Mental distress of physicians in the outpatient care throughout the COVID-19 pandemic: emotional and supportive human relations matter - Cross-sectional results of the VOICE-study.

BACKGROUND: The aim of this cross-sectional study was to evaluate the course of self-reported mental distress and quality of life (QoL) of physicians, working in the outpatient care (POC). Outcomes were compared with a control group of physicians working in the inpatient care (PIC), throughout the Corona Virus Disease (COVID)-19 pandemic. The impact of risk and protective factors in terms of emotional and supportive human relations on mental distress and perceived QoL of POC were of primary interest. METHODS: Within the largest prospective, multi-center survey on mental health of health care workers (HCW), conducted during the first (T1) and second (T2) wave of the COVID-19 pandemic in Europe, we investigated the course of current burden (CB), depression (Patient Health Questionnaire-2), anxiety (Generalized Anxiety Disorder-2) and QoL, cross-sectionally, in n = 848 POC (T1: n = 536, T2: n = 312). The primary outcomes were compared with an age- and gender-matchted control group of n = 458 PIC (T1: n = 262, T2: n = 196). COVID-19-, work-related, social risk and protective factors were examined. RESULTS: At T1, POC showed no significant differences with respect to CB, depression, anxiety, and QoL, after Bonferroni correction. Whereas at T2, POC exhibited higher scores of CB (Cohen´s d/ Cd = .934, p < .001), depression (Cd = 1.648, p < 001), anxiety (Cd = 1.745, p < .001), work-family conflict (Cd = 4.170, p < .001) and lower QoL (Cd = .891, p = .002) compared with PIC. Nearly all assessed parameters of burden increased from T1 to T2 within the cohort of POC (e.g. depression: CD = 1.580, p < .001). Risk factors for mental distress of POC throughout the pandemic were: increased work-family conflict (CB: ß = .254, p < .001, 95% CI: .23, .28; PHQ-2: ß = .139, p = .011, 95% CI: .09, .19; GAD-2: ß = .207, p < .001, 95% CI: .16, .26), worrying about the patients´ security (CB: ß = .144, p = .007, 95% CI: .07, .22; PHQ-2: ß = .150, p = .006, 95% CI: .00, .30), fear of triage situations (GAD-2: ß = .132, p = .010, 95% CI: -.04, .31) and burden through restricted social contact in spare time (CB: ß = .146, p = .003, 95% CI: .07, .22; PHQ-2: ß = .187, p < .001, 95% CI: .03, .34; GAD-2: ß = .156, p = .003, 95% CI: -.01, .32). Protective factors for mental distress and QoL were the perceived protection by local authorities (CB: ß = -.302, p < .001, 95% CI: -.39, -.22; PHQ-2: ß = -.190, p < . 001, 95% CI: -.36, -.02; GAD-2: ß = -.211, p < .001, 95% CI: -.40, -.03; QoL: ß = .273, p < .001, 95% CI: .18, .36), trust in colleagues (PHQ-2: ß = -.181, p < .001, 95% CI: -.34, -.02; GAD-2: ß = -.199, p < .001, 95% CI: -.37, -.02; QoL: ß = .124, p = .017, 95% CI: .04, .21) and social support (PHQ-2: ß = -.180, p < .001, 95% CI: -.22, -.14; GAD-2: ß = -.127, p = .014, 95% CI: -.17, -.08; QoL: ß = .211, p < .001, 95% CI: .19, .23). CONCLUSIONS: During the pandemic, the protective role of emotional and supportive human relations on the mental distress and quality of life of POC should be taken into account more thoroughly, both in practice and future research.

