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1.
J Clin Microbiol ; 60(7): e0017422, 2022 Jul 20.
Article in English | MEDLINE | ID: covidwho-1874497

ABSTRACT

COVID-19 is associated with prolonged hospitalization and a high risk of intubation, which raises concern for bacterial coinfection and antimicrobial resistance. Previous research has shown a wide range of bacterial pneumonia rates for COVID-19 patients in a variety of clinical and demographic settings, but none have compared hospitalized COVID-19 patients to patients testing negative for severe acute respiratory syndrome coronavirus (SARS-CoV-2) in similar care settings. We performed a retrospective cohort study on hospitalized patients with COVID-19 testing from March 10th, 2020 to December 31st, 2020. A total of 19,219 patients were included, of which 3,796 tested positive for SARS-CoV-2. We found a 2.6-fold increase (P < 0.001) in respiratory culture ordering in COVID-19 patients. On a per-patient basis, COVID-19 patients were 1.5-fold more likely than non-COVID patients to have positive respiratory cultures (46.8% versus 30.9%, P < 0.001), which was primarily driven by patients requiring intubation. Among patients with pneumonia, a significantly higher proportion of COVID-19 patients had ventilator-associated pneumonia (VAP) relative to non-COVID patients (86.3% versus 70.8%, P < 0.001), but a lower proportion had community-acquired (11.2% vs 25.5%, P < 0.01) pneumonia. There was also a significantly higher proportion of respiratory cultures positive for methicillin-resistant Staphylococcus aureus, Klebsiella pneumoniae, and antibiotic-resistant organisms in COVID-19 patients. Increased rates of respiratory culture ordering for COVID-19 patients therefore appear to be clinically justified for patients requiring intubation, but further research is needed to understand how SARS-CoV-2 increases the risk of VAP.


Subject(s)
COVID-19 , Coinfection , Methicillin-Resistant Staphylococcus aureus , Pneumonia, Bacterial , COVID-19 Testing , Coinfection/epidemiology , Hospitals, Urban , Humans , New York City/epidemiology , Pneumonia, Bacterial/epidemiology , Retrospective Studies , SARS-CoV-2
2.
Salud Publica Mex ; 64(2): 119-130, 2022 Apr 08.
Article in English | MEDLINE | ID: covidwho-1791482

ABSTRACT

OBJECTIVE: To describe differences in Case Fatality Rate (CFR) for Covid-19 among healthcare subsystems in Mexico City between March and December 2020. MATERIALS AND METHODS: This is a retrospective secondary data analysis from the National Epidemiological Surveillance System data of Covid-19 cases. Information about health provider institutions was retrieved from the Catalogue of Health Establishments (CLUES). Logistic regressions were fitted to determine the association between health subsystems and mortality associated to Covid-19. The analyses were divided between hospitalized and ambulatory patients. RESULTS: The probability of dying from Covid-19 was higher among those treated at Instituto Mexicano del Seguro Social (IMSS) (Hospitalized:OR=5.11, Ambulatory:OR=36.57), Instituto de Se-guridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) (Hospitalized:OR=2.10, Ambulatory:OR=9.19), Secretaría de Salud (SS) (Hospitalized:OR=1.94, Ambulatory:OR=5.29) or other public institutions (Hospitalized: OR=1.70, Ambulatory:OR=9.56) than in those treated in private in-stitutions. CONCLUSIONS: Differences in healthcare quality and access between health subsystems are profound. It is imperative to increase the capacity and quality of the different health subsystems to improve health outcomes.


Subject(s)
COVID-19 , Ambulatory Care Facilities , Hospitalization , Hospitals, Urban , Humans , Mexico/epidemiology , Retrospective Studies
4.
Med J Aust ; 216(8): 413-419, 2022 05 02.
Article in English | MEDLINE | ID: covidwho-1753886

