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Objectives: To assess protein and energy intake and duration of venous-venous ECMO in critically ill patients with covid-19 Methods: We conducted a retrospective observational analysis on the intensive care units of a large tertiary private teaching Hospital. Adult patients admitted to intensive care unit (ICU) with laboratory confirmed SARS-CoV-2 (RT-PCR), cannulated on venous-venous ECMO and on exclusive enteral feeding were included. Data between march 2020 and june 2021 were collected. Weight and height data were acquired at the time of admission in ICU. Body mass index (BMI) was subsequently calculated. We obtained delivery and adequacy of nutrition data from a enteral nutrition form routinely filled out by nutritionists during hospitalization. Other data were obtained from electronic medical record. For statistical analysis of the data, we used SPSS version 13.0. Result(s): This cohort included 39 patients. 27 (69.2%) were men, mean age was 50 (+/- 12) years and 11 (28,2%) had more than 60 years. The more prevalent comorbidities were obesity in 22 (56%), hypertension in 20 (51,3%) and diabetes in 6 (15,4%) patients. The mean time on ECMO was 24.7 +/- 15.2 days. 29 patients (74%) died. Regarding nutritional support, the average protein intake was 0,9 +/- 0.4 g/kg/day and calories 13.9 +/- 5.2 cal/kg/day. No statistically significant association was observed between the nutritional intake and the duration on ECMO and clinical outcomes of patients. Conclusion(s): There was a high mortality in our cohort. Center;s inexperience may have played a role in these results, in addition to other factors. We observed a high prevalence of obesity. Neither energy nor protein intake were associated with the duration of ECMO and clinical outcomes. These results are similar to other recent observational studies where an insufficient energy and protein intake did not affected mortality or other outcomes. Our small sample and study design prevents a definitive conclusion on the subject. Thus, we propose further studies to elucidate the role of adequate nutrional strategies to improve outcomes and reabilitation of patients on ECMO.
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The stay-at-home measures imposed by governments to counteract the COVID-19 pandemic have drawn attention to the domestic sphere. Besides spending much more time at home in general, people also required the private sphere to fulfill multiple functions, including as workplaces, schools, and fitness centers. Within a qualitative social research framework, the paper examines how people in Vienna, Austria re-ordered their homes during lockdowns to address these challenges. We discuss ordering work as a form of care work regarding the home's conception, realization and maintenance, and understand the home as being produced in and through practices, including ordering practices. In particular, we are interested in whether and how ordering practices gained higher significance during the pandemic, and in how-by reordering their homes-people re-negotiated their social relations and the inequalities connected to care work and the home.
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BACKGROUND: The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients' follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. METHODS: The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. RESULTS: Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service's evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. CONCLUSIONS: We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.
Subject(s)
Cardiac Surgical Procedures , Delivery of Health Care , Follow-Up Studies , Humans , Learning , Pilot ProjectsABSTRACT
The aim of this study was to identify, in the scientific literature, the strategies used by health services to influence the formation of a culture of patient safety through hand hygiene among health professionals during the Covid-19 pandemic. This is a descriptive study of an integrative literature review. An advanced search was performed in the databases that make up the Virtual Health Library (VHL), of the 700 scientific publications identified, after applying the inclusion and exclusion criteria, 11 publications were selected that made up the final sample of the study, as they were from according to the proposed theme. During the study analysis process, the following thematic categories were highlighted: "Hand hygiene and its main public policies", "Nursing and the Covid-19 pandemic" and "Consequences of the breach of the hand hygiene protocol regarding safety of the patient". The studied literature showed that the consequences in relation to breaking the hand hygiene protocol regarding patient safety, especially in the Covid-19 pandemic, are worrisome because they affect both the patient's safety and the health professional's integrity. Furthermore, an increase in hospital stay and hospital costs, increased demand for the use of broad-spectrum antibiotics and increased morbidity and mortality rates were also identified.