Atuação da enfermagem em unidades dedicadas e não dedicadas à COVID-19: implicações na saúde ocupacional

Objetivo: analisar as implicações da pandemia sobre a saúde ocupacional da equipe de enfermagem conforme a atuação em unidades dedicadas e não dedicadas à COVID-19. Método: estudo multicêntrico, de método misto, estratégia explanatória sequencial. Participaram 845 profissionais na primeira etapa, respondendo a um formulário eletrônico contendo variáveis sociodemográficas, laborais, sobre a pandemia e sua saúde e o Self-Reporting Questionnaire. Na segunda etapa, 19 profissionais foram entrevistados. Os dados quantitativos foram submetidos à estatística analítica e os qualitativos à análise temática de conteúdo, sendo integrados por conexão. Resultados: os impactos da pandemia sobre a saúde dos profissionais ocorreram tanto nas áreas dedicadas como nas não dedicadas à COVID-19. Contudo, a composição das equipes apresentou características distintas entre as áreas, bem como as percepções de risco e das exigências no trabalho. Conclusão: os profissionais que atuam em áreas dedicadas e não dedicadas à COVID-19 estão igualmente adoecidos, mas com exposição laboral distinta quanto às exigências no trabalho nas unidades dedicadas e o medo da contaminação nas unidades não dedicadas.Alternate :Goal:to analyze the implications of the pandemic on the occupational health of the nursing team according to their work in units dedicated and not dedicated to COVID-19. Method:multicenter, mixed-method study, sequential explanatory strategy. 845 professionals participated in the first stage, responding to an electronic form containing sociodemographic and labor variables, about the pandemic and their health, and the Self-Reporting Questionnaire. In the second stage, 19 professionals were interviewed. Quantitative data were submitted to analytical statistics and qualitative data to thematic content analysis, being integrated by connection. Results:the impacts of the pandemic on the health of professionals occurred both in areas dedicated and non-dedicated to COVID-19. However, the composition of the teams showed different characteristics between the areas, as well as the perceptions of risk and demands at work. Conclusion:professionals who work in areas dedicated and not dedicated to COVID-19 are equally ill, but with different occupational exposure regarding the demands at work in dedicated units and the fear of contamination in non-dedicated units.

Diabetes in all hospitalized cases in Germany 2015-2019 and impact of the first COVID-19 year 2020.

Objective: To analyze the proportion of diabetes among all hospitalized cases in Germany between 2015 and 2020. Methods: Using the nationwide Diagnosis-Related-Groups statistics, we identified among all inpatient cases aged ≥ 20 years all types of diabetes in the main or secondary diagnoses based on ICD-10 codes, as well all COVID-19 diagnoses for 2020. Results: From 2015 to 2019, the proportion of cases with diabetes among all hospitalizations increased from 18.3% (3.01 of 16.45 million) to 18.5% (3.07 of 16.64 million). Although the total number of hospitalizations decreased in 2020, the proportion of cases with diabetes increased to 18.8% (2.73 of 14.50 million). The proportion of COVID-19 diagnosis was higher in cases with diabetes than in those without in all sex and age subgroups. The relative risk (RR) for a COVID-19 diagnosis in cases with vs without diabetes was highest in age group 40-49 years (RR in females: 1.51; in males: 1.41). Conclusions: The prevalence of diabetes in the hospital is twice as high as the prevalence in the general population and has increased further with the COVID-19 pandemic, underscoring the increased morbidity in this high-risk patient group. This study provides essential information that should help to better estimate the need for diabetological expertise in inpatient care settings.

A new challenge for child psychiatrists: Inpatient care management during coronavirus pandemic

The first objective of this article;is to define, as the child psychiatry inpatient service team, the approaches to patients who need both professional help and treatment in terms of mental health and need protection from an infection during the Covid-19 outbreak. Secondly, to evaluate the adaptation of the clinical skills (mechanism) to this critical process. A great burden is imposed on health systems during COVID-19 Pandemic. In this process, it is essential to follow the guidelines on transmission of infection and provide inpatient service treatment for child and adolescent in urgent need of mental health treatment. Length of hospitalization may be shorter in the pandemic period and high rate of antipsychotic use and predominance of patients with insufficient response to monotherapy may be related to hospitalization of patients with more severe disease during pandemic period. Timely organized regulations in psychiatry clinics can be effective against risk of transmission. This study shows the importance of how the pandemic process and the psychiatric disease treatment process can be carried out together. The continuation of the treatment services with infectious prevention measures in the field of mental health during pandemic times has an crucial place. As the healthcare professionals in the field of Child and Adolescent Mental Health, we think that it may be important to share inpatient service functioning and experiences in the face of the COVID-19. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Anorexia nervosa admissions during the COVID-19 pandemic: results from a Department of Psychiatry in northern Portugal

