The Association of Bedside Nurse Staffing on Patient Outcomes and Throughput in a Pediatric Cardiac Intensive Care Unit

Health care throughput is the progression of patients from admission to discharge, limited by bed occupancy and hospital capacity. This study examines heart center throughput, cascading effects of limited beds, transfer delays, and nursing staffing on outcomes utilizing elective surgery cancellation during the initial severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic wave. This study was a retrospective single-center study of staffing, adverse events, and transfers. The study period was January 1, 2018 to December 31, 2020 with the SARS-CoV-2 period March to May 2020. There were 2,589 patients, median age 5 months (6 days-4 years), 1,543 (60%) surgical and 1,046 (40%) medical. Mortality was 3.9% ( n = 101), median stay 5 days (3-11 days), median 1:1 nurse staffing 40% (33-48%), median occupancy 54% (43-65%) for step-down unit, and 81% (74-85%) for cardiac intensive care unit. Every 10% increase in step-down unit occupancy had a 0.5-day increase in cardiac intensive care unit stay ( p = 0.044), 2.1% increase in 2-day readmission ( p = 0.023), and 2.6% mortality increase ( p < 0.001). Every 10% increase in cardiac intensive care unit occupancy had 3.4% increase in surgical delay ( p = 0.016), 6.5% increase in transfer delay ( p = 0.020), and a 15% increase in total reported adverse events ( p < 0.01). Elective surgery cancellation is associated with reduced high occupancy days (23-10%, p < 0.001), increased 1:1 nursing (34-55%, p < 0.001), decreased transfer delays (19-4%, p = 0.008), and decreased mortality (3.7-1.5%, p = 0.044). In conclusion, Elective surgery cancellation was associated with increased 1:1 nursing and decreased mortality. Increased cardiac step-down unit occupancy was associated with longer cardiac intensive care unit stay, increased transfer, and surgical delays.

Educating health professionals about COVID-19 with ECHO telementoring

Background: When the COVID-19 pandemic began, primary care clinicians had almost no knowledge regarding best practices COVID-19 treatment. Project ECHO developed a COVID-19 Infectious Disease Office Hours (Office Hours) program to respond to the needs of clinicians seeking COVID-19 information. Methods: This mixed-methods evaluation analyzed weekly post-session data and focus group results from the weekly Office Hours ECHO sessions during June 1, 2020-May 31, 2021. Results: A total of 1,421 participants attended an average of 4.9 sessions during the 45 Office Hours sessions studied. The most common specialties included: nurses= 530 (37%), physicians= 284 (20%), and 493 (34%) having other degrees. The participants stated that they were definitely (68.2%) or probably (22.0%) going to use what they learned in their work, especially vaccination information. Focus group results identified these themes: 1) quality information, 2) community of practice, 3) interprofessional learning, and 4) increased knowledge, confidence, and practice change. Conclusions: This evaluation demonstrates that the Office Hours program was successful in bringing a large group of health professionals together each week in a virtual community of practice. The participants acknowledged their plans to use the information gained with their patients. This diffusion of knowledge from clinician to patient amplifies the response of the program, changes practice behavior and may improve patient care. (c) 2021 The Author(s). Published by Elsevier Inc. on behalf of Association for Professionals in Infection Control and Epidemiology, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

How Will the Cost Change after Transformation in Public Nature-Based Attractions? A Framework and Case Study

Financial viability is crucial for public nature-based attractions, especially in the context where many are seeking to transform their business model and goals in order to survive because of the heavy hit by COVID-19 and pressure from Chinese central government policies to lower entrance fees in state-owned attractions. However, there is little literature relating to the relationship between finance and transformation. To fill the gap, the framework "resource-function-transformation-cost" was proposed to explain the relationship between transformation and cost structure change by combining resource-based theory and function analysis. A case study of Shanghai Sheshan National Forest Park (SNFP) tested the framework and further revealed that (a) transformation happened because of the recombination of resources, followed by the change of functions, leading to capital expenditure being more prominent during the early stages and management costs more so in the latter stage. Further, we conclude that the elasticity of the cost structure is low;(b) the structure of functions tended to be stable over the years;and (c) the cost structure of the management, production and business, and tourism and leisure functions did not change much, while that of ecological protection functions changed significantly from capital expenditure to management costs.

