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1.
Anaesthesist ; 69(10): 717-725, 2020 Oct.
Article in German | MEDLINE | ID: covidwho-1453673

ABSTRACT

BACKGROUND: Following the regional outbreak in China, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world, presenting the healthcare systems with huge challenges worldwide. In Germany the coronavirus diseases 2019 (COVID-19) pandemic has resulted in a slowly growing demand for health care with a sudden occurrence of regional hotspots. This leads to an unpredictable situation for many hospitals, leaving the question of how many bed resources are needed to cope with the surge of COVID-19 patients. OBJECTIVE: In this study we created a simulation-based prognostic tool that provides the management of the University Hospital of Augsburg and the civil protection services with the necessary information to plan and guide the disaster response to the ongoing pandemic. Especially the number of beds needed on isolation wards and intensive care units (ICU) are the biggest concerns. The focus should lie not only on the confirmed cases as the patients with suspected COVID-19 are in need of the same resources. MATERIAL AND METHODS: For the input we used the latest information provided by governmental institutions about the spreading of the disease, with a special focus on the growth rate of the cumulative number of cases. Due to the dynamics of the current situation, these data can be highly variable. To minimize the influence of this variance, we designed distribution functions for the parameters growth rate, length of stay in hospital and the proportion of infected people who need to be hospitalized in our area of responsibility. Using this input, we started a Monte Carlo simulation with 10,000 runs to predict the range of the number of hospital beds needed within the coming days and compared it with the available resources. RESULTS: Since 2 February 2020 a total of 306 patients were treated with suspected or confirmed COVID-19 at this university hospital. Of these 84 needed treatment on the ICU. With the help of several simulation-based forecasts, the required ICU and normal bed capacity at Augsburg University Hospital and the Augsburg ambulance service in the period from 28 March 2020 to 8 June 2020 could be predicted with a high degree of reliability. Simulations that were run before the impact of the restrictions in daily life showed that we would have run out of ICU bed capacity within approximately 1 month. CONCLUSION: Our simulation-based prognosis of the health care capacities needed helps the management of the hospital and the civil protection service to make reasonable decisions and adapt the disaster response to the realistic needs. At the same time the forecasts create the possibility to plan the strategic response days and weeks in advance. The tool presented in this study is, as far as we know, the only one accounting not only for confirmed COVID-19 cases but also for suspected COVID-19 patients. Additionally, the few input parameters used are easy to access and can be easily adapted to other healthcare systems.


Subject(s)
Coronavirus Infections/therapy , Critical Care/organization & administration , Hospital Bed Capacity , Hospitals, University/organization & administration , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/epidemiology , Critical Care/statistics & numerical data , Germany , Hospitals, University/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Pandemics , Pneumonia, Viral/epidemiology , Prognosis , SARS-CoV-2
2.
Medicine (Baltimore) ; 100(32): e26847, 2021 Aug 13.
Article in English | MEDLINE | ID: covidwho-1358517

ABSTRACT

ABSTRACT: Infectious disease pandemics has a great impact on the use of medical facilities. The purpose of this study was to analyze the effects of coronavirus disease 2019 (COVID-19) on the use of emergency medical facilities in the Republic of Korea. This single-center, retrospective observational study was conducted in a tertiary teaching hospital located in Incheon Metropolitan City, Republic of Korea. We set the pandemic period as February 19, 2020 to April 18, 2020, and the control period was set to the same period in 2018 and 2019. All consecutive patients who visited the emergency department (ED) during the study period were included. Patients were divided into 3 groups according to age (pediatric patients, younger adult patients and older adult patients). The total number, demographics, clinical data, and diagnostic codes of ED patients were analyzed. The total number of ED patients in the pandemic period was lower than that in the control period, which was particularly pronounced for pediatric patients. The proportion of patients who used the 119 ambulances increased in all 3 groups (P  = .002, P < .001, and P = .001), whereas the proportion of patients who visited on foot was decreased (P  = .006, P < .001, and P = .027). In terms of diagnostic codes, a significant decrease was observed in the proportion of certain infectious or parasitic diseases (A00-B99), and respiratory diseases (J00-J99) in the pediatric and younger adult patient groups (P < .001 and P < .001, respectively). The COVID-19 pandemic reduced the number of ED patients; however, the proportion of patients using ambulances increased. In particular, the proportion of patients with diagnostic codes for infectious and respiratory diseases significantly decreased during the pandemic period.


Subject(s)
COVID-19/prevention & control , Emergency Service, Hospital/statistics & numerical data , Patient Acceptance of Health Care/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/transmission , Child , Child, Preschool , Emergency Service, Hospital/organization & administration , Female , Hospitals, University/organization & administration , Hospitals, University/statistics & numerical data , Humans , Infant , Male , Middle Aged , Republic of Korea , Retrospective Studies
3.
Antimicrob Resist Infect Control ; 10(1): 114, 2021 08 05.
Article in English | MEDLINE | ID: covidwho-1346265

