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The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Aims: The COVID-19 pandemic presented new difficulties for integrated healthcare worldwide. Our study aims to highlight developing needs for cooperation while describing structures and practices of consultation liaison (CL) services established during pandemic across Europe. Method(s): The cross-sectional survey used an ONLINE self-developed 25-item questionnaire in four language versions (English, French, Italian, German). Dissemination was via national professional societies cooperating in EAPM, and heads of CL services from June to October 2021 Results: 259 hospital CL services took part in the study (28.0% response rate). 222 (85.7%) of these services reported providing COVID-19-related mental health care (COVIDpsyCare). Among them, 192 services (86.5%) reported the development of specialized COVID-psyCare co-operation arrangements. 135 services (50.8%) provided specific COVID-psyCare for patients, 85 (38.2%) for relatives, and 171 (77.0%) for staff, with 56.3%, 14.6%, and 23.7% of time resources invested for these groups, respectively. Interventions for hospital staff, commonly related to the liaison function of CL services, were rated as being the most helpful. Regarding newly emerging demands, 129 (58.1%) CL services stated a need for communication and support among themselves concerning COVID-psyCare, and 142 (64.0%) suggested certain adjustments or enhancements that they thought were crucial for the future. Conclusion(s): Specific structure to provide COVID mental health care for patients, their relatives, or staff were implemented in over 80% of the participating CL services. Resources were primarily allocated for patient care, and staff assistance was mostly achieved through the implementation of specialized interventions. COVID psyCare's development calls for further intra- and interinstitutional cooperation.Copyright © 2023
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BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant S. aureus (VRSA) frequently cause nosocomial infections yearly. During the COVID-19 pandemic, the potential for excessive use of antibiotics is a global threat to the increasing incidence of multiresistant bacteria. AIM: This study aimed to determine MRSA and VRSA colonization and identify factors associated with the risk of MRSA and VRSA nasal colonization in health workers at Dr. Soemarno Sosroatmodjo General Hospital, Kuala Kapuas, as one of the type C hospitals in Indonesia. METHOD(S): This cross-sectional analytic study at Dr. Soemarno Sosroatmodjo General Hospital, a tertiary hospital in Indonesia. A 128 health workers' subjects had undergone nasal swab screening for MRSA and VRSA colonization examinations. Then, they were asked to complete a questionnaire concerning the risk factors of MRSA and VRSA infections. RESULT(S): Nasal swab results obtained as many as 30 (23.5%) MRSA positive subjects and 6 (4.7%) subjects with positive VRSA. The most common risk factors that led to MRSA colonization included a history of positive MRSA in the previous hospital (60%), a history of ear, nose, and throat infection (41.7%), and did not do hand rub/handwash (36.7%). In comparison, the most risk factors for VRSA colonization were having pigs farm at home (33.3%), a history of positive MRSA in the previous hospital (20%), and a history of hospitalization in the past 6-12 months (16.7%). The results of multivariate analysis showed the most powerful and statistically significant risk factors in influencing nasal MRSA colonization were a history of positive MRSA in the previous hospital (OR 13.69, 95% confidence intervals [CI]: 1.34-140.25, p = 0.028) and did not do hand rub/handwash (OR 2.95, 95% CI: 1.167-7.49, p = 0.023). Meanwhile, marital status (OR 0.160, 95% CI: 0.02-1.06), p = 0.058) and home care service (OR 6.10, 95% CI: 0.79-46.96, p = 0.082) were the strongest risk factors for nasal colonization of VRSA but not statistically significant. CONCLUSION(S): As many as, 23.5% and 4.7% of healthcare workers' subjects were found with nasal colonization of MRSA and VRSA, respectively. Accordingly, strict policies are needed to minimize the transmission of these organisms from the hospital setting to the community.Copyright © 2023 Siti Nur Rohmah, Rizka Humardewayanti Asdie, Ida Yosopa, Daya Daryadijaya.
