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1.
Deutsche Apotheker Zeitung ; 161(48), 2021.
Article in German | EMBASE | ID: covidwho-1647351

ABSTRACT

The pressure on the unvaccinated is growing and with it the number of those who try to get a digital vaccination certificate with fake vaccination certificates. Against this background, the Berlin Chamber of Pharmacists advises pharmacies against digitizing vaccination certificates in the emergency service.

2.
Anaesthesia ; 77:32, 2022.
Article in English | EMBASE | ID: covidwho-2032348

ABSTRACT

Rapid infusion of warmed blood products is an essential part of the resuscitation of massive haemorrhage [1]. Anaesthetic trainees must therefore be confident and competent in the use of their Trust's chosen device. The aim of this project was to assess and improve trainee confidence in the operation of the newly acquired Belmont Rapid Infuser 2 (RI-2) after informal feedback from trainees that they did not feel proficient in its use. Methods An anonymous online survey was disseminated to anaesthetic trainees at St Mary's Hospital to assess their confidence in the set-up, operation and troubleshooting of the Belmont RI-2. A face-to-face practical teaching session was then delivered by a consultant anaesthetist and experienced operating department practitioner (ODP), where trainees were shown how to use the Belmont RI- 2 and had the opportunity to practise operating and troubleshooting it. Trainees were then asked to complete a follow-up questionnaire to assess their confidence after the teaching session. Results Twenty trainees, ranging from CT1 to ST7, completed the primary questionnaire. Sixteen (80%) had used the Belmont RI-2 less than five times prior to arriving on this rotation and most did not feel confident in the set-up, operation and troubleshooting of the device (Fig. 1). All (100%) respondents felt they would benefit from a practical teaching session. The post-teaching questionnaire demonstrated that trainee confidence in the use of the Belmont RI-2 increased (Fig. 1). (Figure Presented) Discussion Trainee experience in use of the Belmont RI-2 is variable and most did not feel confident in its use, highlighting a need for additional training after induction. Face-to-face practical teaching improved confidence, but the ability to deliver this was hampered due to trainee on-call commitments (13 of the original 20 trainees were absent) and COVID-19 limits on the number of people in a room. In the future, we plan to video the teaching session so that trainees can learn the information at induction in a COVID-19-safe manner and refresh their knowledge as required.

3.
Acta bio-medica : Atenei Parmensis ; 93(4):e2022287, 2022.
Article in English | MEDLINE | ID: covidwho-2010583

ABSTRACT

BACKGROUND AND AIM: Interprofessional collaboration (IPC) between health professionals is fundamental for the provision of an efficient and effective medical care service. This is especially so in states of emergency, as highlighted by the ongoing coronavirus disease 2019 pandemic. This study aimed to obtain further evidence regarding the validity and reliability of the Italian language IPC scale -an instrument for measuring interprofessional collaboration- in a setting that has yet to be investigated at an in-depth level: the emergency departments in Italian hospitals. METHODS: The survey tool was a structured questionnaire in the Italian language. It comprised the validated Italian version of the IPC scale plus a question concerning the frequency of collaborations between the nurses interviewed and other health professionals. Confirmatory factor analysis was applied to rate the three factors ("communication", "accommodation" and "isolation") that compose the scale. RESULTS: Four hundred thirty-six nurses working in an emergency department for at least one year completed the questionnaire, which assessed collaboration with other health professionals working in the same department. The model fit statistics are satisfactory for all the nurse-target group combinations analysed. Regarding the Cronbach's alpha statistic used to compute the reliability of the scale, acceptable values were obtained for all items, except for those related to the isolation factor for each case of interprofessional collaboration considered. CONCLUSIONS: The results confirm the validity of the IPC scale as an instrument for the assessment of interprofessional collaboration involving nurses and other workers occupied in the provision of healthcare in Italian emergency departments.

4.
Open Access Macedonian Journal of Medical Sciences ; 10:1252-1256, 2022.
Article in English | EMBASE | ID: covidwho-2010395

ABSTRACT

BACKGROUND: In 2015, approximately 350,000 adults in the United States experienced nontraumatic out-of-hospital cardiac arrest and were treated by the emergency medical services (EMS) personnel. Despite recent increases, <40% of adults receive layman-initiated cardiopulmonary resuscitation (CPR), and <12% apply an automated external defibrillator before EMS personnel. AIM: To know the ability of the Medan city community in handling cardiac arrest for the first time and implementing the 2020 AHA basic life support (BLS). METHODS: This study used a descriptive method with a cross-sectional approach and was conducted in the city of Medan in the period July–October 2021. Sampling used cluster sampling and purposive sampling with inclusion and exclusion criteria. RESULTS: In this study, it was found that the majority of the people of Medan City had less knowledge about CPR in BLS. In this study, only respondents from Medan Marelan District were dominated by good knowledge by 80%. It was found that the people of Medan City have a good level of knowledge about these cardiac events, and the people of Medan City have a low level of knowledge about BLS and CPR. CONCLUSION: The ability of the people of Medan City in implementing BLS and CPR in BLS for cardiac events outside the hospital is still lacking.