ABSTRACT

BACKGROUND: In healthcare facilities, nosocomial transmissions of respiratory viruses are a major issue. SARS-CoV-2 is not exempt from nosocomial transmission. Our goals were to describe COVID-19 nosocomial cases during the first pandemic wave among patients in a French university hospital and compliance with hygiene measures. METHODS: We conducted a prospective observational study in Grenoble Alpes University Hospital from 01/03/2020 to 11/05/2020. We included all hospitalised patients with a documented SARS-CoV-2 diagnosis. Nosocomial case was defined by a delay of 5 days between hospitalisation and first symptoms. Hygiene measures were evaluated between 11/05/2020 and 22/05/2020. Lockdown measures were effective in France on 17/03/2020 and ended on 11/05/2020. Systematic wearing of mask was mandatory for all healthcare workers (HCW) and visits were prohibited in our institution from 13/03/2021 and for the duration of the lockdown period. RESULTS: Among 259 patients included, 14 (5.4%) were considered as nosocomial COVID-19. Median time before symptom onset was 25 days (interquartile range: 12-42). Eleven patients (79%) had risk factors for severe COVID-19. Five died (36%) including 4 deaths attributable to COVID-19. Two clusters were identified. The first cluster had 5 cases including 3 nosocomial acquisitions and no tested HCWs were positive. The second cluster had 3 cases including 2 nosocomial cases and 4 HCWs were positive. Surgical mask wearing and hand hygiene compliance were adequate for 95% and 61% of HCWs, respectively. CONCLUSIONS: The number of nosocomial COVID-19 cases in our hospital was low. Compliance regarding mask wearing, hand hygiene and lockdown measures drastically reduced transmission of the virus. Monitoring of nosocomial COVID-19 cases during the first wave enabled us to determine to what extent the hygiene measures taken were effective and patients protected. Trial registration Study ethics approval was obtained retrospectively on 30 September 2020 (CECIC Rhône-Alpes-Auvergne, Clermont-Ferrand, IRB 5891).


Subject(s)
COVID-19/epidemiology , Cross Infection/epidemiology , SARS-CoV-2/isolation & purification , Aged , Aged, 80 and over , COVID-19/diagnosis , COVID-19/virology , COVID-19 Testing/methods , Cross Infection/virology , Female , France/epidemiology , Hand Hygiene/methods , Health Personnel , Hospitals, University/statistics & numerical data , Humans , Infection Control/methods , Male , Masks/microbiology , Middle Aged , Pandemics , Prospective Studies , Retrospective Studies
4.
Med Intensiva (Engl Ed) ; 45(6): 325-331, 2021.
Article in English | MEDLINE | ID: covidwho-1343315

ABSTRACT

OBJECTIVE: To describe outcomes of critically ill patients with COVID-19, particularly the association of renal replacement therapy to mortality. DESIGN: A single-center prospective observational study was carried out. SETTING: ICU of a tertiary care center. PATIENTS: Consecutive adults with COVID-19 admitted to the ICU. INTERVENTION: Renal replacement therapy. MAIN VARIABLES OF INTEREST: Demographic data, medical history, illness severity, type of oxygen therapy, laboratory data and use of renal replacement therapy to generate a logistic regression model describing independent risk factors for mortality. RESULTS: Of the total of 166 patients, 51% were mechanically ventilated and 26% required renal replacement therapy. The overall hospital mortality rate was 36%, versus 56% for those requiring renal replacement therapy, and 68% for those with both mechanical ventilation and renal replacement therapy. The logistic regression model identified four independent risk factors for mortality: age (adjusted OR 2.8 [95% CI 1.8-4.4] for every 10-year increase), mechanical ventilation (4.2 [1.7-10.6]), need for continuous venovenous hemofiltration (2.3 [1.3-4.0]) and C-reactive protein (1.1 [1.0-1.2] for every 10mg/L increase). CONCLUSIONS: In our cohort, acute kidney injury requiring renal replacement therapy was associated to a high mortality rate similar to that associated to the need for mechanical ventilation, while multiorgan failure necessitating both techniques implied an extremely high mortality risk.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Critical Illness/therapy , Renal Replacement Therapy , SARS-CoV-2 , Acute Kidney Injury/etiology , Acute Kidney Injury/mortality , Adrenal Cortex Hormones/therapeutic use , Adult , Age Factors , Aged , C-Reactive Protein/analysis , COVID-19/blood , Comorbidity , Continuous Renal Replacement Therapy , Critical Illness/mortality , District of Columbia/epidemiology , Female , Hospital Mortality , Hospitals, University/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/etiology , Multiple Organ Failure/mortality , Oxygen Inhalation Therapy/statistics & numerical data , Procedures and Techniques Utilization/statistics & numerical data , Prospective Studies , Renal Replacement Therapy/statistics & numerical data , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/therapy , Risk Factors , Tertiary Care Centers/statistics & numerical data , Treatment Outcome
5.
PLoS One ; 16(7): e0254581, 2021.
Article in English | MEDLINE | ID: covidwho-1311287

ABSTRACT

BACKGROUND: Research has revealed that asymptomatic and pre-symptomatic infections are important contributors to the transmission of SARS-CoV-2 in populations. In Egypt, the true prevalence of infections is veiled due to the low number of screening tests. The aim of this study was to determine the SARS-CoV-2 PCR positivity rate as well the seroprevalence of the SARS-CoV-2 antibodies before the ultimate development of a second wave of the epidemic in Cairo, Egypt. METHODS: Our study was carried out between May 5 and the end of October 2020. It included all patients requiring admission to Ain Shams University hospitals. An interview questionnaire was used to collect demographic and clinical data. Laboratory tests for all participants included RT-PCR and total antibody assay for SARS-CoV-2. RESULTS: A total of 4,313 subjects were enrolled in our study, with females representing 56% of the sample. Adults and middle-aged individuals represented around 60% of the study sample. The positivity rate of SARS-CoV-2 PCR was 3.84% (95% CI 3.29-4.48), and the SARS-CoV-2 antibody seroprevalence was 29.82% (95% CI: 28.16-31.51). Males showed a higher risk for getting the COVID-19 infection, while middle-age group had significantly higher antibody seroprevalence rates. CONCLUSION: SARS-CoV-2 infection imposes a high burden on the community as detected by high seroprevalence rates.