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Objective: To determine the clinical-surgical features of critical limb ischaemia (CLI) within the context of infection by SARS-CoV-2. Method(s): Cross-sectional, retrospective, observational, descriptive study, with clinical data obtained from printed and electronic records of patients with CLI treated by the Angiology and Vascular Surgery Service of the General Hospital of Mexico in the period between January 2020 and July 2021. Result(s): We evaluated the data of 33 patients with critical limb ischaemia of which 15 were positive for SARS-CoV-2 in the period from January 2020 to July 2021, females were the most affected representing the 53.3% of the total, patients under 60 years old accounted for 26.67%. Twenty-six percent of the patients presented critical limb ischaemia without having previous comorbidities, 60% of these presented with an advanced state of the disease and a delay in specialised medical care of more than 6 hours after the onset of symptoms, which warranted a major amputation in 37% of cases, the lower extremities represented 90% of the affected anatomical regions. Conclusion(s): the outcomes in our study show that the incidence of critical limb ischaemia during the SARS-CoV2 pandemic period occurred in an atypical way in a segment of young patients and without known event-generating comorbidities. Thromboembolic events, probably associated with the hypercoagulable state generated by this infection, also evolved rapidly and aggressively from the onset of symptoms despite prompt treatment.Copyright © 2022 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.
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Background & Aim: The long-term effects of human mesenchymal stem cell (MSC) treatment on COVID-19 patients have not been fully characterized. The aim of this study was to evaluate the safety and efficacy of a MSC treatment administered to severe COVID-19 patients enrolled in a randomized, double-blind, placebo-controlled clinical trial (NCT 04288102). Methods, Results & Conclusion(s): A total of 100 patients experiencing severe COVID-19 received either MSC treatment (n = 65, 4x107 cells per infusion) or a placebo (n = 35) combined with standard of care on days 0, 3, and 6. Patients were subsequently evaluated 18 and 24 months after treatment to evaluate the long-term safety and efficacy of the MSC treatment. The outcomes measured included: 6-minute walking distance (6-MWD), lung imaging, quality of life according to the Short Form 36 questionnaire, COVID-19-related symptoms, titers of SARS-CoV-2 neutralizing antibodies, MSC-related adverse events (AEs), and tumor markers. Two years after treatment, a marginally smaller proportion of patients had a 6-MWD below the lower limit of the normal range in the MSC group than in the placebo group (OR = 0.19, 95% CI: 0.04-0.80, Fisher's exact test, p = 0.015). On the SF-36 questionnaire, a marginally higher general health score was received by the MSC group at month 18 compared with the placebo group (50.00 vs. 35.00;95% CI: 0.00-20.00, Wilcoxon rank sum test, p = 0.016). In contrast, there were no differences in the total severity score of lung imaging or the titer of neutralizing antibodies between the two groups. Meanwhile, there were no MSC-related AEs reported at the 18- or 24-month follow-ups. The serum levels of most of the tumor markers examined remained within normal ranges and were similar between the MSC and placebo groups. Long-term safety was observed for the COVID-19 patients who received MSC treatment. Yet few sustained efficacy of MSC treatment was observed at the end of the 2-year follow-up period. Funding(s): The National Key Research and Development Program of China (2022YFA1105604, 2020YFC0860900), the specific research fund of The Innovation Platform for Academicians of Hainan Province (YSPTZX202216) and the Fund of National Clinical Center for Infectious Diseases, PLA General Hospital (NCRCID202105,413FZT6). [Figure presented]Copyright © 2023 International Society for Cell & Gene Therapy
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Autoimmune haemolytic anaemia (AIHA) is rare but described after the SARS-CoV- 2 Pfizer-BioNTech vaccine. We present a case of severe refractory warm AIHA after this vaccine, managed with emergency splenectomy and complement inhibition with eculizumab. A male in his teens with a history of liver transplant for biliary atresia (aged 2 years) and AIHA (aged 6 years) presented to his district general hospital with jaundice, dark urine, fatigue and chest discomfort 48 h after the first dose of SARS-CoV- 2 Pfizer-BioNTech vaccine (BNT162b2 mRNA). Investigations revealed haemoglobin (Hb) of 70 g/L and bilirubin of 98 mumol/L, which was treated as AIHA. The patient initially responded to prednisolone (1 mg/kg, 60 mg) but subsequently deteriorated and failed to respond to second-line rituximab (375 mg/m2) and two units of packed red blood cells (PRBC). By day 29 the patient had developed life-threatening anaemia culminating in a Hb of 35 g/L (after transfusion), lactate dehydrogenase (LD) of 1293 units/L and bilirubin of 228 mumol/L. This necessitated an immediate transfer to our tertiary centre for specialist support. Further investigations revealed a haptoglobin <0.1 g/L and direct antiglobulin test (DAT) strongly positive for IgG (4+) and negative for C3d. The peripheral blood film showed severe anaemia, nucleated red cells, anisocytosis and spherocytes with no autoagglutination, schistocytes or platelet clumps. Thrombocytopaenia (platelets 49 +/- 109/L) was present. Differentials were ruled out, such as paroxysmal nocturnal haemoglobinuria and heparin-induced thrombocytopaenia. HIV and hepatitis serology were negative, as were adenovirus, cytomegalovirus and Epstein-Barr virus PCR assays. A CT showed splenomegaly of 15.5 cm. Urinalysis