5.
Journal of Obstetrics and Gynaecology Canada ; 44(5):626, 2022.
Article in English | EMBASE | ID: covidwho-2004261

ABSTRACT

Objectives: In 2017, mifepristone became available for first trimester medical abortion (FTMA) in Canada. Shortly after, regulations permitted pharmacies to dispense mifepristone to patients, facilitating telemedicine provision. Our objective was to explore the barriers to providing FTMA using telemedicine in Canada in 2019. Methods: We conducted a cross-sectional, national, self-administered, anonymized survey of physicians and nurse practitioners who provided abortion care in Canada in 2019. Online invitations were sent through professional health organizations using a modified Dillman technique to optimize recruitment. Questions elicited provider demographics and perceived barriers to offering telemedicine FTMA. We used R software for descriptive statistics. Results: Four hundred sixty-five clinicians were included for analyses, of which 388 reported providing FTMA. Among those, 44.0% reported using telemedicine (for consultations, while often obtaining testing) for FTMA. British Columbia respondents reported the highest proportion of telemedicine use at 63.8%;the lowest was in Québec (10.7%). The majority of FTMA respondents (77.7%) reported barriers to telemedicine. The most common barriers were inability to confirm gestational age with ultrasound (43.0%), and lack of provincial fee code to pay practitioners (30.2%), timely access to serum hCG testing (24.6%), and nearby emergency services (23.3%). Few reported facility regulations (8.9%) and provincial regulations (4.9%) as barriers to providing telemedicine-based care;provincial regulation barriers were most common in Québec (16.1%). Conclusions: Less than half of respondents reported providing some abortion care via telemedicine and the majority perceived barriers. Low-test medical abortion protocols developed during COVID-19 have the potential to overcome some barriers. Keywords: telemedicine;abortion, induced;surveys and questionnaires;Canada;delivery of health care;mifepristone

6.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003502

ABSTRACT

Background: Non-accidental trauma (NAT) is a global health issue and is responsible for 50,000 deaths worldwide and 1,800 deaths in the United States annually. Established risk factors for NAT include lower socioeconomic status and ethnic minority status. Memphis, TN has the nation's second poorest metropolitan area, with greater than one-third of children living in poverty and a disproportionate number of those being ethnic minority children. The COVID-19 Pandemic, in addition to direct health effects, has brought with it increased financial and social hardship, possibly exacerbating the factors leading to violence against children. We sought to explore what impact the COVID19 Pandemic had on the incidence of NAT within an already atrisk population. Methods: Retrospective registry data was obtained for patients with suspected and confirmed NAT admitted through the Pediatric Emergency Department at our Level 1 Pediatric Trauma Center from 2011-2020. We compared the NAT rates before and during the COVID-19 Pandemic, designated as year 2020, using risk ratios and Chi-squared test. We conducted interrupted time series analysis to examine the impact of COVID-19 and time on the rate of NAT. A P-value ≤ 0.05 was considered statistically significant. Results: The year 2020 showed an increase risk of NAT compared to prior years since 2011, both individually and as a whole. Interrupted time series analysis revealed a steady rise in NAT admissions over the last decade, but this rise was eight-fold above expected rates in the time of the COVID-19 Pandemic, RR 8.64 (95% CI: 3.3-13.9;p 0.006). There was decrease in emergency department encounters by 35.5% during the COVID-19 Pandemic compared to the average over the prior nine years. Patient demographics of NAT admissions prior to the COVID-19 pandemic and during the Pandemic did not significantly change. Injury Severity Score showed a decrease during the pandemic compared to the decade prior to the pandemic (p 0.002). Total hospital days were unaffected but total ICU days showed a decrease from 5.7 to 1.5 days (p <0.001). Conclusion: Our study found a disproportionate increase in incidence of hospitalized NAT cases despite overall decreased volume of emergency department encounters during the COVID-19 Pandemic. Additionally, there was a decrease in injury severity and ICU length of stay, suggesting the increase in hospitalized NAT cases did not result in more critical injury, but rather increased frequency of mild-to-moderate severity of injury. We hypothesize the added social stress and financial impact of the COVID-19 Pandemic has resulted in heightened external stress on families, therefore increasing the risk of NAT in the pediatric population. Further evaluation on a national level, including non-hospitalized children, will need to be conducted. Our study supports the need for increased community awareness of NAT for at-risk children during times of social disruption and financial crisis.

