Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 649
Filter
1.
Philosophies ; JOUR(5), 7.
Article in English | Web of Science | ID: covidwho-2099720

ABSTRACT

Part of the rationale behind public health measures is protecting the vulnerable. One of the groups most vulnerable to COVID-19 are the elderly and, consequently, many countries adopted public health measures that aimed to keep the elderly safe. The effectiveness and the consequences of those measures, however, leaves a lot to be desired. In my article, I will look at the steps that the Nordic countries took to protect their elderly and assess their success. I will further analyze those in the light of standard ethical theories. Public health crises often call for choices between two evils. Selecting patients for intensive care is one such choice, and again, it seems that for the elderly, the outcome was less than favorable. Overall, from the point of view of ethics, many countries failed miserably when it came to the treatment of the elderly. I will end my paper by discussing the lessons we can learn from the COVID-19 pandemic and suggests measures we need to take to offer genuine respect for the rights of the elderly.

2.
J Pak Med Assoc ; 72(8): 1572-1576, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2101071

ABSTRACT

OBJECTIVE: To assess the discrepancy in terms of history related to coronavirus disease-2019 and symptoms given in the pre-clinic triage and to the doctor attending the patient in a gastroenterology clinic. METHODS: The observational study was conducted from September 2020 to January 2021 at the Gastroenterology outpatient department of Dr Ziauddin Hospital's Clifton unit in Karachi, and comprised all patients visiting the facility regardless of age and gender. Data was collected using a questionnaire that was first filled up by the receptionist outside the clinic and was then administered again once the patient entered the clinic. Discrepancy on the answers was then checked and associations were determined with clinical assessment. Data was analysed using SPSS 20. RESULTS: Of the 300 patients, 184(61.3%) were males and 116(38.6%) were females. The overall mean age was 55 ± 16.98 (range: 18-92 years). Discrepancy between pre-clinic and in-clinic self-reported data was significant for fever, cough, fatigue, headache, body ache, diarrhoea, sore throat, loss of sense of smell/taste, shortness of breath, and contact with someone positive for coronavirus disease-2019 was significant (p<0.05). CONCLUSIONS: Patients were found to be afraid of getting barred from seeing a consultant, had fear of hospital-based isolation or were in denial regarding the pandemic.


Subject(s)
COVID-19 , Gastroenterology , Male , Female , Humans , Adult , Middle Aged , Aged , Triage , SARS-CoV-2 , Pandemics
3.
Scand J Trauma Resusc Emerg Med ; 28(1): 80, 2020 Aug 14.
Article in English | MEDLINE | ID: covidwho-2098373

ABSTRACT

BACKGROUND: Rapid access to emergency medical communication centers (EMCCs) is pivotal to address potentially life-threatening conditions. Maintaining public access to EMCCs without delay is crucial in case of disease outbreak despite the significant increased activity and the difficulties to mobilize extra staff resources. The aim of our study was to assess the impact of two-level filtering on EMCC performance during the COVID-19 outbreak. METHODS: A before-after monocentric prospective study was conducted at the EMCC at the Nantes University Hospital. Using telephone activity data, we compared EMCC performance during 2 periods. In period one (February 27th to March 11th 2020), call takers managed calls as usual, gathering basic information from the caller and giving first aid instructions to a bystander on scene if needed. During period two (March 12th to March 25th 2020), calls were answered by a first-line call taker to identify potentially serious conditions that required immediate dispatch. When a serious condition was excluded, the call was immediately transferred to a second-line call taker who managed the call as usual so the first-line call taker could be rapidly available for other incoming calls. The primary outcome was the quality of service at 20 s (QS20), corresponding to the rate of calls answered within 20 s. We described activity and outcome measures by hourly range. We compared EMCC performance during periods one and two using an interrupted time series analysis. RESULTS: We analyzed 45,451 incoming calls during the two study periods: 21,435 during period 1 and 24,016 during period 2. Between the two study periods, we observed a significant increase in the number of incoming calls per hour, the number of connected call takers and average call duration. A linear regression model, adjusted for these confounding variables, showed a significant increase in the QS20 slope (from - 0.4 to 1.4%, p = 0.01), highlighting the significant impact of two-level filtering on the quality of service. CONCLUSIONS: We found that rapid access to our EMCC was maintained during the COVID-19 pandemic via two-level filtering. This system helped reduce the time gap between call placement and first-line call-taker evaluation of a potentially life-threatening situation. We suggest implementing this system when an EMCC faces significantly increased activity with limited staff resources.


Subject(s)
Betacoronavirus , Communication , Coronavirus Infections/epidemiology , Emergencies , Emergency Medical Service Communication Systems/organization & administration , Emergency Medical Services/methods , Pneumonia, Viral/epidemiology , Triage/methods , COVID-19 , Controlled Before-After Studies , Humans , Pandemics , Prospective Studies , SARS-CoV-2 , Telephone
4.
J Med Internet Res ; 24(10): e37436, 2022 10 24.
Article in English | MEDLINE | ID: covidwho-2089629