found urobilinogen and bilirubin at high concentrations and negative urinary haemosiderin. Together, the investigations were consistent with warm AIHA. On day 29, four units of PRBC were transfused alongside 100 mg methylprednisolone and 1 g/kg IVIG. On day 30 the patient deteriorated despite the escalated treatment: Hb had only increased to 54 g/L, bilirubin was 200 mumol/L and LD was rising. Considering this life-threatening fulminant haemolysis, an emergency splenectomy was performed. This slowed haemolysis but did not completely ameliorate it: by day 33 the patient had received 15 units of PRBC. Thus, eculizumab, a terminal complement pathway inhibitor, was trialled to arrest intravascular haemolysis, alongside rituximab, repeat IVIG 1 g/kg, prednisolone 40 mg and tacrolimus 2 mg. This showed a favourable response, requiring less frequent transfusions and settling haemolysis. This case highlights the rare complication of warm AIHA with the SARS-CoV- 2 Pfizer-BioNTech vaccine, the use of emergency splenectomy for disease control, and the potential of eculizumab for refractory cases.
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The Coronavirus pandemic has caused major change across the world and in the National Health Service. In order to cope and help limit contagion, numerous institutions recognised the need to adjust clinical practice quickly yet safely. In this paper, we aim to describe the changes implemented in a general surgery department at a district general hospital in the United Kingdom. Across the surgical specialties, frameworks, protocols and guidelines have been established locally and nationally. The aerosol generating procedures involved in general surgery required us to alter our daily activities. Modifications to patient management were necessary to try and reduce viral spread. Staff wellbeing was heavily promoted in order to help maintain the frontline workforce. A holistic approach was required.
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Background: Little is known about the impact of the COVID-19 pandemic on physiotherapists' mental health. The aim of this study was to investigate the impact of the COVID-19 pandemic on physiotherapists' mental health in Belgium. Method(s): A total of 115 physiotherapists from 12 general hospitals in Brussels, working in COVID-19 care units (CCU) or non-COVID-19 care units (NCCU), participated in an electronic survey including validated measurement tools for PTSD, anxiety, insomnia and burnout. Descriptive analyses were performed to assess differences in mental health outcomes between physiotherapists who worked in a CCU and those who worked in an NCCU. Multivariable logistic regression analyses were also performed to assess risk factors for burnout. Result(s): Results showed significant levels of PTSD (9.6%), anxiety (33.9%), insomnia (40%) and burnout (33.9%) among participants. However, no significant differences were found between the 2 groups. It was also found that being isolated during the COVID-19 pandemic was a risk factor for burnout. Conclusion(s): Although no significant differences were found between the two groups, this study highlights a concerning rate of psychopathological symptoms among participants. Hospitals should therefore invest more time and resources into actions aiming at preserving the mental health of physiotherapists.Copyright © 2023 Informa UK Limited, trading as Taylor & Francis Group.
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As a district general hospital (DGH) registrar, clinical duties are varied. The geographical location of these clinical duties can vary in different hospital settings. In our trust, the inpatient Haematology ward was reallocated to become the designated 'COVID ward' at the start of the pandemic, due to a lack of availability of side rooms in the hospital. Haematology inpatients are now managed on general medical wards, with no specific Haematology ward available. This has further increased the geographical spread of registrars' clinical duties. In order to quantify the impact of this geographical spread, we undertook an audit of physical activity over a four-week period. We included the physical activity during working hours recorded by the attending haematology registrar and an on call medical registrar for comparison. We collected data using smart devices on steps walked, distance travelled, time spent walking and calories burnt whilst walking. We collected data for all day shifts worked from 09:00-17: 00 for all days of the week. Overall, the attending haematology registrar walked an average of 10 241 steps a day, covering 7.87 km over a period of 107 min and burning 410 calories whilst active. The medical registrar walked an average of 7498 steps a day, covering 5.76 km over a period of 79 min and burning 300 calories whilst active. By comparison the attending haematology registrar covered 37% more steps per day than the medical registrar, a statistically significant difference (p-value 0.002, students unpaired t-test). During a 7.5 h working day (taking into account a contractual 30-min unpaid lunch break), our DGH haematology registrars spend 107 min walking, which is 24% of their working hours. Our results highlight the time pressures on DGH haematology registrars. Time pressures on registrars in London have become more important as a result of Health Education England's (HEE) medical specialty redistribution programme, which will see the number of specialty trainees in London reduced by 46% over 5 years. Addressing the geographical spread of clinical duties could help to reduce the time pressures on registrars allowing them to spend more time on providing a clinical service. We have presented our data to trust management as evidence to lobby for the creation of a new haematology ward, which has now been included in the plans for a new hospital at our trust.
