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

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

The Impact of COVID-19 on Outcome Indicators of Hospitals of Shahid Beheshti University of Medical Sciences: An Interrupted Time Series Analysis

Background and Aim: With the outbreak of the COVID-19 pandemic, the performance of hospitals were affected, and changes were made in the utilization of hospital services. Analyzing hospital performance data during the COVID-19 pandemic can provide insights into service utilization patterns and care outcomes for managers and policymakers. This study was conducted to investigate the impact of COVID-19 on selected outcome indicators in the hospitals of Shahid Beheshti University of Medical Sciences, Tehran. Materials and Methods: This research was descriptive-analytical and of the time series analysis type. Six outcome indicators were considered: hospitalization rate, bed occupancy rate, the average length of stay, emergency visits, laboratory tests, and imaging requests. Related data from 12 affiliated hospitals from 2017-2019 (pre-COVID) and 2020 (post-COVID) were obtained from the hospital's intelligent management system. The data were analyzed using R software's interrupted time series analysis method. Results: The hospitalization rate (P=0.015), bed occupancy rate (P=0.04), and the number of laboratory tests (P=0.003) significantly increased immediately after the outbreak of the pandemic. In contrast, emergency visits (P=0.034) have significantly decreased. The bed occupancy rate and the number of imaging requests showed no significant change. The decrease in emergency room visits within one year after the pandemic was significant, but the changes in other outcome indicators were non-significant (P>0.05). Conclusion: Understanding the changes and impact of a major event on hospital outcome indicators is necessary for decision-makers to effectively plan for resource allocation and effective pandemic response. The outbreak of COVID-19 has caused a change in performance and hospital outcomes by affecting the supply and demand of services. In a year after the pandemic's beginning, except for emergency visits, the other indicators have not experienced significant changes. Preservation of essential services such as emergency room visits is recommended in the strategy of rapid response to an epidemic outbreak and public campaigns to encourage people to seek medical care if needed in future waves of the pandemic. © 2022 the Authors.

Is COVID-19 a risk for postoperative delirium and death in elderly patients after emergency surgery?

Aim: While recent evidence describes atypical outcomes of coronavirus disease 2019 (COVID-19) in elderly patients, the frequency of delirium and associated outcomes in elderly patients with COVID-19 (coronavirus disease 2019) infection undergoing emergency surgery are not well defined. This study aims to determine the effect of COVID-19 on postoperative delirium and postoperative death in elderly patients undergoing emergency surgery. Material(s) and Method(s): This descriptive and cross-sectional study was conducted in general surgery, orthopedics, and cardiovascular surgery clinics of a public hospital, including 30 days of follow-up between April 1 and May 1, 2021. All patients who were admitted to these clinics for emergency surgery intervention on these dates constituted the study population, while a total of 140 patients aged >=65 years, who met the study criteria, formed the sample of the study. Descriptive Characteristics Form and Nursing Delirium Screening Scale (Nu-DESC) were used as data collection tools in the study. SPSS 25.0 statistical program was used for data analysis. Result(s): Thirty (42.85%) of the SARS-CoV-2 positive (n=70) patients developed delirium in the study. 12.9% (n=18) of the patients died within 30 days of follow-up after surgery. There were 30 (69.8) of 70 SARS-CoV-2 positive patients who developed delirium, and 12 patients (25.5) died after testing positive for COVID-19, with a mean of 8.08T1.56 days within 30 days of admission. Discussion(s): These findings may lead to a poor clinical prognosis for COVID-19 infection delirium and postoperative death in patients over 65 years of age undergoing emergency surgery.Copyright © 2023, Derman Medical Publishing. All rights reserved.