ABSTRACT

BACKGROUND: Online consultations (OCs) allow patients to contact their care providers on the web. Worldwide, OCs have been rolled out in primary care rapidly owing to policy initiatives and COVID-19. There is a lack of evidence regarding how OC design and implementation influence care quality. OBJECTIVE: We aimed to synthesize research on the impacts of OCs on primary care quality, and how these are influenced by system design and implementation. METHODS: We searched databases from January 2010 to February 2022. We included quantitative and qualitative studies of real-world OC use in primary care. Quantitative data were transformed into qualitative themes. We used thematic synthesis informed by the Institute of Medicine domains of health care quality, and framework analysis informed by the nonadoption, abandonment, scale-up, spread, and sustainability framework. Strength of evidence was judged using the GRADE-CERQual approach. RESULTS: We synthesized 63 studies from 9 countries covering 31 OC systems, 14 (22%) of which used artificial intelligence; 41% (26/63) of studies were published from 2020 onward, and 17% (11/63) were published after the COVID-19 pandemic. There was no quantitative evidence for negative impacts of OCs on patient safety, and qualitative studies suggested varied perceptions of their safety. Some participants believed OCs improved safety, particularly when patients could describe their queries using free text. Staff workload decreased when sufficient resources were allocated to implement OCs and patients used them for simple problems or could describe their queries using free text. Staff workload increased when OCs were not integrated with other software or organizational workflows and patients used them for complex queries. OC systems that required patients to describe their queries using multiple-choice questionnaires increased workload for patients and staff. Health costs decreased when patients used OCs for simple queries and increased when patients used them for complex queries. Patients using OCs were more likely to be female, younger, and native speakers, with higher socioeconomic status. OCs increased primary care access for patients with mental health conditions, verbal communication difficulties, and barriers to attending in-person appointments. Access also increased by providing a timely response to patients' queries. Patient satisfaction increased when using OCs owing to better primary care access, although it decreased when using multiple-choice questionnaire formats. CONCLUSIONS: This is the first theoretically informed synthesis of research on OCs in primary care and includes studies conducted during the COVID-19 pandemic. It contributes new knowledge that, in addition to having positive impacts on care quality such as increased access, OCs also have negative impacts such as increased workload. Negative impacts can be mitigated through appropriate OC system design (eg, free text format), incorporation of advanced technologies (eg, artificial intelligence), and integration into technical infrastructure (eg, software) and organizational workflows (eg, timely responses). TRIAL REGISTRATION: PROSPERO CRD42020191802; https://tinyurl.com/2p84ezjy.


Subject(s)
COVID-19 , United States , Humans , Female , Male , Pandemics , Artificial Intelligence , Referral and Consultation , Quality of Health Care
5.
Pakistan Journal of Medical and Health Sciences ; 16(8):192-195, 2022.
Article in English | EMBASE | ID: covidwho-2067748

ABSTRACT

Aim: To evaluate the pattern of surgical emergencies and surgical care provided during COIVD 19 pandemic. Study design: Cross-sectional Study Place and duration of study: Department of Surgery, CMH, Lahore from 15th March - 15 June 2020. Methodology: Data was collected retrospectively, of all the patients who were admitted in department of surgery over the duration of 3 months. Demographic variables, diagnosis, work up related to COVID-19, specialty of admission and surgical vs conservative management was recorded. Results: A total of 312 patients were included. Majority were male 216(69.2%). Most of the patients 191(61.2%) were admitted via clinic, predominantly in month of May 148(41%). COVID-19 PCR was done on 210 patients (67.3%), chest x-ray was done on 271(87.9%), HRCT chest was done on 113 patients (29.20%). Although general surgery was the busiest service line with a total patient admission of 89(43.1%), Orthopedic surgery top the operative interventions list with 85.1% of admissions underwent operative management. Conclusion: The current local guidelines about patient flow and management of patients in COVID crisis are practical and can be implemented. In the wake of the later waves of COVID 19 hospitals should prepare to divert their resources to high volume specialties like General and orthopedic surgery. Simple, but important procedures like arteriovenous fistula creation should only be stopped it there is shortage of manpower.

6.
American Journal of Transplantation ; 22(Supplement 3):776, 2022.
Article in English | EMBASE | ID: covidwho-2063545

ABSTRACT

Purpose: COVID-19 infection in kidney transplant (KT) recipients is characterized by an unpredictable course and can be life-threatening. Prompt adjustment of immunosuppression and hospitalization when decompensated are potential strategies to increase survival. Our objective is to determine if advanced practice nurse (APN)-driven COVID-19 monitoring would result in better health outcomes for KT recipients. Method(s): We performed a retrospective study on KT patients diagnosed with COVID-19 between 4/1/2020 and 11/30/2021. The patients were stratified into two groups: (1) a control group who initially presented to the emergency department (ED) with COVID-19 symptoms, (2) an intervention group where patients were diagnosed with COVID-19 outside of the ED and followed by the APN team. The APNs monitored this group daily via telephone and/or video call for symptom assessment, immunosuppression adjustment, health counseling, and emotional support. If the patients were distressed, the APNs arranged admission to the nearest hospital or transplant center. Data were analyzed using Pearson Chi-squared for comparisons and linear or logistic regression modeling with adjustment for age, ethnicity, diabetes, and obesity Results: In our cohort, there were 102 KT patients that were infected with the SARS-CoV-2 virus. The majority were Hispanic ethnicity and male gender who presented with fever and flu like symptoms. Fourty-four patients required oxygen therapy. Immunosuppression was adjusted earlier in the intervention group . When the APNs recommended hospitalization, those patients experienced less acute kidney injury (AKI), shorter duration of illness, lower readmission rates, and greater survival than the control group. Conclusion(s): In this single transplant center study, KT recipients diagnosed with COVID-19 had better clinical outcomes when intervention occurred in a timely manner by the APN team. Possible explanations include earlier withdrawal of antimetabolites, prompt triage for hospitalization, and enforcing of nursing practices (dietary educations, blood pressure/glucose management, emotional support). Interpretation and generalization of these findings should be cautious due to a small sample size. As more treatment options for COVID-19 emerge, earlier interventions and close monitoring as demonstrated in our APN-driven model has the potential to achieve better health outcomes.

