Establishment of medical service protocols in large public hospitals for the prevention and control of coronavirus disease 2019.

Coronavirus disease 2019(COVID-19) poses a challenge to hospitals for the prevention and control of public health emergencies. As the main battlefield of preventing and controlling COVID-19, large public hospitals should develop service protocols of diagnosis and treatment for outpatient, emergency, hospitalization, surgery, and discharge. The construction of medical protocols should be based on the risk factors of key points and focused on pre-inspection triage and screening, to establish a rapid response mechanism to deal with exogenous and endogenous risk factors. Implementation of all-staff training and assessment, strengthening the information system, and use of medical internet service are important. This study explores the construction of medical protocols in large public hospitals during the pandemic, and provides a reference for the orderly diagnosis and treatment in hospitals during the pandemic.Copyright © 2021, Peking Union Medical College Hospital. All rights reserved.

Emergency Medical Services: COVID-19 crisis.

The COVID-19 epidemic required rapid and frequent adaptations from the prehospital emergency medical services (EMS). The exposure of EMS providers is significant, particularly during procedures at risk of aerosolization such as advanced airways management or cardiopulmonary resuscitation. EMS personal need to be equipped with appropriate personal protective equipment and trained in its use. Interhospital transfers from COVID-19 patients are complex and involve mainly intubated patients. The possible shortage of resources may motivate the implementation of dedicated prehospital triage and orientation recommendations, which should be consistent with the hospital processes.Copyright © 2020 Editions Medecine et Hygiene. All rights reserved.

Medicolegal Aspects during Mass Casualty Due to Road Traffic Accidents in the Era of Covid: A Tertiary Care Institutional Experience

Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic. Countries introduced public health measures to contain and reduce its spread. The effect of mandated societal lockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is not known. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai. As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge to manage these mass casualty patients who require intensive care as well as Medicolegal documentation, record keeping, Consent for life saving procedures in absence of Relatives. Material(s) and Method(s): We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai from January 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock down and 1st July as the first day of re-opening. Result(s): We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries during lockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medical resources, manpower as most of manpower and resources were being utilized for covid patients. Conclusion(s): Road traffic accidents are a prominent contributor to hospitalization and may negatively impact the existing hospital resources directed towards COVID-19.Copyright © 2023, World Informations Syndicate. All rights reserved.

Effect of the COVID-19 Pandemic on Trauma Volume and Transport Time at a Level I Trauma Center

Introduction: Baystate Medical Center is the only Level I Trauma Center in Western, MA. The COVID-19 pandemic has had varying effects on Trauma Centers in regards to volume. Initial studies showed an increase in volume during the lockdown phase, but there has been no evidence of trends after lockdown. Method(s): Retrospective, review of trauma registry data pre- COVID (1/2016-2/2020) and during COVID-19 pandemic (3/2020-12/2021). Comparisons between time periods performed using T-Test. Result(s): Mean total traumas per month were significantly increased during the pandemic (191.3 v. 110.3 patients per month, p <0.001). Both blunt (174.2 v. 100.4, p <0.001) and penetrating (17.1 v 9.9, p <0.001) traumas increased during the COVID pandemic. There was a significant increase in both scene calls (105.0 v 73.8, p<0.001) and interfacility transfers (IFT) (42.7 v 36.0 P = 0.004) during the pandemic. There was no change in injury severity score (11.0 v 11.2, p = 0.498) during the pandemic. Ground interfacility transport times (34.13 min v 28.60 min, p = 0.036) increased significantly during COVID. Other transport times were not changed. Conclusion(s): During the COVID-19 pandemic, Baystate Medical Center saw a statistically significant increase in trauma volume across multiple dimensions that continued even after the end of the lockdown period. In addition, IFT ground transport times increased suggesting that patients were being transported from facilities farther away likely due to the strain on the regional health system from the pandemic.