Introduction: Emerging evidence suggests that the COVID-19 pandemic had a negative impact on mental health. In particular, patients with Anorexia nervosa (AN) may have faced increased symptom severity. Objective(s): To compare the clinical characteristics of inpatients with AN admitted amidst the COVID-19 pandemic versus the two previous years. Method(s): Retrospective observational study of inpatients admitted between January 2018 and December 2020 in a psychiatry inpatient unit of a tertiary hospital. Result(s): There were 11 admissions of patients with AN in 2020 (8 from March onwards), a 22% increase relative to 2019, which in turn saw a 28% increase in admissions relative to 2018. Most patients had an AN diagnosis previous to the pandemic. The majority were undergoing outpatient treatment for over a year. Two patients were admitted within a month of outpatient treatment. There was an increase in admissions through the emergency service in 2020. The most frequent diagnostic was AN binge-eating/ purging type in 2020 and 2019, whereas in 2018 the AN restrictive type was dominant. Mean BMI at admission and average length of stay were similar across the three years. Readmission in a 12-month period was 54,5% in 2020 (22,2% in 2019 and 42,9% in 2018). Conclusion(s): Despite the widespread impression of a negative impact of the pandemic on AN patients, in our study the clinical characteristics of AN patients admitted in 2020 were mostly similar to the two previous years. Readmissions were higher in 2020, therefore future analysis of data from 2021 might be more enlightening.

Performance of Subnational Governments in the COVID-19 Pandemic: An Analysis of the Public and Private Health Services in Brazil

This article analyzes the differences between public and private health services regarding infrastructure and human resources at the state (subnational) and macro-regional levels in Brazil. The research collected monthly data on inpatient beds and the number of nurses, physiotherapists, and doctors from Brazilian states for 2020. Indicators were created following quarterly changes and comparing the actions of public and private healthcare entities. Variations were analyzed using temporal graphs based on means and standard deviation. The findings suggest: (1) exponential growth in health care infrastructure and human resources led by public sector investment in the second quarter, followed by a slowdown;(2) a more significant variation in the acceleration and deceleration of the public sector response in the North of Brazil and the states of Maranhäo, Rio Grande do Norte, and the Federal District;(3) the public sector was the primary response mechanism to the pandemic considering the variations throughout the year. The study concludes that the government was the leading actor in response to the COVID-19 pandemic in Brazil in 2020, pointing out that responses were uneven in the states.

The identification of risk factors associated with COVID-19 in a large inpatient cohort using machine learning approaches

Coronavirus disease 2019 (COVID-19) has become a global pandemic that significantly challenged healthcare systems worldwide, with over 4 million deaths among 18.6 million identified cases as of June 2021. Understanding the current COVID-19 cases and determining clinical solutions is of paramount importance. In this chapter, we describe an exploratory study of identifying risk factors associated with COVID-19 inpatient care. Based on a set of COVID-19 inpatient medical health records in a US hospital system, we used both unsupervised and supervised machine learning methods to explore risk factors associated with hospitalized COVID-19 patients. We found that the most important features related to the COVID-19 disease include (1) influenza vaccines, (2) pneumococcal vaccines, and (3) weight-related variables (i.e., weight, height, and BMI). As such, we provide a use case that machine learning methods are valuable for predicting COVID-19 inpatient risk factors, and the results are promising to guide further research in this area. © 2022 Elsevier Inc. All rights reserved.

Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study.

A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.

Impact of the COVID-19 Pandemic on Utilization of Inpatient Mental Health Services in Shanghai, China.