Access to Sickle Cell Disease Treatment in the Indigenous Tharu Population of Nepal

Purpose of Study: Sickle cell disease (SCD) is a hemoglobinopathy that disproportionately affects the indigenous Tharu population of Nepal, a marginalized ethnic group concentrated in the Dang district. There are significant global disparities in the prognosis of SCD;in low-income countries, which lack screening and management infrastructure, up to 80% of those born with SCD are undiagnosed and less than half survive beyond 5 years of age. Since 2015, University of British Columbia medical student teams have collaborated with a local community partner, Creating Possibilities (CP), to improve SCD awareness, screening, diagnosis, and management for the Tharu population in and around Dang. Community members with SCD have previously expressed numerous challenges in obtaining treatment once diagnosed. This study aims to better understand difficulties in accessing SCD care for this community. Methods Used: The Access to SCD Care Questionnaire was developed from items in existing scales, deductive and inductive item generation, and feedback from expert local partners to ensure it is culturally appropriate, needs-specific, and easily understandable. The questionnaire includes closed-ended questions using a Likert scale and open-ended interview prompts. It centers around five core themes: personal beliefs, community attitudes, finances, transportation, and medical infrastructure. Interviews were conducted in Tharu (local dialect) by CP staff members in January to March 2022. Themes and sub-themes were qualitatively analyzed. Summary of Results: Participants aged from 14 to 42 with an equal sex ratio, a total of 12 interviews were conducted before study saturation was reached. All participants reported at least one minor or major problem with access to SCD care in each of the five core themes of the questionnaire. Inadequate healthcare infrastructure was the most frequently reported barrier, with participants reporting lack of local medication accessibility and low supplies at further district hospitals. Additionally, despite government funding for treatment coverage, participants reported difficulties obtaining the necessary legal documents to prove eligibility. The second largest perceived barrier to care was transportation, which was reported to be costly, time-consuming, and not readily available. Regardless of sub-theme, participants reported that system-wide effects from COVID-19 perpetuated these issues. Conclusion(s): Results from the Access to SCD Care Questionnaire demonstrate that availability and accessibility to medications and transportation services are the primary challenges to receiving SCD care in this indigenous community. Therefore, future interventions for this community should focus on these findings. In contrast with previous literature, community stigma and personal beliefs were not often reported as hindering SCD treatment. This may be attributed to successful education campaigns within this specific community or due to participation bias.

Excess of Mortality in Older People during the Covid-19 Pandemic in Mozambique

Background: The impact of COVID-19 pandemic was apparently less severe in African continents, probably underestimated due to the limited testing capacities and access to health facilities, particularly in rural areas. Hospital and community surveillance of COVID-19 was established in Manhica District, rural Mozambique to understand the epidemic curve and natural history of SARSCoV- 2 including age-specific incidence of severe COVID-19 and reproduction number and effects of interventions through mathematical modelling Methods: Suspected cases visiting the Manhica District Hospital were screened for SARS-CoV-2 by qRT-PCR. Four age-stratified (0-19, 20-39, 40-59 and >=60 years, n=300 each) community-based serosurveys were conducted (Apr 2021-Feb 2022) to estimate the prevalence of antibodies (Abs) against SARS-CoV-2. We fitted a statistical model within a Bayesian framework, to estimate the extent to which older people were over-represented in mortality data throughout the pandemic. This involved training the model on data from the pre-pandemic period and then using this model to generate estimates of the expected levels of mortality in the absence of COVID-19 in adults aged 40+ using data from our reference category (15-39 year olds). Result(s): Between Dec 2020 and Aug 2022, 31.2% of 1332 swabs tested positive for SARS-CoV-2, with high proportion among people aged 50-59 years (62.1%, 36/58). Abs against SARS-CoV-2 were detected in 28% (180/666) of subjects enrolled in survey one, which increased two and tri-fold, in surveys 2 (64%, 595/936) and 3 (91%, 700/768);remaining stable (91.3%, 1023/1121) in 4. Age-specific analysis showed consistency on Abs detection over the surveys, including people non-eligible for vaccination (0-17 years) where >80% (165/188) had Abs detected. 93% (359/384) of subjected with Abs in survey 3, remained positive 3 months later. Shifting age-patterns throughout the pandemic are consistent with a high impact of the disease particularly in older ages. Depending on assumptions made in our modelling, we estimate a cumulative excess mortality rates in adults aged 80+ of between 8 and 17% with the largest peak coinciding with the peak in the delta variant wave. Conclusion(s): Our data reveal that people in rural areas were widely exposed across including unvaccinated ones;and there was a signature COVID-19-like shift in mortality patterns towards older ages, suggesting substantial impact, of the pandemic that is largely not reflected in patterns of confirmed COVID-19 deaths. Quantitative estimates of shift in age-patterns throughout the pandemic. (A) Shows the fit of the model to age-patterns of mortality in the pre-pandemic period 2018-2020. This model is then used to generate the expected numbers of deaths in individuals aged 40+ throughout the pandemic (2020-2022). (B) excess deaths in the pandemic relative to the model, shown in (A), black lines and grey shaded regions show estimates assuming that declines in reported mortality in under 40s are due to declines in mortality (assumption 1), coloured show equivalent estimates assuming that declines in mortality in under 40s are due to declines in ascertainment (assumption 2). (C) Shows estimates from (A) as mortality per 1000 individuals within the age strata, (D) shows each excess mortality estimate as a proportion of the population within the age strata, with seroprevalence estimated from the first two cross-sectional surveys highlighted for reference.