Author Correction: The dual role of anti-viral therapy in the treatment of Coronavirus disease 2019.

Correction to: European Review for Medical and Pharmacological Sciences 2020; 24 (22): 11939-11944-DOI: 10.26355/eurrev_202011_23854-PMID: 33275267, published online 30 November, 2020. The authors state that "Figures 3 and 4 were used twice due to a careless mistake during the preparation of Figures". There are amendments to this paper.  The Publisher apologizes for any inconvenience this may cause. https://www.europeanreview.org/article/23854.

Epidemiological analysis of 18 patients with COVID-19.

OBJECTIVE: The present study aimed to explore the transmission pattern and the incubation period of coronavirus disease 2019 (COVID-19) as well as the clinical characteristics of infants with COVID-19 to provide a scientific basis for introducing further measures to reduce the infection rate and control the pandemic. PATIENTS AND METHODS: A descriptive epidemiological study of 18 patients with COVID-19 in People's Hospital of Deyuan was carried out. Among these patients, 16 cases were connected with clusters (11 family-cluster cases and 5 public-cluster cases). The basic characteristics, clinical symptoms, and epidemiological characteristics of the patients were considered in the investigation. RESULTS: The median age of the 18 patients was 44.5 years (37.5-52.0 years), and there were 10 males and 8 females in the sample. The main clinical symptoms were fever and cough. The epidemiological characteristics were as follows: (1) the median incubation period was 8 days (with an interquartile range of 4-12 days); (2) the incubation period in one case was ≥18 days; (3) one infant patient was asymptomatic prior to their diagnosis; and (4) two asymptomatic patients had a positive nucleic acid test after their family members were diagnosed with COVID-19. CONCLUSIONS: COVID-19 can be transmitted in many ways, including via respiratory droplets and indirect contact, and it spreads easily among close contacts. People with a history of contact with areas affected by the disease should be isolated at home for 14 days. Moreover, attention should be focused on the issues of asymptomatic infectors, asymptomatic infants, and infants with mild symptoms.

The dual role of anti-viral therapy in the treatment of Coronavirus disease 2019.

OBJECTIVE: Coronavirus disease 2019 (COVID-19) has become a worldwide public health emergency; unfortunately, there is currently no treatment for improving outcomes or reducing viral-clearance times in infected patients. The aim of the present study was to evaluate the efficacy of interferon (IFN) with or without lopinavir and ritonavir as antiviral therapeutic option for treating COVID-19 infection. PATIENTS AND METHODS: The present study enrolled 148 patients that received either standard care, treatment with IFN alfa-2b, or IFN alfa-2b combined with lopinavir plus ritonavir. Viral testing was performed using Reverse-Transcription Polymerase Chain Reaction (RT-PCR). RESULTS: There was no significant difference in the viral-clearance time at 28 days after treatment between patients receiving standard care and those receiving anti-viral treatments. However, the average viral-clearance time of patients receiving standard care (14 days) was shorter than that for patients receiving IFN alfa-2b or IFN alfa-2b combined with lopinavir plus ritonavir (15.5 or 17.5 days) (p<0.05). Patients treated with IFN alfa-2b within five days or IFN alfa-2b combined with lopinavir plus ritonavir after three days of symptoms exhibited shorter viral-clearance times than the other groups (p<0.05). Moreover, viral-clearance times were significantly longer in patients receiving standard care or anti-viral treatment 5 days after symptoms appeared than those of patients who received these treatments within five days of symptom onset (p<0.05). CONCLUSIONS: Early symptomatic treatment is most critical for maximizing amelioration of COVID-19 infection. Anti-viral treatment might have complicated effect on viral-clearance.