The Knowledge and Attitude Medical Surgical Nursing Relates to Alertness in Giving Care to Nursing COVID-19 Patients

Introduction: The purpose of this study was to analyze the relationship between the knowledge and attitudes of medical-surgical nurses and preparedness in providing nursing care for COVID-19 patients. The long COVID-19 pandemic has exhausted nurses serving patients, resulting in a lack of preparedness for health workers. Nurse preparedness is strongly influenced by the knowledge and attitudes of nurses in dealing with problems that arise. The preparedness, knowledge, and attitudes of nurses in providing nursing care for COVID-19 patients are not yet known in detail. Methods: The research design that has been used is cross-sectional. The population that has been used in this study is nurses in the Emergency Department. The sample that has been recruited is 34 people using the purposive sampling technique. The independent variables that have been determined are nurses' knowledge and attitudes about COVID-19. The dependent variable that has been used is the readiness of nurses in providing care about COVID-19. The instrument to collect data that has been used is a modified knowledge, attitude, and preparedness questionnaire. The data analysis that has been used is Spearman's rho correlation test. Results: The results showed that the knowledge and attitudes of medical-surgical nurses were related to nursing preparedness in providing nursing care to COVID-19 patients (p = 0.022 and p = 0.018). Conclusion: Nurses' knowledge and attitudes in providing nursing care to COVID-19 patients can maintain nurse preparedness properly. Training and seminars about COVID-19 are highly recommended to be carried out frequently so that nurse preparedness remains good. [ FROM AUTHOR] Copyright of Malaysian Journal of Medicine & Health Sciences is the property of Universiti Putra Malaysia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Trajectories of children and adolescents attending a psychiatric emergency unit during the COVID-19 confinements: 2020-2022 longitudinal study.

INTRODUCTION: The prevalence of psychiatric disorders has not shifted widely through the COVID pandemic, except for some specific groups such as young people or women. Our objective is to examine prospectively the evolution of children and adolescents who consulted in a psychiatric emergency service during the COVID-19 confinements. METHOD: We collected prospective clinical information about 296 young people under 18 who visited a tertiary hospital for psychiatric reasons during the confinement periods in Spain. Clinical diagnoses, suicide attempts, hospital admissions, and pharmacological prescriptions were extracted from electronic health records through 2020, 2021, and 2022. Features of those who maintained psychiatric care and those who did not were compared. RESULTS: Three out of four children and adolescents who visited the psychiatric emergency department during the confinements continued psychiatric care at the end of 2022. Those who did not showed better premorbid adjustment at baseline. During follow-up, diagnoses of neurodevelopmental disorders and eating disorders, as well as the dosage of psychotropic drug prescriptions, increased. The diagnoses of major depressive disorder and eating disorder at baseline were associated with attempting suicide during follow-up. Patients with internalizing symptoms were admitted earlier than those with externalizing symptoms but no differences were found in terms of suicide attempts. CONCLUSIONS: The continuity of psychiatric care after an initial emergency visit during the confinements implied greater clinical severity, as reflected by changes in clinical diagnoses and pharmacological regimens. Emergent symptoms of depression or eating disorders after social distancing or isolation could predict subsequent suicidal behavior in young populations.

BNT162b2 immunization-related myocarditis in adolescents and consequent hospitalization: Report from a medical center.