7.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003458

ABSTRACT

Background: The COVID-19 pandemic presented unique challenges to pediatric emergency medicine (PEM) departments nationwide. The purpose of this study was to identify these challenges and ascertain how centers overcame barriers in creating solutions to continue to provide high-quality care while keeping their workforce safe. Methods: This is a qualitative study based on semi-structured interviews with PEM physicians in leadership positions within their institution's COVID-19 response or emergency/disaster management departments. Participants were identified through convenient purposive sampling. Demographic data was captured in a pre-interview survey. Interviews were recorded and transcribed electronically. Themes and codes were extracted from the transcripts by two independent coders. Constant comparison analysis was performed until thematic saturation was achieved. Member checking was completed to ensure trustworthiness of the results. Results: Fourteen PEM-trained physicians participated in this study. Eleven of the participants received specialized disaster management training, and ten are directors of their institutions' emergency/disaster management departments. Communication, leadership and planning, clinical practice, and personal adaptations were the principal themes identified. Within these themes, participants discussed challenges and offered examples as to how they overcame them within their department and their larger institution. To improve communication and disseminate new information, departments might consider shift huddles, town hall meetings, limiting the number of daily emails, and highlighting the newest changes. During traumas and resuscitations, “gatekeepers” oversee who goes into the trauma bay, and technology should be utilized to communicate with the team outside. For leadership and planning, the emergency department should appoint leaders to summarize updates and attend incident command meetings. Institutions should consider developing containment units and having multiple vendors for key supplies as part of their pandemic plans. Business continuity plans should be updated regularly as part of pandemic preparedness. Hospitals should be prepared to utilize telehealth and accept adult patients if pediatric volumes drop. Recommendations regarding adjusting clinical practice include having clear guidelines for what constitutes an aerosol-generating procedure, drive-through testing sites to alleviate pressure on emergency centers, and performing triage in the patient's room if possible. Personal protective equipment (PPE) should be safely re-purposed if supplies are insufficient. Staff must be trained on the proper donning and doffing of PPE with regular reminders during prolonged pandemics. Transparency with the workforce regarding supplies, testing, and safety protocols help alleviate fear and anxiety. Medical caregivers can limit their exposure by utilizing cardiac monitors visible from outside patient rooms and providing updates via telephone in patient rooms. For a full list of challenges and recommendations, see Table 1. Conclusion: By sharing COVID-19 experiences and offering solutions to commonly encountered problems nationwide, pediatric emergency centers and their institutions may better prepare both themselves and one another for future pandemics.

8.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003352

ABSTRACT

Background: Awareness of day to day situations that can effect children and families in disasters is an important component to mitigation in the disaster cycle through the development of standardized metrics to evaluate all types of events. Children make up 20% of the US population and are impacted physically and emotionally by disasters. Issues related to social and physical determinants of health emphasize the inequities between preparedness for the segments of the US population in different communities, as evidenced by the COVID pandemic. Tools have been created to assist communities to address hazards, such as the Hazard Vulnerability Analysis (HVA) and the Threat Hazard Identification and Risk Assessment (THIRA), but unique needs of children are not included or highlighted in these tools. The Assistant Secretary for Preparedness and Response (ASPR) created two Pediatric Disaster Centers of Excellence (COE) in 2019, Western Regional Alliance for Pediatric Emergency Management (WRAP- EM) and Eastern Great Lakes Pediatric Consortium for Disaster Response (EGLPCDR) and situational awareness around pediatrics and disasters was a important deliverable. Methods: Along with the two pediatric COE, and Emergency Medical Services for Children (EMSC/EIIC) disaster domain experts, a group of pediatric disaster subject matter experts (SME) identified key infrastructures and support mechanisms that exist and could be important to healthcare coalitions or communities when considering children and families within a region. Through a modified delphi process, nine domains were recommended. The domains consisted of healthcare expertise available within a region, mental health considerations, community resiliency, early education and schools, transportation services, public health jurisdiction, shelters and sheltering in place, supply chain and patient tracking, reunification and evacuation. Results: An extensive literature search was completed to review existing resources that could inform quality measures within the domains identified. Alignment of available measures that could inform the domains was completed and a scorecard was created to pilot among healthcare coalitions to better assess community level awareness for children and families that are important to the entire disaster cycle. This scorecard and preliminary evaluation will be used to create the first regional metrics scorecard for situational awareness to help inform the nine domains within communities or healthcare coalitions that can be important to consider when mitigating for disasters effecting children and families. Conclusion: When used at least annually, this regional metrics scorecard can inform where improvement and where further attention is needed to better prepare for future disasters improving the resilience for children and families and the entire community.

