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The COVID-19 has placed pandemic modeling at the forefront of the whole world's public policymaking. Nonetheless, forecasting and modeling the COVID-19 medical waste with a detoxification center of the COVID-19 medical wastes remains a challenge. This work presents a Fuzzy Inference System to forecast the COVID-19 medical wastes. Then, people are divided into five categories are divided according to the symptoms of the disease into healthy people, suspicious, suspected of mild COVID-19, and suspicious of intense COVID-19. In this regard, a new fuzzy sustainable model for COVID-19 medical waste supply chain network for location and allocation decisions considering waste management is developed for the first time. The main purpose of this paper is to minimize supply chain costs, the environmental impact of medical waste, and to establish detoxification centers and control the social responsibility centers in the COVID-19 outbreak. To show the performance of the suggested model, sensitivity analysis is performed on important parameters. A real case study in Iran/Tehran is suggested to validate the proposed model. Classifying people into different groups, considering sustainability in COVID 19 medical waste supply chain network and examining new artificial intelligence methods based on TS and GOA algorithms are among the contributions of this paper. Results show that the decision-makers should use an FIS to forecast COVID-19 medical waste and employ a detoxification center of the COVID-19 medical wastes to reduce outbreaks of this pandemic. © 2023, Crown.
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INTRODUCTION: Previous studies suggest that delayed initiation of extracorporeal membrane oxygenation (ECMO) is associated with higher patient mortality. Hence, we hypothesized that prolonged invasive mechanical ventilation (IMV) prior to ECMO was associated with higher mortality in patients with COVID-19. METHOD(S): The COVID-19 Critical Care Consortium, a prospective international multicenter registry, was queried for all patients with COVID-19 infection who received IMV and ECMO. Patients who were intubated prior to transfer to a study site were excluded. The primary variable was number of days on IMV prior to ECMO initiation and study endpoint was death or discharge from the study site. Cox proportional hazards model for the time between ECMO initiation and death was built using covariates including age, gender, selected comorbidities, and time intervals from ICU admission to IMV and IMV to ECMO initiation. RESULT(S): Between 1/1/2020 and 6/6/2022, A total of 593 patients from 107 study sites and 25 countries were included in the analysis. In this cohort, the median age was 50 (Interquartile range [IQR]: 40-58) years. Obesity and hypertension were prevalent among 220 (38.4%) and 223 (38.8%) of the patients, respectively. Twenty-four (4.2%) patients had chronic pulmonary disease. Prior to ECMO initiation, patients spent a median of 3.68 (IQR: 1.36-8.07) days in the ICU and a median of 2.49 (IQR: 0.88-5.65) days on IMV. Overall mortality was 47.2% with 3.9% patients' status not finalized or unknown. According to the final survival model, the number of days on IMV prior to ECMO initiation was not associated with mortality. The hazard ratios for 0, 3, 7, and 14 days of pre-ECMO IMV were 0.94 (95% confidence interval [CI]: 0.83 to 1.07), 1.02 (95% CI: 0.97 to 1.08), 1.09 (95% CI: 0.92 to 1.3) and 1.09 (95% CI: 0.83 to 1.42), respectively. Other noticeable contributory factors in the model included age and gender. CONCLUSION(S): Among patients with COVID-19 who received ECMO, the length of pre-ECMO IMV was not associated with hospital mortality. Further studies evaluating the ventilator settings before and after ECMO initiation are needed.