BACKGROUND: To investigate Pfizer-BioNTech 162b2 mRNA COVID-19 vaccine (BNT162b2) immunization-related myocarditis and describe the risk factors for consequent hospitalization in the pediatric intensive care unit (PICU) in children between 12 and 18 years. METHODS: Children and adolescents 12 years of age and older who presented with discomfort after BNT162b2 immunization (BNTI) and visited pediatric emergency room (PER) at Chang Gung Memorial Hospital from September 22, 2021 to March 21, 2022, were included for analysis. RESULTS: 681 children presented with discomfort after BNTI and visited our PER. The mean age was 15.1 ± 1.7 years. Three hundred and ninety-four (57.9%) and 287 (42.1%) events were after 1st and 2nd dose, respectively. 58.4% (n = 398) were male. The most common complaints were chest pain (46.7%) and chest tightness (27.0%). The median (interquartile range [IQR]) interval of discomfort after BNTI was 3.0 (1.0-12.0) days. BNTI-related pericarditis, myocarditis and myopericarditis were diagnosed in 15 (2.2%), 12 (1.8%) and 2 (0.3%) patients, respectively. Eleven (1.6%) needed hospitalization in PICU. The median (IQR) hospital stay was 4.0 (3.0-6.0) days. There was no mortality. More patients were diagnosed myocarditis (p = 0.004) after 2nd dose BNTI. PICU admission occurred more commonly after 2nd dose BNTI (p = 0.007). Risk factors associated with hospitalization in PICU were abnormal EKG findings (p = 0.047) and abnormal serum troponin levels (p = 0.003) at PER. CONCLUSION: Myocarditis in children aged 12-18 years occurred more commonly following 2nd dose BNTI. Most cases were of mild or intermediate severity without death. Factors predicting BNTI-related myocarditis and consequent hospitalization in PICU were abnormal EKG findings and abnormal serum troponin levels at PER in this study.

Effect of the COVID-19 Pandemic on Musculoskeletal Care in the Emergency Room.

OBJECTIVE: Study the effect of the COVID-19 pandemic on emergency room (ER) utilization for musculoskeletal (MSK) complaints. METHODS: Data from ER encounters in a teaching hospital for years 2019 and 2020 were extracted from an electronic database. The ICD-10-CM code were used to assign the primary diagnosis. Joinpoint regression was applied to time-series to detect changes in daily encounters (all-cause and MSK). Total number and median daily encounters were calculated by year, sex, age groups, and diagnostic codes for each year. RESULTS: Overlapping intervals within March 2020 showed drops of 8.1 all-cause encounters per day (95% CI: 4.8-11.5), and 1.2 MSK encounters per day (95% CI: 0.8-1.7), resulting in net losses for the year of 33.2 % for all-cause and 35.8% for MSK encounters . Reductions were observed for both sexes and all age groups. MSK codes with largest declines were low back pain, joint pain, and limb pain. CONCLUSION: The COVID-19 pandemic resulted in major reductions in all-cause and MSK encounters in the ER of an academic hospital probably due to governmental restricions and a change in patients behavior. Persistence of the observed reduction suggests that patients requiring ER services delayed seeking care for MSK and other health conditions.

[Suicide attempt before and during the COVID-19 pandemic: A comparative study from the emergency department]. / Intento de suicidio antes y durante la pandemia de covid-19. Estudio comparativo desde el servicio de urgencias.

OBJECTIVES: To study the prevalence and characteristics of the patients who consulted in the emergency department for attempted suicide in 2021 and to compare them with those carried out in the pre-Covid period in 2019. METHODS: Retrospective cross-sectional study between January 1 and December 31, 2019 and 2021. Demographic, clinical variables (history, psychiatric medication, toxic abuse, mental health follow-up, and previous suicide attempt) and characteristics of the current suicide episode (mechanism, triggering reason, and patient destination) were included. RESULTS: They consulted 125 patients in 2019 and 173 in 2021, mean age 38.8±15.2 and 37.9±18.5 years, women 56.8% and 67.6%. They presented: previous suicide attempt, men 20.4% and 19.6%, women 40.8% and 31.6%; substance use disorder, men 51.8% and 46.4%, women 39.4% and 17.1%, due to alcohol, men 78.6% and 88.5%, women 82.1% and 70%. Characteristics of the autolytic episode: pharmacological cause, 68.8% in 2019, 70.5% in 2021, benzodiazepines (81.3% and 70.2%); toxic (30.4% and 16.8%), alcohol (78.9% and 86.2%), medication more associated with alcohol (benzodiazepines, 56.2% and 59.1%); self-harm (11.2% and 8.7%). Destination of the patients: outpatient psychiatric follow-up (84% and 71.7%), hospital admission (8.8% and 11%). CONCLUSIONS: There was an increase in consultations of 38.4%, the majority were women, who also presented a higher prevalence of previous suicide attempt; men presented more substance use disorder. The most frequent autolytic mechanism was drugs, especially benzodiazepines. The most used toxicant was alcohol, most of the time associated with benzodiazepines. Upon discharge, most patients were referred to the mental health unit.

