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The recent increase in the number of cases of COVID-19 in Brazil and worldwide, caused by the Omicron Variant, has brought to light concern to the population and the government, especially in the states most affected by the pandemic. To find a way to help combat the pandemic, a case study was conducted to acquire new speedboats by the Brazilian Navy (BN), through the application of the ELECTRE-MOr multicriteria method. The boats would be employed as mobile hospitals, aiming to perform first aid and evacuation of patients from riverside regions to qualified hospitals. Another important use would be the transport of vaccines, medicines and basic supplies for riverside populations, such as water, food and hygiene materials. For the proposed analysis, we consulted three specialists from the BN, who evaluated eight boat models in seven tactical, operational and medical criteria. After the application of the method, the Guardian 25 and RAC boats were chosen to be employed in humanitarian assistance. This study brings a valuable contribution to academia and society since it represents the application of a multi-criteria decision-aid method in the state of the art to contribute to the solution of a real problem that affects millions of people in Brazil and worldwide.
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INTRODUCTION: The Surviving Sepsis Campaign guidelines recommend prompt intravenous antibiotic administration within one hour for patients with septic shock or a high likelihood of sepsis. To improve timeliness of antibiotic administration, piperacillin-tazobactam and cefepime were stocked in the automated dispensing cabinets (ADCs) in five intensive care units (ICU).The aim of this study was to evaluate the time from order entry of piperacillintazobactam or cefepime to administration in ICU patients before and after addition to the ADC. METHOD(S): This was a retrospective study of adult, presumed septic patients who received their first dose of piperacillin-tazobactam or cefepime in an ICU. Patients included from March 23, 2019 - March 23, 2020 received antibiotics from the inpatient pharmacy (Pre-ADC) and those from March 25, 2020 - March 25, 2021 received piperacillintazobactam and cefepime from the ICU ADCs (Post-ADC). The primary outcome was time from antibiotic order entry to administration. Secondary outcomes included time from order entry to pharmacy verification, in-hospital mortality, and hospital length of stay. RESULT(S): One thousand eight hundred and three patients were included with 903 patients in the Pre-ADC group and 900 in the Post-ADC group. Baseline characteristics were similar, and respiratory infection was the most common antibiotic indication (37% Pre-ADC vs. 36% Post-ADC). Additionally, more Post-ADC patients had isolation precautions at the time of antibiotic administration (15% Pre-ADC vs. 19% Post-ADC, p=0.04). The median (IQR) time (minutes) from order of antibiotics to administration was shorter in the Pre-ADC group at 57 (32-97) vs. 75 (43-126) Post-ADC (p < 0.001). Median (IQR) time (minutes) from pharmacy verification to nursing administration was 51 (28- 91) Pre-ADC vs. 75 (43-126) Post-ADC, p< 0.001. Hospital length of stay and mortality were similar between the groups. CONCLUSION(S): Adding piperacillin-tazobactam and cefepime to the ICU ADCs did not result in earlier antibiotic administration in presumed septic patients. Due to the timing of this study, the COVID-19 pandemic and isolation precautions likely confounded the results. Further investigation of antibiotic administration barriers is needed to optimize patient care and meet Surviving Sepsis Campaign recommendations.
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Background: Among women, breast cancer (BC) is the most frequently diagnosed cancer and is ranked as the leading cause of cancer death. Given that aging is one of the strongest risk factors for the development of breast cancer, older adults (65+) are disproportionately affected. At the same time, more than half of older cancer patients are considered frail or pre-frail and are at increased risk of adverse outcomes including treatment intolerance, as well as morbidity, and mortality. Frailty is thus recognized as an important metric to guide decision-making in geriatric oncology. This study characterizes the use of frailty measurements in observational studies on older women with breast cancer. Material(s) and Method(s): MEDLINE, EMBASE, and Cochrane Library were systematically queried to identify observational studies (cohort, casecontrol, cross-sectional) on older women with breast cancer which evaluate survival or mortality before or after treatment, published from 2017-2022. Studies were managed using Covidence software and assessed for inclusion with predefined criteria by independent reviewers. Data was extracted with respect to the characteristics of the studies. Frailty measurements were identified, the proportion of studies using frailty measurements was calculated, and the prevalence of frailty among BC patients was determined. Result(s): A total of 9823 studies were screened on title and after deduplication. Based on specified criteria, 217 full text studies were assessed for eligibility, 71 of which were excluded, mainly due to incorrect target population with respect to age, or incorrect outcome assessment. Overall, 146 studies were included. Preliminary results revealed that frailty status was not considered in all identified observational studies. Among studies that measured frailty, a relevant proportion of female BC patients were considered frail. Detailed results will be shown at the conference. Conclusion(s): Despite having significant prognostic importance, the use of frailty measurements is not a compulsory practice in observational studies on breast cancer in older women. Additionally, although multiple frailty screening tools have been developed, there is no gold standard measurement used to detect frailty. As a result of such heterogeneity in clinical practice, an established definition of frailty remains elusive. Efforts to create a unified definition and gold standard may improve targeted care and health outcomes for older breast cancer patients. No conflict of interest. Copyright © 2022 Elsevier Ltd. All rights reserved
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The number of persons with 60 years and more worldwide is estimated to triple by 2050. With the raising burden of the mental health conditions that accompany population ageing, mental health care for older adults has to be under pined by a dignity and human rights based approach. The extraordinary number of human rights violations of the older population during the COVID-19 pandemic has come to the forefront, as consequence of this population vulnerability, the lack of political will to give prior attention to this group needs and the disseminated ageistic attitudes. Discrimination based on age can lead to catastrophic social consequences such as elder abuse, neglect and all forms of violences. Their access to services become reduced, including health, social and justice services. These negative attitutdes, more than only morally unacceptable, are source of unnecessary suffering and increase morbidity and mortality rate. Intersecting across psychiatric diagnoses and interventions are the principles of dignity, autonomy, respect and equality which are all at the base of the call for an United Nations Convention of Rights of the Older People. Keeping all thes points in mind, the World Pschiatric Association Section of Old Age Psychiatry and the International Psychogeriatric Association are working together to promote the Human Rights of Older Adults. The presentation of a webinar, the publication of joint position statements, the organization of symposia in several international congress and the publication of a recent special issue of the America Jornal of Geriatric Psychiatry (October 2021 - https:// www.ajgponline.org/issue/S1064-7481(21)X0010-3) are some examples of this common effort.