Subject(s)
COVID-19 Nucleic Acid Testing/statistics & numerical data , COVID-19 Serological Testing/statistics & numerical data , COVID-19/epidemiology , Adolescent , Adult , COVID-19/diagnosis , Egypt , Female , Hospitals, University/statistics & numerical data , Humans , Male , Mass Screening/statistics & numerical data , Middle Aged , Seroepidemiologic Studies
6.
J Med Virol ; 93(2): 1013-1022, 2021 02.
Article in English | MEDLINE | ID: covidwho-1196432

ABSTRACT

BACKGROUND: There is currently very limited information on the nature and prevalence of post-COVID-19 symptoms after hospital discharge. METHODS: A purposive sample of 100 survivors discharged from a large University hospital were assessed 4 to 8 weeks after discharge by a multidisciplinary team of rehabilitation professionals using a specialist telephone screening tool designed to capture symptoms and impact on daily life. EQ-5D-5L telephone version was also completed. RESULTS: Participants were between 29 and 71 days (mean 48 days) postdischarge from hospital. Thirty-two participants required treatment in intensive care unit (ICU group) and 68 were managed in hospital wards without needing ICU care (ward group). New illness-related fatigue was the most common reported symptom by 72% participants in ICU group and 60.3% in ward group. The next most common symptoms were breathlessness (65.6% in ICU group and 42.6% in ward group) and psychological distress (46.9% in ICU group and 23.5% in ward group). There was a clinically significant drop in EQ5D in 68.8% in ICU group and in 45.6% in ward group. CONCLUSIONS: This is the first study from the United Kingdom reporting on postdischarge symptoms. We recommend planning rehabilitation services to manage these symptoms appropriately and maximize the functional return of COVID-19 survivors.


Subject(s)
COVID-19/complications , COVID-19/rehabilitation , Patient Discharge/statistics & numerical data , Survivors/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Critical Care , Cross-Sectional Studies , Female , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Prevalence , United Kingdom/epidemiology , Young Adult
7.
Psychoneuroendocrinology ; 128: 105213, 2021 06.
Article in English | MEDLINE | ID: covidwho-1164355

ABSTRACT

In the critical context of COVID-19 pandemic, healthcare workers are on the front line, participating directly in the care, diagnosis, and treatment of patients with COVID-19. This exposes them to a higher risk of developing chronic stress, psychological distress, and any other mental health symptoms. OBJECTIVE: to evaluate stress and burnout in a health workers population and, in addition, to measure hair cortisol concentration as a current biomarker of stress. MATERIALS AND METHODS: 234 health workers from Hospital de Clínicas "José de San Martín", Buenos Aires University, were included in this study. In this population hair samples were obtained from the posterior vertex as close to the scalp as possible and the individuals completed the following surveys: perceived stress, social support, burnout scale, life event scale, and sociodemographic data. Hair cortisol was measured by an automated chemiluminescent method. The studied population was divided into three groups considering those individuals below the healthy reference sample range (< 40 pg/mg hair), within the healthy reference range (40-128 pg/mg hair) and above the reference range (> 128 pg/mg hair). This study used a transversal and observational design. RESULTS: Our results show that 40% of the studied population presented hair cortisol values outside of the healthy reference range. In the whole studied population, a direct correlation was found between hair cortisol concentration and perceived stress as well as between hair cortisol concentration and the emotional exhaustion component of burnout (r = 0.142, p = 0.030; r = 0.143, p = 0.029, respectively). 12% of the studied population showed Burnout (52% doctors and residents, 19% nurses, 19% administrative personnel). Higher values in hair cortisol levels were found in the group with burnout versus individuals without burnout (p = 0.034). Finally, a mediation analysis was performed, finding that depersonalization is a mediating variable in the relationship between self-perceived stress and hair cortisol level (F = 4.86, p = 0.0086; indirect effect IC: 0.0987-1.8840). CONCLUSION: This is the first study in which a stress biomarker such as hair cortisol is evaluated in this population and in this context. Healthcare workers are subjected to increased levels of stress and burnout. High depersonalization, emotional exhaustion, and decreased personal sense of accomplishment characterize this population. It is the responsibility of the health authorities to implement strategies to manage this psychological emergency.