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Objective To analyze the changes of disease spectrum in pediatric inpatients before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The data of gender, age, habitual residence, diagnosis and other relevant information of 1 931 hospitalized children in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Feb. 2019 to Jan. 2020 (1 year before the COVID-19 epidemic) and 618 hospitalized children from Feb. 2020 to Jan. 2021 (1 year after the COVID-19 epidemic) were collected. The total number, habitual residence, gender and disease spectrum of hospitalized children 1 year before and 1 year after the COVID-19 epidemic were statistically analyzed. Results The number of hospitalized children decreased by 68.00% (1 313/1 931) 1 year after the COVID-19 epidemic. The number of hospitalized children from other provinces and cities was decreased (17.80%110/618vs 29.00%560/1 931) and there was significantly difference in the distribution of habitual residence of hospitalized children between 1 year before and 1 year after the COVID-19 epidemic (P<0.01). One year after the COVID-19 epidemic, the number of children with respiratory diseases decreased by 92.04% (971/1 055), and the proportion was also decreased (13.59%84/618vs 54.63%1 055/1 931);the number of children with endocrine system diseases increased by 20.71% (29/140), and the proportion was increased (27.35%169/618vs 7.25%140/1 931);the number of children with neonatal diseases decreased by 43.01% (166/386), but the proportion was increased (35.60%220/618 vs 19.99%386/1 931). Compared with 1 year before the COVID-19 epidemic, there were significant differences in the proportions of respiratory diseases, endocrine system diseases and neonatal diseases in hospitalized children 1 year after the COVID-19 epidemic (all P<0.01). The age distribution of hospitalized children 1 year before and 1 year after the epidemic of COVID-19 was different (P<0.01), and the number of hospitalized children was also different in different seasons (P<0.05). One year after the epidemic of COVID-19, the number of hospitalized children with respiratory diseases was decreased most significantly, and the number of children with pneumonia decreased by 93.71% (655/699), with a significant difference found in the proportions of pneumonia between 1 year before and 1 year after the COVID-19 epidemic (52.38%44/84vs 66.26% 699/1 055, P<0.05). Compared with 1 year before the COVID-19 epidemic, the proportion of endocrine system diseases such as short stature/growth retardation was decreased and the proportion of precocious puberty/early puberty development was increased 1 year after the COVID-19 epidemic (P<0.05). Conclusion The COVID-19 epidemic has led to a significant decrease in hospitalized children in department of pediatric, especially in the proportion of respiratory diseases, but it has led to an increase in hospitalized children with endocrine system diseases, suggesting that epidemic prevention and control measures can effectively reduce respiratory diseases requiring hospitalization, but may increase precocious puberty and early puberty development. These changes should be considered by department of pediatrics in general hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Background: The virulent pathogen SARS-CoV-2 first appeared in the Chinese province of Hubei in December 2019. Pregnant women were a high-risk population in the pandemic because immune system alterations that occur during pregnancy make them more vulnerable to foreign infections. Late-pregnancy cholestasis is a dangerous liver condition that can cause the foetus to experience potentially fatal problems like early birth and stillbirth. In the present study we were testing the Bile acid level during pregnancy patients after covid pandemic. Objective(s): To evaluate the prevalence of intrahepatic cholestasis in pregnant patients after Covid -19 pandemic. Material(s) and Method(s): This cross-sectional study was conducted at department of Dr.fida painless and General Hospital Peshawar from jan 2022 to Dec 2022. We enrolled 186 pregnant patients after fulfilling the inclusion criteria. 5 ml blood sample were also taken from the patients. Serum was extracted and Bile acid test were performed in clinical laboratory. Data were collected in predesign questionnaire. Result(s): Total 186 patients were enrolled in the study with mean age of 37.18+/-6.39 years (Range 18-45 years). The mean value of all enrolled patients was 31.38+/-5.79 with minimum and maximum value of bile acids 20 micromol/L and 40.6.00 micromol/L. In our study 95 (56.5%) of patients belongs to 36 to 45 years of age group followed by age group of 26 to 35 years in which 60 (35.7%) patients and 13 (7.7%) patients were belongs to age group of 18 to 25 years. Practical implication: This study will help the clinical practitioner to take care of pregnant patients in order to avoid the prevalence of intrahepatic cholestasis. Conclusion(s): It is concluded from this research study that prevalence of intrahepatic cholestasis in pregnancy has increased after Covid-19 pandemic.