ABSTRACT

OBJECTIVES: To assess the capacity of the COVID Positive Pathway, a collaborative model of care involving the Victorian public health unit, hospital services, primary care, community organisations, and the North Western Melbourne Primary Health Network, to support people with coronavirus disease 2019 (COVID-19) isolating at home. DESIGN, SETTING, PARTICIPANTS: Cohort study of adults in northwest Melbourne with COVID-19, 3 August - 31 December 2020. MAIN OUTCOME MEASURES: Demographic and clinical characteristics, and social and welfare needs of people cared for in the Pathway, by care tier level. RESULTS: Of 1392 people referred to the Pathway by the public health unit, 858 were eligible for enrolment, and 711 consented to participation; 647 (91%) remained in the Pathway until they had recovered and isolation was no longer required. A total of 575 participants (81%) received care in primary care, mostly from their usual general practitioners; 155 people (22%) received care from hospital outreach services, and 64 (9%) needed high tier care (hospitalisation). Assistance with food and other basic supplies was required by 239 people in the Pathway (34%). CONCLUSIONS: The COVID Positive Pathway is a feasible multidisciplinary, tiered model of care for people with COVID-19. About 80% of participants could be adequately supported by primary care and community organisations, allowing hospital services to be reserved for people with more severe illness or with risk factors for disease progression. The principles of this model could be applied to other health conditions if regulatory and funding barriers to information-sharing and care delivery by health care providers can be overcome.


Subject(s)
COVID-19 , Adult , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Hospitals, Urban , Humans , Primary Health Care , Public Health
6.
Bone Joint J ; 102-B(6): 671-676, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1724736

ABSTRACT

AIMS: The current pandemic caused by COVID-19 is the biggest challenge for national health systems for a century. While most medical resources are allocated to treat COVID-19 patients, several non-COVID-19 medical emergencies still need to be treated, including vertebral fractures and spinal cord compression. The aim of this paper is to report the early experience and an organizational protocol for emergency spinal surgery currently being used in a large metropolitan area by an integrated team of orthopaedic surgeons and neurosurgeons. METHODS: An organizational model is presented based on case centralization in hub hospitals and early management of surgical cases to reduce hospital stay. Data from all the patients admitted for emergency spinal surgery from the beginning of the outbreak were prospectively collected and compared to data from patients admitted for the same reason in the same time span in the previous year, and treated by the same integrated team. RESULTS: A total of 19 patients (11 males and eight females, with a mean age of 49.9 years (14 to 83)) were admitted either for vertebral fracture or spinal cord compression in a 19-day period, compared to the ten admitted in the previous year. No COVID-19 patients were treated. The mean time between admission and surgery was 1.7 days, significantly lower than 6.8 days the previous year (p < 0.001). CONCLUSION: The structural organization and the management protocol we describe allowed us to reduce the time to surgery and ultimately hospital stay, thereby maximizing the already stretched medical resources available. We hope that our early experience can be of value to the medical communities that will soon be in the same emergency situation. Cite this article: Bone Joint J 2020;102-B(6):671-676.


Subject(s)
Coronavirus Infections , Models, Organizational , Neurosurgical Procedures , Orthopedic Procedures , Pandemics , Patient Care Team/organization & administration , Pneumonia, Viral , Spinal Cord Compression/surgery , Spinal Fractures/surgery , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19 , Critical Pathways/organization & administration , Efficiency, Organizational , Emergencies , Female , Health Care Rationing/organization & administration , Hospitals, Urban , Humans , Italy , Length of Stay/statistics & numerical data , Male , Middle Aged , Outcome and Process Assessment, Health Care , Prospective Studies , Time-to-Treatment/statistics & numerical data , Young Adult
7.
PLoS One ; 17(2): e0263607, 2022.
Article in English | MEDLINE | ID: covidwho-1666781

ABSTRACT

BACKGROUND: A reduction in overall acute coronary syndrome (ACS) cases, increases in the severity of ACS presentation, and increased rates of out-of-hospital cardiac arrest (OHCA) have been reported from multiple countries during the COVID-19 pandemic. The attributed factors include COVID-19 infection, fear of COVID-19 and resultant avoidance of health care facilities, and restrictions on mobility. Pakistan, a country with a high burden of cardiovascular disease (CVD) and challenges related to health care access, will be expected to demonstrate these same findings. Therefore, we compared ACS hospitalization, ACS severity, and patients who have already died (dead on arrival, or DOA) due to presumed OHCA at a tertiary cardiac hospital during pre-pandemic and intra-pandemic periods in Pakistan. METHODS: Standardized data elements were extracted from the charts of patients with ACS, and telephonic verbal autopsies (VA) using a validated tool were conducted for patients who were arrived DOA. As a comparison, cases during the same months prior to the COVID-19 were analyzed for respective waves. Events were counted, and proportions and frequencies are reported for each time period. RESULTS: A total of 4,480 ACS cases were reviewed; 1,216 cases during March-July 2019, 804 cases in the same months of 2020 (33.8% decrease); 1,304 cases in August 2019-January 2020 and 1,157 in the corresponding months of 2020 and 2021 (11.2% decrease). There was no observed change in the baseline characteristics of patients with ACS or their symptom-to-door time, and in-hospital mortality was unchanged across all time periods. There were 218 DOA cases in pre-pandemic months and 360 cases during the pandemic. The pre-pandemic rate of DOA was 12/1000 emergency patients (95% CI 10-13) compared to 22/1000 (95% CI 22-27) during the pandemic (30/1000in the 1st wave and 17/1000 during 2nd wave). On VA, CVD was found to be the major cause of death during both time periods. CONCLUSION: At a cardiac hospital in Pakistan, the COVID-19 pandemic was associated with a reduction in ACS hospitalization and an increased DOA rate.