Emergency room presentations of people with anorexia nervosa.

People with anorexia nervosa (AN) tend to shy away from engaging in typical primary care provider relationships in order to avoid detection. Therefore, they may seek care for their medical concerns through a local emergency department (ED). Inherently, AN is associated with a litany of medical complications, which become more prevalent as the severity of their eating disorder increases. Notwithstanding the typical young age at the onset of AN, no body system is immune to these medical complications. Thus, ED providers may need to pursue a medical diagnosis in order to explain presenting symptoms in people with AN. In addition to the medical issues, AN is also a serious mental illness with high mortality rates, including deaths by suicide. Therefore, ED providers also need to be familiar with relevant mental health issues for these people.

People with anorexia nervosa frequent emergency departments to obtain their medical care. It is thus important for emergency department personnel to be familiar with this increasingly common and serious disorder. As opposed to most other mental illnesses, anorexia nervosa is associated with many dangerous medical complications, which become more problematic as the malnutrition and weight loss become more severe. All body systems are adversely affected. The mortality rate of anorexia nervosa is the second highest of all mental disorders, with medical complications and suicide being the top two causes of death. Mandated medical care may occasionally be required to obtain ongoing treatment for people with anorexia nervosa when they present to the emergency department with severe malnutrition and other emergent complications.

Psychiatric Emergencies in Los Angeles County During, and After, Initial COVID-19 Societal Restrictions: An Interrupted Time-Series Analysis.

Emergency department (ED) visits for psychiatric care in the US reportedly declined during the COVID-19 pandemic. This work, however, does not control for strong temporal patterning in visits before the pandemic and does not examine a potential "rebound" in demand for psychiatric care following the relaxation of initial societal restrictions. Here, we examine COVID-19-related perturbations in psychiatric care during and after the 1st stage of societal restrictions in the largest safety-net hospital in Los Angeles. We retrieved psychiatric ED visit data (98,888 total over 156 weeks, Jan 2018 to Dec 2020) from Los Angeles County + USC Medical Center. We applied interrupted time series methods to identify and control for autocorrelation in psychiatric ED visits before examining their relation with the 1st stage of societal restrictions (i.e., March 13 to May 8, 2020), as well as the subsequent "rebound" period of relaxed restrictions (i.e., after May 8, 2020). Psychiatric ED visits fell by 78.13 per week (i.e., 12%) during the 1st stage of societal restrictions (SD = 23.99, p < 0.01). Reductions in ED visits for alcohol use, substance use, and (to a lesser extent) anxiety disorders accounted for the overall decline. After the 1st stage of societal restrictions, however, we observe no "rebound" above expected values in psychiatric ED visits overall (coef = - 16.89, SD = 20.58, p = 0.41) or by diagnostic subtype. This pattern of results does not support speculation that, at the population level, foregoing ED care during initial societal restrictions subsequently induced a psychiatric "pandemic" of urgent visits.

Does the remote consultation mobile unit or phygitale medical unit, a new way of managing unscheduled care in general medicine, make it possible to reduce the use of emergency rooms?

Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS

Demand Analysis of a Psychiatric Emergency Room and an Adolescent Acute Inpatient Unit in the Context of the COVID-19 Pandemic in Madrid, Spain.