Reinfection rate and protection effectiveness from past infection among healthcare workers in public tertiary hospitals in Malaysia: A prospective cohort study

Introduction: As of 29 July 2022, SARS-CoV-2 has infected 4.7 million Malaysians. Reinfection, defined as a new infection 90 days from initial infection is now rising due to the emergence of new variants. Studies have shown that healthcare workers (HCW) are 3.4 times more likely to test positive for COVID-19. This study aims to describe the reinfection rate of COVID-19 and protection effectiveness (PE) from past infection among HCWs in public hospitals in Malaysia. Method(s): A prospective cohort study was conducted from March 2021. HCWs were followed up to determine the post BNT162b2 vaccination humoral response to SARS-CoV-2. Additionally, participants were prompted to self-report a positive COVID-19 result. Reinfection rates were calculated using the total number of patients who had a prior infection as denominator. Infection rates were analysed at a predetermined period throughout our follow-up. Protection offered by prior infection was calculated as one minus the ratio of infection rate for COVID-19 positive patients and COVID-19 naive patients (1 - RR x 100%). Result(s): In this cohort, the cumulative incidence rate for SARS-CoV-2 is 44.6% (246/551). Reinfection rate is 6.5% (16/246). The PE at 3 and 6 months were 100% respectively while the PE at 9 and 12 months were 72.1% and 56.2%. Conclusion(s): Past infection offers 100% protection against reinfection up to 6 months but this protection steadily declines with the emergence of Omicron variant, even among vaccinated and boosted individuals. As variant-specific vaccines are still in development, reducing exposure and compliance to COVID-19 prevention guidelines are imperative to avoid infection.

Tropheryma Whipplei Endocarditis: A Diagnosis In Hindsight

Description of case: We report a case of Tropheryma whipplei endocarditis, a rare cause of bloodculture-negative infective endocarditis (BCNIE). Due to its rarity and lack of availability of diagnostic tests in district hospitals, the diagnosis remains challenging. The objective of this case report is to increase physician awareness of this pathogen. A 61-year-old man presented to the Emergency Department with central chest pain at rest. A 12-lead ECG demonstrated ST- segment depression in V4-V6 leads, and his serial troponin levels were raised. He was commenced on treatment for acute coronary syndrome and transferred to the Coronary Care Unit. An echocardiogram showed a 15mm x 15mm vegetation in the aortic valve with mild aortic regurgitation. His initial microbiology workup, which included two sets of blood cultures (pre-antibiotics), MRSA screen & COVID-19 PCR, was negative. He was transferred to a cardiothoracic centre four days later. Pre-operative CT coronary angiogram showed severe three vessel coronary artery disease. He underwent triple coronary artery by-pass grafts and tissue aortic valve replacement. During early post-op recovery, he had fever episodes and an elevated C-reactive protein of 280 mg/L but normal white cell counts. He was treated with intravenous Tazocin for hospital-acquired pneumonia and discharged on doxycycline. Two weeks post-discharge, he had a positive 16S/18S PCR for Tropheryma whipplei on molecular analysis of the aortic valve. He was treated for Whipples endocarditis with a 4-week course of IV Ceftriaxone, followed by a 12-month course of oral Cotrimoxazole. The patient has reported doing well since the surgery. Discussion(s): Molecular assay with PCR of the heart valve is the mainstay of diagnosing Whipple's endocarditis. There have been 5 previously reported cases of Whipple's endocarditis in the United Kingdom in our knowledge. It is likely under-reported because of a reliance on tissue diagnosis. Preceding intestinal manifestations and arthralgia should raise its clinical suspicion for timely workup. Physician awareness of Whipple's Endocarditis is paramount in investigating for this pathogen.