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Background: Hemorrhage, coagulopathy and thrombosis (HECTOR) are reported complications of coronavirus disease 2019 (COVID-19) however, more information is needed on the prevalence of these complications and their associated outcomes in intensive care unit (ICU) settings. Aim(s): To determine the prevalence and outcomes of HECTOR complications in ICU patients with COVID-19. Method(s): Observational cohort study spanning 229 ICUs across 32 countries. Patients >=16 years admitted for severe COVID-19 from 1st January 2020, through 31st December 2021 were included. Patient characteristics and clinical data were collected. Survival analysis estimated the instantaneous impact of HECTOR complications on ICU-mortality and discharge. Result(s): HECTOR complications occurred in 1,735 (14%) of 11,972 study-eligible patients. Acute thrombosis occurred in 1,249 (10%) patients, including 712 (57%) with pulmonary embolism, 413 (33%) with myocardial infarction, 93 (7.4%) with deep vein thrombosis, and 49 (3.9%) with ischemic stroke. Hemorrhagic complications were reported in 582 (4.9%) patients, including 276 (48%) with gastrointestinal hemorrhage, 83 (14%) with hemorrhagic stroke, and 77 (13%) with pulmonary hemorrhage. Disseminated intravascular coagulation occurred in 11 (0.09%) patients. Univariate analysis identified diabetes, hypertension, cardiac and kidney disease and ECMO as statistically-significant risk factors for HECTOR complications. Patients with versus without HECTOR complications suffered higher ICU-mortality at 28 days (25%vs.13%, p < 0.001), 90 days (32%vs.15%, p < 0.0001) and overall (44%vs.36%, p < 0.001). Among ICU survivors, the ICU stay was longer (median days 19vs.12, p < 0.001). ICU mortality was similar between patients with and without HECTOR complications (HR = 1.01, 95%CI 0.92-1.12, p = 0.783) where an increased hazard of ICU mortality with hemorrhage (HR = 1.26, 1.09-1.45, p = 0.002) was balanced by a reduced hazard of thrombosis (HR = 0.88, 0.79-0.99, p = 0.03). Kaplan-Meier curves are presented in the Figure. Conclusion(s): HECTOR events are frequent complications of severe COVID-19 in ICU patients. Hemorrhagic, but not thrombotic complications are associated with increased ICU-mortality.
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Background: In patients with COVID-19 and respiratory failure, class 3 obesity (body mass index > 40 kg/m2) has been associated with worse survival. Obese patients on mechanical ventilation with progressively more severe acute respiratory syndrome (ARDS) may be offered venovenous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The impact of morbid obesity on the outcome of COVID-19 patients supported with VV ECMO has been underexplored. Methods: This is a multicenter, retrospective observational cohort analysis of critically ill adults with COVID-19 ARDS requiring advanced mechanical ventilation with or without VV ECMO. Data was collected from 236 international institutions forming the COVID-19 Critical Care Consortium international registry. Patients were admitted between January 2020 to December 2021. Included patients were stratified by ECMO status and a BMI threshold at 40 kg/m2. Median values with interquartile range (IQR) were used to summarize continuous variables and multi-state analysis was used to explore the effect of Class 3 obesity on the study endpoints of patient survival to discharge or death. Results: Complete data was available on 8851 of 9059 patients on mechanical ventilation, of which 767 patients required VV ECMO. For the entire study group, older age and male gender were associated with an increased risk of death. The demographics and comorbidities of the higher BMI (H >40 kg/m2) and lower BMI (L ≤40 kg/m2) cohorts were similar with the exception of age and weight. Patients with a higher BMI were younger. The median age of the H, non-ECMO cohort was 56 years (46-64), and the H, ECMO cohort was 41 years (35-51) versus the L, non-ECMO cohort of 64 years(55-71), and the L, ECMO cohort of 53years (45-60). Patients requiring VV ECMO had higher SOFA scores, experienced longer ICU and hospital lengths of stay, and a longer duration of total mechanical ventilation. Table The median time to intubation was longer in the mechanical ventilation only group (2 versus 0 days). Predictors for requiring ECMO included younger age, higher BMI and male gender. Risk factors for death included advancing age (every 10 years), male gender and increasing BMI (every 5kg/m2). The association between BMI and a higher rate of death was reduced in the mechanical ventilation only group (HR 0.92, 95% confidence interval 0.85 to 0.99). Conclusion: In patients with severe ARDS due to COVID-19 requiring mechanical ventilation, the likelihood of progressing to VV ECMO therapy or experiencing death is impacted by age, gender and higher BMI. The cohort of COVID-19 patients that ultimately required ECMO appear to be sicker at time hospital admission owing to the shorter time until mechanical ventilation. It appears the association between increasing BMI and death differs among the ECMO and mechanical ventilation alone cohorts. We would advocate for a prospective study to determine the benefit of VVECMO for the obese patient requiring VV-ECMO for COVID-19 ARDS. (Figure Presented).