7.
American Journal of Transplantation ; 22(Supplement 3):639, 2022.
Article in English | EMBASE | ID: covidwho-2063507

ABSTRACT

Purpose: Despite the large numbers of reports on patient risk factors for poor clinical outcomes with COVID-19, little is known about how these risks may differ for solid organ transplant (SOT) recipients versus non-SOT (NSOT) patients. Method(s): We reviewed demographic and comorbid conditions in a cohort of SOT (n=129) and NSOT patients (n=708) admitted to our center for COVID-19 between December 2019 and February 2021. Patient characteristics were compared between groups using the t-test or chi-square test. Univariable and multivariable (stepwise reduced) logistic regression models were constructed for our outcomes of interest. Result(s): Patient age and sex were similar between SOT and NSOT cohorts. However, SOT patients were more likely to be of Hispanic ethnicity (64% v. 39%, p<0.001). Both SOT and NSOT had similar incidence of neurologic conditions (23% and 21%, p=0.476), but SOT patients were more likely to have comorbid conditions including diabetes mellitus, cardiovascular condition, or lung disease (all p<0.001). Several clinical factors were associated with ICU admission in NSOT patients, including patient age, diabetes, cardiac disease, neurologic disease, obesity, and hepatobiliary disease (all p < 0.05). In contrast, only cardiac disease was associated with ICU admission for SOT patients (p=0.010). Multivariable analysis of factors associated with increased mortality revealed that neurologic condition (OR 3.0, 95% CI 0.8-11.4) and lung disease (OR 3.5, 95% CI 0.7-18.2) were significant for SOT patients in a model including age, sex, and other comorbid conditions. In contrast, for NSOT patients, history of a neurologic condition (OR 2.3, 95% CI 1.3-4.0) and age >65 (OR 4.2, 95% CI 2.1-8.7) were significantly associated with death in a multivariate analysis. Conclusion(s): It has been previously unclear whether risk factors associated with poor outcomes in NSOT patients with COVID-19 will be similarly important in SOT recipients. Our analysis demonstrated different risk associations in contemporaneous patient cohorts at a single academic center. This observation suggests that SOT-specific approaches for risk stratification would be beneficial for patient evaluation and triage.

8.
Clinical Toxicology ; 60(Supplement 2):112, 2022.
Article in English | EMBASE | ID: covidwho-2062725

ABSTRACT

Background: More and more, young children are victims of the ongoing epidemic of opioid use disorder. Xylazine, an alpha-2 adrenergic agonist with notorious use as a veterinary tranquilizer, is an increasingly encountered component of the illicit opioid supply in the US, but has been rarely documented in biological samples obtained from children. We report a 19-day-old infant with classic manifestations of central nervous system and respiratory depression associated with fentanyl and xylazine poisoning. Case report: A 19-day-old boy was taken to the emergency department (ED) by his parents for episodes of straining, breathholding, and his eyes rolling backwards. The formula-fed boy was born of an uncomplicated full-term spontaneous vaginal delivery and had previously been thriving. During ED triage assessment he had a period of apnea, then bradypnea, with pulse-oximetric oxygen saturation drop to 55%. He was supported with stimulation and supplemental oxygen via nonrebreather mask but remained lethargic, with temperature 96F, heart rate 166/min, and brisk capillary refill. Point of care blood dextrose testing was 88mg/dL. Analysis of respiratory secretions for common viruses by polymerase chain reaction was negative for respiratory syncytial virus, influenza, or SARS-CoV-2. Computed tomography imaging of the brain was unremarkable. A urine drug immunoassay (Vitros 4600 Chemistry , Ortho- Clinical Diagnostics) resulted positive for fentanyl (cutoff 1 ng/ mL), but negative for amphetamine, barbiturate, benzodiazepine, cannabinoids, cocaine, heroin, morphine, buprenorphine, methadone, or oxycodone. Liquid chromatography tandem mass spectroscopy analysis of the urine confirmed the presence of fentanyl (25 ng/mL) and norfentanyl (245 ng/mL). Gas chromatography with mass spectrometry also detected the presence of xylazine (qualitative result based on spectra matching). Over the ensuing hours the boy recovered fully and the family was connected with child protection services;an exposure route was not identified. Discussion(s): This 19-day-old infant suffered fentanyl/xylazine poisoning. The infant's age and urine fentanyl concentrations exclude pre-natal exposure as an explanation for the drug test findings, and the baby was bottle-fed excluding drug transmission through breast milk. Xylazine has been known to be in this hospital's regional heroin supply since the early 2000s, and in 2019 xylazine was implicated in more than 31% of opioid-associated deaths at the city's medical examiner's office. In 2022, many fentanyl samples tested by regional law enforcement find more xylazine than fentanyl. Until recently, xylazine was an uncommon finding in our testing of pediatric opioid poisoning victims. Similar to fentanyl, xylazine may cause pupillary miosis and CNS depression;unfortunately it may be resistant to reversal with naloxone. Conclusion(s): This case is remarkable for the young age of this infant ill from post-natal fentanyl poisoning and for the detection of xylazine in his urine. Healthcare providers may not immediately consider opioid poisoning in the differential diagnosis of infants with altered mental status, and proper toxicological testing is important for appropriate child protection support. Detection of xylazine is a marker for a non-medical, or "street," source of fentanyl.