Knowledge Attitude and Practice Related to COVID Appropriate Behaviour and COVID-19 Vaccine Acceptance Among Pregnant Women attending a District Hospital in Kashmir India: A Mixed Method Study

Introduction: WHO recommends that pregnant women should receive a vaccine against COVID-19 as it has been observed that the clinical course of COVID-19 infection in pregnant women is worse than in non-pregnant women. Vaccines are effective intervention to reduce the burden of the disease, however, public hesitancy is a problem for public health authorities. Aim(s): To determine Knowledge Attitude and Practice Related to COVID Appropriate Behaviour and COVID-19 Vaccine acceptance among pregnant women attending the Antenatal care Clinic at District Hospital Shopian. Material(s) and Method(s): A Hospital-based mixed-method approach comprising both quantitative part (Cross-Sectional method) and qualitative part (In depth interviews). Study participants were all pregnant women attending antenatal care clinic at District Hospital Shopian during the study period (1st January-31st March 2022). Result(s): All of the 262 study participants (100%) reported that they had heard about the corona virus pandemic. Attitude and practice related to COVID-19 preventive behaviour was average. The COVID- 19 vaccine acceptance was found to be 77.4%. The highest number (40.3%) of COVID-19 vaccine hesitance found was because the respondents believed that the COVID-19 vaccine would harm their fetus. Conclusion(s): Health care providers should pay extensive attention to the dissemination of accurate vaccination information and address misinformation to boost vaccine acceptance among pregnant women.

Coping with COVID: Performance of China's hierarchical medical system during the COVID-19 pandemic.

Objective: The COVID-19 pandemic has challenged the health system worldwide. This study aimed to assess how China's hierarchical medical system (HMS) coped with COVID-19 in the short-and medium-term. We mainly measured the number and distribution of hospital visits and healthcare expenditure between primary and high-level hospitals during Beijing's 2020-2021 pandemic relative to the 2017-2019 pre-COVID-19 benchmark period. Methods: Hospital operational data were extracted from Municipal Health Statistics Information Platform. The COVID-19 period in Beijing was divided into five phases, corresponding to different characteristics, from January 2020 to October 2021. The main outcome measures in this study include the percentage change in inpatient and outpatient emergency visits, and surgeries, and changing distribution of patients between different hospital levels across Beijing's HMS. In addition, the corresponding health expenditure in each of the 5 phases of COVID-19 was also included. Results: In the outbreak phase of the pandemic, the total visits of Beijing hospitals declined dramatically, where outpatient visits fell 44.6%, inpatients visits fell 47.9%; emergency visits fell 35.6%, and surgery inpatients fell 44.5%. Correspondingly, health expenditures declined 30.5% for outpatients and 43.0% for inpatients. The primary hospitals absorbed a 9.51% higher proportion of outpatients than the pre-COVID-19 level in phase 1. In phase 4, the number of patients, including non-local outpatients reached pre-pandemic 2017-2019 benchmark levels. The proportion of outpatients in primary hospitals was only 1.74% above pre-COVID-19 levels in phases 4 and 5. Health expenditure for both outpatients and inpatients reached the baseline level in phase 3 and increased nearly 10% above pre-COVID-19 levels in phases 4 and 5. Conclusion: The HMS in Beijing coped with the COVID-19 pandemic in a relatively short time, the early stage of the pandemic reflected an enhanced role for primary hospitals in the HMS, but did not permanently change patient preferences for high-level hospitals. Relative to the pre-COVID-19 benchmark, the elevated hospital expenditure in phase 4 and phase 5 pointed to hospital over-treatment or patient excess treatment demand. We suggest improving the service capacity of primary hospitals and changing the preferences of patients through health education in the post-COVID-19 world.

