ABSTRACT
Identifying and incorporating lessons learned as a crisis unfolds is challenging. Current emergency preparedness frameworks do not include an intermediate evaluation structure for acute or prolonged crises, making it difficult to learn and adapt in a timely manner. The Pause and Learn (PaL) action-learning process developed by the National Aeronautics and Space Administration (NASA) was adapted to the healthcare environment to capture timely, critical lessons learned in response to COVID-19. Research showed that PaL was an ideal tool to obtain interim feedback from diverse perspectives. The Pause and Learn process could be adapted easily within other hospitals and healthcare systems to facilitate rapid learning. It also could enable the sharing of meaningful lessons learned among those in the healthcare industry by creating a common framework.
ABSTRACT
Introduction: The global spread of the SARS-CoV-2 virus has resulted in a worldwide pandemic with important socio-health repercussions. Current clinical experience and several published retrospective studies suggest that digestive symptoms are common in infected patients. [1][2] The aim of this study was to evaluate the frequency of gastrointestinal (GI) symptoms and complications in patients with COVID-19 disease managed on an outpatient basis. Aims & Methods: International, multicenter, prospective cohort study was conducted in 18 centers from Latin America, Asia, Africa and Europe. Subjects ≥18 years old, with COVID-19 disease, managed on an outpatient basis were included. Followed up period was 6 months. Baseline characteristics, comorbidities, GI symptoms or complications, hospital admission, ICU admission and mortality data were collected. A descriptive analysis of the study results was performed. A multivariate analysis was carried out, evaluating the association of GI symptoms and complications with age, baseline characteristics, comorbidity and COVID-19 treatments received. The adjusted Odd Ratio (ORa) was calculated assuming a significance level of p <0.05. Results: The preliminary analysis included a total of 436 patients. The median age was 35 years, interquartile range (IQR) 27-48 years. Two hundred and ten patients (48.2%) were male. The median of age-adjusted Charlson Comorbidity Index was 0 (IQR 0-1). The most frequent GI symptoms were anorexia 216 (49.5%), diarrhea 207 (47.5%), nausea 134 (30.7%), abdominal pain 122 (28%) and abdominal distension 121 (27.8%). At 4-week follow- up, symptoms resolved in most cases. Multivariate analysis showed that nausea was associated with Ivermectin treatment ORa 3.24 (95% CI 1.11-9.43) p= 0.030;abdominal pain was associated with Hydroxychloroquine treatment ORa 5.27 (95% CI 1.52-18.19) p= 0.009;diarrhea was associated with age ORa 0.966 (95% CI 0.93-0.99), p= 0.020 and Hydroxychloroquine treatment ORa 6.9 (95% CI 1.55-30.79), p= 0. 011;abdominal distension was associated with body mass index ORa 1.147 (95% CI 1.05-1.24), p< 0.001 and Hydroxychloroquine treatment ORa 7.6 (95% CI 2.00-29.51), p= 0.003. Digestive complications were infrequent (1 gastritis, 2 duodenitis, 1 jejunal ulcer, 3 hypertransaminasemia, 1 enteritis, 1 colitis). Twenty-three patients (5.3%) required hospital admission, of whom 4 (0.9%) required ICU admission and 2 (0.5%) died. Conclusion: Anorexia, diarrhea, nausea, abdominal pain and abdominal bloating were common symptoms in patients with COVID-19 disease managed on an outpatient basis. GI complications were infrequent in patients with COVID-19 who do not require hospitalization. Treatment with Hydroxychloroquine and Ivermectin was associated with more GI symptoms in COVID-19 outpatients.