9.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003161

ABSTRACT

Background: Limited data exist regarding parental acceptance of COVID-19 vaccines for children or likelihood of acceptance in a pediatric emergency department (PED). We sought to determine rates of COVID-19 immunization among eligible children with a minor illness or injury treated in a pediatric emergency department (PED), to ascertain parent willingness for their child to receive COVID-19 vaccine (CV) in general and during future PED visits, and to describe factors associated with vaccine acceptance. Methods: Structured interviews were conducted with caregivers of children aged 6+ months evaluated in a large, urban PED in the summer of 2021 using questions derived from the literature and prior surveys. Exclusion criteria included temperature 103+F, communication barrier, Emergency Services Index (ESI) triage score of 1 or 2, or evaluation for non-accidental trauma or psychiatric complaints. Demographic and visit data, contact information, patient and parent vaccination history, and intent and willingness to receive CV were recorded, along with responses regarding parental concerns about COVID-19 illness or vaccination. Data were analyzed using standard descriptive statistics. Participants will be contacted by phone 6 months after vaccines become available for their age group to assess vaccination status. Results: Of 205 families approached, 17 declined participation, 7 were ineligible, and 181 have been enrolled. The mean patient age was 6.15 (+/- 5) years;43.6% were black. 33 (18.2%) had asthma and 16 (8.8%) had another high-risk condition. 17 (9.4%) had been previously diagnosed with COVID. Only 8/36 eligible patients (22.2%) were vaccinated. Among those previously unvaccinated, 55/173 (31.7%) definitely/probably would vaccinate their child when CV becomes available. 59/181 (32.6%) would definitely/probably accept CV in the PED at a similar future visit. Factors associated with increased overall CV acceptance included caregiver flu vaccine receipt (52.3% vs. 26.5%, p = 0.002), caregiver CV receipt (43.2% vs. 21.2%, p = 0.022), and concern that the child currently has COVID (77.8% vs. 35.6%, p = 0.012). Factors associated with acceptance in the PED included intent to vaccinate against CV (81.8% vs. 17.2%, p < 0.001), caregiver flu vaccine receipt (46.1% vs. 25.2%, p = 0.004), caregiver CV status (40.7% vs. 11.1% %, p < 0.001) and caregiver concern the child has COVID (87.5% vs. 31.9%, p = 0.001). Caregivers who were very/somewhat concerned that the child would become ill from CV were less likely to accept (overall (32.6% vs. 51.4%) and significantly less likely to accept in the PED (26.2% vs. 51.4% accepting, p < 0.001). Conclusion: Caregiver intent to immunize children against COVID is concerningly low, but is associated with caregiver vaccination status and concern for current COVID-19 illness. Those who intend to vaccinate are willing to receive CV while in the PED, indicating potential viability for future COVID-19 vaccine programs in the PED.

10.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003148

ABSTRACT

Background: Our frontline nurses and physicians seemed to have increased anxiety at the beginning of the COVID-19 pandemic and increased depression as the year progressed. Perceptions of anxiety and depression coincided with concern for one's own health, limited knowledge of how to care for patients during a pandemic, limited personal protective equipment (PPE), and/or financial constraints. To date, there are no studies looking at pediatric frontline healthcare providers and their rates of anxiety and depression over the course of a pandemic. Furthermore, nurses and physicians have distinct roles in the emergency setting that affect their perceptions of anxiety and depression. Currently, there are limited studies comparing nurse and physician anxiety and depression rates during a pandemic. The purpose of this study was to determine if there was a difference in perceptions of anxiety and depression among our Pediatric Emergency and Urgent Care frontline providers during the COVID-19 pandemic. Methods: This was a prospective cross-sectional study at a large quaternary level 1 trauma center including 3 emergency departments and 7 urgent care sites. We used the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-2 (PHQ-2), both standardized validated screening tools for identifying anxiety and depressive disorders, respectively. The GAD-7 scores range from 0-21 points, with 0-4 considered minimal anxiety, 5-9 mild anxiety, 10-14 moderate anxiety, and 15-21 severe anxiety. PHQ-2 scores range from 0-6 points with 3-6 considered likely major depressive disorder. We surveyed healthcare providers including physicians and nurses twice with the GAD-7, once at the beginning of the pandemic in Spring 2020 and again after vaccine implementation in Spring 2021. We surveyed healthcare providers once after vaccine implementation with the PHQ-2. Results: 396 surveys were distributed in Spring 2020 and 466 surveys were distributed in Spring 2021, with one-third physician and two-thirds nurse response each time. Table 1 shows the average GAD-7 and PHQ2 scores for healthcare providers by role. The average GAD-7 score decreased for both nurses and physicians from the beginning of the pandemic to after vaccine implementation. Nurses on average had higher anxiety scores with mild score range compared to minimal score range for physicians. Nurses on average had higher depression scores compared to physicians but both roles had scores in the low likelihood range. Conclusion: Many healthcare providers perceived higher anxiety and depression levels during the pandemic. The anxiety levels appeared to decrease after vaccine implementation although hospital-wide pandemic relief efforts may have played a role in improved perceptions. Even though nurses had higher anxiety scores, the difference in the score is unlikely to be clinically significant. Our data supports rigorous mental health infrastructure during pandemic preparedness to support the sudden feelings of anxiety and depression in frontline healthcare providers.

