global higher-education community has been thrust into an unplanned, unwanted and fraught experiment in online learning. Experts in the academic world must be encouraged to spread and share the strategies they are using to face these challenges. This extraordinary health emergency, which is being experienced in our country and all over the world, has forced Italian universities to modify the organisation of the final tests of their degree courses, including those of the health professions, with the effect of transforming them into online tests. The objective pursued is to not interrupt the completion of university courses by ensuring that students can complete the qualifying exams for these professions. This paper describes the method used at an Italian university to carry out the final exam of the degree course in physiotherapy in electronic form. Final exams have been organised on the basis of the guidance provided at a national level. The technical tool chosen by this university to allow participation in remote exams is the Microsoft Teams platform. The Exam Commission will start the exam, after verifying the environmental requirements in which each candidate wishes to take the exam. At the end of the exam, the President of the Exam Commission will transcribe the names and marks of the student, as well as the names of the members of the Commission on the minutes, and he or she will sign them. This paper represents a first step in the dissemination and sharing, at an academic level, of how one university is dealing with the current situation. It is an important element in helping academics and academia to manage this emergency. © Proceedings of the 14th IADIS International Conference e-Learning 2020, EL 2020 - Part of the 14th Multi Conference on Computer Science and Information Systems, MCCSIS 2020. All rights reserved.