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Nowadays, spatial geographic data analysis and GIS related software are more and more applied to the planning of urban public facilities. Under the COVID-19, people pay more attention to the protection of medical facilities for people's health, and a reasonable distribution of hospital facilities is conducive to people's health. Taking Haikou City as an example, this research will optimize the location of hospital space layout according to the existing third-level first-class general hospitals in Haikou City by using GIS software, road analysis, spatial analysis, and other methods. The results show that the existing hospitals in Haikou are too concentrated in the central urban area, the overall distribution of medical facilities is lack of balance, and there is a serious lack of medical facilities in new urban development areas and suburbs. According to the comparison between population density analysis and traffic analysis and the service scope of existing hospitals, the author finds out the scope of hospitals that need to be supplemented, and then calculates the scope of service area after taking several random points within the scope, and finally finds the one with the largest service scope is the optimal location. The results obtained by optimizing the site selection can provide a scientific reference for the rational layout of medical facilities in Haikou City in the future. © 2023 SPIE.
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The COVID pandemic has affected and changed the way we work in healthcare. Through this presentation, I aim to share with others about new workflow and procedure changes done in my institution, Singapore General Hospital. We identified ways to modify the ultrasound procedures to protect ourselves and patients during this pandemic disease outbreak. Finally, we modified the current ultrasound protocol to limit scanning time when attending to COVID positive patients.
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Introduction: Early Warning Scores (EWS) use physiological parameters to create an aggregate score alerting medical teams to patient deterioration. Although vital tools for triggering referrals to critical care services in appropriate patients, the score does not take account of patients with persistently altered physiology or patients who are not deemed suitable for escalation to critical care. In these instances, EWS can result in the over-monitoring of patients and inappropriate contact of already strained critical care outreach services.1-2 Guidelines state that in such circumstances routine recording of EWS may be stopped.1 The COVID-19 pandemic has placed unprecedented demands on already overstretched resources in the critical care services,3 in particular on the Critical Care Outreach Team (CCOT). This makes their judicious use, and this QIP, ever more pertinent. Objective(s): In our trust, it was found that despite documented decisions not to escalate patients to critical care, these patients were still being monitored according to EWS, resulting in the inappropriate call out of the CCOT. We introduced measures to improve the proportion of inpatients with treatment limitations in place that had these limitations documented on their EWS charts, with the overall aim of reducing the number of inappropriate call-out of the CCOT. Method(s): We performed two snapshot audits on acute medical (control) and general medical wards (intervention) in a large district general hospital between the years 2018-2019. We obtained the percentage of patients with treatment limitations in place who had this documented on their EWS charts before and after improvement measures. Firstly, a paper prompt on the EWS chart was used in both control and intervention wards. Secondly, targeted communication interventions to general medical wards only. Targeted communication was not repeated after the second audit. A third snapshot audit was completed a year after improvement measures (2020) to identify whether improvements were sustained. Result(s): There was no significant difference in EWS amendment in the acute medical ward, where only a paper prompt was used. However, where targeted communication was used (general medical ward), there was a statistically significant improvement in review and amendment of EWS scores between the first and second audit in the intervention ward (37.2% vs 59.1%, p=0.017). However, this improvement was not sustained when the audit was repeated a year later. Conclusion(s): The proportion of inpatients with treatment escalation limitation decisions in place that have EWS amended can be improved by targeted communication, but paper prompts alone are not sufficient. However, these improvements are not sustained without repeated communication. The importance of appropriate amendment of EWS has two key benefits. Firstly, it reduces inappropriate and futile monitoring of end-of-life patients, allowing them to have a more dignified death. Secondly, instead of performing repeated observations (nursing staff) or patient reviews (CCOT) that will not alter management, nursing staff can better utilise their time in providing palliative support where appropriate (particularly considering current visiting restrictions), and the ever- stretched CCOT can be used more judiciously.