(1) Purpose: The ongoing COVID-19 pandemic has had an impact on mental health and the utilization of hospital-based inpatient mental health care worldwide. The aim of this study was to determine the impact of this pandemic on the utilization of this service in Shanghai by comparison with hospital-based health care records during the preceding 4 years. (2) Methods: The medical records were provided by the Shanghai Municipal Health Insurance Bureau. Diagnostic coding was based on International Classification of Diseases-10th revision (ICD-10), and inpatients with codes from F00 to F99 were examined. (3) Results: Inpatients were compared according to gender, age, pandemic stage, and type of mental disease. Utilization of psychiatric inpatient care in Shanghai during each of the four stages of the pandemic (1 January 2016 to 21 January 2020; 22 January 2020 to 9 February 2020; 10 February 2020 to 1 March 2020; 2 March 2020 to 31 July 2020) was analyzed. Before the lockdown, the utilization of psychiatric inpatient care had an overall upward trend; after the lockdown, the number of inpatients dropped sharply; as of 31 July 2020, it has not been restored. The utilization of this service for most types of mental disease declined rapidly during the pandemic; for vascular dementia (VAD, F01), it was relatively steady. The observed number of inpatient patients was about 51.07% lower than the predicted number in 2020. (4) Conclusions: The COVID-19 pandemic led to the implementation of prevention and control measures that reduced the utilization of psychiatric inpatient care in Shanghai. The use of inpatient services for categories F20-F29 had the greatest decline, and VAD (F01) had the smallest change during the pandemic. This service consequence of COVID-19 is apparent; to assure access to adequate service during a pandemic, health care professionals should pay close attention to changes in the utilization of different mental health services.

The association of strained ICU capacity with hospital patient racial and ethnic composition and federal relief during the COVID-19 pandemic.

OBJECTIVE: To identify the association between strained intensive care unit (ICU) capacity during the COVID-19 pandemic and hospital racial and ethnic patient composition, federal pandemic relief, and other hospital characteristics. DATA SOURCES: We used government data on hospital capacity during the pandemic and Provider Relief Fund (PRF) allocations, Medicare claims and enrollment data, hospital cost reports, and Social Vulnerability Index data. STUDY DESIGN: We conducted cross-sectional bivariate analyses relating strained capacity and PRF award per hospital bed with hospital patient composition and other characteristics, with and without adjustment for hospital referral region (HRR). DATA COLLECTION: We linked PRF data to CMS Certification Numbers based on hospital name and location. We used measures of racial and ethnic composition generated from Medicare claims and enrollment data. Our sample period includes the weeks of September 18, 2020 through November 5, 2021, and we restricted our analysis to short-term, general hospitals with at least one intensive care unit (ICU) bed. We defined "ICU strain share" as the proportion of ICU days occurring while a given hospital had an ICU occupancy rate ≥ 90%. PRINCIPAL FINDINGS: After adjusting for HRR, hospitals in the top tercile of Black patient shares had higher ICU strain shares than did hospitals in the bottom tercile (30% vs. 22%, p < 0.05) and received greater PRF amounts per bed ($118,864 vs. $92,407, p < 0.05). Having high versus low ICU occupancy relative to pre-pandemic capacity was associated with a modest increase in PRF amounts per bed after adjusting for HRR ($107,319 vs. $96,627, p < 0.05), but there were no statistically significant differences when comparing hospitals with high versus low ICU occupancy relative to contemporaneous capacity. CONCLUSIONS: Hospitals with large Black patient shares experienced greater strain during the pandemic. Although these hospitals received more federal relief, funding was not targeted overall toward hospitals with high ICU occupancy rates.

