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From the perspective of the IRB, the requirements for data safety monitoring as appropriate for assent by minors, for permission from parents, is already there to apply to COVID-19 research. If you had a research protocol seeking to enroll minors, and it required them to give up standard of care therapy in order to participate and they had asthma, that would be cause for concern by the IRB. Russell-Einhorn: We've drawn lines to review this research for adults vs. pediatrics for numerous years. Since we do make a distinction between a minor and an adult, and a 17-yearold is considered a minor.
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Improving the process of strategic management in hospitals preparation and equipping the intensive care units (ICUs) and the availability of medical devices plays an important role for knowing consumer behaviour and need. This cross-sectional study was performed in the ICU of Farhikhtegan Hospital, Tehran, Iran for a period of six months. During these months, ten medical devices have been used 5,497 times. These devices include: ventilator, oxygen cylinder, infusion pump, electrocardiography machine, vital signs monitor, oxygen flowmeter, wavy mattress, ultrasound sonography machine, ultrasound echocardiography machine, and dialysis machine. The Apriori algorithm showed that four devices: ventilator, oxygen cylinder, vital signs monitoring device, oxygen flowmeter are the most used ones by patients. These devices are positively correlated with each other and their confidence is over 80% and their support is 73%. For validating the results, we have used equivalence class clustering and bottom-up lattice traversal (ECLAT) algorithm in our dataset.
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ObjectiveTo assess the effectiveness of hydroxychloroquine in patients admitted to hospital with coronavirus disease 2019 (covid-19) pneumonia who require oxygen.DesignComparative observational study using data collected from routine care.SettingFour French tertiary care centres providing care to patients with covid-19 pneumonia between 12 March and 31 March 2020.Participants181 patients aged 18-80 years with documented severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who required oxygen but not intensive care.InterventionsHydroxychloroquine at a dose of 600 mg/day within 48 hours of admission to hospital (treatment group) versus standard care without hydroxychloroquine (control group).Main outcome measuresThe primary outcome was survival without transfer to the intensive care unit at day 21. Secondary outcomes were overall survival, survival without acute respiratory distress syndrome, weaning from oxygen, and discharge from hospital to home or rehabilitation (all at day 21). Analyses were adjusted for confounding factors by inverse probability of treatment weighting.ResultsIn the main analysis, 84 patients who received hydroxychloroquine within 48 hours of admission to hospital (treatment group) were compared with 89 patients who did not receive hydroxychloroquine (control group). Eight additional patients received hydroxychloroquine more than 48 hours after admission. In the weighted analyses, the survival rate without transfer to the intensive care unit at day 21 was 76% in the treatment group and 75% in the control group (weighted hazard ratio 0.9, 95% confidence interval 0.4 to 2.1). Overall survival at day 21 was 89% in the treatment group and 91% in the control group (1.2, 0.4 to 3.3). Survival without acute respiratory distress syndrome at day 21 was 69% in the treatment group compared with 74% in the control group (1.3, 0.7 to 2.6). At day 21, 82% of patients in the treatment group had been weaned from oxygen compared with 76% in the control group (weighted risk ratio 1.1, 95% confidence interval 0.9 to 1.3). Eight patients in the treatment group (10%) experienced electrocardiographic modifications that required discontinuation of treatment.ConclusionsHydroxychloroquine has received worldwide attention as a potential treatment for covid-19 because of positive results from small studies. However, the results of this study do not support its use in patients admitted to hospital with covid-19 who require oxygen.
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BackgroundPenetrating injury of the oropharynx occurs frequently in children, however, anesthetic management is seldom described in such cases.Case presentationA 2-year old child came to the emergency room with a toothbrush impacted in the gingivobuccal sulcus making airway management difficult. We used a simple yet unique approach to secure the airway safely given the lack of pediatric size fibreoptic and videolaryngoscopes in our emergency operation theatre. The patient was kept in Pediatric ICU and watched for any complications and discharged on the 4th postoperative day.ConclusionsThus, ingenious non-invasive techniques to secure the airway can prevent the patient from undergoing surgical tracheostomy.