Subject(s)
COVID-19 , Hydrocortisone/metabolism , Occupational Stress/diagnosis , Occupational Stress/metabolism , Personnel, Hospital/psychology , Adult , Argentina/epidemiology , Burnout, Professional/diagnosis , Burnout, Professional/epidemiology , Burnout, Professional/metabolism , Burnout, Professional/physiopathology , Female , Hair/chemistry , Health Care Surveys , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Occupational Stress/epidemiology , Occupational Stress/physiopathology , Personnel, Hospital/statistics & numerical data
8.
Acta Anaesthesiol Scand ; 65(6): 755-760, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1096648

ABSTRACT

BACKGROUND: The initial wave of the Covid-19 pandemic has hit Italy, and Lombardy in particular, with violence, forcing to reshape all hospitals' activities; this happened even in pediatric hospitals, although the young population seemed initially spared from the disease. "Vittore Buzzi" Children's Hospital, which is a pediatric/maternal hospital located in Milan (Lombardy Region), had to stop elective procedures-with the exception of urgent/emergent ones-between February and May 2020 to leave space and resources to adults' care. We describe the challenges of reshaping the hospital's identity and structure, and restarting pediatric surgery and anesthesia, from May on, in the most hit area of the world, with the purpose to avoid and contain infections. Both patients and caregivers admitted to hospital have been tested for Sars-CoV-2 in every case. METHODS: Observational cohort study via review of clinical charts of patients undergoing surgery between 16th May and 30th September 2020, together with SARS-CoV -2 RT-PCR testing outcomes, and comparison to same period surgeries in 2019. RESULTS: An increase of approximately 70% in pediatric surgeries (OR 1.68 [1.33-2.13], P < .001) and a higher increase in the number of surgeries were reported (OR 1.75 (1.43-2.15), P < .001). Considering only urgent procedures, a significant difference in the distribution of the type of surgery was observed (Chi-squared P-value < .001). Sars-CoV-2-positive patients have been 0.8% of total number; 14% of these was discovered through caregiver's positivity. CONCLUSION: We describe our pathway for safe pediatric surgery and anesthesia and the importance of testing both patient and caregiver.


Subject(s)
Anesthesia Department, Hospital/organization & administration , Appointments and Schedules , COVID-19 Nucleic Acid Testing , COVID-19/epidemiology , Hospitals, Pediatric/organization & administration , Hospitals, University/organization & administration , Pandemics , SARS-CoV-2 , Surgery Department, Hospital/organization & administration , Surgical Procedures, Operative/statistics & numerical data , Tertiary Care Centers/organization & administration , Adolescent , COVID-19 Nucleic Acid Testing/statistics & numerical data , Caregivers , Child , Child, Preschool , Cohort Studies , Diagnosis-Related Groups , Elective Surgical Procedures/statistics & numerical data , Emergencies/epidemiology , Female , Hospital Bed Capacity/statistics & numerical data , Hospitals, Pediatric/statistics & numerical data , Hospitals, University/statistics & numerical data , Hospitals, Urban/organization & administration , Hospitals, Urban/statistics & numerical data , Humans , Infant , Infant, Newborn , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Italy/epidemiology , Male , Nasopharynx/virology , Patients , SARS-CoV-2/isolation & purification , Symptom Assessment , Tertiary Care Centers/statistics & numerical data , Young Adult
9.
CJEM ; 23(2): 242-244, 2021 03.
Article in English | MEDLINE | ID: covidwho-1086719

ABSTRACT

The Toronto Addis Ababa Academic Collaboration in Emergency Medicine (TAAAC-EM) is an educational global health partnership established 10 years ago to support the growth of EM in Ethiopia. In-person global health partnership activities were disrupted by the COVID-19 pandemic. We describe our five-step process for transitioning our global health partnership to a virtual space. Each step was conducted in collaboration between the University of Toronto and Addis Ababa University EM physicians: (1) risk identification and needs assessment, (2) discussing mitigation strategies, (3) crafting and piloting an approach, (4) revising based on pilot results, 5) implementation with continuous evaluation and revision. Teaching was modified iteratively in response to feedback. Our experience shows that virtual teaching, while not a replacement for in-person engagement, can be a valuable tool both to supplement partnership activities when travel is not possible, and to enhance global health partnerships long term. This approach can also inform the transition of other forms of medical education to the virtual space.


RéSUMé: La Toronto Addis-Ababa collaboration universitaire en médecine d'urgence (TAAAC-EM) est un partenariat mondial en éducation à la santé établi il y a 10 ans pour soutenir la croissance de la médecine d'urgence en Éthiopie. Les activités du partenariat mondiale pour la santé en personne ont été perturbées par la pandémie de COVID-19. Nous décrivons notre processus en cinq étapes pour la transition de notre partenariat mondial pour la santé vers un espace virtuel. Chaque étape a été menée en collaboration entre les médecins d'urgences de l'Université de Toronto et de l'Université d'Addis-Ababa : 1) identification des risques et évaluation des besoins, 2) discussion des stratégies d'atténuation, 3) élaboration et pilotage d'une approche, 4) révision basée sur les résultats des projets pilotes, 5) mise en œuvre avec évaluation et révision continues. L'enseignement a été modifié de manière itérative en réponse aux commentaires. Notre expérience montre que l'enseignement virtuel, bien qu'il ne remplace pas l'engagement en personne, peut être un outil précieux à la fois pour compléter les activités de partenariat lorsque les déplacements ne sont pas possibles, et pour renforcer les partenariats mondiaux pour la santé à long terme. Cette approche peut également faire apprendre la transition d'autres formes de formation médicale vers l'espace virtuel.