OLDER PERSON’S ASSESSMENT SERVICE (OPAS): DELIVERING COMPREHENSIVE GERIATRIC ASSESSMENT (CGA) IN THE EMERGENCY DEPARTMENT (ED)

Introduction Innovative models of service delivery are required to provide Comprehensive Geriatric Assessment for older patients presenting to the Emergency Department with frailty syndromes. Method In 2018, the Older Person’s Assessment Service began a liaison service to the ED, taking referrals from the medical and ED teams for patients who presented with frailty syndromes (falls, cognitive impairment, care dependence, polypharmacy). The service saw 437 patients April–August 2018. 76% of the patients assessed were discharged by utilising available community services, rapid access outpatient follow up and inpatient reablement off the acute site. The service was estimated to avoid 50–80 admissions per month to medicine (saving 17–23 beds a year) and was commissioned as a permanent service. Phase 2 In 2020, a dedicated unit within ED was allocated to OPAS, enabling the acceptance of patients directly from triage and from the Ambulance Service by direct referral. This provided rapid access to specialist assessment, continued access to Elderly Care services, avoided exposure to coronavirus related admissions and the risks of nosocomial infection associated with admission. The service operates from 8 am-4 pm on weekdays. Results Between June 2020 and October 2021, the service saw 1,173 new patients. 988 patients (84.5%) were discharged off the acute site on the day of assessment. 68 (5.79%) patients were admitted to other facilities run by the Health Board (e.g Inpatient Reablement). The average age of an OPAS patient was 83 yrs and had a CFS > 5. Readmission rate at 14 days was 4% (47).Of the 253 patients who were admitted to an inpatient setting, 13.5% (35) contracted nosocomial covid-19. Conclusion The service has been supported and funded to expand into extended weekday hours as a result of this success and there are plans for future 7 day working.

USING VIDEO TELEMEDICINE FOR INPATIENT WORKING: A NOVEL APPROACH TO REMOTE WORKING DURING THE COVID-19 PANDEMIC

Background Orthogeriatrics inpatient ward. Introduction The COVID-19 pandemic changed working patterns for many trainees. Remote telephone or video outpatient consultations became established practice, with clinically vulnerable staff able to support this provision. We adapted the use of telemedicine to provide remote clinical working for inpatient care and continued speciality training opportunities. Method Microsoft Teams video conferencing facilitated interaction between the specialist registrar working remotely and the on-site multidisciplinary team (MDT). Daily activities included virtual handover attendance, inpatient ward round consultations and MDT discussions. A portable computer enabled the clinician to see and interact with inpatients remotely. Access to electronic patient records facilitated timely decision making and enactment of management plans. Anonymous MDT feedback was collected via online questionnaires. This project conformed to service evaluation guidelines and ethical approval was not required. Results Fourteen staff members completed the feedback survey. Results were overwhelmingly positive, with 78.6% of respondents strongly agreeing that the senior doctor working remotely supported the MDT, facilitated complex clinical decision making and was beneficial to patient care. Feedback noted that some patients praised the ‘clever’ and ‘innovative’ method. Limitations included technical difficulties due to Wi-Fi connection, which contributed to communication not being as fluid as face-to-face consultations and increased ward round duration. Patient factors, namely hearing and cognitive impairment, limited the interaction that patients were able to have with the clinician via video link. Conclusion Video inpatient ward round consultations offer an effective opportunity for physicians to continue clinical patient-facing roles whilst working remotely. Furthermore, this minimises the impact of COVID-19 on specialty trainees, by providing continued training and assessment opportunities for individuals required to shield. This novel method affords a framework transferrable to clinicians from other hospital specialties who may be required to work remotely. Future reviews of patient and relative satisfaction with this process are required.

How the COVID-19 pandemic influences the prevalence of pressure injuries in the Czech Republic: A nationwide analysis of a health registry in 2020.