A blueprint for the continuation of comprehensive cardiac rehabilitation during the COVID-19 pandemic. An Australian single hospital experience

Background: The COVID-19 pandemic has disrupted cardiac rehabilitation (CR) around the world with an estimated 50-75% of CR programmes discontinuing or reducing services. Alternative models such as TeleHealth have been encouraged and adopted in place of face to face (F2F) CR. There is a paucity of published data on the continuation of F2F CR during the pandemic. Method(s): A retrospective database audit examined the CR participation rates at an Australian quaternary public hospital during the pre-COVID (2018/2019) and in-COVID (2020/2021) periods. Socio-demographic status, diagnosis at CR entry, CR modalities, and outcome measures (wait times, completion rates) were analysed. Result(s): There were no COVID-19 cases or cross infections occurring in CR during the in-COVID period. An audit of 1623 consecutive patients who attended our CR programme (pre-COVID n=760: In-COVID n=863) were included in this study. No significant differences were observed in age, male sex, CR wait times and completion rates between the two groups. Participation rates of patients diagnosed with heart failure (CCF) increased (p=0.02) and those who entered CR after elective PCI decreased (p=0.03) during the in-Covid period in comparison with the pre-COVID period. Total F2F CR was maintained in the in-COVID period compared to the pre- COVID period (85%: 89%, p=not significant (NS)). A significant increase in F2F utilising home walking (p<0.0001) and a decrease in F2F utilising supervised exercise (p<0.0001) was seen. TeleHealth, introduced during the in-COVID period, only contributed to 6% of the total CR participation. More detailed results of this study are presented in Table 1 below. Conclusion(s): During the COVID-19 pandemic our CR programme adhered to state health orders, recorded zero transmissions, maintained face to face services, and increased CR uptake only partially due to the introduction of TeleHealth. Our blueprint for the successful continuation of CR during COVID involves having expert nursing management, medical CR champions, dedicated CR gym, and well-established, flexible patientcentric programme modalities. (Table Presented).

Real world evidence from a Breast Screening pilot for the underprivileged: Experiences from Bruhat Bengaluru Mahanagara Palike hospitals

Background: In India, less than 5% of women get routine screening for breast cancer due to lack of awareness and the absence of a coordinated national breast cancer screening programme. A community health initiative was launched by Niramai in collaboration with City Health officials in Bangalore as a pilot to increase awareness and make breast health screening available to all. Free breast cancer screening using AI powered Thermalytix test is being offered to all the underprivileged women walking into Bruhat Bengaluru Mahanagara Palike (BBMP) government hospitals from November 14, 2017 till today (after a break for 15 months during COVID). Material(s) and Method(s): This observational study was conducted in 22 BBMP-affiliated primary health centers where outpatient women over the age of 18 years and not pregnant were enrolled. The procedure included a briefing on camp procedures, taking patient consent, identification of eligible candidates, general health education, and conducting the Thermalytix test by a healthcare worker who was trained to use the Thermalytix software tool. Women were triaged using the output generated by Thermalytix 180. Those triaged as red were referred for further detailed imaging investigation in a district hospital using mammography, ultrasound and FNAC/biopsy. Result(s): A total of 6935 women underwent Thermalytix screening in 22 BBMP hospitals during Nov 2017 to July 2022. A total of 1687 participants were excluded from the analysis as they did not meet the eligibility criteria. The median age of the 5248 eligible participants was 42 years (range 18-86). Among them, 90 women (1.71%) had previously noticed a lump in their breast, 431 women (8.12%) had breast pain, 16 women had complained of nipple discharge, and 5 women had noticed skin discoloration. When screened, 62 (1.2%) women were detected with abnormalities and triaged positive by Thermalytix. Among them 11 women have so far gone through diagnostic investigations, of which 8 were radiologically positive and were recommended for histopathology correlation. The overall test positivity rate of Thermalytix in this cohort was 1.2% and positive predictive value with radiological positivity as reference was found to be 9/11 = 81.81%. Furhter histological analysis reported 1 DCIS and 8 benign fibroadenoma. The tests were conducted in screening camps and the average cost of conducting the test in the field came to around 6.5 USD per person. Conclusion(s): Thermalytix could be a potential automated screening tool for population-level screening in resource constrained settings. The portable equipment enabled easy movement across different PHCs. Since it is a privacy-aware test, there was less refusal to participate in the test. Community mobilization with the help of the local government health officials was crucial to ensure walk-ins. Conflict of interest: Ownership: yes Board of Directors: yes Corporate-sponsored Research: yesCopyright © 2022 Elsevier Ltd. All rights reserved