Subject(s)
COVID-19/epidemiology , Emergency Medicine/organization & administration , Hospitals, University/statistics & numerical data , International Cooperation , Pandemics , Program Development , Global Health , Humans , Ontario , Saudi Arabia
10.
PLoS One ; 16(2): e0246956, 2021.
Article in English | MEDLINE | ID: covidwho-1085151

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to the implementation of drastic shutdown measures worldwide. While quarantine, self-isolation and shutdown laws helped to effectively contain and control the spread of SARS-CoV-2, the impact of COVID-19 shutdowns on trauma care in emergency departments (EDs) remains elusive. METHODS: All ED patient records from the 35-day COVID-19 shutdown (SHUTDOWN) period were retrospectively compared to a calendar-matched control period in 2019 (CTRL) as well as to a pre (PRE)- and post (POST)-shutdown period in an academic Level I Trauma Center in Berlin, Germany. Total patient and orthopedic trauma cases and contacts as well as trauma causes and injury patterns were evaluated during respective periods regarding absolute numbers, incidence rate ratios (IRRs) and risk ratios (RRs). FINDINGS: Daily total patient cases (SHUTDOWN vs. CTRL, 106.94 vs. 167.54) and orthopedic trauma cases (SHUTDOWN vs. CTRL, 30.91 vs. 52.06) decreased during the SHUTDOWN compared to the CTRL period with IRRs of 0.64 and 0.59. While absolute numbers decreased for most trauma causes during the SHUTDOWN period, we observed increased incidence proportions of household injuries and bicycle accidents with RRs of 1.31 and 1.68 respectively. An RR of 2.41 was observed for injuries due to domestic violence. We further recorded increased incidence proportions of acute and regular substance abuse during the SHUTDOWN period with RRs of 1.63 and 3.22, respectively. CONCLUSIONS: While we observed a relevant decrease in total patient cases, relative proportions of specific trauma causes and injury patterns increased during the COVID-19 shutdown in Berlin, Germany. As government programs offered prompt financial aid during the pandemic to individuals and businesses, additional social support may be considered for vulnerable domestic environments.


Subject(s)
COVID-19/epidemiology , Fractures, Bone/epidemiology , Quarantine/statistics & numerical data , Trauma Centers/statistics & numerical data , COVID-19/prevention & control , Fractures, Bone/classification , Fractures, Bone/etiology , Germany , Hospitals, University/statistics & numerical data , Humans
11.
J Surg Oncol ; 123(5): 1177-1187, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1074349

ABSTRACT

BACKGROUND: The novel coronavirus pandemic (COVID-19) hinders the treatment of non-COVID illnesses like cancer, which may be pronounced in lower-middle-income countries. METHODS: This retrospective cohort study audited the performance of a tertiary care surgical oncology department at an academic hospital in India during the first six months of the pandemic. Difficulties faced by patients, COVID-19-related incidents (preventable cases of hospital transmission), and modifications in practice were recorded. RESULTS: From April to September 2020, outpatient consultations, inpatient admissions, and chemotherapy unit functioning reduced by 62%, 58%, and 56%, respectively, compared to the same period the previous year. Major surgeries dropped by 31% with a decrease across all sites, but an increase in head and neck cancers (p = .012, absolute difference 8%, 95% confidence interval [CI]: 1.75% - 14.12%). Postoperative complications were similar (p = .593, 95% CI: -2.61% - 4.87%). Inability to keep a surgical appointment was primarily due to apprehension of infection (52%) or arranging finances (49%). Two COVID-19-related incidents resulted in infecting 27 persons. Fifteen instances of possible COVID-19-related mishaps were averted. CONCLUSIONS: We observed a decrease in the operations of the department without any adverse impact in postoperative outcomes. While challenging, treating cancer adequately during COVID-19 can be accomplished by adequate screening and testing, and religiously following the prevention guidelines.


Subject(s)
COVID-19/epidemiology , Hospitals, University/statistics & numerical data , Neoplasms/surgery , Surgical Oncology/statistics & numerical data , Cohort Studies , Humans , India/epidemiology , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , Poverty , Retrospective Studies , Surgical Oncology/methods
12.
Ann Ital Chir ; 91: 563-567, 2020.
Article in English | MEDLINE | ID: covidwho-1068445

ABSTRACT

2019-nCoV currently named SARS-CoV-2 is a highly pathogenic Coronavirus identified in Wuhan China in December 2019. Turkey declared the first case relatively late compared to Asian and European countries on March 11, as the first SARS-CoV-2 infection in Turkey. In this study, we aimed to determine patients' outcomes in 50 surgeries done in the incubation period of SARS-CoV-2 in our hospital. METHODS: We retrospectively analyzed the clinical data of 50 patients who underwent surgeries during the incubation period of CoVid-19 at Istinye University Gaziosmanpasa Medical Park Hospital in Istanbul, from March 2 to April 11, 2020. RESULTS: The age of 50 patients range was 21 to 73, and the median age was 43.32 (64%) patients were women. The median length of hospital stay is 2.6 days (1-21). Operations at various difficulty levels were also performed on patients with co-morbidities. No complication or mortality was observed except for 1 patient, and the ICU requirement of that patient was also due to high energy trauma. CONCLUSION: Although contrary claims have been made in various studies; it is the primary duty of us surgeons to operate CoVid-19 positive/suspicious patients safely and without any contamination, and on the other hand, to continue their operations without victimizing negative patients. In this pilot study, we would like to emphasize with necessary and adequate measures these can be achieved. KEY WORDS: CoVid-19, SARS-CoV-2, Surgery.