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Background: International guidelines recommend thromboprophylaxis for hospitalized coronavirus disease 2019 (COVID-19) patients due to high prevalence of thromboembolism (TE). However, thromboprophylaxis is uncommonly prescribed in Thailand. Aim(s): To determine the incidence of TE and the mortality rate of hospitalized COVID-19 patients in Thailand. Method(s): We retrospectively reviewed medical records of COVID-19 patients admitted to King Chulalongkorn Memorial Hospital between February 2020 and August 2021. Result(s): There were 7452 hospitalized COVID-19 patients with 460 (6.2%) intensive care unit (ICU) patients. The decision of thromboprophylaxis was based on the discretion of attending physicians. Only 85 (1.14%) patients received anticoagulants due to new TE without thromboprophylaxis (43;0.58%), thromboprophylaxis (36;0.48%) or preexisting conditions (6;0.08%). Of 43 newly identified TE, there were 33 (0.44%) venous TE and 10 (0.14%) arterial TE. Among 43 TE, 29 were treated in ICU with an estimated incidence of 6.3% (29 of 460). The incidence of TE in non-ICU patients was very low (0.2 %;14 of 6992). Of 36 receiving standard-dose enoxaparin thromboprophylaxis, 3 (8.3%) developed venous TE. The overall mortality rate was 1.7% (126 of 7452), while the mortality rate in patients with TE was as high as 41.3% (19 of 46). Compared to patients without TE, patients with TE had a substantially increased risk of death (odds ratio of 48.0, 95% confidence interval, 25.9, 89.0;p < 0.0001). Conclusion(s): The incidence of TE in hospitalized COVID-19 patients was lower than those reported from Western countries despite a very low thromboprophylaxis rate in Thailand. Routine thromboprophylaxis for hospitalized COVID-19 Thais may not be cost-effective. However, ICU patients were at higher risk of TE. Patients who developed TE were at greater risk for death.
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Background & objective: Patients with COVID-19 have Acute Respiratory Distress Syndrome (ARDS) which progresses to lung edema and disorders of the liver, kidneys and heart associated with cytokine storms, which are the body's immune response to SARS-CoV-2. SARS-CoV-2 patients showed clinical neutrophilia, increased D-Dimer and increased IL-6. In addition, increased lactate dehydrogenase and increased aminotransferase are often found. This study aimed to analyze the clinical relevance of increased IL-6 and lactate in the first 24 hours of ICU-admission of COVID-19 patients in predicting mortality rate. Methodology: This study was a retrospective cohort design. The study was conducted in the Intensive Care Unit (ICU) of Dr. Moewardi Surakarta Hospital. The study was conducted by tracing the medical records of COVID-19 patients treated in the ICU of Dr. Moewardi Surakarta Hospital during the period of March 1, 2020 to March 31, 2021 that met the admission criteria. The patient's mortality assessment is seen as the patient's condition for a maximum of 30 days after discharge from the hospital. Result(s): Variables that meet the regression model are the lactate levels (OR = 3,143;P = 0.064) as well as the IL-6 levels (OR = 25.41;p<0.001). AUC score of 86.9% with significance of < 0.001. IL-6 levels and lactate levels in the study can be used as predictors of mortality rates with 95.7% sensitivity and 60% specificity. Lactate levels in COVID-19 cases in severe cases can be related to lung damage and tissue damage. Lactate levels have also been recognized as a marker of poor prognosis in patients with COVID-19. IL-6 as a predictor of mortality risk has been recognized and the administration of IL-6 inhibitors in COVID-19 patients may lower the risk of mortality. Conclusion(s): Raised IL-6 and lactate levels in this study can be a predictor of the mortality rate of COVID-19 patients within 24 hours of ICU-admission. Copyright © 2022 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
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The pandemic caused by the new coronavirus has brought to light a series of concerns for the Brazilian population and government departments due to the different costly consequences that it has generated. It has also mobilized different strategic fronts that plan and implement several mitigating measures against the virus. Besides, the search for solutions for adequate care for individuals in need of support has been constant. This work uses ELECTRE-MOr, a Multi-Criteria Decision Aid (MCDA) method, to support the logistic plan for the vaccine distribution throughout Brazil, essentially to remote areas. The method allows an objective and structured classification of ideal types of thermal boxes for the storage of immunobiological inside the Cold Chain, presenting the best alternative that maintains the quality of materials until the final destination and has the best cost-benefit. Currently, the ELECTRE-MOr model is under development in a computational tool in Python, allowing the use of the method intuitively and clearly, enabling professionals of any area of expertise to apply it.