11.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003132

ABSTRACT

Background: During the COVID-19 pandemic, children were out of school due to Stay-at-Home orders, and were potentially unsupervised, increasing their risk for unintentional injury. The objective of this study was to investigate how these events impacted the incidence of burn injuries in children. Methods: A total of 9 Level I pediatric trauma centers participated in a retrospective study evaluating children <18 years of age with traumatic injuries as defined by the National Trauma Data Bank were included. Patients with burn injuries were defined by ICD10 Diagnosis and/or External Cause of Injury Codes. Historical controls from March-September 2019 (“Control” cohort) were compared to patients injured after the implementation of the Stay-at-Home Orders from March through September 2020 (“COVID” cohort). Results: A total of 13,177 pediatric trauma patients were included, of which 987 patients had burn injuries. The total number of children with burn injury increased by 48.6% in 2020, compared to 2019 (COVID cohort 590 patients vs. Control cohort 397 patients;p-value < 0.001), of which 94% was explained by unintentional injury. School aged children accounted for the largest difference in burn injuries between the two cohorts [Table 1]. The average number of burn-injured patients admitted per month increased over time and the difference between 2019 and 2020 peaked in July [Figure 1]. Compared to 2019, the proportion of children sustaining flame burns increased significantly in 2020 (Control 19.1% vs. COVID 26.1%, p=0.0014). Conclusion: During the COVID-19 pandemic, families experienced unprecedented increased social and financial pressure, and children were out of school for extended periods of time. This time period coincided with a considerable increase in burn injuries. The disproportionate increase in burn injuries in July may reflect the cancellation of professional firework shows across the nation and an increase in amateur pyrotechnicians experimenting with their own fireworks. The onset of the COVID pandemic introduced an extraordinary set of events with unclear consequences. (Table Presented).

12.
Pediatrics ; 149, 2022.
Article in English | EMBASE | ID: covidwho-2003063

ABSTRACT

Background: In response to the COVID-19 pandemic, local and regional Stay-at-Home orders (SHO) were implemented. Families experienced job loss, financial strain, and children were unable to attend school. It is unclear how this combination of events and social stress affected the welfare of children and rates of pediatric injury nationwide. We hypothesized that the rate of non-accidental trauma (NAT) would increase during the SHO as children did not have access to mandatory reporters, such as schoolteachers and primary care physicians. Methods: A multi-center, retrospective study was conducted evaluating patients <18 years old with traumatic injuries as defined by National Trauma Data Bank. Patients with ICD-10 Diagnosis and/or External Cause of Injury codes meeting criteria for NAT were included. “Historical” controls from an averaged period of March-September 2016-2019 were compared to patients injured after the implementation of SHO through September 2020 (“COVID” cohort). SHO were defined at the state level for each site. An interrupted time series analysis was utilized to evaluate the effect of the implementation of SHO. Results: A total of 9 Level I pediatric trauma centers were included, contributing 39,331 pediatric trauma patients, of which 2,064 met criteria for NAT. During the initial SHO, the rate of NAT dropped below what was expected based on the historical trends, however, thereafter the rate increased above the expected rates of NAT [Figure 1]. The COVID cohort experienced a significant increase in the proportion of NAT patients age >5 years (Historical 36 patients [13.5%] vs. COVID 103 patients [30.8%], p<0.001). Ultimately, 2020 experienced an increased cumulative burden of NAT cases as reported to institutional trauma registries when compared to the Historical cohort [Figure 2]. Conclusion: The COVID-19 pandemic affected the presentation of children with NAT to the hospital. For school-aged children sequestered at home by the pandemic, increased NAT may reflect the absence of normal safeguards provided by the educational system, potentially leaving a vulnerable population at risk. Particularly in times of public health crisis, maintaining systems of protection for children remains essential.