Introduction: COVID-19 represents a serious threat to mental health worldwide. The aim of this study is to identify changes in adolescent psychiatry treatment demand in a tertiary hospital in Madrid during the first month (March 11 to April 11) after the pandemic declaration by the World Health Organization (WHO). We hypothesized that fear of contagion within COVID-19 may deter people from asking for psychiatric care. Method: The current study is retrospective, observational, and transversal. We reviewed the clinical records of 89 adolescents who went to the Emergency Room (ER) or were hospitalized at the Acute Inpatient Unit (AIU) at the Puerta de Hierro University Hospital-Majadahonda (PHUH-M) between March 11 and April 11. Socio-demographic, clinical, and demand variables were included in the study. Chi-square or Fisher exact tests were performed to compare categorical variables. We used the U Mann-Whitney test to compare quantitative variables. The level of statistical significance was set at p< 0.05. Analyses were conducted using SPSS v11.0. Results: The number of adolescents demanding psychiatric care at the ER dropped from 64 adolescents in 2019 to 25 in 2020. Similarly, psychiatric demand collapsed from 31 to 18 patients when comparing 2019 and 2020. Furthermore, the average hospital stay in 2020 trended toward a decrease when compared to 2019 (8.94 ± 4.87 vs. 14.32 ±10.23, p = 0.08). Self-injurious thoughts and behaviors were the most predominant reasons for consultation at both ER and AIU. Conclusion: The demand for adolescent psychiatric care decreased in the first month after the declaration of the pandemic. Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive reaction described in other disasters. Further studies are needed.

A Following Wave Pattern of Suicide-Related Pediatric Emergancy Room Admissions during the COVID-19 Pandemic.

The COVID-19 pandemic and response, which included physical distancing and stay-at-home orders, disrupted the daily lives of children and adolescents, isolating them from their peers, school, and other meaningful contacts. The present study aims to add to the accumulating evidence on the pandemic's impact on child and adolescent suicidal behavior. Data were extracted from Schneider Children's Medical Center of Israel's pediatric emergency room (ER) admissions for psychiatric consultation for suicidal-risk assessment between 1 January 2020, and 16 April 2022. We applied time-lagged cross-correlation analysis and a Granger causality test to assess the temporal relationships between COVID-19 infection waves and patterns of suicide-related ER admissions. The results revealed a significant lagged correlation between national COVID-19 infection rates and ER admission rates. The highest correlation was above 0.4 and was found with a lag of 80 to 100 days from infection rate to ER admission rate. The findings show that the effects of public crises change over time and may be lagged. This may have important implications for mental health services' readiness to serve growing numbers of children and adolescents at risk for suicide.

Psychiatric Emergencies and Suicide Attempts Before and During COVID-19 Lockdown in Spain.

Background: The COVID-19 pandemic had a significant impact on the mental health of the population. The lockdown period in Spain - from March 14 to June 21, 2020 - was particularly stressful. This study aims to examine the differences in visits to the emergency department for psychiatric reasons before and during the lockdown period in a hospital in the province of Lleida (Catalonia, Spain), which has a catchment area of 431,183 inhabitants. We hope that this study can contribute to the understanding of this difficult period in our recent history and help us to be prepared in case of new social emergencies that may affect the mental health of the general population. Aims: This study aims to examine the differences in ER visits due to psychiatric reasons before and during the COVID-19 lockdown period in a province hospital in Spain. Methods: We compared the n = 1,599 visits to the emergency room and their characteristics before (June 13 to March 13, 2020) and during (March 14 to June 21, 2020) the lockdown period in the province of Lerida, Spain. Data were obtained from the electronic health records. Information collected included sociodemographic variables, reason for consultation, previous diagnosis, and characteristics of suicidal ideation and attempts - including history of previous suicidal behavior, method, days spent in the ER, suicide reattempts at 6-month follow-up. Results: Before lockdown, there were an average of 11.2 psychiatric emergencies per day compared with 9.2 psychiatric emergencies per day during lockdown. Regarding suicidal behavior, before lockdown, there were an average of 0.9 suicide attempts before lockdown compared with 0.7 attempts per day during lockdown. Limitations: Since the data came from the electronic health records, we have relied on the clinical diagnosis made by different psychiatrists. Also, we did not record psychiatric comorbidities, but instead only registered one main Axis I diagnosis and one main Axis II diagnosis. Conclusions: We observed a decrease in the number of visits to the ER in general, as well as a lower frequency of patients with suicidal behavior during the first and only lockdown period in Spain, which occurred during the initial months of the pandemic. This is consistent with previous studies showing a reduction of suicidal behavior during periods of social emergency. However, this decrease could be only temporary, and several authors predict an increase of suicidal behavior in the aftermath of the COVID-19 crisis. Ensuring access to mental healthcare during periods of crisis is crucial for the population.