Moving to accelerated protocols of tDCS in schizophrenic catatonia: A case report

This is a case report of a 74-year-old woman with catatonic schizophrenia who was treated with transcranial Direct Current Stimulation (tDCS) in place of electroconvulsive therapy (ECT) during the Covid-19 pandemic that impacted access to ECT facilities. In 2021, the exceptional number of patients infected with SARS-Cov-2 led the French public hospital system to adjust its organization, temporarily redirecting anesthetists from ECT departments to ICUs. Our patient, who was hospitalized via the emergency department, presented schizophrenia with catatonic features. Due to the pandemic, ECT, which is considered the gold standard treatment for this condition, was not available. Therefore, tDCS, a neuromodulation technique that doesn't require general anesthesia, was recommended for this patient, and was delivered at the relatively (compared to standard protocols) accelerated rate of five sessions a day, five days a week. This protocol was chosen as accelerated rTMS had been shown to be effective against depression in recent trials (Cole et al. 2021), and one study had also reported this exact protocol as effective and harmless for a patient with schizophrenia (Mondino et al. 2021). The Bush-Francis Catatonia Rating Scale (BFCRS) was used to evaluate the severity of the catatonia. After 49 sessions, the clinical response was meaningful, with a BFCRS score of 16, compared to 36 at baseline. We then moved to five sessions a day, three days a week, and then two days a week. After 80 sessions, we noted the complete disappearance of catatonia (BFCRS = 6). This case provides evidence for the feasibility and tolerability of accelerated tDCS for patients with catatonia. Accelerated tDCS represents a potential alternative to ECT in the treatment of catatonia, and needs further randomized clinical studies to confirm its efficacy. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: tdcs, catatonia, covid-19, ECTCopyright © 2023

Analysis of Covid-19 Neutralizing Antibody Levels Post Vaccination using IchromaTMand iFlash Covid-19 Nab

Background: One of the efforts to control SARS-CoV-2 infection in health workers is vaccination. In this study, the levels of SARS-CoV-2 neutralizing antibody (nAb) in health workers were measured with Ichroma and iFlash. Method(s): This study applied an observational analytic design with a prospective cohort and was conducted at Dr. Soetomo Regional Public Hospital, Surabaya, from January to November 2021. The population of this study included a total of 75 health workers after taking the second dose of the SARS-CoV-2 (Sinovac) vaccine. The Covid-19 NAb levels of the population were tested with Ichroma and iFlash on day 0 before vaccination, as well as days 14 and 28, and months 3 and 6 after vaccination. Result(s): The Friedman test indicated a significant difference in NAb levels according to the iFlash test on day 14, day 28, month 3, and month 6 compared to those before vaccination (p < 0.05). The Wilcoxon test revealed a significant difference in NAb levels on day 14, day 28, month 3, and month 6. The results of the Cochran test showed a significant difference in the positivity of NAb according to the Ichroma test on day 14, day 28, month 3, and month 6 compared to those before vaccination (p < 0.05). McNemar's test demonstrated that the COI at month 3 was not significantly different from that before vaccination;The COI at month 6 was not significantly different from those at days 14 and 28. The results of the Pearson correlation test and Bland-Altman plot indicated a moderate correlation between Ichroma and iFlash (r = 0.592, p = 0.002). Conclusion(s): Neutralizing antibodies for Covid-19 were formed after day 14 and started to increase on day 28 and started to decrease in months 3 and 6. The levels of NAb for Covid-19 were measured with Ichroma and iFlash in roughly the same pattern and had a moderate positive correlation.Copyright © 2023 Phcogj.Com.