Patient Safety Culture in the Emergency Center at the University Clinical Center of Kosovo and the COVID-19 Pandemic

BACKGROUND: Despite the developments in Kosovo's healthcare, there are still many challenges that hamper the delivery of proper health-care service. This was especially highlighted during the coronavirus disease 2019 (COVID-19) pandemic. AIM: This study aims to elucidate the factors that impede proper health service as well as reduce preventable medical errors by focusing on safety as a fundamental principle in patient care and a key component health services quality management. The main goal is to improve the overall approach to the patient by improving the workers performance and redesigning systems, with the goal of reducing patient risk not only in normal working environment but also in new and unusual situations such as COVID-19 pandemic. METHOD(S): In this cross-sectional study, data were collected and analyzed. Two questionnaires were compiled for this research: one was compiled to address patients who sought health services at the Emergency Center;the second questionnaire was designed for the Emergency Center personnel to identify the relationships between the workers, managerial staff, the problems of reporting errors, and similar. Moreover, relevant publications on the impact of the pandemic on the provision of health services were compared. Statistical analysis was done by IBM SPSS version 25. CONCLUSION(S): There is a need for improving Patient Safety Culture in The Emergency Center at the University Clinical Center of Kosovo. By reorganizing working hours for the workers of the Emergency Center, preventable medical errors would be reduced. Raising the capacities of the primary care level would reduce the load of the Emergency Center from interventions, which can be handled without a problem at the lower levels. Continuous professional trainings, as well as trainings focused on stress management, working under time pressure, and relationships between health service providers would significantly improve the level of patient safety in the Emergency Center.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.

Trauma: a stress during pandemic?

Introduction: Coronavirus disease 2019 pandemic significantly impacted on trauma systems, since emergency departments (ED) suddenly were overwhelmed by patients requiring intensive care unit (ICU) admission. Once, trauma volume was supposed to decrease due to lockdown policies, we aimed to describe ICU trauma admissions during this period. Method(s): Retrospective observational study of all trauma patients admitted to the ICU of a Portuguese Trauma Center between January 2020 and December 2021. Data were collected from clinical hospital records. Result(s): 437 trauma patients (15% of all admissions), mostly male (71%), with a median age of 59 years-old (42-74) were included. At least one comorbidity was present in 71% of the patients. Median severity scores were: SAPS II 26 (19-38), SOFA 3 (1-6), ISS 13 (9-22), RTS 8 (6-8) and TRISS 96,75 (81.1-98.6). The most frequent mechanisms of injury were falls (59%) and road traffic accidents (25%). The majority consisted of blunt trauma (88%), 65% of brain trauma and 35% of musculoeskeletal trauma. Trauma Team assessment was started in < 3 min in all cases and median length of stay (LOS) in the ED was 261 min (154-418). Surgical intervention was performed in < 4 h in 56% of surgical brain trauma injuries, in < 6 h in 67% of extremity open fractures and in < 1 h in 6% of a penetrating trauma. Shock, mainly hemorrhagic, was present in 8% of the patients on hospital admission. 38% were submitted to invasive mechanical ventilation and 34% to vasopressors. The most common complication was nosocomial infection (18%). The median LOS in the UCI was 12 days (5-24). Only 8% of the patients died in the ICU and 11% in the hospital. Conclusion(s): During pandemic, trauma persisted a major health problem with a significant consumption of time and critical care resources. The high influx of patients may have influenced the LOS in the ED before ICU admission and the time until the surgical intervention. Despite it, mortality remained low.