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INTRODUCTION. Moderate to severe respiratory distress among patients with COVID-19 is associated with a high mortality. This study evaluated ventilator support and mortality by Do Intubate (DI) or Do Not Intubate (DNI) orders. METHODS. This was a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of 15 l/min. The patients were divided into two groups corresponding to the first and second wave of COVID-19 and were subsequently further divided according to DI and DNI orders and analysed regarding need of ventilator support and mortality. RESULTS. The study included 178 patients. The mortality was 24% for patients with DI orders (n = 115) and 81% for patients with DNI orders (n = 63) increasing to 98% (n = 46) for patients with DNI orders and very high flow oxygen requirements ( 30 l/min.). From the first to the second wave of COVID-19, the use of constant continuous positive airway pressure (cCPAP) increased from 71% to 91% (p < 0.001), whereas the use of mechanical ventilation decreased from 54% to 28% (odds ratio = 0.38 (95% confidence interval: 0.17-0.85)). CONCLUSION. The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite an increase in use of cCPAP and treatment with dexamethasone and remdesivir during the second wave. Hence, careful evaluation on transition to palliative care must be considered for these patients.
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Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.
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PurposeThe COVID-19 pandemic has had a significant and worldwide influence on healthcare delivery, and it has significantly increased the pace at which digital technology is being used. Blockchain, one of these developing digital technologies, is distinguished by a number of properties. This study focuses on a blockchain-enabled healthcare supply chain. The purpose of this work is to investigate how blockchain technology (BCT) benefits the performance of healthcare supply chain management (HSCM).Design/methodology/approachThe present study is based on the empirical research. Blockchain Technology (BCT), Healthcare Sustainable Supply Chain Practices (HSSCP), Healthcare Supply Chain Performance (HSCP) and Stakeholders' Involvement (SI) practices are identified from the literature review and hypotheses are framed to check their interrelationship. For testing of hypothesis, a questionnaire was developed. Data collection was done by healthcare professionals via Google docs. The IBM SPSS version 22.0 was used to analyze the data and IBM SPSS AMOS 22.0 software was used for the development of structural modal. The data was collected through the Google form from the stakeholders of healthcare sector and analyzed through Structural Equation Modelling.FindingsThis research is focused on adoption of BCT enabled Healthcare Sustainable Supply Chain to improve HSCP. From the result, it had been found that BCT is positively effecting the stakeholder's involvement (SI) and HSSCP practices. Cumulatively, they positively impact the performance of HSCP. From this study, it is found that adoption of BCT enabled Healthcare Sustainable Supply Chain succours to combat COVID-19 situation.Originality/valueThis study attempts to show the potential benefits of the adoption of BCT enabled HSSCP to improve HSCP.
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Objective: To associate CT severity score with inflammatory markers and to determine outcomes of COVID-19 patients admitted to CMH Lahore. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Mar to Jun 2021. Methodology: Patients of COVID-19 age 18 and above, with a positive RT-PCR, were included in the study Clinical and radiological data of 200 patients was retrieved and analysed from the hospital registry. Results: In the present study, we studied the role of inflammatory markers in predicting the severity of COVID-19. We have compared the levels of LDH, CRP, IL-6 and serum Ferritin between the two groups. LDH (p=0.015), IL-6 (p=0.001) and Ferritin (p=0.001) were significantly different between the two groups, but CRP was not (p=0.811) significant. Conclusion: CT severity score associates well with the COVID-19 clinical severity. Our data suggest that the chest CT scoring system can predict the severity of COVID-19 disease and significantly associates with inflammatory markers.
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Objective: To determine the relationship between pre-existent hyperglycemia among patients with COVID-19 pneumonia requiring oxygen supplementation. Study Design: Cross-sectional study Place and Duration of Study: COVID-19 isolation wards, High Dependency Units, and Intensive Care Units of Mayo Hospital Lahore Pakistan, from Apr to May 2021. Methodology: Eighty-one patients with hyperglycemia but without a prior diagnosis of diabetes mellitus were selected for this study. The data was collected from COVID PCR positive patients admitted to the isolation ward and intensive care unit at Mayo Hospital, Lahore. All the patients admitted during a 2-month duration from April to May 2021. Results: A Total of 81 patients were included, of which 54(66.7%) were males. On the basis of HbA1c, 68(84%), 12(14.8%) and 1 (1.2%) patient(s) were diagnosed diabetic, pre-diabetic and non-diabetic respectively. Of the four patients requiring mechanical ventilation, 3(75%) were diabetic, and 1(25%) was pre-diabetic. Of patients who required non-invasive ventilation, 68(84.4%), 12(14.2%) and 1(1.3%) were diabetic, pre-diabetic and non-diabetic, respectively. Conclusion: There is a significant burden of undiagnosed diabetes mellitus and pre-diabetes among patients with severe COVID-19 who require oxygen supplementation or admission to high-dependency units. Therefore, all patients should undergo thorough testing to exclude underlying diabetes mellitus.