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Introduction: Burnout syndrome (BOS) has been recognized for over 50 years. Over time, it has been reported that certain health care specialties are more vulnerable to BOS, such as those working in an intensive care unit (ICU). The introduction of extracorporeal membrane oxygenation (ECMO) and its growing demand, adds to the overall workload in ICU, and exposes practitioners to complex ethical and administrative situations, which may impact their psychological well-being. We aim to investigate the effects of an ECMO service, on BOS development in the ICU. Methods: We conducted a cross-sectional descriptive study, using an online questionnaire;The Maslach Burnout Inventory Human Services Survey for Medical Personnel. In addition, demographic variables, workload, salary satisfaction, and caring for coronavirus disease 2019 (COVID-19) patients were assessed. Participants were divided based on working in ICU with ECMO service into ICU with (ECMO-ICU) and without (non-ECMO-ICU) ECMO service, and burnout status (burnout and no burnout). Results: The response rate for completing the questionnaire was 36.4% (445/1222). Males represented 53.7% of the participants. The overall prevalence of burnout was 64.5%. The overall burnout prevalence did not differ between ECMO- and non-ECMO-ICU groups (64.5% and 63.7, respectively). However, personal accomplishment (PA) score was significantly lower among ECMO-ICU personnel compared to those in a non-ECMO ICU (42.7% versus 52.6, p = 0.043). Significant predictors of burnout included profession (nurse or physician), acquiring COVID-19 infection, knowing other practitioners who were infected with COVID- 19, salary dissatisfaction, and extremes of workload. Conclusions: Burnout was equally prevalent among participants from ECMO- and non-ECMO ICU, but PA was lower among participants in ICU with an ECMO service. The reported high prevalence of burnout, and its predictors, requires special attention to try and reduce its occurrence.
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The COVID-19 pandemic is far from over. The government has carried out several policies to suppress the development of COVID-19 is no exception in Bogor Regency. However, the public still has to be vigilant especially now we will face a year-end holiday that can certainly be a trigger for the third wave of COVID-19. Therefore, researchers aim to make predictions of the increase in positive cases, especially in the Bogor Regency area to help the government in making policies related to COVID-19. The algorithms used are Gaussian Process, Linear Regression, and Random Forest. Each Algorithm is used to predict the total number of COVID-19 cases for the next 21 days. Researchers approached the Time Series Forecasting model using datasets taken from the COVID-19 Information Center Coordinationn Center website. The results obtained in this study, the method that has the highest probability of accurate and appropriate data contained in the Gaussian Process method. Prediction data on the Linear Regression method has accurate results with actual data that occur with Root Mean Square Error 1202.6262. © 2021 IEEE.
Subject(s)
COVID-19 , Emergency Treatment , Plastic Surgery Procedures , Quarantine , Wounds and Injuries/surgery , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Humans , Infant , Middle Aged , Prospective Studies , Tertiary Care Centers , Young AdultABSTRACT
Transporting patients on ECMO is a proven safe and effective mode of transferring critically ill patients requiring maximum mechanical ventilator support to a regional quaternary care center. Prior to the COVID-19 pandemic, mobile ECMO teams were able to be transported without suffering adverse events. With the COVID-19, the safety of the staff and transport team adds a new layer of challenges. We conducted a retrospective study of 79 patients (median age 36 years old, 41% male) who were cannulated at an outside hospital and transported on Venovenous or Venoarterial ECMO to one of five quaternary care centers. The average distance travelled was 27 miles (SD 23 miles) and the duration of the transport was 56 minutes (SD 36 minutes) from ambulance bay to ambulance bay. The teams consisted of 1-2 physicians for cannulation and patient management, 2 critical care transport nurses and a driver or pilot. Mobile ECMO team members practiced strict ACE precautions while caring for the patient and were in standard PPE at other times. The primary mode of transportation was ground. Six patients were transported by air. There were no instances of transport related adverse events including pump failures, cannulation complications at the OSH or decannulations in transit. There were no instances of the transport team members contracting COVID-19 at 30 days after transport. By adhering to best practices and ACE precautions, patients with COVID-19 can be safely cannulated at an outside hospital and transported to a quaternary care center without increased risk to the transport team.