Subject(s)
Acute Coronary Syndrome/epidemiology , COVID-19/epidemiology , Death , Hospitalization , Hospitals, Urban , Out-of-Hospital Cardiac Arrest/epidemiology , Pandemics , SARS-CoV-2 , Tertiary Care Centers , Aged , COVID-19/virology , Female , Hospital Mortality , Humans , Incidence , Male , Middle Aged , Pakistan/epidemiology
8.
Nephron ; 146(2): 179-184, 2022.
Article in English | MEDLINE | ID: covidwho-1582865

ABSTRACT

BACKGROUND: An increased incidence of thrombotic complications in patients with coronavirus disease 2019 (COVID-19) has been reported. Severe acute kidney injury (AKI) is one of the major clinical manifestations of COVID-19 with the need for renal replacement therapy. It was observed that hemodialysis (HD) accesses tended to thrombose more often in the COVID-19 population than in non-COVID-19 patients. We hypothesize that the hypercoagulable state of COVID-19 is associated with higher incidence of access clotting. METHOD: In this retrospective single-centered study at Kings County Hospital in New York City, 1,075 patients with COVID-19 were screened, and 174 patients who received HD from January 3, 2021 to May 15, 2020 were enrolled to examine the risk factors of dialysis access clotting in patients with COVID-19. RESULTS: Of the 174 patients, 109 (63%) were COVID-19 positive. 39 (22.6%) patients had dialysis access clotting at least once during their hospitalization, and they had significantly higher body mass index (BMI) (p = 0.001), higher rates of COVID-19 (p = 0.015), AKI (p < 0.001), higher platelet counts (p = 0.029), higher lactate dehydrogenase levels (p = 0.009), and lower albumin levels (p = 0.001) than those without access malfunctions. Low albumin levels (p = 0.008), AKI (p = 0.008), and high BMI (p = 0.018) were risk factors associated with HD access clotting among COVID-19 patients. CONCLUSION: Patients with COVID-19 who receive HD for AKI with high BMI are at a higher risk of clotting their HD access.


Subject(s)
Acute Kidney Injury/therapy , COVID-19/complications , Hospitals, Urban/organization & administration , Renal Dialysis/adverse effects , Thrombosis/etiology , Vascular Access Devices/adverse effects , Acute Kidney Injury/etiology , Aged , COVID-19/virology , Female , Humans , Male , Middle Aged , New York City , Retrospective Studies , SARS-CoV-2/isolation & purification
9.
Am J Surg ; 222(4): 832-841, 2021 10.
Article in English | MEDLINE | ID: covidwho-1530585

ABSTRACT

BACKGROUND: A community lockdown has a profound impact on its citizens. Our objective was to identify changes in trauma patient demographics, volume, and pattern of injury following the COVID-19 lockdown. METHODS: A retrospective review was conducted at a Level-1 Trauma Center from 2017 to 2020. RESULTS: A downward trend in volume is seen December-April in 2020 (R2 = 0.9907). February through April showed an upward trend in 2018 and 2019 (R2= 0.80 and R2 = 0.90 respectively), but a downward trend in 2020 (R2 = 0.97). In April 2020, there was 41.6% decrease in total volume, a 47.4% decrease in blunt injury and no decrease in penetrating injury. In contrast to previous months, in April the majority of injuries occurred in home zip codes. CONCLUSIONS: A community lockdown decreased the number of blunt trauma, however despite social distancing, did not decrease penetrating injury. Injuries were more likely to occur in home zip codes.