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Introduction: Barrett's oesophagus is a well identified precursor for oesophageal adenocarcinoma, with the risk of malignant transformation being 0.5% annually. It is therefore crucial that diagnosis and surveillance standards meet national guidelines. This audit was carried out to assess if our District General Hospital was meeting the standards set by the British Society of Gastroenterology with regards to Barrett's diagnosis and surveillance. Method(s): Data was collected looking at 143 OGDs carried out for Barrett's diagnosis and surveillance at a District General Hospital in the United Kingdom from 01/01/2018 to 30/06/2018. The OGD reports were compared against recommended national standards set by the British Society of Gastroenterology. A proforma was created and was put into use from August 2020. It was utilized by all endoscopists when carrying out OGDs for Barrett's diagnosis and surveillance. The proforma was added to the end of the hospital's standard endoscopy report. Following the intervention and use of the proforma, the second cycle of the audit was carried out looking at 58 OGDs completed between 05/08/2020-27/02/2021 to see if they met the standards set out by the British Society of Gastroenterology. The Barrett's surveillance service and the volume of OGDs carried out following the introduction of the proforma was affected by the Covid-19 pandemic. Result(s): The first cycle of the audit found that only 34% of OGDs had a Prague classification documented correctly. 0% of OGDs had the correct biopsy protocol followed and 12.6% of endoscopies did not have any biopsies taken. 26% of patients had no follow up or surveillance endoscopy interval documented or organised. Following the intervention, it was found that 96% of endoscopies now had a Prague classification documented, an increase of 62%. There was a 65% increase in correct biopsy technique being followed and 100% of OGD reports now had surveillance interval documented if deemed appropriate. Conclusion(s): The audit clearly displays that following our intervention there was a significant improvement in the quality of Barrett's diagnostic and surveillance endoscopies, when compared to national guidelines. Given its potential for malignant transformation, correct surveillance is exceptionally important to improve patient care and reduce mortality. The introduction of a proforma drastically improved the standard of the service provided at our District General Hospital and is one that can be transferable to other hospitals.
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Objective To analyze the changes of disease spectrum in pediatric inpatients before and after the outbreak of coronavirus disease 2019 (COVID-19). Methods The data of gender, age, habitual residence, diagnosis and other relevant information of 1 931 hospitalized children in Department of Pediatrics, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Feb. 2019 to Jan. 2020 (1 year before the COVID-19 epidemic) and 618 hospitalized children from Feb. 2020 to Jan. 2021 (1 year after the COVID-19 epidemic) were collected. The total number, habitual residence, gender and disease spectrum of hospitalized children 1 year before and 1 year after the COVID-19 epidemic were statistically analyzed. Results The number of hospitalized children decreased by 68.00% (1 313/1 931) 1 year after the COVID-19 epidemic. The number of hospitalized children from other provinces and cities was decreased (17.80%[110/618]vs 29.00%[560/1 931]) and there was significantly difference in the distribution of habitual residence of hospitalized children between 1 year before and 1 year after the COVID-19 epidemic (P<0.01). One year after the COVID-19 epidemic, the number of children with respiratory diseases decreased by 92.04% (971/1 055), and the proportion was also decreased (13.59%[84/618]vs 54.63%[1 055/1 931]);the number of children with endocrine system diseases increased by 20.71% (29/140), and the proportion was increased (27.35%[169/618]vs 7.25%[140/1 931]);the number of children with neonatal diseases decreased by 43.01% (166/386), but the proportion was increased (35.60%[220/618] vs 19.99%[386/1 931]). Compared with 1 year before the COVID-19 epidemic, there were significant differences in the proportions of respiratory diseases, endocrine system diseases and neonatal diseases in hospitalized children 1 year after the COVID-19 epidemic (all P<0.01). The age distribution of hospitalized children 1 year before and 1 year after the epidemic of COVID-19 was different (P<0.01), and the number of hospitalized children was also different in different seasons (P<0.05). One year after the epidemic of COVID-19, the number of hospitalized children with respiratory diseases was decreased most significantly, and the number of children with pneumonia decreased by 93.71% (655/699), with a significant difference found in the proportions of pneumonia between 1 year before and 1 year after the COVID-19 epidemic (52.38%[44/84]vs 66.26% [699/1 055], P<0.05). Compared with 1 year before the COVID-19 epidemic, the proportion of endocrine system diseases such as short stature/growth retardation was decreased and the proportion of precocious puberty/early puberty development was increased 1 year after the COVID-19 epidemic (P<0.05). Conclusion The COVID-19 epidemic has led to a significant decrease in hospitalized children in department of pediatric, especially in the proportion of respiratory diseases, but it has led to an increase in hospitalized children with endocrine system diseases, suggesting that epidemic prevention and control measures can effectively reduce respiratory diseases requiring hospitalization, but may increase precocious puberty and early puberty development. These changes should be considered by department of pediatrics in general hospitals.Copyright © 2022, Second Military Medical University Press. All rights reserved.