Subject(s)
COVID-19 Testing , COVID-19/diagnosis , Emergencies/epidemiology , Hospitals, Isolation/statistics & numerical data , Hospitals, University/statistics & numerical data , Infectious Disease Incubation Period , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics , SARS-CoV-2 , Surgical Procedures, Operative/statistics & numerical data , Adult , Aged , COVID-19/diagnostic imaging , COVID-19/epidemiology , Comorbidity , Elective Surgical Procedures/mortality , Elective Surgical Procedures/statistics & numerical data , Equipment Contamination/prevention & control , Female , Hospital Mortality , Humans , Infection Control/methods , Male , Middle Aged , Patient Isolation , Pilot Projects , Retrospective Studies , Surgical Procedures, Operative/mortality , Tomography, X-Ray Computed , Turkey/epidemiology , Young Adult
13.
Arch Cardiovasc Dis ; 114(5): 364-370, 2021 May.
Article in English | MEDLINE | ID: covidwho-1064692

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak had a direct impact on adult cardiac surgery activity, which systematically necessitates a postoperative stay in intensive care. AIM: To study the effect of the COVID-19 lockdown on cardiac surgery activity and outcomes, by making a comparison with the corresponding period in 2019. METHODS: This prospective observational cohort study compared adult cardiac surgery activity in our high-volume referral university hospital from 9 March to 10 May 2020 versus 9 March to 10 May 2019. Data were collected in our local certified database and a national database sponsored by the French society of thoracic and cardiovascular surgery. The primary study endpoints were operative mortality and postoperative complications. RESULTS: With 105 interventions in 2020, our activity dropped by 57% compared with the same period in 2019. Patients were at higher risk, with a significantly higher EuroSCORE II score (3.8±4.5% vs. 2.0±1.8%; P<0.001) and higher rates of active endocarditis (7.6% vs. 2.9%; P=0.047) and recent myocardial infarction (9.5% vs. 0%; P<0.001). The weight and priority of the interventions were significantly different in 2020 (P=0.019 and P<0.001, respectively). The rate of acute aortic syndromes was also significantly higher in 2020 (P<0.001). Operative mortality was higher during the lockdown period (5.7% vs. 1.7%; P=0.038). The postoperative course was more complicated in 2020, with more postoperative bleeding (P=0.003), mechanical circulatory support (P=0.032) and prolonged mechanical ventilation (P=0.005). Only two patients (1.8%) developed a positive status for severe acute respiratory syndrome coronavirus 2 after discharge. CONCLUSIONS: Adult cardiac surgery was heavily affected by the COVID-19 lockdown. A further modulation plan is necessary to improve outcomes and reduce postponed operations to decrease operative mortality and morbidity.


Subject(s)
COVID-19/epidemiology , Cardiac Surgical Procedures , Hospitals, High-Volume/statistics & numerical data , Pandemics , Quarantine , SARS-CoV-2 , Aged , Bed Conversion/statistics & numerical data , Cardiac Surgical Procedures/mortality , Cardiac Surgical Procedures/statistics & numerical data , Comorbidity , Cross Infection/epidemiology , Diagnosis-Related Groups , Elective Surgical Procedures/mortality , Elective Surgical Procedures/statistics & numerical data , Female , France/epidemiology , Heart Diseases/epidemiology , Heart Diseases/surgery , Hospitals, University/statistics & numerical data , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Postoperative Complications/epidemiology , Procedures and Techniques Utilization , Prospective Studies , Recovery Room/statistics & numerical data , Time-to-Treatment , Waiting Lists
14.
Epidemiol Prev ; 44(5-6 Suppl 2): 216-225, 2020.
Article in English | MEDLINE | ID: covidwho-1068142

ABSTRACT

OBJECTIVES: to explore clinical and epidemiological characteristics associated with an imaging feature of COVID-19 pneumonia at disease onset, in order to identify factors that may be evaluable by general practitioners at patient's home, and which may lead to identify a more severe disease, needing hospitalization. DESIGN: this is a retrospective/prospective observational hospital cohort. SETTING AND PARTICIPANTS: the study population includes all patients consecutively admitted to the emergency department of Città della salute e della scienza University Hospital from 01.03 to 31.05.2020 with a confirmed diagnosis of SARS-CoV-2 infection. MAIN OUTCOME MEASURES: patients were classified in two groups according to the findings of X-ray imaging, lung ultrasound and chest computer tomography, as pneumonia or not pneumonia patients. RESULTS: in multivariable analysis, factors most strongly associated with emergency department admission with pneumonia were age, oxygen saturation <90% (adj OR 4.16 ;95%CI 1.44-12.07), respiratory rate >24 breaths/min (adj OR 6.50; 95%CI 2.36-17.87), fever ≥38° (adj OR 3.05; 95%CI 1.53-6.08) and the presence of gastroenteric symptoms (vomiting and diarrhea). A delay (> 7 days) between the appearance of the initial lung symptoms (cough and dyspnea) and the admission to the emergency department was also related to a higher probability of receiving a positive imaging report (OR 4.99; 95%CI 2,02-12,34). CONCLUSIONS: in order to reorganize the management of COVID-19 patients in Italy, in view of the risk of a second wave of epidemic or of local outbreaks, it would be desirable to relocate the triage, and possibly the patient's care, from hospital to home. In this scenario it is important to identify all symptoms and signs associated with COVID-19 pneumonia that would facilitate the decision-making process of GPs leading to patients hospitalization.