Subject(s)
COVID-19/prevention & control , Hospitals, Urban/trends , Physical Distancing , Trauma Centers/trends , Violence/trends , Adolescent , Adult , COVID-19/epidemiology , Female , Hospitals, Urban/standards , Hospitals, Urban/statistics & numerical data , Humans , Male , Middle Aged , Retrospective Studies , Trauma Centers/standards , Trauma Centers/statistics & numerical data , Violence/statistics & numerical data , Wounds, Nonpenetrating/epidemiology , Wounds, Nonpenetrating/therapy , Wounds, Penetrating/epidemiology , Wounds, Penetrating/therapy , Young Adult
10.
Acta Biomed ; 92(S6): e2021419, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1503668

ABSTRACT

BACKGROUND: In Europe, Italy and Lombardy, in autumn 2020, there was a steep increase in reported cases due to the second epidemic wave of SARS-Cov-2 infection. We aimed to evaluate the appropriateness of COVID-19 patients' admissions to the ED of the San Raffaele Hospital. METHODS: We compared data between the inter-wave period (IWP, from 1st to 30th September) and the second wave period (WP, 1st October to 15th November) focusing on the ED presentation, discharge priority colour code and outcomes. RESULTS: Out of 977 admissions with a SARS-Cov-2 positive swab, 6% were in the IWP and 94% in the WP. Red, yellow and white code increased (these latter from 1.8% to 5.4%) as well as self-presented in yellow and white code. Discharges home increased from 1.8% to 5.4%, while hospitalizations decreased from 63% to 51%. DISCUSSION: We found a rise in white codes (among self-presented patients), indicating inappropriateness of admissions. The increase in discharges suggests that several patients did not require hospitalization. CONCLUSIONS: The pandemic brought out the fundamental role of primary care to manage patients with low-intensity needs. The important increase in ED admissions of COVID-19 patients caused a reduction of NO-COVID-19 patients, with possible inadequate treatment.


Subject(s)
COVID-19 , Emergency Service, Hospital , Hospitalization , Hospitals, Urban , Humans , Italy/epidemiology , Pandemics , SARS-CoV-2
11.
BMJ Open ; 11(10): e051045, 2021 10 26.
Article in English | MEDLINE | ID: covidwho-1495464

ABSTRACT

OBJECTIVE: Dynamics of humoral immune responses to SARS-CoV-2 antigens following infection suggest an initial decay of antibody followed by subsequent stabilisation. We aim to understand the longitudinal humoral responses to SARS-CoV-2 nucleocapsid (N) protein and spike (S) protein and to evaluate their correlation to clinical symptoms among healthcare workers (HCWs). DESIGN: A prospective longitudinal study. SETTING: This study was conducted in a New York City public hospital in the South Bronx, New York. PARTICIPANTS: HCWs participated in phase 1 (N=500) and were followed up 4 months later in phase 2 (N=178) of the study. They underwent SARS-CoV-2 PCR and serology testing for N and S protein antibodies, in addition to completion of an online survey in both phases. Analysis was performed on the 178 participants who participated in both phases of the study. PRIMARY OUTCOME MEASURE: Evaluate longitudinal humoral responses to viral N (qualitative serology testing) and S protein (quantitative Mount Sinai Health System ELISA to detect receptor-binding domain and full-length S reactive antibodies) by measuring rate of decay. RESULTS: Anti-N antibody positivity was 27% and anti-S positivity was 28% in phase 1. In phase 1, anti-S titres were higher in symptomatic (6754 (5177-8812)) than in asymptomatic positive subjects (5803 (2825-11 920)). Marginally higher titres (2382 (1494-3797)) were seen in asymptomatic compared with the symptomatic positive subgroup (2198 (1753-2755)) in phase 2. A positive correlation was noted between age (R=0.269, p<0.01), number (R=0.310, p<0.01) and duration of symptoms (R=0.434, p<0.01), and phase 1 anti-S antibody titre. A strong correlation (R=0.898, p<0.001) was observed between phase 1 titres and decay of anti-S antibody titres between the two phases. Significant correlation with rate of decay was also noted with fever (R=0.428, p<0.001), gastrointestinal symptoms (R=0.340, p<0.05), and total number (R=0.357, p<0.01) and duration of COVID-19 symptoms (R=0.469, p<0.001). CONCLUSIONS: Higher initial anti-S antibody titres were associated with larger number and longer duration of symptoms as well as a faster decay between the two time points.