9.
Chest ; 162(4):A2594, 2022.
Article in English | EMBASE | ID: covidwho-2060971

ABSTRACT

SESSION TITLE: Late Breaking Pulmonary Vascular Disease Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Pulmonary embolism (PE) is a common form of thromboembolism which has a variable and non-specific presentation that can often be fatal. The Simplified Pulmonary Embolism Severity Index (sPESI) which includes hemodynamic parameters of perfusion has been shown to correlate with 30-day mortality in patients with acute PE. The purpose of this quality improvement project was to compare how lactate and sPESI perform in predicting clinical outcomes at our institution with the hopes of developing institutional guidelines for management of patients admitted with an acute PE. METHODS: We conducted a single center retrospective analysis on patients admitted to the intensive care unit with a new diagnosis of PE between the years 2016-2021. Patients were identified using ICD-9 CM codes. Exclusion criteria included current or prior positive testing for SARS-CoV-2 (COVID-19). We performed univariate, multivariate, and ROC (Receiver Operating Characteristic) analysis to assess correlations between all cause mortality, lactate, and sPESI. Both lactate and sPESI were included as continuous variables. Our covariates included age, sex, Body Mass Index, prior or current history emphysema/COPD, smoking, CKD, diabetes, cancer, atrial fibrillation, and CHF. All analysis was carried out using software R version 3.6.3. RESULTS: Of the 161 patients who were included in the study, the mean age was 60 years (SD 17 years) and 38% (61/161) were females. 31 patients (19.3%) were deceased. Mean BMI of study participants was 29.9 kg/m2. Comorbidities included 9.9% (16/161) with emphysema/COPD, 44% (71/161) with active or prior history of smoking, 6% (10/161) with CKD, 12% (20/161) with diabetes, 15% (24/161) with diagnosis of cancer, 15% (24/161) with atrial fibrillation, 15% (24/161) with history of CHF. We found that in univariate analysis, both sPESI (p=3.4*10

10.
Chest ; 162(4):A2473, 2022.
Article in English | EMBASE | ID: covidwho-2060948

ABSTRACT

SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Asthma is one of the most common chronic respiratory illnesses affecting quality of life of patients, mortality as well as a high impact on health care utilization. In the era of the COVID19 pandemic, telemedicine and remote patient monitoring (RPM) have been heavily utilized by healthcare systems and providers for patient care. In our pilot program at a large US healthcare center, we enrolled patients known to have asthma to evaluate how RPM could be of value to both the patients and providers. METHODS: Patients included in the study had a confirmed diagnosis of moderate/severe asthma, were at least 18 years of age, and had access to an Android/iOS mobile device with internet access. The patients were excluded from the study for any conditions that would prevent them from using an app such as visual, cognitive, or other impairments that may prevent the patient from being able to participate. Patients were provided with a connected mobile spirometer, the KevaTalk app on their phones and educational introductory sessions during 9 months of the study. Each patient had their action plan and list of medications entered into the Keva365 platform by the nurse or the patient themselves. We provided a baseline patient questionnaire to assess usefulness and evaluate the app features, an ATAQ questionnaire for asthma control and a Smoking cessation questionnaire. Patients were asked to check in daily into the app as green (no symptoms), yellow (some symptoms) or red (bad symptoms). Patients were asked to perform spirometry using a connected spirometer. Remote monitoring protocols were set up for patients which included specific requirements for alerts being escalated to the pulmonologists. We monitored check-ins, alerts, and escalations during the study time window. RESULTS: A total of 25 patients were included in this pilot. Mean age was 57 and majority (23) were female. A baseline questionnaire rating the app, indicated that ease of check-in and ease of modification to the patient's asthma plan were the two highest rated features. 2066 total check ins (1550 green, 506 yellow and 10 red checkins) and 1155 spirometry sessions were recorded during this period. 484 alerts were recorded and evaluated by the monitoring team, of which 37% required an escalation to the physician requiring an intervention which included transfer to a medical facility, change in respiratory medication or further education. CONCLUSIONS: Patient driven engagement along with a well executed RPM program leads to increased compliance and improved outcomes among patients with respiratory illnesses. CLINICAL IMPLICATIONS: Our findings demonstrate preliminary evidence of the clinical impact of respiratory focused remote monitoring combined with a process for triaging our pulmonary patients. Adoption by pulmonolgists and allergists of these digital remote programs can pave the way for reduced physican burden, improved outcomes and reduced costs. DISCLOSURES: No relevant relationships by Karim Anis No relevant relationships by Jyotsna Mehta No relevant relationships by Shail Mehta No relevant relationships by Denzil Reid