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At the beginning of the COVID-19 pandemic in Chile, in March 2020, a projection indicated that a significant group of patients with pneumonia would require admission to an Intensive Care Unit and connection to a mechanical ventilator. Therefore, a paucity of these devices and other supplies was predicted. The initiative "Un respiro para Chile" brought together many people and institutions, public and private. In the course of three months, it allowed the design and building of several ventilatory assistance devices, which could be used in critically ill patients.
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Research shows that while inhaling gas and air (Entonox) in labour is safe for mothers and babies, long-term cumulative exposure may carry health risks. Work notice The right to strike The UK government's Strikes (Minimum Service Levels) Bill is, at the time of going to press, at the committee stage in the House of Lords (the first chance for line-by-line examination). Visit bit.ly/ Clementine-register Working mums Maternity leave Careers After Babies research has found that of 848 mothers interviewed, 98% want to return to work after having a child but just 13% can make it work full-time, citing the cost of childcare and lack of flexibility from businesses as the reason. Find out more at hegenbergermedical.com/training Research Healthy eating support Researchers at the University of Hertfordshire are calling for better information on diet and nutrition to be made available to expectant parents.
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Michael's Hospital, Interdepartmental Division of Critical Care Medicine, Toronto, Canada Critical Care 2023, 27(S1): P001 Introduction: In the context of a pandemic with a massive influx of hypoxemic patients, the high oxygen consumption usually required to achieve optimal inspired fraction of oxygen (FiO2) with non-invasive respiratory supports may jeopardize healthcare organization and oxygen delivery capabilities in hospitals. P003 Effect of non-invasive respiratory support on interstitial lung disease with acute respiratory failure: a systematic review and meta-analysis N Sanguanwong1, N Jantarangsi2, J Ngeyvijit3, N Owattanapanich4, V Phoophiboon5 1Chulalongkorn University, Department of Physiology, Bangkok, Thailand, 2Buddhachinaraj hospital, Department of Internal Medicine, Phitsanulok, Thailand, 3Chulalongkorn University, Division of Pulmonary and Critical Care Medicine, Bangkok, Thailand, 4Mahidol University, Division of Trauma Surgery, Bangkok, Thailand, 5Chulalongkorn University, Critical Care Medicine, Bangkok, Thailand Critical Care 2023, 27(S1): P003 Introduction: The data of non-invasive respiratory support (non-invasive positive pressure ventilation;NIPPV and high flow nasal cannula;HFNC) in interstitial lung diseases (ILDs) with acute respiratory failure (ARF) are scarce [1, 2]. A random effects model was used to estimate the PF ratio, PaCO2, mortality, intubation rate and hospital length of stay. Methods: The data of 215 adult patients, who were admitted to ICU of a university hospital between April 2020 and October 2021, with severe COVID pneumonia and received HFOT were enrolled retrospectively in our study.
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Patients with cancer who contracted COVID-19 had high risk for inpatient hospital admission and death, according to study results. "COVID-19 in patients with solid tumors and hematologic malignancies undergoing active therapy is associated with poor outcomes, including a high risk [for] inpatient mortality," Alok A. Khorana, MD, professor of medicine at Cleveland Clinic Lerner College of Medicine, told HemOnc Today. The Leukemia b Lymphoma Society encourages all patients with blood cancer to get vaccinated because the side-effect profile of vaccination is no different for them than the general population.
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In 2008, the Centers for Disease Control and Prevention (CDC, n.d.) National Healthcare Safety Network (NHSN) announced new requirements, enforced with fiscal penalties, for hospitals to address hospital-acquired infections (HAIs). [...]nurse leaders across the United States supported design of new protocols and procedures to reduce central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), surgical site infection (SSI), and more. Recognizing the impact of NVHAP on patient safety and the lack of requirements for hospitals to monitor or report NVHAP, a group of U.S. healthcare leaders sponsored by the Department of Veterans Affairs formed the nurse-led National Organization to Prevent Hospital-Acquired Pneumonia (NOHAP) in 2020. The survey also included questions related to known NVHAP prevention practices on policy, training, monitoring and documentation, family involvement, supply availability, and specific oral care practices related to the COVID19 pandemic. Because recent research demonstrated some promise in the use of antiseptic mouth rinses in eradicating SARS-CoV-2 virus, two questions were included related to use of mouth rinses (Casale et al., 2020;Pelletier et al., 2021).