Subject(s)
COVID-19/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Adult , Aged , Aged, 80 and over , COVID-19/blood , Comorbidity , Diarrhea/epidemiology , Diarrhea/etiology , Dyspnea/epidemiology , Dyspnea/etiology , Emergency Service, Hospital/statistics & numerical data , Female , Hospitals, University/statistics & numerical data , Humans , Italy/epidemiology , Leukocyte Count , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Oxygen/blood , Pneumonia, Viral/blood , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/virology , Prospective Studies , Respiratory Rate , Retrospective Studies , Symptom Assessment , Time Factors , Vomiting/epidemiology , Vomiting/etiology
15.
Front Public Health ; 8: 594117, 2020.
Article in English | MEDLINE | ID: covidwho-1058473

ABSTRACT

The COVID-19 pandemic has caused strains on health systems worldwide disrupting routine hospital services for all non-COVID patients. Within this retrospective study, we analyzed inpatient hospital admissions across 18 German university hospitals during the 2020 lockdown period compared to 2018. Patients admitted to hospital between January 1 and May 31, 2020 and the corresponding periods in 2018 and 2019 were included in this study. Data derived from electronic health records were collected and analyzed using the data integration center infrastructure implemented in the university hospitals that are part of the four consortia funded by the German Medical Informatics Initiative. Admissions were grouped and counted by ICD 10 chapters and specific reasons for treatment at each site. Pooled aggregated data were centrally analyzed with descriptive statistics to compare absolute and relative differences between time periods of different years. The results illustrate how care process adoptions depended on the COVID-19 epidemiological situation and the criticality of the disease. Overall inpatient hospital admissions decreased by 35% in weeks 1 to 4 and by 30.3% in weeks 5 to 8 after the lockdown announcement compared to 2018. Even hospital admissions for critical care conditions such as malignant cancer treatments were reduced. We also noted a high reduction of emergency admissions such as myocardial infarction (38.7%), whereas the reduction in stroke admissions was smaller (19.6%). In contrast, we observed a considerable reduction in admissions for non-critical clinical situations, such as hysterectomies for benign tumors (78.8%) and hip replacements due to arthrosis (82.4%). In summary, our study shows that the university hospital admission rates in Germany were substantially reduced following the national COVID-19 lockdown. These included critical care or emergency conditions in which deferral is expected to impair clinical outcomes. Future studies are needed to delineate how appropriate medical care of critically ill patients can be maintained during a pandemic.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Hospitalization/statistics & numerical data , Hospitals, University/statistics & numerical data , Pandemics/statistics & numerical data , Patient Admission/statistics & numerical data , Quarantine/statistics & numerical data , Emergency Service, Hospital/trends , Forecasting , Germany/epidemiology , Hospitalization/trends , Hospitals, University/trends , Humans , Patient Admission/trends , Quarantine/trends , Retrospective Studies , SARS-CoV-2
16.
Am J Trop Med Hyg ; 104(2): 540-545, 2020 Dec 23.
Article in English | MEDLINE | ID: covidwho-1000466

ABSTRACT

Controversy exists in the literature regarding the possible prognostic implications of the nasopharyngeal SARS-CoV-2 viral load. We carried out a retrospective observational study of 169 patients, 96 (58.9%) of whom had a high viral load and the remaining had a low viral load. Compared with patients with a low viral load, patients with a high viral load did not exhibit differences regarding preexisting cardiovascular risk factors or comorbidities. There were no differences in symptoms, vital signs, or laboratory tests in either group, except for the maximum cardiac troponin I (cTnI), which was higher in the group with a higher viral load (24 [interquartile range 9.5-58.5] versus 8.5 [interquartile range 3-22.5] ng/L, P = 0.007). There were no differences in the need for hospital admission, admission to the intensive care unit, or the need for mechanical ventilation in clinical management. In-hospital mortality was greater in patients who had a higher viral load than in those with low viral load (24% versus 10.4%, P = 0.029). High viral loads were associated with in-hospital mortality in the binary logistic regression analysis (odds ratio: 2.701, 95% Charlson Index (CI): 1.084-6.725, P = 0.033). However, in an analysis adjusted for age, gender, CI, and cTnI, viral load was no longer a predictor of mortality. In conclusion, an elevated nasopharyngeal viral load was not a determinant of in-hospital mortality in patients with COVID-19, as much as age, comorbidity, and myocardial damage determined by elevated cTnI are.


Subject(s)
COVID-19/mortality , COVID-19/virology , Hospital Mortality , Hospitals, University/statistics & numerical data , Viral Load/statistics & numerical data , Aged , Comorbidity , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Nasopharynx/virology , Prognosis , Retrospective Studies
17.
Ann Emerg Med ; 78(1): 27-34, 2021 07.
Article in English | MEDLINE | ID: covidwho-987034