13.
Archives of Academic Emergency Medicine ; 10(1), 2022.
Article in English | EMBASE | ID: covidwho-1998133

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) has directly affected global healthcare, especially the frontline of healthcare provision, including emergency medical services (EMS). The present study aimed to compare EMS processing times and the number of acute stroke patients serviced by EMS before and during COVID-19 pandemic. Methods: This is a retrospective observational review of Bangkok Surgico Medical Ambulance and Rescue Team (S.M.A.R.T.) EMS data from 2018 to 2021. The EMS processing times and the number of acute strokes were compared between pre-COVID-19 era (January 1st, 2018, and December 31st, 2019) and during COVID-19 pandemic (January 1st, 2020, and December 31st, 2021). Results: The number of stroke patients transported by EMS in one year, before and during COVID-19 pandemic was 128 and 150 cases, respectively (Change difference = 17.2%, 95% CI: 11.1–24.9). However, the average number of acute stroke patients per week was not significantly different (p = 0.386). The mean total EMS processing times before and during COVID-19 era were 25.59 ± 11.12 and 45.47 ± 14.61 minutes, respectively (mean difference of 19.88 (95% CI: 16.77–22.99) minutes;p < 0.001). The mean time from symptom onset to EMS arrival (p < 0.001), the mean call time (p < 0.001), the mean response time (p < 0.001), and the mean scene time (p < 0.001) were significantly higher during COVID-19 period. The mean transportation times for stroke patients was similar before and during COVID-19 pandemic (10.14 ± 6.28 and 9.41 ± 6.31 minutes, respectively;p = 0.338). Conclusion: During COVID-19 pandemic, the number of acute stroke patients serviced by EMS increased substantially, but there was no difference in the average number of patients per week. During the pandemic, EMS processing times markedly increased.

14.
Archives of Academic Emergency Medicine ; 10(1), 2022.
Article in English | EMBASE | ID: covidwho-1998132

ABSTRACT

Introduction: Despite the increasing vaccination coverage, COVID-19 is still a concern. With the limited health care capacity, early risk stratification is crucial to identify patients who should be prioritized for optimal management. The present study investigates whether on-admission lactate dehydrogenase to albumin ratio (LAR) can be used to predict COVID-19 outcomes. Methods: This retrospective cross-sectional study evaluated hospitalized COVID-19 patients in an academic referral center in Iran from May 2020 to October 2020. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of LAR in the prediction ofmortality. The Yuden index was used to find the optimal cut-off of LAR to distinguish severity. Patients were classified into three groups (LAR tertiles), first: LAR<101.46, second: 101.46≤LAR< 148.78, and third group: LAR ≥ 148.78. Logistic regression analysis was used to identify the association between tertiles of LAR, as well as the relationship between each one-unit increase in LAR with mortality and ICU admission in three models, based on potential confounding variables. Results: A total of 477 patients were included. Among all patients, 100 patients (21%) died, and 121 patients (25.4%) were admitted to intensive care unit (ICU). In the third group, the risk of mortality and ICU admission increased 7.78 times (OR=7.78, CI: 3.95-15.26;p <0.0001) and 4.49 times (OR=4.49, CI: 2.01-9.04;p <0.0001), respectively, compared to the first group. The AUC of LAR for prediction of mortality was 0.768 (95% CI 0.69-0.81). LAR ≥ 136, with the sensitivity and specificity of 72% (95%CI: 62.1-80.5) and 70% (95%CI: 64.9-74.4), respectively, was the optimal cut-off value for predicting mortality. Conclusion: High LAR was associated with higher odds of COVID-19 mortality, ICU admission, and length of hospitalization. On-admission LAR levels might help health care workers identify critical patients early on.

15.
Resuscitation ; 175:S69-S70, 2022.
Article in English | EMBASE | ID: covidwho-1996697

ABSTRACT

Purpose of the study: Coronavirus disease 2019 (COVID-19) has caused severe morbidity and mortality around the world. As a consequence, emergency calls have increased worldwide. Emergency services in Italy are coordinated by 118 Operation Centres (118-OC). This study analizes newtendencies in emergency calls received by 118- OC in Foggia University Hospital, covering the whole Province of Foggia and beyond, about 650,000 inhabitants. Materials and methods:We analized all emergency calls received by our 118-OC during the second half of 2020, corresponding to the second wave of COVID-19, when emergency services and hospitals were better prepared than the first wave. A similar period was chosen before pandemic, from July to December 2019, as control. R statistical software was used for analysis and chi-squared tests were performed to compare frequencies. Results: The increase in emergency calls in 2020 immediately stands out (p-value < 0.00001). However, in 2020 there was a statistically significant increase in “non-emergencies” and a decrease in “emergencies” (p-value < 0.00001). The decrease in overall emergencies was not proportional to all types of emergencies. Evaluating cardiocirculatory emergencies compared to non-cardiovascular ones, the former decreased much more than the others (p-value < 0.00001). Ultimately, a traumatic event was more likely to activate “118” than a cardiovascular event compared to pre-COVID times. Nevertheless, this decrease in cardiocirculatory emergencies was not accompanied by a decrease in STEMI, which were more numerous than expected (pvalue < 0.0001). Conclusions: COVID pandemic caused a decrease in real emergency calls, probably due to the fear of activating “118” even on the part of those who needed it. The suspicion of many cardiovascular diagnoses that have not been observed is conceivable. Moreover, our results show that in 2020 there were more cardiocirculatory events with STEMI than expected. Perhaps we need to recognize a linkbetween SARS-CoV-2 and acute coronary syndrome, as literature is beginning to hypothesize