Subject(s)
COVID-19 , SARS-CoV-2 , Antibodies, Viral , Antibody Formation , Health Personnel , Hospitals, Urban , Humans , Longitudinal Studies , New York City/epidemiology , Prospective Studies
12.
Ghana Med J ; 54(4 Suppl): 46-51, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-1436194

ABSTRACT

INTRODUCTION: The novel corona virus disease 2019 (COVID-19) was diagnosed in Wuhan, China in December 2019 and, in Ghana, in March 2020. As of 30th July 2020, Ghana had recorded 35,142 cases. COVID-19 which can be transmitted by both symptomatic and asymptomatic individuals usually manifest as pneumonia with symptoms like fever, cough, dyspnoea and fatigue. The current non-availability of a vaccine or drug for COVID-19 management calls for early detection and isolation of affected individuals. Chest imaging has become an integral part of patient management with chest radiography serving as a primary imaging modality in many centres. METHODS: The study was a retrospective study conducted at Ga East Municipal Hospital (GEMH). Chest radiographs of patients with mild to moderate disease managed at GEMH were evaluated. The age, gender, symptom status, comorbidities and chest x-ray findings of the patients were documented. RESULTS: 11.4 % of the patients had some form of respiratory abnormality on chest radiography with 88.9% showing COVID-19 pneumonia features. 93.8% showed ground glass opacities (GGO), with 3.1% each showing consolidation (CN) only and CN with GGO. There was a significant association between COVID-19 radiographic features and patient's age, symptom status and comorbidities but not with gender. CONCLUSION: Most radiographs were normal with only 11% showing COVID-19-like abnormality. There was a significant association between age, symptom status and comorbidities with the presence of COVID-19 like features but not for gender. There was no association between the extent of the lung changes and patient characteristics. FUNDING: None declared.


Subject(s)
COVID-19/diagnostic imaging , Radiography, Thoracic/statistics & numerical data , SARS-CoV-2 , Adolescent , Adult , Age Factors , Aged , COVID-19/epidemiology , Comorbidity , Female , Ghana/epidemiology , Hospitals, Urban , Humans , Lung/diagnostic imaging , Lung/virology , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Symptom Assessment/methods , Young Adult
14.
Medicine (Baltimore) ; 100(25): e26433, 2021 Jun 25.
Article in English | MEDLINE | ID: covidwho-1410303

ABSTRACT

ABSTRACT: The subclinical severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate in hospitals during the pandemic remains unclear. To evaluate the effectiveness of our hospital's current nosocomial infection control measures, we conducted a serological survey of anti-SARS-CoV-2 antibodies (immunoglobulin [Ig] G) among the staff of our hospital, which is treating coronavirus disease 2019 (COVID-19) patients.The study design was cross-sectional. We measured anti-SARS-CoV-2 IgG in the participants using a laboratory-based quantitative test (Abbott immunoassay), which has a sensitivity and specificity of 100% and 99.6%, respectively. To investigate the factors associated with seropositivity, we also obtained some information from the participants with an anonymous questionnaire. We invited 1133 staff members in our hospital, and 925 (82%) participated. The mean age of the participants was 40.0 ±â€Š11.8 years, and most were women (80.0%). According to job title, there were 149 medical doctors or dentists (16.0%), 489 nurses (52.9%), 140 medical technologists (14.2%), 49 healthcare providers (5.3%), and 98 administrative staff (10.5%). The overall prevalence of seropositivity for anti-SARS-CoV-2 IgG was 0.43% (4/925), which was similar to the control seroprevalence of 0.54% (16/2970) in the general population in Osaka during the same period according to a government survey conducted with the same assay. Seropositive rates did not significantly differ according to job title, exposure to suspected or confirmed COVID-19 patients, or any other investigated factors.The subclinical SARS-CoV-2 infection rate in our hospital was not higher than that in the general population under our nosocomial infection control measures.