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Background and Aims: The treatment of chronic hepatitis C (CHC) has evolved from genotype-specific to pan-genotypic direct acting antivirals (DAAs) with high efficacy and safety. However, drug-drug interactions (DDIs) must be avoided when used in combination with other medications, especially with the possible concomitant use of COVID-19 infection antivirals during the COVID-19 pandemic. This study aimed to access the potential DDIs of concomitant drugs with pan-genotypic DAAs and COVID-19 infection antivirals, and actual incidence of DDIs in real-world experience. Method(s): From January 2022 to October 2022, consecutive 116 HCV patients receiving pan-genotypic DAAs were retrospectively enrolled in Taipei Veterans General Hospital. The number of comedications and their potential DDIs with three pan-genotypic DAA regimens and three COVID-19 infection antivirals were analyzed. The actual incidence of DDIs during DAAs treatment were also investigated. Result(s): The mean age was 60.9 years old, with male predominant (55.2%). Of them, 12 (10.3%) patients had cirrhosis, and 24 (20.7%) patients had diabetes mellitus. Most patients were within Child-Pugh class A (109/116, 94.0%). The distribution of HCV genotypes was 8.6% in GT 1a, 36.2% in GT 1b, 39.7% in GT 2, 6.9% in GT 6, and 8.6% in indeterminate genotype, respectively. Of them, 43 (37.1%) patients received GLE/PIB, 69 (59.5%) received SOF/VEL 7plusmn;RBV, and 4 (3.4%) received SOF/VEL/VOX as DAAs regimen. Noteworthy, four patients had COVID-19 infection during DAAs treatment course. The rates of ETVR and SVR12 were 97.6% and 95.3%. The mean number of concomitant medications was 2.01. The distribution of concomitant drugs was 64.7% with no concomitant drug, 11.2% with 1-3 drugs, 11.2% with 4-6 drugs, 9.5% with 7-9 drugs, and 3.4% had more than 9 drugs, respectively. In potential contraindicated (red) DDI class, GLE/PIB was the most prevalent (7.3%), followed by SOF/VEL/VOX (6.4%), and SOF/VEL (1.8%) for non-cirrhosis and compensated cirrhosis patients;and no red DDI occurred in decompensated cirrhosis patients. In addition, the percentage of patients without potential DDIs was higher with SOF/VEL (79.8%) than with the other regimens. The potential red DDIs were predominantly with lipid-lowering agents for DAAs. For potential red DDI class with COVID-19 infection antivirals, Nirmatrelvir/Ritonavir was the most prevalent (6%), followed by Remdesivir (0.9%), and no potential DDIs with Molnupiravir. For COVID-19 antivirals, the potential red DDIs was mainly with central nervous system drugs. Finally, the actual incidence of DDIs during DAAs treatment showed no red DDI occurred for all patients, and GLE/PIB was the most prevalent (93%) of no potential DDIs. Conclusion(s): The potential DDIs between these comedications differed, with the most potential DDIs occurring with GLE/PIB and Nirmatrelvir/Ritonavir. After careful assessment of comedications and their potential DDIs, the actual incidence of DDIs could be reduced, and optimize safety in real-world practice.