16.
Hepatology International ; 16:S302, 2022.
Article in English | EMBASE | ID: covidwho-1995904

ABSTRACT

Objectives: Background: COVID-19 infection has been affecting humans globally since December, 2019 and Remdesivir was first approved by FDA for treating severe COVID-19 pneumonia in July, 2020 though its hepatic safety has not been adequately studied. Remdesivir, a nucleotide analog prodrug, has been found to create derangement in liver function. However, COVID-19 infection itself has transient implications over liver enzymes. Aims: To evaluate the effect of Remdesivir on liver function in COVID-19 in-patients with normal liver function. Materials and Methods: This prospective study was conducted at Mediplus Hospital and Trauma Center from 1st September, 2020 to 31st May, 2021. Ethical approval was obtained and 107 PCR positive COVID-19 in-patients with normal liver function test (LFT) were included in the study. Liver enzymes ( alanine and aspartate transaminases and alkaline phosphatases) and serum bilirubin were sent after 72 h of initiation of the drug. Data was entered in Microsoft excel and result studied. Results: Out of 125 included patients, LFT became deranged in 39 (31.2%) patients. Among those 39 patients, 16 (41.0%) had isolated raised ALT, 9 (23.1%) had isolated raised AST and 14 (35.9%) had all three enzymes (AST, ALT and ALP) raised, while serum bilirubin was found to be raised in only 11 (28.2%) (Diagram1). Conclusion: Biochemical alteration in liver function has been noted in Covid-19 patients after the Remdesivir therapy. However, that effect could also be due to hepatic implications of Covid-19 infection itself and concomitant use of other drugs.

17.
Hepatology International ; 16:S230-S231, 2022.
Article in English | EMBASE | ID: covidwho-1995903

ABSTRACT

Objectives: Background: Coronavirus disease 2019 (COVID-19), a global pandemic, has hit the whole world since December, 2019. COVID-19 has got multi-organ impact and liver is no exception. Studies have shown raised liver enzymes primarily alanine aminotransferase (ALT), aspartate aminotransferase (AST), and alkaline phoshatase (ALP);the mechanism being multifactorial. Aims: To evaluate the effect of COVID-19 infection on liver enzymes. Materials and Methods: It is a prospective study conducted at Mediplus Hospital and Trauma Center from 1st January, 2021 to 30th June, 2021. Ethical approval was obtained and a total of 210 PCR positive COVID-19 inpatients were included. Liver enzymes (ALT, AST and ALP) were measured. Data was entered in Microsoft excel and result studied. Results: Out of 210 PCR positive COVID-19 patients, 57 (27.1%) had raised liver enzymes, while 153 (72.9%) had normal. Among the raised ones, 13 (22.9%) had ALT raised more than one time of upper normal limit (UNL, 45 IU/L), 29 (50.8%) had ALT raised more than two times of UNL and 15 (26.3%) had ALT raised more than three times of UNL, while 42 (73.7%) had AST raised more than one time of UNL (35 IU/L) and 15 (26.3%) had AST raised more than two times of UNL, and ALP was found to be raised in only 5 (8.7%) patients (Table 1). Conclusion: Raised liver enzymes have been commonly noticed in patients with PCR positive COVID-19 due to its direct or indirect impact on liver. (Figure Presented).