Subject(s)
Antibodies, Viral/blood , Asymptomatic Infections/epidemiology , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Seroepidemiologic Studies , Adult , COVID-19/blood , COVID-19/immunology , COVID-19/transmission , Cross-Sectional Studies , Female , Hospitals, Urban/organization & administration , Hospitals, Urban/standards , Hospitals, Urban/statistics & numerical data , Humans , Immunoglobulin G/blood , Infection Control/organization & administration , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Patient-to-Professional/statistics & numerical data , Japan/epidemiology , Male , Middle Aged , Pandemics/statistics & numerical data , Prevalence , Risk Factors , SARS-CoV-2/immunology , Surveys and Questionnaires/statistics & numerical data
15.
West J Emerg Med ; 22(5): 1051-1059, 2021 Sep 02.
Article in English | MEDLINE | ID: covidwho-1405512

ABSTRACT

INTRODUCTION: Diverse coronavirus disease 2019 (COVID-19) mortalities have been reported but focused on identifying susceptible patients at risk of more severe disease or death. This study aims to investigate the mortality variations of COVID-19 from different hospital settings during different pandemic phases. METHODS: We retrospectively included adult (≥18 years) patients who visited emergency departments (ED) of five hospitals in the state of Texas and who were diagnosed with COVID-19 between March-November 2020. The included hospitals were dichotomized into urban and suburban based on their geographic location. The primary outcome was mortality that occurred either during hospital admission or within 30 days after the index ED visit. We used multivariable logistic regression to investigate the associations between independent variables and outcome. Generalized additive models were employed to explore the mortality variation during different pandemic phases. RESULTS: A total of 1,788 adult patients who tested positive for COVID-19 were included in the study. The median patient age was 54.6 years, and 897 (50%) patients were male. Urban hospitals saw approximately 59.5% of the total patients. A total of 197 patients died after the index ED visit. The analysis indicated visits to the urban hospitals (odds ratio [OR] 2.14, 95% confidence interval [CI], 1.41, 3.23), from March to April (OR 2.04, 95% CI, 1.08, 3.86), and from August to November (OR 2.15, 95% CI, 1.37, 3.38) were positively associated with mortality. CONCLUSION: Visits to the urban hospitals were associated with a higher risk of mortality in patients with COVID-19 when compared to visits to the suburban hospitals. The mortality risk rebounded and showed significant difference between urban and suburban hospitals since August 2020. Optimal allocation of medical resources may be necessary to bridge this gap in the foreseeable future.


Subject(s)
COVID-19/mortality , Emergency Service, Hospital/statistics & numerical data , Hospital Mortality , Hospitals, Urban/statistics & numerical data , Pandemics , Suburban Health Services/statistics & numerical data , Adult , Aged , Humans , Male , Medicare , Middle Aged , Residence Characteristics , Retrospective Studies , SARS-CoV-2 , United States/epidemiology
16.
J Surg Res ; 268: 389-393, 2021 12.
Article in English | MEDLINE | ID: covidwho-1360088

ABSTRACT

BACKGROUND: The COVID-19 pandemic led to large-scale cancellation and deferral of elective surgeries. We quantified volume declines, and subsequent recoveries, across all hospitals in Maryland. MATERIALS AND METHODS: Data on elective inpatient surgical volumes were assembled from the Maryland Health Service Cost Review Commission for years 2019-2020. The data covered all hospitals in the state. We compared the volume of elective inpatient surgeries in the second (Q2) and fourth quarters (Q4) of 2020 to those same quarters in 2019. Analysis was stratified by patient, hospital, and service characteristics. RESULTS: Surgical volumes were 55.8% lower in 2020 Q2 than in 2019 Q2. Differences were largest for orthopedic surgeries (74.3% decline), those on Medicare (61.4%), and in urban hospitals (57.3%). By 2020 Q4, volumes for most service lines were within 15% of volumes in 2019 Q4. Orthopedic surgery remained most affected (44.5% below levels in 2019 Q4) and Plastic Surgery (21.9% lower). CONCLUSIONS: COVID-19 led to large volume declines across hospitals in Maryland followed by a partial recovery. We observed large variability, particularly across service lines. These results can help contextualize case-specific experiences and inform research studying potential health effects of these delays and cancellations.


