ABSTRACT
Introduction: Leukocyte differential, present certain features in SARS-CoV2 infected patients neutrophilia, lymphopenia and morphology alterations, which could be useful for screening. Cell population data (CPD) are reported as part of leukocyte differentials by Sysmex XN analyze;they are morphometric parameters that characterize neutrophils, lymphocytes and monocytes and classify them according to their volume, granularity and their content in nucleic acids. CPD reflects in numbers the changes in morphology and activation status triggered by infections. We aimed to evaluate the predictive power of CPDs for the differential diagnosis of COVID19 versus non-COVID19 pneumonia. Method(s): The prospective, observational, multicenter study was conducted in 3 hospitals, including patients > 18 years admitted with the diagnosis community-acquired pneumonia in the period November 2019 - October 2020. Complete blood count were analyzed using Sysmex XN counters. Diagnosis of SARS-CoV-2 infection was done using real-time reverse transcriptionpolymerase chain reaction. Patients were divided into two groups: (1) referral cohort in a hospital for the development of the model (2) the sample of two other hospitals for its validation. Multivariate logistic regression model has been developed for the detection of COVID patients. Robustness of the model has been evaluated by means of the area under the ROC curve and the calibration of the model. Statisticalsignificance p < 0.05. Result(s): 598 patients were recruited, 322 in the referral cohort and 276 in the validation group. The average age was 67.0 years (Standard Deviation 14.59 years ) and 61.49 % male. Neutrophil lymphocyte ratio, NE-WZ, LYY, LY-Z, LY-WX, LY- WY, MO- WY, MO-Z were included in the multivariate analysis, and presented a significant association for the differential diagnosis of SARS-CoV-2 infection with AUC of 0.84 (95% CI 0.82-0.92) in the referral cohort and 0.77 (0.69-0.85) in the validation cohort Conclusion(s): Leukocyte differential and CPDs could be very useful in the differential diagnosis of SARS-CoV-2 pneumonia and lead to a cheap and early diagnosis of the disease.
ABSTRACT
Objective: We conducted a survey to understand the challenges faced by the staff of residential aged care facilities (RACF), during the COVID-19 pandemic. Background: In the current pandemic, the RACF workforce has been required to work under stressful conditions, with immense mental and physical pressures, resulting in anxiety and stress felt towards their jobs. Study design and methods: We electronically surveyed both clinical and non-clinical staff at public and private RACFs in Australia in June and August 2020. The survey asked a mix of openended and closed questions about preparedness for the pandemic, information flow, experience with personal protective equipment (PPE), management of suspected COVID cases, restrictions on visitors, and impact on RACF staff personal and home life. Quantitative data were analysed in SPSS;qualitative data using content analysis. Results: We received 371 responses: 198 from clinical staff and 168 from non-clinical staff. Respondents were between 20-71 years old, and 87% were female most commonly from Victoria (28%) or New South Wales (28%). The majority (80%) felt that Australian RACFs were well-prepared for the pandemic and 87% agreed that relevant healthcare authorities were contactable for information needed. A total of 37% reported challenges in estimating and ordering appropriate quantities of protective equipment. Ninety percent of facilities reported screening residents for possible symptoms and 77% introduced precautions or quarantine measures to protect residents. Most participants (98%) reported their RACF implemented restrictions on visitor access and 43% reported unfair or abusive treatment by family or friends of the residents. Commonly reported personal impacts included: workload increase, stress, emotional toll, family issues and fatigue. Support from colleagues as well as training, de-brief sessions and frequent meetings were identified as helpful facilitators during this time. Conclusion: We identified a wide range of practices and coping strategies among Australian RACFs. Whilst a majority of respondents reported coping well, a large proportion reported struggling both mentally and physically. Factors reported as helpful by the respondents may assist RACFs in planning for future pandemics. Implications for research, policy and practice: Understanding the challenges faced by all levels of staff within RACFs may aid decision-makers on a range of different levels - researchers, aged care providers, local/regional/state health departments and national leaders within government to help inform the development of interventions that may help the sector to recover, as well as prepare for potential future outbreaks. Of particular importance, are interventions or initiatives that focus on supporting the physical and mental health of staff i.e. those that prevent or minimise worker fatigue, emotional burnout and stress. What is already known about the topic? Nursing staff in Australian RACFs did not feel prepared for the COVID outbreak in their workplace. Early in 2020, RACF nurses experienced a greater overall workload and some had their staff hours reduced by their employers due to financial constraints caused by the outbreak. What this paper adds This paper offers a comprehensive insight into how RACF staff coped both individually and as part of the facility overall during the COVID crisis. It identified that a commonly reported source of stress was first-hand verbal abuse from family or friends of residents in response to visitor and lockdown restrictions implemented by the authorities. The paper highlighted that whilst the majority of respondents felt that RACFs were well prepared for managing residents during the pandemic, some facilities experienced significant problems with workloads, PPE and human resourcing. Furthermore, the survey showed that on an individual level, some staff experienced significant mental and physical stress during the outbreak.