11.
Chest ; 162(4):A1711, 2022.
Article in English | EMBASE | ID: covidwho-2060853

ABSTRACT

SESSION TITLE: Lung Cancer Imaging Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: The Coronavirus disease 2019 (COVID-19) pandemic affected millions of people globally, prompting the emergent need for an effective vaccine. Lymphadenopathy associated with COVID-19 vaccine is a recognized phenomenon that can present a diagnostic dilemma for staging thoracic malignancies. We present a case of post COVID-19 vaccination axillary lymphadenopathy complicating the staging process for a patient with newly diagnosed lung adenocarcinoma. CASE PRESENTATION: A 64-year-old-male with chronic obstructive pulmonary disease, former smoker with a 20-pack-year smoking history was found to have a 1.7 cm solid nodule in the left upper lobe with irregular margins on low dose computed tomography (CT) scan of the chest for lung cancer screening. Fine needle aspiration of the nodule was done, and histopathology results were consistent with the diagnosis of adenocarcinoma. Patient then underwent fluorodeoxyglucose-positron emission tomography (FDG-PET) scan that showed a 16 mm nodule in the left upper pulmonary lobe with maximum standardized uptake value (SUVmax) of 5.3 and left axillary nodes measuring up to 8 mm with SUVmax of 4.4 concerning for metastatic disease. On further history, patient had received the Pfizer mRNA vaccination booster three days prior to undergoing the FDG-PET scan. Patient was evaluated by oncology and decision was made to treat with a 7-day course of prednisone 20 mg daily and to repeat FDG-PET scan. FDG-PET scan done four weeks later showed resolution of axillary lymphadenopathy. Patient was clinically staged as T1bN0M0 stage 1A and underwent robotic left upper lobe lingular-sparing lobectomy. DISCUSSION: In patients with thoracic malignancies, lymphadenopathy related to COVID-19 vaccination with avid FDG uptake on PET scan was reported in 29% of patients (2). The presentation of FDG avid lymphadenopathy creates a clinical challenge by confounding accurate cancer staging and leading to unnecessary workup (3). More importantly, detection of lymphadenopathy while staging lung cancer has crucial implications in the process of triaging patients to oncologic management in terms of candidacy for surgical resection (3). Currently, no consensus is available to guide management for incidental lymphadenopathy associated with COVID-19 vaccination in lung cancer patients. For this patient, we chose to treat with steroids and to obtain repeat imaging within 4 weeks of the original FDG-PET to not delay treatment planning. Repeat imaging showed resolution of the axillary lymphadenopathy and patient was able to undergo definitive treatment promptly. CONCLUSIONS: This case highlights the diagnostic challenge posed by COVID-19 lymphadenopathy in patients with newly diagnosed lung cancer and delineates our approach to navigating this challenge to avoid malignancy up-staging and treatment delay. Reference #1: Polack FP, Thomas SJ, Kitchin N, et al. Safety and Efficacy of the BNT162b2 mRNA Covid-19 Vaccine. N Engl J Med. 2020;383(27):2603-2615. doi:10.1056/NEJMoa2034577 Reference #2: Nishino M, Hatabu H, Ricciuti B, Vaz V, Michael K, Awad MM. Axillary Lymphadenopathy After Coronavirus Disease 2019 Vaccinations in Patients with Thoracic Malignancy: Incidence, Predisposing Factors, and Imaging Characteristics. J Thorac Oncol. 2022;17(1):154-159. doi:10.1016/j.jthoCH.2021.08.761 Reference #3: Lehman CD, D'Alessandro HA, Mendoza DP, Succi MD, Kambadakone A, Lamb LR. Unilateral Lymphadenopathy After COVID-19 Vaccination: A Practical Management Plan for Radiologists Across Specialties. J Am Coll Radiol. 2021;18(6):843-852. doi: 10.1016/j.jacr.2021.03.001 DISCLOSURES: No relevant relationships by Hadya Elshakh No relevant relationships by Stephen Karbowitz No relevant relationships by Gina Villani

12.
Chest ; 162(4):A1321, 2022.
Article in English | EMBASE | ID: covidwho-2060804

ABSTRACT

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: COVID-19 surges due to variants continue to intermittently strain healthcare resources, highlighting the need to refine crisis standards of care (CSC) guidelines and study how they may perform in actuality. Studies to date, focusing on excess deaths or exacerbations of existing health disparities, simulate retrospective patient cohorts that synchronize patient presentation to a single point in time, rather than the reality where patients present continually throughout time. This artificial static model may not be an accurate reflection of patient throughput and dynamic resource strain, which occurs in reality, and might distort patient cohorts and mislead CSC simulated outcomes. METHODS: All intubated COVID-19 patients in a single healthcare system in New York City during the first surge (1/1/20 to 6/30/20) were included. A crisis period requiring CSC activation was defined as occurring once 95% of pre-pandemic ventilators were utilized and lasted 2 weeks in duration, consistent with prior simulated length of CSC for this cohort under the New York State Ventilator Allocation Guidelines (NY). NY, Maryland (MD), Pittsburgh (PA), Saskatchewan Canada (SAC), and California (CA) CSC policies were reviewed for exclusionary and other criteria that would affect patient triage (admission diagnosis, comorbidities, occupation, or other patient circumstances). NY, MD, SAC, and CA all use exclusionary criteria. Subsequently NY and SAC only use a SOFA score for triage whereas MD, PA, and CA all integrate tiered comorbidities in addition to a SOFA score to generate an overall triage score. Partial triage priority is provided by PA, SAC, and CA for certain occupations and by PA for those socially disadvantaged. Patient charts were reviewed to determine if they would satisfy triage criteria from any of these guidelines and if they would be relevant during the specific crisis period. RESULTS: 936 patients were included in the total cohort, of which 573 were involved during the crisis period. Those not involved during the crisis period required a ventilator when less than 95% of all ventilators were utilized and would not be relevant during a CSC simulation. NY, MD, PA, SAC, and CA would have excluded 1, 3, 0, 79, and 4 patients respectively for the entire cohort, but 0, 0, 0, 29 (36.7%), and 2 (50%) during the specific crisis period. MD, PA, & CA would have modified 49, 88, & 102 individual’s triage score due to comorbidities in the entire cohort but only 17 (34.7%), 40 (45.5%), and 41 (40.2%) during the crisis period respectively. CONCLUSIONS: CSC simulations that include patients outside the crisis period will include patients that may not be relevant to understanding how CSC might perform. CLINICAL IMPLICATIONS: Understanding CSC performance, particularly when studying excess deaths or exacerbating social disparities, requires incorporating patient throughput for an accurate real-world understanding. DISCLOSURES: No relevant relationships by Deepak Pradhan No relevant relationships by Brandon Walsh