Increase in traumatic injury burden amidst COVID-19 was disproportionately shouldered by racial and ethnic minority patients: An urban case study

Background: When the COVID-19 pandemic intersected with the longstanding global pandemic of traumatic injury, it exacerbated racial and ethnic disparities in injury burden. As Milwaukee, Wisconsin is a racially diverse yet segregated urban city due to historic and ongoing systemic efforts, this populace provided an opportunity to further characterize injury disparities. Method(s): We analyzed trauma registry data from the only adult Level 1 trauma center in Milwaukee, WI before and during the COVID-19 pandemic (N = 19,908 patients from 2015-2021). We retrospectively fit seasonal ARIMA models to monthly injury counts to determine baseline injury burden pre-COVID-19 (Jan 2015-Mar 2020). This baseline data was used to forecast injury by race and ethnicity from April 2020 to December 2021 and was compared to actual injury counts. Result(s): For all mechanisms of injury (MOI), counts during the pandemic were significantly higher than forecasted for Black or African American (mean absolute percentage error, MAPE = 23.17) and Hispanic or Latino (MAPE = 26.67) but not White patients (MAPE = 12.72). Increased injury for Black or African American patients was driven by increases in motor vehicle crashes (MVCs) and firearm-related injury;increased injury for Hispanic or Latino patients was driven by falls and MVCs. Conclusion(s): The exacerbation of injury burden disparities during COVID-19, particularly in specific MOI, underscores the need for primary injury prevention within specific overburdened communities. Injury prevention requires intervention through social determinants of health, including addressing the impact of structural racism, as primary drivers of injury burden disparities.Copyright © The Author(s) 2023.

Integrated surveillance and early warning system for emerging infectious diseases based on One Health concept: Structures and innovations.

One Health is an upgrade and optimization of health concepts, which recognizes the integrated health of the human-animal-environment. It emphasizes the use of interdisciplinary collaboration, multi-sectoral coordination, and multi-organizational One Health approaches to solve scientific questions. The surveillance and early warning system is the basis of public health emergency prevention and control. The COVID-19 pandemic and the emerging infectious disease (EID) have put great challenges on the existing surveillance and early warning systems worldwide. Guided by the concept of One Health, we attempt to build a new pattern of integrated surveillance and early warning system for EID. We will detail the system including the One Health-based organizational structure, zoonotic and environmental science surveillance network, EID reporting process, and support and guarantee from education and policy. The integrated surveillance and early warning system for EID constructed here has practical and application prospects, and will provide guidance for the prevention and control of COVID-19 and the possible EID in the future.Copyright © 2022, National Institute of Parasitic Diseases. All rights reserved.

A Research of Emergency Service Admission Due To Home Accidents Before and During The Covid-19 (Sars-Cov-2) Pandemic In Ankara (Turkey)

Home accidents can cause serious injuries, disabilities, and deaths. Approximately 40 million people were treated in hospitals annually because of injuries occurring in homes, and these injuries were responsible for approximately 76% of preventable deaths. The aims of this study are to compare the home accidents in the one-year period during the pandemic and the home accidents in the one-year period before the pandemic, and to reveal how the home accidents are affected in which part of the home and in which types of injuries. A retrospective study was made of the records of patients injured in home accidents between pre-pandemic and pandemic one-year periods. The patients were classified according to age groups, gender, season, day and time of the home accident, accident type, part of the home, trauma localization and type, and severity of injuries. While 46.5% of the 581 injured patients were before the pandemic, 53.5% were in the pandemic period. The injuries increased as the number of households staying at home increased compared to the pre-pandemic period. Likewise, there was a significant increase in the number of falls from balconies and windows during the pandemic period. It is still not possible to make a definite prediction about the course of the pandemic. In this context, it is of great importance to provide information on prevention from home accidents, especially in television programs and distance education activities.Copyright © 2023, Yuzuncu Yil Universitesi Tip Fakultesi. All rights reserved.