Pediatric psychiatric emergency rooms during COVID-19: a multi-center study.

BACKGROUND: The COVID-19 (SARS-CoV-2) pandemic has been a major stressor for the mental health and well-being of children and adolescents. Surveys and reports from hotlines indicate a significant rise in mental health problems. As the psychiatric emergency room (ER) is a first-line free-of-charge facility for psychiatric emergencies, we expected to see a significant increase in visits, specifically of new patients suffering from anxiety, depression, or stress-related disorders. METHODS: Data from two psychiatric hospital ERs and one general hospital were included. All visits of children and adolescents from the computerized files between March and December of 2019 were analyzed anonymously and compared to the same months in 2020, using multilevel linear modeling. RESULTS: There was a significant decline in the total number of visits (p = .017), specifically among those diagnosed as suffering from stress-related, anxiety, and mood disorder groups (p = .017), and an incline in the proportion of visits of severe mental disorders (p = .029). DISCUSSION: The limited use of child and adolescent psychiatric emergency facilities during the pandemic highlights the importance of tele-psychiatry as part of emergency services. It also suggests the importance of the timeline of the emergence of clinically relevant new psychiatric diagnoses related to the pandemic. Future studies are needed to establish the long-term effects of the pandemic and the expeditious use of tele-psychiatry.

Does the remote consultation mobile unit or phygitale medical unit, a new way of managing unscheduled care in general medicine, make it possible to reduce the use of emergency rooms?

Introduction: In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method(s): We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lo Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Result(s): The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26 years (P < 0.001). The interventions lasted an average of 1 hour and 27 minutes. Discussion(s): This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion(s): The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents. Copyright © 2022 Elsevier Masson SAS

L'unité mobile de télémédecine ou unité médicale phygitale, un nouveau vecteur de prise en charge des soins non programmés en médecine générale, permet-elle de diminuer le recours au SAU (service d'accueil des urgences) ?