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Ventilators we are available with have several drawbacks such as difficult to port, expensive and meant to be operated by professionals which create hardness in fighting with medical care. Thus, it creates suffering for people in the pandemic like COVID19. So, it is required to develop a ventilator that can be affordable, easy to port and install. We aimed to design a IoT based ventilator system using various electronic devices such as microcontroller and sensors that could monitor patient's body status. People suffering from COVID19 or any lung disease find difficulty in breathing so in such condition of emergency this smart ventilator system can be used. Ambu bag is used to provide certain volume of air that is pressed by using motor mechanism. A portable low-cost ventilator with computerized controlling and feedback system is installed. Ventilator designed can be connected to an interface for smart functioning. This paper provides us with different methods to monitor the patient's health condition by measurement of pressure, level of breathing to know whether the condition is healthy or unhealthy. The designing and developing of low-cost portable ventilator deliver breaths to patients when Ambu bag is compressed by using a piston connected to servo motor whose speed can be varied. Input of the designed system is patient's heart beat and breathing rate and the volume of oxygen provided to patient's lung with required beathing rate is the output of the system. PID (proportional Integral Derivative) and Full state feedback H2 controllers are used for the performance analysis of the system. Result of this review paper is found that a low-cost ventilator is developed removing all the possible shortcomings of existing conventional ventilator. Ventilator designed is portable and smart by using Arduino, servo motor and ambu bag preferred for emergency uses and available for clinical application. © 2023 IEEE.
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Results: The study presents information about the medical treatment outcome in the case of 5 patients (0,67%) who experienced spontaneous hemorrhage as a part of Covid 19 infection in relation to the total number of 745 patients who were treated during that period in the Respiratory clinic as Covid patients with severe forms of infection. All patients who were directed to surgical treatment were prior to the transfer to Surgical clinic, i.e. Intensive care unit of the Anesthesiology and Reanimation Clinic of the University Clinical Center Tuzla, retested and their PCR tests were negative. In the group of patients with serious forms of hemorrhage caused by Covid 19 infection that we have analyzed so far, a very small number of patients 0, 67% (5) have been registered as such when compared with the total number of treated patients within the Respiratory center of Tuzla University Clinical Center, (745 patients), during the monitoring period of 16 months in 2020 and 2021. With realistic prognosis that this pandemic will prevail through mutated forms of viral infection, we consider that the incurrence of spontaneous hemorrhage will be more and more evident and will require clear guidance and response as to "what to do with those patients", how to choose the best approach, how to detect high risk patients and provide better treatment strategy.
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Objectives: During the COVID-19 surge, our hospital was overloaded due to the increasingly high volume of patients and lack of resources, which resulted in difficulties in complying with infection control and prevention (IPC) practices. In this study, we estimated healthcare-associated infection (HAI) incidence and relevant factors among COVID-19 patients in Hung Vuong hospital. Methods: This study included all SARS-CoV-2–positive adult patients hospitalized between September 1 and October 31, 2021. The Centers for Disease Control and Prevention definition of HAI in the acute-care setting was used. Results: Among 773 patients, 21 (2.72%) developed 26 separate HAIs. The cumulative days of hospitalization were 5,607. The incidence of HAI among COVID-19 patients was 4.64 per 1,000 days of hospitalization. The most frequent HAI was clinically defined pneumonia (46.2%), for which the ventilator-associated pneumonia (VAP) rate was 41.9 per 1,000 ventilator days. Among 21 positive cultures, the most frequently isolated microorganisms were pseudomonas aeruginosa, Klebsiella pneumoniae, and escherichia coli. HAIs were significantly associated with the number of central-line days (OR, 1.74;95% CI, 1.33–2.78), the number of indwelling urinary catheter days (OR, 1.46;95% CI, 1.05–2.03), the length of administration days (OR, 1.25;95% CI, 1.07–1.45), antibiotics use prior to HAIs (OR, 0.01;95% CI, 0.01–0.21), and the number of nasal cannula days (OR, 0.62;95% CI, 0.44–0.85). Conclusions: COVID-19 makes patients more vulnerable and may require more invasive procedures, increasing the infection risk by opportunistic pathogens like gram-negative Enterobacteriaceae. Hence, fundamental IPC recommendations should be strongly implemented.