13.
Chest ; 162(4):A319, 2022.
Article in English | EMBASE | ID: covidwho-2060563

ABSTRACT

SESSION TITLE: Critical Care in Chest Infections Case Report Posters 2 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: During the COVID-19 pandemic, acute respiratory distress syndrome (ARDS) was a very common presentation. Many clinicians sought to rule out COVID-19 in those presenting with hypoxia and shortness of breath due to the importance of triage and quarantining infected individuals and those under investigation. As a result, delay in diagnosis of other viral and bacterial pathogens occurred. There is a known but rare overlapping of disease processes and sometimes even co-infections with COVID-19 and Pneumocystis jirovecii pneumonia (PJP) which made narrowing the differential challenging [1,2]. We present a case of a patient with known HIV who presented with typical features of COVID-19 and clinically worsened. Further investigation revealed PJP and AIDS. CASE PRESENTATION: A 55-year-old female with a past medical history of human immunodeficiency virus (HIV), previously controlled on highly active antiretroviral therapy (HAART), presented with shortness of breath, cough, and syncope. She required sedation and mechanical ventilation following significant hypoxia on admission. Chest radiograph and computed tomography (CT) were concerning for acute respiratory distress syndrome (ARDS) with diffuse bilateral ground glass opacities (Figure 1 and Figure 2) and she was found to be in septic shock requiring vasopressors. She presented during the COVID-19 pandemic and it was initially thought to be the cause of her condition, however she repeatedly tested negative via polymerase chain reaction (PCR). Through further investigation, it was found that her total cluster of differentiation 4 (CD4) cell count was 184/??L, posing a risk for opportunistic infections. Prior records indicated her last CD4 count was greater than 250/??L. Bronchoscopy showed progressively darker-tinged aliquots significant for diffuse alveolar hemorrhage that stained positive for Pneumocystis jirovecii pneumonia (PJP). She was treated with appropriate antimicrobial therapy, eventually weaned from ventilation, and transferred to the floor despite her high risk of morbidity and mortality [3]. DISCUSSION: This clinical case demonstrates PJP infection in an individual with features on imaging nearly identical to those of COVID-19 during the pandemic. There is a strong role in verifying CD4 count and HIV viral level in those affected with HIV with reported medication adherence who present with critical illness. There should be a low threshold to perform bronchoscopy in patients with ARDS and negative COVID-19 if no known source is identified. CONCLUSIONS: It is important to consider all causes of ARDS in patients who are immunocompromised with a low threshold to test for and treat uncommon causes, such as opportunistic infections, because the treatment should be directed at the underlying cause. Reference #1: Coleman, H., Snell, L., Simons, R., Douthwaite, S. and Lee, M., 2020. Coronavirus disease 2019 and Pneumocystis jirovecii pneumonia: a diagnostic dilemma in HIV. AIDS, 34(8), pp.1258-1260. Reference #2: Menon, A., Berg, D., Brea, E., Deutsch, A., Kidia, K., Thurber, E., Polsky, S., Yeh, T., Duskin, J., Holliday, A., Gay, E. and Fredenburgh, L., 2020. A Case of COVID-19 and Pneumocystis jirovecii Coinfection. American Journal of Respiratory and Critical Care Medicine, 202(1), pp.136-138. Reference #3: Dworkin, M., Hanson, D. and Navin, T., 2001. Survival of Patients with AIDS, after Diagnosis of Pneumocystis carinii Pneumonia, in the United States. The Journal of Infectious Diseases, 183(9), pp.1409-1412. DISCLOSURES: No relevant relationships by salah alandary No relevant relationships by Joella Lambert No relevant relationships by Joshua Lung

14.
Chest ; 162(4 Supplement):A295, 2022.
Article in English | EMBASE | ID: covidwho-2060555

ABSTRACT

SESSION TITLE: Imaging Across the Care Spectrum SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Mortality from coronavirus disease 2019 (COVID-19) has been associated with multiple risk factors. Despite this, prediction of illness trajectory remains difficult. We conducted a retrospective, exploratory case control study to determine risk factors for death among COVID-19 hospitalized patients in our local patient population. METHOD(S): Data was ed from 03/01 to 05/31/2020. Study population included hospitalized COVID-19 patients. We reviewed their demographics, past medical history, symptoms, oxygen requirements, BMI, imaging, laboratory markers, admission location, length of stay, requirement of CRRT/HD, final outcome. We compared those who died to those who survived to discharge. Mortality rates within individual risk factors were analyzed using an independent t-Test of percentages. The percentages were compared across the most common risk factors and tested for statistical significance with Chi square analysis at p< 0.05. RESULT(S): There were 281 patients admitted with COVID-19, 48 of them died. There was a significant increased risk of death with age (p<0.0001, OR=1.07;CI=1.05-1.1);history of obstructive sleep apnea (p=0.03), CKD/ESRD (p=0.01), CAD (p=0.02);presenting symptoms of dyspnea (p=0.04), respiratory rate (p=0.0002, OR=1.07;CI=1.03-1.12);absolute lymphopenia (p=0.03);LDH (p<0.0001, OR = 1.00;CI=1.001-1.004);AST (p=0.03);CRP (p=0.003, OR = 1.00;CI=1.00-1.01);on initial presentation, requiring non-rebreather (p<0.0001, OR 3.60;CI 95%, 1.73-7.50), BiPAP (p=0.004, OR 4.592;CI 95%, 1.47-14.34), invasive ventilation (p< 0.0001, OR 7.36;CI 95%, 2.73-19.85);imaging findings of bilateral infiltrates/consolidation (p=0.04);CRRT/HD (p< 0.0001, OR 6.78;CI 95%, 2.69-17.12);admission to ICU (p-< 0.0001, OR 3.52CI 95%, 1.82-6.81);transfer to ICU (p<0.0001, OR 3.62CI 95%, 1.81-7.22). There was no significant association between death and sex, hypertension, diabetes, CHF, COPD, asthma, obesity, length of stay, fever, cough, fatigue, GI symptoms, D-Dimer, Ferritin, Fibrinogen, PaO2/FiO2 ratio, and requiring nasal cannula on presentation. CONCLUSION(S): We identified a range of patient characteristics, comorbidities, symptoms, and laboratory markers that are suggestive of an increased risk of mortality from COVID-19. There were some factors that differed but did not reach statistical significance. A larger sample size is needed to resolve this. Interestingly, we identified obesity to have a protective trend with a relative 30% lower death rate, and a larger sample size could make this significant, suggesting a possible obesity paradox. However, many experts argue against this, citing that obesity is a detrimental risk factor and these patients need aggressive monitoring and treatment. CLINICAL IMPLICATIONS: Although COVID-19 mortality is associated with multiple risk factors, a physician's clinical judgment is still imperative in triaging which patients are at increased risk of death. DISCLOSURES: No relevant relationships by Mohamed Ghiath Bayasi No relevant relationships by Alan Bridgmon No relevant relationships by Kristen Hartnett No relevant relationships by Bineh-Karan Kalra No relevant relationships by Joanna Wieckowska No relevant relationships by Elise Wojcik Copyright © 2022 American College of Chest Physicians