Prevalence of dry socket associated with urgent dental extractions due to pain performed at an emergency service in the Buenos Aires Metropolitan Area during the mandatory preventive social isolation for the COVID-19 pandemic in Argentina

Objective: To evaluate the prevalence of dry socket as a postoperative complication in cases where there was intense local pain in the preoperative state, during the preventive mandatory social isolation (PMSI) for the COVID-19 pandemic in Argentina. Method(s): This was a descriptive study, which included 1209 walk-in patients at the emergency and orientational service at Buenos Aires University School of Dentistry during the PMSI from March 20 to June 20, 2020, with indication for dental extraction as well as intense acute pain at the surgical site. The presence of dry socket was exploratoryly associated with the variables age, sex, smoking and chronic medication use. Result(s): 1209 patients were operated, resulting in a total 1372 dental extractions. Average patient age was 41 years. The prevalence found in this study was 1.06%. Conclusion(s): The prevalence of dry socket was 1%, not being higher than other experiences where pain was not considered a condition prior to extraction.Copyright © 2023 Duke University Press. All Rights Reserved.

Molecular point-of-care tests: efficiency of RT-LAMP in the rapid diagnosis of COVID-19 to assess hospital access.

Background: Safe hospital access needs rapid testing for SARS-CoV-2 to enable rationale use of limited resources. The current standard method for Coronavirus detection is the RT-qPCR. This study aimed to determine the diagnostic performance of the new rapid RT-LAMP test, compared to RT-qPCR, and his efficiency for rapid hospital access through the Emergency Department (E.D.). Method(s): 1576 UTM nasopharyngeal swabs, collected in E.D., have been tested for SARS-CoV-2 infection, using a kit RTLAMP. The same samples were also analyzed with a traditional RT-qPCR assay and the results have been compared in terms of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Result(s): The assay has demonstrated a sensitivity of 73.3% (95%CI: 62.4/82.0) and specificity of 87.1% (95%CI: 85.3/88.7), PPV 22.1%, NPV 98.5%. Conclusion(s): ICGENE RNA RT-LAMP kit (ICGENEHEALTH;Enbiotech, Angri, Salerno, Italy) efficiently exclude the presence of infection and reliably detects infectious patients (with Ct<30). RNA RT-LAMP could replace rRTPCR where there is the need to rapidly identify potentially contagious individuals, but its low PPV suggests that positive results should be confirmed by a reference method.Copyright © 2022 EDIZIONI MINERVA MEDICA.

Polytrauma patient with lateral thoracic spondyloptosis: case report and literature review

Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.

Epidemiological shift of paediatric fracture characteristics during COVID-19 in Hong Kong - a reflection on bone health crisis

Introduction: Since the beginning of Coronavirus disease 2019 (COVID-19) pandemic, schools in Hong Kong were suspended intermittently as part of the anti-epidemic measure. This study aims to investigate the impact of COVID-19 pandemic on the epidemiology of paediatric fracture and bone health of children. Method(s): We recruited patients aged 3-17 admitted to tertiary paediatric orthopaedic trauma centres for fractures from 1st February 2020 till 4th March 2021 during COVID-19 period as study group and compared with patients admitted from 1st February 2019 till 31st January 2020 before COVID-19 as control group. Result(s): Total number of admissions due to fracture was reduced by 49% (pre-COVID period: 345, COVID period: 177). Demographic data such as age, age group distribution, sex, location of fractures, energy of injury, prior history of fracture were comparable in the two groups. There was no statistically significant difference in the proportion of patients requiring operative treatment. Significant change was found in injury mechanisms, with injury related to body-powered vehicles (33.7%, n = 58) becoming the leading cause of injury during COVID period (p < 0.001). There was significant drop in proportion of patient with injury from level ground fall (p < 0.001) and sports (p < 0.001). The percentage of obese children increased significantly (p = 0.009) during the COVID period (32.7%, n = 48) than pre-COVID period (21.0%, n = 67). The proportion of patients with hypocalcaemia was found to be higher (p = 0.002) during COVID period. Conclusion(s): This study reflects paediatric bone health issues during COVID-19 pandemic. We postulate the reduction in fracture incidence, change in the distribution of injury mechanisms, and more obesity could be related to a more sedentary lifestyle during COVID period. Hypocalcaemia can be associated with reduced sunlight exposure, obesity, and lack of physical activities. If the problem is left neglected, it can lead to long-term bone health problems.Copyright © The Author(s) 2023.