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Introduction: At pediatric age, an emergency endoscopic procedure is required in a limited number of circumstances, mainly due to accidental foreign body ingestion (FBI), gastrointestinal bleeding and caustic ingestion. FBI may represent most of the procedures, occurring typically in young children (6 months to 3 years of age) at home. Although most FBIs in the gastrointestinal tract pass spontaneously without complications, endoscopic or surgical removal may be required in a few cases. SARS-CoV2 pandemic has led to significant family lifestyle changes, which forced children to stay at home for prolonged periods of time. It has been suggested that pandemic contingency may have increased the frequency of domestic accidents during lockdown period (namely FBI and caustic ingestion) and consequently the risk of potentially fatal episodes, as compared with non-pandemic periods. Aims & Methods: A retrospective analysis of the overall admissions to the pediatric emergency department of a tertiary referral hospital center with need of emergency endoscopy was performed. Children and adolescents aged between 0 and 18 years were included in the study. We compared the first 6 months of the pandemic (peak months April to September 2020-Group A) with the homologous period of the previous year (2019-Group B). The aim of the study was to evaluate if the changes in the lifestyle and hospital practices imposed by the pandemic had an impact on the frequency and profile of the emergency endoscopy. Chi-square and Mann-Whitney U tests were used for statistical analysis using IBM-SPSS®. Statistically significance was considered when p-value was under 0.05. Results: A total of 89 cases were analyzed (54% of the admissions in group A). Median age of admissions was 4.5 years. Groups did not differ for gender (p = 0.399) or age (p = 0.242). Concerning overall emergency endoscopies, 28% (25/89) occurred in children under the age of two, with most of these episodes occurring in Group A (19/89;p = 0.009). Groups did not differ considering the endoscopy indication (foreign body ingestion, caustic ingestion, food impaction and digestive hemorrhage) (p=0.899), nor about the presence of associated lesions (p = 0.597). The most frequent ingestions were caustics (18%, 16/89), coins (17%, 15/89), food impaction (12%, 11/89) and batteries (10%, 9/89). However, battery ingestions and food impactions were more frequent in 2020, respectively 67% (9/89;p = 0.419) and 64% (7/89;p = 0.49). There were no statistically significant differences on the time delay to reach the emergency department (p = 0.934) or on the time delay since emergency room admission until the endoscopic procedure (p = 0.266). More foreign bodies were removed in Group A (p = 0.026) and when lesions were present, they were more frequently seen on the esophagus (p = 0.007). Most of the patients (84%) were discharged home, after a brief recovery time after the procedure, with no difference between groups (p = 0.397). Conclusion: This study shows that there were no significant differences between both groups on the number and type of emergency endoscopies, on the time to reach the emergency room or to the performance of the endoscopy. Children under the age of 2 had more episodes with need of emergency endoscopy during the pandemic as compared to the homologous period. Overall, the pandemic did not seem to affect the quality of healthcare practice concerning emergency endoscopic procedures.
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Objectives: To understand indicators of the social representation of the coronavirus in adolescents undergoing cancer treatment during the COVID -19pandemic.
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Objectives: to understand indicators of the social representation of the coronavirus in adolescents undergoing cancer treatment during the COVID -19pandemic. Methods: the theory of social representations was used as theoretical and methodological support in its procedural approach in an exploratory study of a qualitative nature. The free word association technique was used in the application of virtual forms using guidelines of the snowball method. The terms ‘Coronavirus’, ‘Going to the hospital’ and ‘Cancer treatment’ were applied. After that moment, the participants were asked for a hierarchy and justification of the evoked words. Data analysis was based on content analysis and frequency distribution of the content produced. Results: articulations were made on the impacts that the pandemic situation had on the treatment experience of that population. It was identified a character endowed with fear and tension about the elaboration of the reality of these subjects in the current period in face of the inevitability of a hospital scenario that facilitates contamination and facing the immunological vulnerability characteristic of their treatments. Conclusions: the participants constructed different contents of psychological suffering aimed at expressions of fear and insecurity experienced during the pandemic period in the face of assistance in the hospital setting. This study is understood as a contribution to more effective actions in order to adapt the care plan of this population, aiming at future professional interventions. © 2021, Instituto Materno Infantil Professor Fernando Figueira. All rights reserved.