Résumé Introduction En partenariat avec l'Association SAUVlife (unité mobile de télémédecine) « phygital » et le SAMU 50, l'UMT où une unité phygitale a été déployée dans la Manche destinée à des patients âgés et/ou dépendants pour lesquels l'accès aux soins est rendu difficile par la carence de médecin traitant et de la diminution des visites à domicile. Ce nouveau vecteur pourrait être une alternative au recours aux urgences hospitalières. Méthode Nous avons réalisé une étude observationnelle rétrospective monocentrique de l'activité de l'UMT du 1er janvier au 30 juin 2021 au sein du service du SAMU 50 au CH Saint-Lô. Après régulation médicale, les patients ne relevant pas d'une urgence vitale pouvaient bénéficier d'une intervention de l'UMT. Résultats L'UMT est intervenue 681 fois. Au décours, 65,6 % de patients ont pu être laissés sur place. Cette unité phygitale a réalisé 621 téléconsultations permettant à 414 patients (66,7 %) de rester chez eux et 199 patients (32 %) d'être transportés vers un SAU. Ceux transportés étaient significativement plus âgés avec un âge moyen de 71,26 ans (p<0,001). Les interventions ont duré 1h27 en moyenne. Discussion Cette expérimentation est inédite dans le cadre de l'urgence. Cet outil semble répondre à la carence d'offre de soins du département. Son utilisation dans le cadre de la pandémie de COVID-19 est probante et permet par ses prises en charge à domicile une limitation des transmissions virales. Toutefois, les interventions sont longues et l'utilisation de l'UMT peut être optimisée tant sur le temps d'intervention que sur le nombre réalisé par jour. Conclusion L'unité mobile de télémédecine est un vrai apport en l'absence de médecins généralistes pour réaliser des visites à domicile de soins non programmés d'autant plus dans un contexte épidémique où elle limite le recours aux urgences et in fine la transmission des agents infectieux. Summary Introduction In partnership with SAUVlife volunteers and SAMU 50, a remote consultation mobile unit (UMT) was deployed in the Manche department of France, targeting elderly and dependent patients where access to care is difficult due to the lack of a general practitioner and the decrease of home visits. This new vector could be an alternative to the use of emergency rooms. Method We performed a monocentric retrospective observational study of the activity of the UMT from January 1 to June 30, 2021 within the SAMU 50 at the Saint-Lô Hospital. After initial medical regulation, the patients without a vital emergency could benefit from an intervention of the UMT. Results The UMT intervened 681 times. At the end of the intervention, 65.6% of the patients could be left on site. The phygital unit performed 621 teleconsultations allowing 414 patients (66.7%) to remain at home and 199 patients (32%) to be transported to an emergency room. Those transported were significantly older with an average age of 71.26years (P<0.001). The interventions lasted an average of 1hour and 27minutes. Discussion This experiment is new in the emergency context. This tool seems to respond to the lack of ambulatory care in the department. Its use in the context of the COVID-19 pandemic is convincing and allows for the limitation of viral transmissions through home care. However, the interventions are long and the use of the UMT can be optimized both in terms of intervention time and the number of interventions performed per day. Conclusion The mobile telemedicine unit is a real contribution in the absence of general practitioners, to carry out unscheduled home visits. Even more in an epidemic context where it limits the use of emergency rooms and ultimately the transmission of infectious agents.

How Covid-19 changed emergency department access: observational study comparison of patient stage of the day access in the psychiatric emergency department over three years

Introduction: A few studies have analyzed the impact of COVID-19 pandemic on psychiatric Emergency Department (ED) accesses. The pandemic may indeed have influenced the phase of day accesses for patients with psychiatric disorders. Objective(s): Aim of this cross-sectional study is to analyze how COVID-19 weighed on psychiatric patients daily accesses over the course of three years. Method(s): Data on 219 patients were retrospectively collected from the ED in the Policlinico Tor Vergata, Rome. According to the stage of the day, accesses were divided into 4 groups: between 00:00 and 6:00;between 6:00 a.m. and 12:00 a.m.;between 12:00 a.m. and 18:00 p.m.;between 18:00 p.m. and 00:00 p.m. Result(s): Performing a regression analysis, a relation was found between psychiatric symptoms, stage of the day admission and year. In 2019 the admissions seem to be homogeneously distributed, however during 2021 and 2020 the admissions rates have a delayed evening trend. Conclusion(s): Despite the low number of accesses considered, the Covid-19 pandemic appears to exert an effect that still lasts in terms of both accesses and worsening or new onset of psychiatric symptoms. Measures taken to prevent the spread of infections may have affected access in the ED of patients in various ways. However, the trend of increasing evening accesses could be related to a saturation of territorial psychiatric services that work mainly until the afternoon. Thus, an enhancement of territorial psychiatric services seems highly necessary to cope with what could be an increase in psychopathology in patients without previous diagnosis.

[Impact of the COVID-19 crisis in Spring 2020 on trauma case numbers of an academic teaching hospital in Stuttgart : Trauma during a pandemic]. / Einfluss der COVID-19-Krise im Frühjahr 2020 auf traumatologische Fallzahlen eines akademischen Lehrkrankenhauses in Stuttgart : Trauma während einer Pandemie.