Mental health predictors of medical staff in the early stage of COVID-19 pandemic in Poland

Aim of the study: To identify the sociodemographic predictors of general functioning, stress, anxiety and depression in Polish medical workers' group in the early stage of COVID-19 pandemic. Material(s) and Method(s): A cross-sectional observational study using an online questionnaire was conducted via both professional organizations and social media groups. A total of 303 completed responses were received. More than half of participants (54.8%) work in public hospitals, the majority was females (77.6%), nurses (38.3%), the age was ranged from 22 to 68 years (M = 41.37;SD = 11.38). The semi-structured online questionnaire covered following areas: (1) general sociodemografic data, including health state and COVID-19 related questions;(2) psychological impact and mental health, measured by GHQ-30 and DASS-21. Result(s): Overall, our results showed that sex, years of experience and profession have predictive power to explain mental health being of medical workers during COVID-19. In our study, females reported worse general functioning (GHQ-30) and higher stress (DASS-21) than males. Longer working experience is predictor of better interpersonal relationships (GHQ-30). Discussion(s): Years of experience and gender accounted for 27% of the variance of the level of stress in medical staff group. With the years of experience of healthcare professionals, the stress decreases. Nurses reported less severity of anxiety than other medical workers. We assume those results are connected with education process as well as experience level. Conclusion(s): It may be important to develop a personalized intervention, considering the main predictors of mental well-being. Authorities should consider creating the tailored-made programs for medical professions.Copyright © 2023 Polish Psychiatric Association. All rights reserved.

A retrospective study to evaluate CTPA outcomes in COVID-19 patients at a district hospital in London

Background: COVID-19 is associated with the development of life-threatening prothrombotic events, including pulmonary emboli (PE), for which the gold standard investigation is a CTPA. Aim(s): To assess the incidence of PE in our local high-dependency and ward-based COVID-19 ward and identify common indications for CTPA. Method(s): Data was collected retrospectively from inpatients admitted to our COVID-19 ward between August 1st to October 31st, 2021. Patient demographics, D-dimer values, oxygen requirements, and CTPA request indications and findings were analysed. Result(s): From a total of N=123 patients, N=45 (36.9%) had a CTPA, and N=4 (3.3% of all patients, 8.9% of CTPA requests) were positive for PE. N=44 (97.8%) CTPAs were requested to rule out a PE, with the main indications being a raised D-dimer (26.7%), hypotension (24.4%), persistent oxygen requirement (22.2%), and desaturation (22.2%). N=18 (40%) required non-invasive ventilation (NIV) at the time of CTPA request. The median time spent on therapeutic anticoagulation before a CTPA was 6 days (IQR 9). N=8 (17.7%) had bleeding complications from therapeutic anticoagulation. Conclusion(s): Our 3.3% incidence of PE is lower than the 11.7% average in a recent meta-analysis of ITU patients, consistent with studies showing that those with more severe COVID-19 have a higher incidence of PE (Tan, B.K. et al. Thorax 2021;76: 970-979). Our study was limited, as our patients could not have a CTPA whilst on NIV. They remained on therapeutic anticoagulation during this time, leading to potential false-negative results. Further studies are needed to estimate the incidence of PE and optimum duration of thromboprophylaxis in non-severe COVID-19 cases.

Clinical consequences of health measures and lock down for covid-19 in exacerbations in patients with chronic obstructive pulmonary disease (COPD)

Introduction: Covid-19 pandemic has meant that measures such as social distance, self protection measures and lock down can have an impact on exacerbations in patients with COPD. The aim of our study is to evaluate the impact about these measures on exacerbations in COPD patients. Material(s) and Method(s): Retrospective observational study of COPD patients visited at two public hospitals in Lleida in 2019. Several clinical variables and the number and type of exacerbations from March 2019 to December 2021 were collected from their electronic history. The mean number of exacerbations from March to May 2020 (period of lock down) was analyzed and compared with the same period of the previous year (March-May 2019). The behavior of exacerbations after progressive ending of lock down period (June 2020-December 2021) was observed. Result(s): A total of 310 patients were included with a mean (SD) age of 66.8+/-8.34 years. Patients had a FEV1 of 48.5+/-18.8% and 19.7% of them belong to group D according to GOLD guidelines. In lock down period between March and May 2020 there was a reduction in the mean number of exacerbations compared to the same period of the previous year (0.13+/-0.34 vs. 0.36+/-0.55;p<0.001). An increase in exacerbations was observed in the subsequent periods from June 2020 to February 2021 (0.3+/-0.56) and from June 2021 to December 2021 (0.43+/-0.68), coinciding with the relaxation of health measures. Conclusion(s): The results of our study suggest that measures such as lock down, social distance and self-protection have an impact on exacerbations in patients with COPD.