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Background. In early 2020, the novel coronavirus pandemic forced communities around the globe to shut down and isolate. Routine graduate medical education activities have also been suspended as resident and fellow physicians-in-training have been re-deployed to support critical patient care services.Innovation. We developed a two-part hybrid telesimulation model to teach COVID-19 ventilator management strategies while physically separating a group of learners and an instructor from one another. Learners consisted of non-ICU health care providers with limited experience in ventilator management being redeployed to manage ICU level COVID-19 infected patients. In the first week, the video tutorial has been viewed over 500 times and we have facilitated 14 telesimulation sessions, including 48 participants comprised of hospitalists, emergency medicine physicians and physician assistants, pediatric residents, nurses, and a nurse educator.Conclusion. We believe that the combination of a video tutorial followed by an interactive telesimulation was successful in providing timely education during a coronavirus pandemic. Furthermore, it reinforced the value and flexibility in which simulation education could continue conveniently for learners despite significant restrictions in place during the coronavirus pandemic. Research is needed to assess the efficacy of this hybrid intervention in preparing healthcare workers and to determine if the knowledge is successfully transferred to the clinical setting.
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Dès la fin du mois de février 2020, les urgentistes français ont été confrontés à une situation inédite et complexe dans la gestion des cas les plus sévères d'infections pulmonaires associées au nouveau coronavirus (SARSCoV- 2). Les informations en provenance de Chine et les recommandations initiales de l'Organisation mondiale de la santé ont rapidement amené à considérer l'intubation et la ventilation mécanique précoce des malades atteints par la pneumonie de la Covid-19. Or, dès la fin du mois de mars 2020, grâce aux retours d'expérience et de prise en charge, d'abord de la part des réanimateurs et urgentistes italiens, puis espagnols, les pratiques et les recommandations concernant les modalités d'oxygénation et de ventilation des patients Covid-19 ont évolué. Le caractère exceptionnel de cette pandémie et la grande adaptabilité des services de Samu/Smur de France, en l'espace de quelques semaines, pour prendre en charge ces patients oxygénodépendants, justifient que nous en fassions le retour d'expérience, et ce, d'autant plus que nous sommes exposés à un risque de recrudescence d'infections respiratoires graves associées au SARS-CoV-2 à court terme, risquant de saturer une nouvelle fois notre système de santé. Nous détaillons donc ici le retour d'expérience des prises en charge médicales préhospitalières concernant principalement les supports d'oxygénation et de ventilation mécanique.Alternate abstract: At the end of February 2020, French emergency physicians were faced with a new and complex situation in the management of critical cases of SARS-CoV-2 infection. First information from China and the initial recommendations of the World Health Organization (WHO) quickly led us to consider early intubation and mechanical ventilation of patients with hypoxemic COVID-19 pneumonia. However, since the end of March 2020, feedback from Italian intensive care and emergency physicians, then Spanish, led to change in clinical practices and guidelines about oxygenation and mechanical or noninvasive ventilation of COVID-19 patients have evolved. The exceptional character of this pandemic and the great adaptability of French pre-hospital emergency medical services (Samu/Smur) in a few weeks, to manage those oxygen dependent patients, justified our feedback, especially because we are exposed to a risk of resurgence of serious short-term SARS-CoV-2-associated acute respiratory distress syndrome (ARDS), which could once again saturate our health system. We therefore detail here the feedback of pre-hospital medical care, mainly concerning the management of oxygenation and ventilation supports.
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The potential of the Internet of Health Things (IoHT), also identified in the literature as the Internet of Medical Things (IoMT), is enormous, since it can generate expressive impacts on healthcare devices, such as the capnograph. When applied to mechanical ventilation, it provides essential healthcare to the patient and helps save lives. This survey elaborates on a deep review of related literature about the most robust and effective innovative healthcare solutions using modern technologies, such as the Internet of Things (IoT), cloud computing, Blynk, Bluetooth Low Energy, Robotics, and embedded systems. It emphasizes that IoT-based wearable and smart devices that work as integrated systems can be a faster response to other pandemic crises, respiratory diseases, and other problems that may occur in the future. It may also extend the performance of e-Health platforms used as monitoring systems. Therefore, this paper considers the state of the art to substantiate research about sensors, highlighting the relevance of new studies, strategies, approaches, and novelties in the field.