BACKGROUND: To cope with the COVID-19 outbreak in Germany, the government imposed a lockdown, which led to restrictions and lifestyle changes for the population. PURPOSE: This study aimed to evaluate the impact of the lockdown on activities causing trauma and the consultation in emergency rooms. MATERIAL AND METHODS: All consecutive trauma patients consulting the Emergency Department of the Marienhospital Stuttgart (MHS), Germany, during the 6 weeks preceding the lockdown, during and after the lockdown were included. The time and type of consultation, treatment received, Manchester triage score, type of trauma, the anatomical region of the injury as well as demographic data were reported and compared. RESULTS: The study included 551 cases during lockdown, 943 cases before and 783 cases after the lockdown. We observed a reduced caseload during the lockdown of 41.6% compared to before and of 29.7% compared to after (p < 0.001). Patients were on average older in the observation group than in both control groups (before : 51.5 years, lockdown: 56.1 years, after: 51.6 years) (p < 0.001). Injuries to the head and neck were constant (25.0%, 25.4%, 25.5%). We noticed lower limb injuries decreasing (26.1%, 22.3%, 22.7%) and upper limb injuries increasing (25.5%, 31.8%, 30.1%). A decrease in sports injuries (11.1%, 5.1%, 9.1%) and work accidents (16.1%, 10.7%, 12.8%) resulted in more domestic accidents (30.4%, 52.5%, 31.8%). Self-referral decreased (67.7%, 53.2%, 60.3%) while referral via paramedics increased (28.3%, 38.7%, 35.6). Blunt trauma was the most common cause of injury (55.6%, 61.0%, 55.3%). Indications for surgery were higher (16.8%, 21.6%, 14.0%). CONCLUSION: The lockdown and restrictions in personal life and daily routine had an impact on the frequency, etiology and management of trauma patients in Stuttgart.

The Impact of COVID-19 Pandemic on Psychiatric Emergencies in Two Different Settings: Emergency Room and Community Mental Health Service.

Background: The SARS-CoV-2 pandemic caused a public health emergency with profound consequences on physical and mental health of individuals. Emergency Rooms (ER) and Community Mental Health Services (CMHS) played a key role in the management of psychiatric emergencies during the pandemic. The purpose of the study was to evaluate urgent psychiatric consultations (UPCs) in the ERs of the General Hospitals and in the CMHS of a Northern Italian town during the pandemic period. Methods: This monocentric observational study collected UPCs carried out in ER from 01/03/2020 to 28/02/2021 (the so called "COVID-19 period") and the demographic and clinical characteristics of patients who required UPCs in the 12-months period, comparing these data with those collected from 01/03/2019 to 29/02/2020 (the so called "pre-COVID-19 period"). The same variables were collected for UPCs carried out in CMHS from 01/03/2020 to 31/01/2021 and compared with those collected from 01/03/2019 to 31/01/2020. The data, were statistically analyzed through STATA 12-2011. Results: In ER, we reported a 24% reduction in UPCs during the COVID-19 period (n = 909) in comparison with the pre-COVID-19 period (n = 1,194). Differently, we observed an increase of 4% in UPCs carried out in CMHS during the COVID-19 period (n = 1,214) in comparison with the previous period (n = 1,162). We observed an increase of UPCs in ER required by people who lived in psychiatric facilities or with disability pension whereas more UPCs in CMHS were required by older people or those living in other institutions compared to the previous period. In the COVID-19 period, the most frequent reasons for UPCs in ER were aggressiveness, socio-environmental maladjustment and psychiatric symptoms in organic disorders whereas in CMHS we reported an increase of UPCs for control of psychopharmacology therapy and mixed state/mania. Conclusion: In light of our findings, we conclude that the most vulnerable people required more frequent attention and care in both ER and CMHS during pandemic, which disrupted individuals' ability to adapt and induced many stressful reactive symptoms. In order to reduce the impact of the COVID-19 pandemic on mental health, psychological support interventions for the general population should be implemented, having particular regard for more psychologically fragile people.