Infectious Disease Response Based on the Main Entrance Plan Type of Regional Public Hospitals

This study aims to analyze the main entrances of regional public hospitals responding to infectious diseases after the spread of COVID-19 and to suggest direction for entrance planning in case of future epidemics. The infection control response guidelines were examined, and eight regional public hospitals were visited to research the current entrance access procedures while interviewing hospital facility managers. The purpose of the equipment and facilities installed for infectious disease response and changes in the main entrance area were analyzed by its architectural floor plans. Problems were then derived upon examining the required elements at the entrance and the newly added infectious disease response of visitors flow and procedure. The floor plan of regional public hospitals was classified into four plan types, and the improvement direction of the entrance layout during an infectious disease epidemic was presented. The results showed that there were different responses of entrance procedure with the same plan type. In addition, the suitable entrance flow and procedure reflecting the relative differences and various aspects of each plan type was derived. This study could be used in the future as basic data for the architectural planning direction of a new hospital. © 2023 Aidnreetural Institute of Korea.

Hospital-onset COVID-19 and antivirals

Aim: The PINETREE study showed benefit of remdesivir in non-hospitalised COVID patients. This became the evidence base for the NHSE policy on antivirals use in hospital-onset COVID patients. However, there are differences between PINETREE inclusion criteria and NHSE policy eligibility criteria, and PINETREE was conducted when Delta was dominant. We describe attributes, risk stratification and outcomes in hospital-onset COVID patients when Omicron is dominant. Method(s): A retrospective analysis of patients testing COVID +ve post-admission over 30 days at two district hospitals, collecting risk factors as defined by the QCovid model, and outcomes including days on/off oxygen, survival/discharge at 28 days, and whether antivirals were considered/given. Result(s): 68 eligible cases were identified. CV followed by respiratory diseases were the commonest risk factors. In the 28 days after a +ve test, 31% required supplemental oxygen and 16% died. Being male, and having CV disease, active solid malignancy and recent chemo/radiotherapy were over-represented in patients who died. Supplemental oxygen was associated with significantly higher 28-day mortality risk (43% v 4.3%). Average age of those who died was higher than the overall cohort (84 v 75y). 28-day mortality rates for those who received 1, 2 and 3 COVID vaccines were 60%, 21% and 5% respectively. 18 patients met criteria for highest risk group and were eligible for antivirals. Only 11% were considered for antivirals. Conclusion(s): Despite the milder omicron variant and high vaccination rate, hospital-onset COVID is associated with worse outcomes compared to community clinical trials. The lack of antivirals use according to NHSE criteria should push MDTs to consider a validated risk model for antivirals use.

Socio economic deprivation and its Impact on COVID-19 recovery -analysis of radiological outcome from an English Hospital

Introduction: West Cheshire houses some of the most affluent and deprived neighbourhoods in England. Currently there is no information regarding radiological recovery from COVID pneumonia in relation to socioeconomic status. Aims and Objective: To explore if radiological recovery among COVID-19 hospitalised patients is affected by their socio-economic status. Method(s): A retrospective analysis of COVID 19 pneumonia patients admitted to a district hospital between 03/2020 & 03/2021 was performed. Patients were identified from Radiology software and coding data. Findings were classified as per Fleischer society glossary. Patients were classified in 3 cohorts (deprived, intermediate and affluent) based on post code aligned English Index of Multiple Deprivation 2019. Result(s): 336 patients were included with a mean age of 66.2 years (18 to 96). Males 51.7% & 48.3% females. All these patients had ground glass opacities, consolidation, reticulation or atelectasis on initial imaging. Patients from deprived region were 157/336 (46.7%), intermediate 38/336 (11.3%) and affluent 141/336 (62.2%). COVID infection prevalence in deprived was 14 per 10,000 and affluent was 9 per 10,000. 106 patients had Persistent Lung Opacities (PLO) on follow up radiology. Of these deprived were 54/106 (50.9%), intermediate 14/106 (13.2%), and affluent 38/106 (35.8%). Prevalence of PLO in deprived was 4.6 per 10,000 and affluent was 2.6 per 10,000. Conclusion(s): We noticed COVID prevalence in our deprived cohort is 1.5 times higher than affluent. PLO in the deprived group were twice higher than affluent group. This confirms the health inequalities highlighted by COVID in prevalence and recovery.