15.
Int Emerg Nurs ; 65: 101229, 2022 Oct 11.
Article in English | MEDLINE | ID: covidwho-2061248

ABSTRACT

BACKGROUND: The COVID-19 pandemic brought important changes in access to the Emergency Department (ED). At present, an analysis of how the COVID-19 pandemic has changed not only the number but also the nature of the urgency of ED access is not available. This study aimed to verify the effect of the COVID-19 pandemic on the urgency of patients admitted to the ED utilizing timebased analyses. METHODS: A quasi-experimental interrupted time series analysis based on a retrospective review of data from all ED admissions occurring at the Merano Hospital (Italy) from 1 January 2015 to 30 June 2021 was conducted. RESULTS: From January 2015 to June 2021, 416,560 patients were admitted to the ED. Since the pandemic outbreak, the trend of urgent patients (classified as orange and red by triage) remained unchanged compared to the pre-pandemic period (p = 0.095, p = 0.155). In contrast, patients classified as blue (non-urgent) increased exponentially since the outbreak of the pandemic (p < 0.001). CONCLUSION: The present study reported stability in urgent codes (orange and red) since the pandemic outbreak while a dramatic increase in non-urgent codes (blue and green) is reported. The results of the study may indicate the need to find health policy solutions to manage this large increase in nonurgent patients requiring assessment in EDs since the outbreak of the pandemic.

16.
Appl Soft Comput ; 129: 109626, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2060419

ABSTRACT

Triage is a fundamental process in hospitals and emergency care units, as it allows for the classification and prioritization of patient care based on the severity of their clinical conditions. In Brazil, the triage of suspected COVID-19 cases is performed using a specific protocol, which involves manual steps, requiring the completion of four different forms, by four health care professionals. Aiming to investigate the possibility of improving the triage processes in Brazil, this article proposes the use of computational techniques for decision-making based on fuzzy inference systems. We argue that fuzzy set theory is appropriate to the problem because it allows the use of natural language to express the patient's symptoms, making it easier for health care professionals. After modelling the problem in a fuzzy system we applied a pilot test. The model includes symptoms that health professionals currently use to analyse COVID-19 cases. The results suggest that the model presents convergence with the sample data, highlighting its potential application in supporting triage for the classification of the severity of COVID-19 cases. Among the benefits of the proposed model, we emphasize contributions as the reduction of the time and number of professionals required for triage as well as the reduction of exposure of health care professionals and other patients suspected of carrying the virus. In this context, this research provides an opportunity to obtain social contributions regarding the services in public hospitals improvement.

17.
Notfall und Rettungsmedizin. ; 2022.
Article in German | EMBASE | ID: covidwho-2059880

ABSTRACT

Background: Due to the changes in demographics and morbidity, the demand for emergency medical services (EMS) in Germany continues to rise, which requires further enhancement of acute care structures especially between the sectors of outpatient and inpatient care. Therefore, the concept of the community paramedic (in German "Gemeindenotfallsanitater" [G-NFS]) was introduced in 2019 in the region of Oldenburg, Germany, as part of a pilot project with scientific supervision. Method(s): In this mixed-methods study, online focus group interviews (participation of 56.7% of all G-NFS) were conducted with all four regional groups of G-NFS (city of Oldenburg and the districts of Vechta, Cloppenburg, and Ammerland). In addition, a short online survey (participation of 53.3% of all G-NFS) was carried out with the same interviewees. The interviews and the online survey focused on the personal experiences of the G-NFS before and during the corona pandemic. The interview findings were analyzed based on thematic coding and subsequent evaluation. Result(s): In all, 17 G-NFS participated in the interviews, and 16 G-NFS took part in the survey. According to the G-NFS, the EMS system (so far based on non-urgent and urgent care ambulances) is complemented by the G-NFS with a useful and skilled resource, which offers the necessary relief for urgent care ambulances. The indispensable cross-sectional collaboration with other services works target-oriented and efficiently but differs depending on the local setting. The same applies to the collaboration with the responsible dispatch centers. In addition, the G-NFS was dispatched to triage patients during the corona pandemic peaks and eased the burden on the overall EMS system in the region. Conclusion(s): The G-NFS who participated believe that the concept has thus far in the project phase proven to be very useful. Based on the present experiences and results, the concept can be further developed. Copyright © 2022, The Author(s).