BACKGROUND: COVID-19 significantly influences the overall patient status and, in severe symptomatology, the ability to move and the low oxygenation of the tissue for the ventilated patient in Intensive Care Units (ICU). There is a higher risk for Pressure injuries (PIs) development. OBJECTIVES: The nationwide analyses of the National health register aimed to compare the prevalence of PIs reported before the pandemic COVID-19 started and during the pandemic in 2020. METHOD: A retrospective, nationwide cross-sectional analysis of data regarding the STROBE checklist collected by the National Health Information System (NHIS), focusing on the PIs reporting based on the International Classification of Diseases (ICD-10) diagnoses L89.0-L89.9 for PIs in 2020. The data from the pandemic period of COVID-19 in 2020 were compared to the prevalence of PI cases in the period 2010-2019 in the Czech Republic in all hospitalized patients. RESULTS: The total number of admissions for L89 in 2020 was 14,441, of which 1509 (10.4%) also had COVID-19. In the ICU were 4386 admissions, 12.1% of which also had COVID-19. A higher proportion of PIs is observed in patients hospitalized with COVID-19 than in patients without COVID-19 (2.62% vs 0.81%, respectively 1.05% vs 0.46% when standardized to the 2013 ESP = European Standard Population). In patients hospitalized in ICU, 3.68% with COVID-19 had PIs vs 1.42% without COVID-19 had PIs (1.97% vs 0.81% using the 2013 ESP). CONCLUSION: The national health registers analyses have proven that the prevalence of PIs was higher among patients hospitalized with the SARS-CoV-2 infection.

Changes and Challenges in Inpatient Mental Health Care During the First Two High Incidence Phases of the COVID-19 Pandemic in Germany - Results From the COVID Ψ Psychiatry Survey.

Psychiatric inpatient treatment, an important pillar of mental health care, is often of longer duration in Germany than in other countries. The COVID-19 pandemic called for infection prevention and control measures and thereby led to shifts in demand and inpatient capacities. The Germany-wide COVID Ψ Psychiatry Survey surveyed department heads of German psychiatric inpatient institutions. It assessed changes in utilization during the first two high incidence phases of the pandemic (spring 2020 and winter 2020/21) and also consequences for care, telemedicine experiences, hygiene measures, treatment of patients with mental illness and co-occuring SARS-CoV-2, and coercive measures in such patients. A total of n = 71 psychiatric departments (of 346 contacted) participated in the survey. The results showed a median decrease of inpatient treatment to 80% of 2019 levels and of day hospital treatment to 50% (first phase) and 70% (second phase). Reductions were mainly due to decreases in elective admissions, and emergency admissions remained unchanged or increased in 87% of departments. Utilization was reduced for affective, anxiety, personality, and addiction disorders but appeared roughly unaffected for psychotic disorders. A lack of integration of patients into their living environment, disease exacerbations, loss of contact, and suicide attempts were reported as problems resulting from reduced capacities and insufficient outpatient treatment alternatives. Almost all departments (96%) treated patients with severe mental illness and co-occurring SARS-CoV-2 infection. The majority established special wards and separate areas for (potentially) infectious patients. Telephone and video consultations were found to provide benefits in affective and anxiety disorders. Involuntary admissions of persons without mental illness because of infection protection law violations were reported by 6% of the hospitals. The survey showed high adaptability of psychiatric departments, which managed large capacity shifts and introduced new services for infectious patients, which include telemedicine services. However, the pandemic exacerbated some of the shortcomings of the German mental health system: Avoidable complications resulted from the lack of cooperation and integrated care sequences between in- and outpatient sectors and limited options for psychiatric hospitals to provide outpatient services. Preventive approaches to handle comparable pandemic situations in the future should focus on addressing these shortcomings.

Effectiveness of Regdanvimab at Preventing the Need for Oxygen Therapy in Patients with Mild-to-Moderate COVID-19: A Retrospective Cohort Study.