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Background/Aims Baricitinib is the most common Janus Kinase inhibitor (JAKi) used in the treatment of rheumatological conditions. Whilst randomised controlled trials have demonstrated the efficacy and safety profile of baricitinib, real-world data on the experience of JAKi use in clinical practice is lacking. The aim of this analysis was to evaluate baricitinib use in a real-world patient population in South London. Methods We looked at two rheumatology departments in South London (St George's Hospital;a tertiary teaching centre and Kingston Hospital;a district general hospital). All patients prescribed baricitinib between January 2017 to June 2022 were included. A retrospective assessment of electronic patient notes was performed to evaluate disease activity (determined by DAS-28 scores at baseline, 3-6 months and presently);adverse effects including side effects, rates of and reasons for discontinuation;and prescribing practice, including previous use of other biological disease modifying anti-rheumatic drugs (bDMARDs). Baseline data including age, gender, co-morbidities and rheumatological diagnoses were also included. Results 233 patients were included in this evaluation, with seropositive rheumatoid arthritis being the most common diagnosis (58%) and with a significant female population (87%). Baricitinib improved average DAS-28 scores from 5.75 (range 3.57-8.3) at baseline to 3.23 (range 0.28-7.49) at 3-6 months post-baricitinib, with the most recent DAS-28 score of 2.90 (range 0.56-6.77). Rates of adverse effects were low as shown in Table 1. Baricitinib was discontinued in 60/233 patients, with average duration to discontinuation of 9.5 months. The most common reasons for discontinuation were: ineffective disease control (28/60), recurrent bacterial infection (5/60), deranged liver function (3/60) and venous thromboembolism (2/60). Eight patients died whilst taking baricitinib. Where documented, the causes of death were Covid-19 (4/8) and malignancy (1/8). 110 out of 233 patients had received other bDMARDs before starting baricitinib. Documented reasons for baricitinib choice over tumour necrosis factor inhibitors (TNFi) included: previous lack of response to TNFi (89/233), contra-indication to TNFi (11/233) and preference of oral route (10/ 233). Conclusion Our real-world study of JAKi use shows that baricitinib is efficacious in the treatment of rheumatological conditions. Moreover, baricitinib is well tolerated, with low rates of adverse effects and subsequent discontinuation. (Table Presented).
ABSTRACT
The epidemic of coronavirus disease 2019 (COVID-19) has seriously affected people's normal work, life, and medical treatment. Since Mar. 2022, there has been a pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant in Shanghai. In order to meet the needs of hospitalization for patients, and at the same time for better control of epidemic and nosocomial infections, a large hospital in Shanghai innovatively set up a centralized transition ward in the hospital, and established scientific rules of medical work, regulations for prevention of nosocomial infections and efficient norms for patient admission. During the operation of the ward, a total of 211 patients were treated and one of the patients was confirmed of COVID-19 recurrence. All work was carried out methodically, and neither hospitalized patients nor medical staff had nosocomial infection of COVID-19. The preparation, operation and management of the central transition ward in our hospital are summarized here to provide guidance and reference for general hospitals to carry out similar work under the epidemic.Copyright © 2022, Second Military Medical University Press. All rights reserved.
ABSTRACT
BACKGROUND: In the search for innovative methods to improve the quality and efficiency of health services, integrated clinical pathways (ICPs) have been introduced. AIM: As there is a gap in research on ICP efficiency, the aim of the study was to investigate the role and impact of collaboration and communication among three interprofessional ICP teams on the self-assessment of efficiency of ICPs. METHOD(S): A cross-sectional study was conducted using a descriptive quantitative with a survey (n = 152) and qualitative methods with a focus group (n = 27) and in-depth interviews (n = 22) in a typical general hospital in Slovenia. RESULT(S): The results showed that health-care professionals found patient health care and the work of healthcare professionals' better quality with ICP than without ICP. The ICPs team members assessed communication, cooperation, and effectiveness in the ICP team as relatively good but identified the lack of staff as the main reason for their limitations. The impact of ICP team collaboration and communication on ICP safety exists but it does not explain a sufficient proportion of the variance and the corelation is medium strong. The result also revealed that the COVID-19 pandemic did not primarily affect ICP team members' fear of possible infection, as studies have shown in the first wave of the COVID-19 pandemic, but rather staff shortages leading to increased fear of errors and possible complaints and lawsuits from patients and relatives. CONCLUSION(S): Measures are needed for the additional employment of team members and the retention of current staff through financial compensation and the promotion of supportive workplace characteristics.Copyright © 2023 Mateja Simec, Sabina Krsnik, Karmen Erjavec.