ABSTRACT

STUDY OBJECTIVE: We determine the percentage of diagnosed and undiagnosed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among a sample of US emergency department (ED) health care personnel before July 2020. METHODS: This was a cross-sectional analysis of ED health care personnel in 20 geographically diverse university-affiliated EDs from May 13, to July 8, 2020, including case counts of prior laboratory-confirmed coronavirus disease 2019 (COVID-19) diagnoses among all ED health care personnel, and then point-in-time serology (with confirmatory testing) and reverse transcriptase-polymerase chain reaction testing in a sample of volunteers without a previous COVID-19 diagnosis. Health care staff were categorized as clinical (physicians, advanced practice providers, and nurses) and nonclinical (clerks, social workers, and case managers). Previously undiagnosed infection was based on positive SARS-CoV-2 serology or reverse transcriptase-polymerase chain reaction result among health care personnel without prior diagnosis. RESULTS: Diagnosed COVID-19 occurred in 2.8% of health care personnel (193/6,788), and the prevalence was similar for nonclinical and clinical staff (3.8% versus 2.7%; odds ratio 1.5; 95% confidence interval 0.7 to 3.2). Among 1,606 health care personnel without previously diagnosed COVID-19, 29 (1.8%) had evidence of current or past SARS-CoV-2 infection. Most (62%; 18/29) who were seropositive did not think they had been infected, 76% (19/25) recalled COVID-19-compatible symptoms, and 89% (17/19) continued to work while symptomatic. Accounting for both diagnosed and undiagnosed infections, 4.6% (95% confidence interval 2.8% to 7.5%) of ED health care personnel were estimated to have been infected with SARS-CoV-2, with 38% of those infections undiagnosed. CONCLUSION: In late spring and early summer 2020, the estimated prevalence of severe acute respiratory syndrome coronavirus 2 infection was 4.6%, and greater than one third of infections were undiagnosed. Undiagnosed SARS-CoV-2 infection may pose substantial risk for transmission to other staff and patients.


Subject(s)
COVID-19/epidemiology , Emergency Service, Hospital/statistics & numerical data , Health Personnel/statistics & numerical data , SARS-CoV-2 , Adult , COVID-19/diagnosis , Cross-Sectional Studies , Female , Hospitals, University/statistics & numerical data , Humans , Male , Middle Aged , Prevalence , United States/epidemiology
18.
Pediatr Infect Dis J ; 39(7): e137-e140, 2020 07.
Article in English | MEDLINE | ID: covidwho-930114

ABSTRACT

The unexpected outbreak of Corona Virus Disease 19 had several consequences worldwide and on the Italian Health System. We report our experience in the reorganization of our Pediatric Department to prevent the risk of infection for both children and staff. We strongly believe that the need to face an unpredictable emergency situation should not affect the quality of the assistance to the non-Corona Virus Disease patients.


Subject(s)
COVID-19/epidemiology , Health Facilities/statistics & numerical data , Pandemics , Public Health/standards , Child , Hospitals, University/statistics & numerical data , Humans , Infant , Infant, Newborn , Intensive Care Units, Pediatric , Italy/epidemiology , Pediatric Emergency Medicine , Public Health/statistics & numerical data
19.
Strahlenther Onkol ; 196(12): 1080-1085, 2020 12.
Article in English | MEDLINE | ID: covidwho-928408

ABSTRACT

PURPOSE: The described work aimed to avoid cancellations of indispensable treatments by implementing active patient flow management practices and optimizing infrastructure utilization in the radiation oncology department of a large university hospital and regional COVID-19 treatment center close to the first German SARS-CoV­2 hotspot region Heinsberg in order to prevent nosocomial infections in patients and personnel during the pandemic. PATIENTS AND METHODS: The study comprised year-to-date intervention analyses of in- and outpatient key procedures, machine occupancy, and no-show rates in calendar weeks 12 to 19 of 2019 and 2020 to evaluate effects of active patient flow management while monitoring nosocomial COVID-19 infections. RESULTS: Active patient flow management helped to maintain first-visit appointment compliance above 85.5%. A slight appointment reduction of 10.3% daily (p = 0.004) could still significantly increase downstream planning CT scheduling (p = 0.00001) and performance (p = 0.0001), resulting in an absolute 20.1% (p = 0.009) increment of CT performance while avoiding overbooking practices. Daily treatment start was significantly increased by an absolute value of 18.5% (p = 0.026). Hypofractionation and acceleration were significantly increased (p = 0.0043). Integrating strict testing guidelines, a distancing regimen for staff and patients, hygiene regulations, and precise appointment scheduling, no SARS-CoV­2 infection in 164 tested radiation oncology service inpatients was observed. CONCLUSION: In times of reduced medical infrastructure capacities and resources, controlling infrastructural time per patient as well as optimizing facility utilization and personnel workload during treatment evaluation, planning, and irradiation can help to improve appointment compliance and quality management. Avoiding recurrent and preventable exposure to healthcare infrastructure has potential health benefits and might avert cross infections during the pandemic. Active patient flow management in high-risk COVID-19 regions can help Radiation Oncologists to continue and initiate treatments safely, instead of cancelling and deferring indicated therapies.


Subject(s)
Appointments and Schedules , COVID-19/prevention & control , Cross Infection/prevention & control , Hospitals, University/organization & administration , Infection Control/organization & administration , Neoplasms/radiotherapy , Outpatient Clinics, Hospital/organization & administration , Pandemics , Radiation Oncology/organization & administration , Radiology Department, Hospital/organization & administration , SARS-CoV-2/isolation & purification , Workflow , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing/statistics & numerical data , Cross Infection/epidemiology , Dose Fractionation, Radiation , Germany/epidemiology , Hospitals, University/statistics & numerical data , Humans , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Neoplasms/surgery , Outpatient Clinics, Hospital/statistics & numerical data , Personal Protective Equipment , Procedures and Techniques Utilization , Radiology Department, Hospital/statistics & numerical data , Radiosurgery/statistics & numerical data , Radiotherapy/statistics & numerical data , Triage/methods , Triage/standards
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