The epidemiological characteristics of the admitted cases of COVID-19 in a tertiary hospital in India

Introduction: COVID -19 disease broke out in Wuhan, China at the end of 2019 and the deadly virus spread out rapidly worldwide by the end of March 2020. India has the second largest number of cases in the world with 1,05,95,660 COVID 19 cases and has had 1,52,718 deaths at the end January 2021.3 As it is a new emerging infectious disease, it is a challenging task for the health system to manage the pandemic. This study will provide epidemiological characteristics of COVID-19 in Indian population which will help to make new policies and programs. Aim and Objective: To study the epidemiology of COVID-19 cases in a tertiary care hospital in North India. Material(s) and Method(s): This Retrospective study included 2985 patients treated as COVID -19 positive cases admitted in AIIMS Trauma centre-JPNATC (Jai Prakash Narayan Apex Trauma Centre - JPNATC). The patient's data were collected between 1st April 2020 to 30th October 2020 from AIIMS -EWD and CPRS platform were COVID 19 data recorded. Demographic details such as age, gender, date of admission for COVID-19 and the outcome were collected and analyzed. Result(s): A total number of 2985 cases were included in this study. The mean+/-SD age of the male patients were 44.37 +/-19.65 and mean+/-SD female patients were 45.75 +/- 19.58. The majority were male patients constituted 62.5% of the sample. The mean+/-SD age of the male patients were died during the treatment 51.75 +/-18.68 and female 51.31 +/- 18.71. The death ratio of male: female was 1.78Copyright © 2020 Ubiquity Press. All rights reserved.

Effect of COVID 19 pandemic on oral maxillofacial trauma casualties: A cross-sectional analytical study at a regional trauma centre, Chidambaram

COVID -19 pandemic has unprecedented effect globally. The world health organization has declared it to be a Public Health Emergency of International Concern (PHEIC). The pandemic has a widespread effect on all sectors particularly on health care and management. This has an indirect effect on the lifestyle of people. Various studies have shown that there is a drastic reduction in cases with heart ailments and other major systemic diseases during this era of pandemic. This is a study conducted on trauma cases that has been reported during this pandemic before and after lockdown to analyze the effect of lifestyle on road traffic accidents, to differentiate the mode of maxillofacial injuries, to assess the severity of injury. Aim(s): To study and compare prevalence, mode, severity and the effect of lifestyle on maxillofacial injury reported at casualty during lockdown. Objective(s): 1) To estimate the total prevalence of OMF trauma casualties for the past 7 months (Jan 2020-July 2020) at a Regional Trauma Centre, Chidambaram. 2) Assess the prevalence of OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 3) Assess the mode of injury in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 4) Assess the severity of injury (soft tissue and bony) in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram. 5) To compare the effect of alcohol in relation to OMF trauma casualties during the pre & post lockdown period at a Regional Trauma Centre, Chidambaram.Copyright © 2021 The Authors

Psychological Impacts of COVID-19 Pandemic

Thousands of millions of people faced devastating impacts around the world during COVID-19 pandemic. Not only anxiety or fear of COVID-19 dominated the negative psychological impacts, mental disorders such as depression, posttraumatic stress disorder, and sleep disturbance increasingly appeared during or after the pandemic. Apart from the confirmed patients, survivors of the viral infection, close family members, elders, children and adolescents, people quarantined, people with preexisting psychiatric conditions, frontline police, emergency medical services, and health-care workers, mental distress specific to the vulnerable groups should be recognized. Preventive strategies including self-regulations, leadership, and teamwork were highlighted. Specific evaluations for at-risk population and efficacious treatment such as cognitive behavioral treatment could be considered. This article delineated directions for mental health workers during pandemic.Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.