18.
Journal of General Internal Medicine ; 37:S578, 2022.
Article in English | EMBASE | ID: covidwho-1995836

ABSTRACT

STATEMENT OF PROBLEM/QUESTION: In the spring of 2020 during the initial outbreak of COVID-19, the Rocky Mountain Regional VA (RMR) was tasked with ensuring the health of infected veterans. The RMR COVID-19 Telehealth Clinic was developed to support veterans in the community diagnosed with COVID-19, identify those with clinical deterioration requiring a higher level of care, and encourage appropriate isolation protocols. DESCRIPTION OF PROGRAM/INTERVENTION: Patients were stratified by risk factors (obesity, CHF, DM, cancer, CAD, HTN, age > 64) and clinical status into 3 tiers, with high-risk (Tier 3) receiving daily telehealth, moderate-risk (Tier 2) telehealth every other day, and low-risk (Tier 1) telehealth every three or more days. Providing care seven days a week, Tier 1 veterans were contacted by nurses and advanced practitioners, while Tier 2 and 3 veterans were managed predominantly by resident physicians and attendings, who provided clinical care for exacerbations of chronic disease as well as comprehensive care of COVID-19 infection. Hypoxic patients were provided oxygen and closely monitored with pulse oximeters. MEASURES OF SUCCESS: Between April 13 to October 5, 2020, 351 veterans testing positive for COVID-19 were followed. Thirty-eight were excluded (26 were outside study dates, 7 covid negative, 5 never received care). Charts for the remaining 313 patients were retrospectively evaluated for demographic data, comorbid conditions, duration of follow-up, and interventions provided, including prescribing and managing medications, referrals for emergency services, and escalating tiers. FINDINGS TO DATE: Of the cohort, 88% were male, 43% obese, 34% over age 64, 40% HTN, and 27% DM. Veterans were followed for 10.4 days on average. Approximately 54% were assigned to Tier 1, 29% to Tier 2, and 16% to Tier 3. Medications were prescribed for 45% and 27% of Tier 3 and Tier 2 patients respectively, and emergency care was advised for 22% and 20% of Tier 3 and Tier 2 veterans. Of Tier 1 patients, medications were ordered on 5%, emergency care recommended for 3%, and only 7% were escalated to Tier 2. Of the five deaths that occurred, two were directly attributed to COVID-19. KEY LESSONS FOR DISSEMINATION: A dedicated telehealth clinic for veterans with Covid-19 appropriately identified patients into low, moderate, and high-risk categories based on risk factor assessment. Low-risk patients were safely followed with intermittent telehealth emphasizing self-care and isolation, avoiding unnecessary Emergency Department visits. More frequent monitoring of symptoms and pulse oximetry in moderate to high-risk patients facilitated identification of patients with clinical deterioration requiring emergency evaluation and avoiding admissions for at-risk clinically stable patients. Tiered management resulted in judicious utilization of health care resources during a critical time marked by scarcity of hospital beds and personal protective equipment.

19.
European Journal of Molecular and Clinical Medicine ; 9(4):1052-1059, 2022.
Article in English | EMBASE | ID: covidwho-1995352

ABSTRACT

Introduction: COVID-19 has pushed Government of India to take various public health measures for curtailing transmission of infection. It included imposition of total lockdown on all non-essential services across the country when number of cases started increasing during the first wave. The first lockdown lasted from March 25th to may 31st 2020, following which a period of gradual unlocking began. Thereafter during the second wave of the COVID pandemic in India, lockdowns of varying intensities were imposed at different intervals by individual states. Near complete lockdown was implemented in the National Capital from April 19th 2021 to 31st May 2021, in response to a sharp rise in the number of cases. These lockdowns along with the pandemic itself has had a major impact on the healthcare system, including trauma care. There are limited number of studies specifically from India, which have examined the effect of these restrictions on trauma admissions. Objectives: Objective of this study is to assess the effect of COVID related lockdowns on trend of trauma admissions in a tertiary care facility of North India. Material and Methods: In this retrospective study, data on trauma admissions were ed from the Health Management Information system of All India Institute of Medical Sciences, Trauma Center, New Delhi corresponding to the following time periods (1) April 15, 2019, to May 31, 2019 - which corresponds with the pre-COVID phase (2) April 15, 2020, to May 31, 2020- which corresponds with first nationwide lockdown imposed in India during the first wave of the COVID outbreak and (3) April 15, 2021, to May 31, 2021- which corresponded with the near complete lockdown in state of Delhi during the second wave of COVID outbreak in India. Results: During the first-time interval (pre-COVID), a total of 8847 trauma casualty cases were reported in the Emergency Department of the level 1 Trauma Center. Due to lock down, number of patients presenting to trauma emergency had significantly reduced to 2185 during second interval. However, trauma casualty cases slightly increased during the third interval. Conclusion: This study showed that during the pandemic lockdown trauma admissions had been significantly reduced. However, the volume of trauma admissions was greater during the 2nd Peak of COVID-19, as the lockdown was partial. This study demonstrated that self-quarantines and lockdowns had led to a significant decrease in trauma footfall.

20.
World Journal of Emergency Medicine ; 13(5):144-147, 2022.
Article in English | EMBASE | ID: covidwho-1988369

ABSTRACT

Out-of-hospital cardiac arrest (OHCA) is one of the three leading causes of death in industrialized countries.[1,2] Some studies have described the impact of the first COVID-19 pandemic wave in terms of the number of cases and OHCA survival rates in various regions,[3,4] but few have addressed the relationship between the successive phases and how they affected OHCA.[5,6] The 14-day cumulative incidence peaked at more than 990 cases, with these rates remaining above 200 for an eight-month period between 15 March 2020 and 15 March 2021 in Madrid, Spain. The objectives of the current study were twofold. First, we sought to describe how the different waves in the first pandemic year aff ected the healthcare activity of the Spanish emergency medical services (EMS). Second, we compared effects of the pandemic year on OHCA care to those of the preceding non-pandemic year in terms of initiating cardiopulmonary resuscitation and survival in a community with a high incidence of COVID-19.

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