BACKGROUND: Monoclonal antibodies are a treatment option for patients with mild-to-moderate coronavirus disease (COVID-19). We investigated the effectiveness of regdanvimab, an anti-severe acute respiratory syndrome coronavirus-2 monoclonal antibody approved in Korea, in the treatment of patients with mild-to-moderate COVID-19. MATERIALS AND METHODS: Medical records of patients who were admitted to a COVID-19 designated hospital during the study period of February 1 to June 31 and met the indications for administration of regdanvimab were reviewed to assess baseline characteristics and clinical outcomes such as supplemental oxygen requirements, mortality, and length of hospitalization. Multivariable logistic regression analysis was conducted to identify factors associated with requiring supplemental oxygen. Subgroup analysis was performed according to the presence of pneumonia confirmed on a chest X-ray. RESULTS: Three hundred ninety-eight COVID-19 patients were included in the study, and 65 (16.3%) of them were administered regdanvimab. The proportion of patients requiring supplemental oxygen was significantly lower in the regdanvimab group than in the control group (6.2% vs. 20.1%, P = 0.007). There was no significant difference in mortality (0% vs. 1.5%, P >0.999) and the length of hospitalization (median: 10 days vs. 10 days, P = 0.267) between two groups. The multivariable analysis demonstrated that administration of regdanvimab was independently associated with lower oxygen supplement [odds ratio (OR): 0.20, 95% confidence interval (CI): 0.06 - 0.55, P = 0.004] after adjustment of potential risk factors related to supplemental oxygen including age, sex, chest X-ray abnormality, and underlying chronic kidney disease. Among the patients with pneumonia radiologically, administration of regdanvimab was also associated with lower risk of oxygen supplement (OR: 0.13, 95% CI: 0.02 - 0.46, P = 0.007). CONCLUSION: Regdanvimab use was related to lower need for supplemental oxygen in patients with mild-to-moderate COVID-19 for the indications for administration of regdanvimab.

Exploring Effectiveness Reserves in Hospitals with the DEA Method

In our study, we undertake a relative efficiency analysis of hospitals providing inpatient care, which play a key role in the Hungarian health care system. According to the Competitiveness Report 2020 of the Hungarian National Bank, the Hungarian health care system has a number of reserves, and the sustainability of the system can be improved by using these reserves. In the 2015-2019 period, particular attention has been paid to the identification of achievable and meaningful indicators in the sector under review. The relative effectiveness analysis (DEA) method can be used to address this challenge. The units of our analysis are state-owned institutions in Hungary, typologised by the total number of beds. General profile hospitals with a bed count between 600 and 1200 beds were included in the analysis. The results of running the programme have clearly shown that there are some institutions that do not operate as efficiently as the majority of the organisations included in the study, but further research and refinement of the indicators is needed to determine the practical application of the pilot studies.

Digitally enabled flash glucose monitoring for inpatients with COVID-19: Feasibility and pilot implementation in a teaching NHS Hospital in the UK.

BACKGROUND: COVID-19 placed significant challenges on healthcare systems. People with diabetes are at high risk of severe COVID-19 with poor outcomes. We describe the first reported use of inpatient digital flash glucose monitoring devices in a UK NHS hospital to support management of people with diabetes hospitalized for COVID-19. METHODS: Inpatients at University Hospitals Coventry & Warwickshire (UHCW) NHS Trust with COVID-19 and diabetes were considered for digitally enabled flash glucose monitoring during their hospitalization. Glucose monitoring data were analysed, and potential associations were explored between relevant parameters, including time in hypoglycaemia, hyperglycaemia, and in range, glycated haemoglobin (HbA1c), average glucose, body mass index (BMI), and length of stay. RESULTS: During this pilot, digital flash glucose monitoring devices were offered to 25 inpatients, of whom 20 (type 2/type 1: 19/1; mean age: 70.6 years; mean HbA1c: 68.2 mmol/mol; mean BMI: 28.2 kg/m2) accepted and used these (80% uptake). In total, over 2788 h of flash glucose monitoring were recorded for these inpatients with COVID-19 and diabetes. Length of stay was not associated with any of the studied variables (all p-values >0.05). Percentage of time in hyperglycaemia exhibited significant associations with both percentage of time in hypoglycaemia and percentage of time in range, as well as with HbA1c (all p-values <0.05). The average glucose was significantly associated with percentage of time in hypoglycaemia, percentage of time in range, and HbA1c (all p-values <0.05). DISCUSSION: We report the first pilot inpatient use of digital flash glucose monitors in an NHS hospital to support care of inpatients with diabetes and COVID-19. Overall, there are strong arguments for the inpatient use of these devices in the COVID-19 setting, and the findings of this pilot demonstrate feasibility of this digitally enabled approach and support wider use for inpatients with diabetes and COVID-19.

Sebaceous Carcinoma Masquerading As Orbital Cellulitis.