STRESS MANAGEMENT OF EMERGENCY NURSES DURING THE COVID-19 PANDEMIC: SCOPING ARTICLE

Nurses are front-line health professionals. This is especially so for those in the Emergency Room (ER) and during the COVID-19 pandemic, as they are the key to controlling virus transmission. The purpose of this article is to review the stress management strategies applied by nurses in emergency rooms throughout the COVID-19 pandemic. A scoping review was done by searching for related literature using databases from Science Direct, ProQuest, SAGE Journal, and BMJ. We explored the literature from a relevant point of view and assessed the quality of the research. The data were then mapped to identify the main themes found in the literature. A total of 36 articles were found from the search results and six articles were selected to be analyzed. We observed that stress on nurses is caused by an excessive burden of several factors, such as having a family or child, lifestyle changes, lack of access to personal protective equipment (PPE), lack of self-confidence, as well as feelings, and fatigue. We also observed how nurses managed stress, namely, by strengthening training, positive spiritual coping, social support, and access to mental health services. © 2022, Universitas Jenderal Soedirman. All rights reserved.

Change in Diagnosis of Benign Paroxysmal Positional Vertigo During COVID-19 Pandemic.

Purpose: The present study investigated the impact of coronavirus disease 2019 (COVID-19) pandemic on benign paroxysmal positional vertigo (BPPV). Patients and Methods: The medical records of BPPV patients who were evaluated in the outpatient department (OPD) and emergency room (ER) during (435 patients) and before (517 patients) the COVID-19 pandemic were retrospectively reviewed. Dix-Hallpike and supine head-roll tests were used to classify the subtype of BPPV as posterior semicircular canal (PSCC), geotropic lateral semicircular canal (geotropic LSCC), or apogeotropic lateral semicircular canal (apogeotropic LSCC) BPPV. Results: More patients with PSCC BPPV were diagnosed at the OPD compared with those who were diagnosed at the ER both before and during the COVID-19 pandemic; however, more patients with LSCC BPPV were diagnosed at the ER compared with those who were diagnosed at the OPD during the same periods. The mean time interval between vertigo onset and initial evaluation was remarkably longer during the pandemic in patients with PSCC BPPV. Conclusion: This study demonstrated that the incidences of BPPV subtypes according to hospital visit type were not significantly different before and during the COVID-19 pandemic. Because hospital visits were delayed in patients with PSCC BPPV during the COVID-19 pandemic, telemedicine or e-health could be suitable alternatives to face-to-face medical care for these patients.

La médecine d’urgence de la création aux perspectives

Résumé Pour comprendre la crise actuelle des urgences et les solutions que l’on peut y apporter, il est nécessaire de d’analyser les origines de la médecine urgence. Sa dimension pré hospitalière qui est parfois critiquée et décriée est directement issue de la réponse à des crises sanitaires majeures. Sa reconnaissance réglementaire a pris du temps et a fait l’objet de nombreuses discussions avant d’aboutir en 1986 à une loi. Le rapprochement de la composante pré hospitalière et hospitalière de la Médecine d’Urgence a permis la création d’une nouvelle spécialité médicale. Des événements récents, notamment la crise COVID, ont montré l’adaptabilité et l’évolutivité de ce système et sa pertinence. La crise actuelle des urgences fait partie d’un phénomène plus global qui touche tout l’hôpital. De nombreuses solutions existent optimiser aussi bien l’amont, l’aval et l’organisation du service d’accueil des urgences (SAU). Mais, au-delà de ces considérations c’est dans le cadre d’une refonte du système de soins qu’il faut définir un nouveau contrat rassemblant les professionnels et le public, autour de la demande et pas seulement l’offre existante de soins. C’est le meilleur garant d’une utilisation pertinente des ressources de médecine d’urgence aussi bien hospitalières que pré hospitalières. Summary To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.