18.
Investigative Ophthalmology and Visual Science ; 63(7):3792-F0213, 2022.
Article in English | EMBASE | ID: covidwho-2058417

ABSTRACT

Purpose : In recent years, innovations in tele-ophthalmology have shown promise in providing quality ophthalmic care to patients in low-access settings and high-risk environments such as the COVID-19 pandemic. Emergency departments and urgent centers may benefit from tele-ophthalmology applications;the tele-images can be sent to the covering ophthalmologist or, to another ED for evaluation of images prior to transferring the patient. In this study, we aimed to assess the ability of resident physicians to identify features of posterior-pole retinal pathology using teleophthalmology. Methods : Retrospective study on 16 patients (32 eyes;30 with retinal pathology and 2 controls) who presented to a retina clinic at an academic medical center. Automated OCT-B images with 3D topographic maps and fundus photographs of the posterior pole using a Topcon Maestro 3D OCT-1 unit were taken. Images were transmitted remotely to a resident physician who attempted to identify retina pathology using fundus photography and OCT. The same images were consequently evaluated by a retina specialist for grading. We then tested the concordance between diagnoses rendered via tele-OCT by the resident physician and the gold standard clinical examination (performed by the retina specialist) using Cohen's Kappa statistic (κ). Results : An overall average of 79.9% concordance for 69 potential findings was obtained between the retina attending's diagnosis with clinical examination and the resident physician's diagnosis using tele-OCT/fundus images based on Cohen's Kappa statistic (κ). The concordance was lower in eyes with vitreous hemorrhage most likely due to the inferior quality fundus and OCT-B images. The resident exam also identified the presence of any macular pathology in all 30 eyes with macular pathology and correctly identified the controls, indicating 100% sensitivity for identifying abnormal findings using tele OCT/fundus images. Conclusions : This study verifies the utility of resident screening of tele-OCT fundus and OCT-B images to identify retinal pathology. Tele-ophthalmology likely has a useful role in triaging retinal pathology whose outcomes could be affected by timely intervention. Many unnecessary emergency transfers may be avoided if the on-call ophthalmology residents are able to review the fundus and OCT images before hand.

19.
European Journal of Molecular and Clinical Medicine ; 9(7):185-192, 2022.
Article in English | EMBASE | ID: covidwho-2058367

ABSTRACT

INTRODUCTION: Patients Infected with CORONA VIRUS- 2019 (COVID-19) showed changes in their platelet counts and Mean platelet volume (MPV). The present study was aimed to observe any association between lowered platelet counts with mean platelet volume (MPV) from the corana positive individuals. METHOD(S): It is a prospective study from 1-8-2020 to 30-9-2020 .Patients who presented with complaints of Fever, sore throat, body pains, cough, breathlessness, diarrhoea were evaluated at the triage area of the Hospital. Throat swab was taken and RT-PCR was done and only 200 confirmed cases were included in the study. Patient blood samples were collected and processed in SYSMAX 5 -part Haematology analyser in the Hospital Central Laboratory. The patients CBP, Platelet count and MPV were tabulated. RESULT(S): Out of 200 COVID-19 confirmed cases, the numbers of males were 145 (72.5%) and females 55 (27.5%). Most of the patients belonged to age group 50 years (25.5%), 60yrs age group (21%). The Maximum age in our study group was 80 years, minimum age was 19 years and mean age was 50 years. In our study it was noticed that Severe thrombocytopenia was seen in one patient with platelet count 38,000/muL,(0.5%), Moderate thrombocytopenia was seen in two patients(1%) and mild thrombocytopenia was seen in 12 (6%) cases. In our study only fifteen cases (7.5%) showed thrombocytopenia. The MPV for all fifteen cases were studied and MPV was in Range of 9.6- 11.8 fl. CONCLUSION(S): Low platelet count and high MPV are associated with disease severity. Platelet count is one of easy cheap method for the assessing the disease severity along with other parameters Copyright © 2022 Ubiquity Press. All rights reserved.

20.
Australian Journal of Primary Health ; 28(4):xlix, 2022.
Article in English | EMBASE | ID: covidwho-2058330

ABSTRACT

Background: While the UK's Royal College of General Practitioners developed guidance concerning the delivery of essential services during the COVID pandemic, no such guidance was available in Australia and little is known about the experiences or approaches taken by general practitioners (GPs) for the delivery of care in Australia. Aims/Objectives: To describe GPs' experiences and approaches to delivering essential clinical services (ECS) during COVID lockdowns. Method(s): A survey of GPs who had practiced during lockdowns in Melbourne and Sydney. Questions focused on changes made to care delivery including what services were continued: (1) regardless of outbreak scale, (2) if capacity allowed, or (3) postponed. Finding(s): Of 274 completed surveys, 95% of participants reported increased use of telehealth for diagnosis, investigation, and management of clinical conditions, and 97% for follow-up. Time-sensitive services such as provision of care for symptoms consistent with cancer or those with immediate health impact (e.g., immunisations, prolia injections) were generally continued even if requiring face-to face delivery. Consultations involving screening or health assessments or those necessitating face-to-face care but not clinically urgent (e.g., low risk cervical cancer screening and IUD insertions), were more likely to be postponed, as were visits to homebound and nursing home patients. Implications: The almost universal uptake of telehealth by GPs supported continuity of service provision during lockdown. Australian GPs acted autonomously to triage and provide ECS face to face through the lockdowns. To optimise future preparedness, local guidance for safe delivery of ECS must be developed considering contextual factors relevant to the Australian primary healthcare system.

SELECTION OF CITATIONS
SEARCH DETAIL