Sebaceous cell carcinoma is an uncommonly encountered cutaneous malignancy. Often considered a great masquerader, sebaceous cell carcinoma arises from meibomian glands and can have a poor prognosis if not diagnosed early. In this case report, we present a patient with sebaceous cell carcinoma who presented to our emergency department with a clinical presentation that was concerning for orbital cellulitis. The patient was initially started on intravenous antibiotics. However, workup, including imaging and laboratory results, pointed toward malignancy as the diagnosis. The patient underwent an incisional biopsy and pathology confirming the diagnosis of sebaceous cell carcinoma. We engaged in further discussion of this peculiar cutaneous masquerader, differential diagnoses, and important considerations.

The difference between inpatient and outpatient programs regarding trait -anxiety, social support and state-anxiety in during the covid-19 pandemic in Israel

Purpose>COVID-19 pandemic is affecting the well-being and the psychological resilience of different populations, particularly in the addiction field. This study aims to assess anxiety and its severity among patients and staff from different types of addiction services in Israel during this emergency.Design/methodology/approach>The study was conducted during the period from March–July 2020. Participants included patients and staff (N = 282) from three different types of addiction services, were administered the State-Trait Anxiety Inventory, the multi-dimensional scale of perceived social support and demographic variables. In addition, a logistic regression model was applied to identify predictors of state anxiety by using statistical package for the social sciences software.Findings>The results show that therapeutic communities clients reported more social support compared to other subjects. State anxiety has a positive strong correlation with trait anxiety both among patients and staff, and it was found as a crucial predictor of state anxiety in the regression equation. There is no statistically significant correlation between state anxiety and social support, gender or education among clients and staff as one. The state anxiety remains relatively stable and characterizes most people, staff and patients, men and women, medical staff members and other professionals.Research limitations/implications>The current study has some contributions to the addiction field by understanding the psychological distress of a vulnerable population: substance users in treatment settings. The study population relied on convenient samples and future studies should be planned using a cross-sectional design and should take into account substance use measures. The findings are reinforcing the assumption that state anxiety was likely to increase during the coronavirus pandemic.Practical implications>Adequate services should be planned to avoid relapse or mental deterioration of people who use drugs during health emergencies.Originality/value>The research points out the unique and real difficulties of SUD clients, as well as the complexity and risks in their staff members’ works. The authors also saw that staff members need attention and maintenance;they are in the front line.

QUALITY IMPROVEMENT PROJECT ON TRANSFER TIMES OF ACUTE HIP FRACTURE PATIENTS FROM ED TO INPATIENT BED POST SIMULATION TRAINING

Introduction The care of patients with hip fractures is a surrogate marker of trauma care. Irish hip Fracture Standard (IHFS) 1 involves patients with a hip fracture being admitted to an orthopaedic ward bed within 4 hours of attending the ED. We wanted to audit our current practice and introduce a quality improvement project to improve the timeliness and efficiency of care of our hip fracture patients compared with the gold standard IHFS 1. We introduced a 90 minute multidisciplinary simulation training programme on the hip fracture pathway to our ED in February 2021. All key stakeholders were represented;from Emergency Medicine, Orthopaedics, Nursing (EM and Orthopaedic), Radiology, Radiography, Porters (32 people overall). Because of covid-19, the training was available in person and online via zoom. Methods We performed a retrospective audit of patients presenting to TUH ED with a proximal third of femur fracture between 4th February and 31st March inclusive in 2020 and 2021, pre and post introduction of multidisciplinary simulation based medical education on the hip fracture pathway. Data was collected from the electronic record database (symphony). We recorded the following data;Results 2020 n = 31 Average time to ward—8 hrs 29 mins. 26% patients reached ward <4 hours. (8/31) 2021 n = 25 Average time to ward—5 hrs 58 mins (32% reduction vs 2020) 72% patients reached ward <4 hours. (18/25) (46% increase vs 2020). Conclusion Simulation based medical education is a successful intervention to improve compliance with our hip fracture pathway, time from presentation to transfer to an orthopaedic ward bed and achieve IHFS 1.