Subject(s)
COVID-19 , Elective Surgical Procedures/statistics & numerical data , Hospitalization/statistics & numerical data , Aged , Hospitals, Urban , Humans , Inpatients , Maryland/epidemiology , Medicare , Pandemics , United States/epidemiology
17.
Emerg Med Australas ; 34(1): 52-57, 2022 02.
Article in English | MEDLINE | ID: covidwho-1348113

ABSTRACT

OBJECTIVE: There is a growing recognition of the impact of lockdowns on non-COVID-19 demand for critical care services. While a reduction in demand has been postulated, there remains a paucity of quantitative data on the extent and nature of this reduction. The present study aims to quantify the impact of lockdown on critical care services, namely ED, intensive care unit (ICU), medical emergency team (MET) and emergency theatre (ET) demand, during the lockdown in Victoria, Australia. METHODS: This is a single-centred, retrospective observational study on critical service demand, comparing activity levels during the lockdown (31 March to 27 October 2020) with the matched time period from 1 year prior. RESULTS: There was a reduction in presentations to ED (27.2%), MET calls (27.4%), ICU patient episodes (14.5%) and ET bookings (5.8%). There was an unexpected increase in ICU admissions for metabolic diagnoses, comprising drug overdoses and diabetic ketoacidosis, and a reduction in respiratory ICU admissions. There was a reduction across all ED triage categories, which included triage 1 and 2 patients, indicating a reduction even in life-threatening and emergency presentations. CONCLUSION: Lockdowns lead to a significant reduction in ICU, MET call and ED demand, and to a lesser extent ET demand. This pattern should be considered in surge capacity and workforce redeployment planning. There are also impacts on public health epidemiology, with potential adverse consequences on mental health and chronic disease management. Further research on the impact of lockdowns on long-term disease outcomes is needed.


Subject(s)
Critical Care , Emergency Service, Hospital , Hospitals, Urban , Humans , Retrospective Studies , Victoria
18.
Breast ; 59: 301-307, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1340566

ABSTRACT

PURPOSE: To examine clinicodemographic determinants associated with breast cancer survivorship follow-up during COVID-19. METHODS: We performed a retrospective, population-based cohort study including early stage (Stage I-II) breast cancer patients who underwent resection between 2006 and 2018 in a New York City hospital system. The primary outcome was oncologic follow-up prior to and during the COVID-19 pandemic. Secondary analyses compared differences in follow-up by COVID-19 case rates stratified by ZIP code. RESULTS: A total of 2942 patients with early-stage breast cancer were available for analysis. 1588 (54%) of patients had attended follow-up in the year prior to the COVID-19 period but failed to continue to follow-up during the pandemic, either in-person or via telemedicine. 1242 (42%) patients attended a follow-up appointment during the COVID-19 pandemic. Compared with patients who did not present for follow-up during COVID-19, patients who continued their oncologic follow-up during the pandemic were younger (p = 0.049) more likely to have received adjuvant radiation therapy (p = 0.025), and have lower household income (p = 0.031) on multivariate modeling. When patients who live in Bronx, New York, were stratified by ZIP code, there was a modest negative association (r = -0.56) between COVID-19 cases and proportion of patients who continued to follow-up during the COVID-19 period. CONCLUSION: We observed a dramatic disruption in routine breast cancer follow-up during the COVID-19 pandemic. Providers and health systems should emphasize reintegrating patients who missed appointments during COVID-19 back into regular surveillance programs to avoid significant morbidity and mortality from missed breast cancer recurrences.


Subject(s)
Breast Neoplasms/mortality , COVID-19/psychology , Cancer Survivors/psychology , Survivorship , Adolescent , Adult , Aged , Breast Neoplasms/drug therapy , COVID-19/epidemiology , Cohort Studies , Female , Hospitals, Urban , Humans , Male , Mastectomy , Middle Aged , Neoplasm Recurrence, Local , New York City/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2 , Young Adult
19.
Am J Health Syst Pharm ; 77(19): 1598-1605, 2020 09 18.
Article in English | MEDLINE | ID: covidwho-1317904

ABSTRACT

PURPOSE: To describe our medical center's pharmacy services preparedness process and offer guidance to assist other institutions in preparing for surges of critically ill patients such as those experienced during the coronavirus disease 2019 (COVID-19) pandemic. SUMMARY: The leadership of a department of pharmacy at an urban medical center in the US epicenter of the COVID-19 pandemic proactively created a pharmacy action plan in anticipation of a surge in admissions of critically ill patients with COVID-19. It was essential to create guidance documents outlining workflow, provide comprehensive staff education, and repurpose non-intensive care unit (ICU)-trained clinical pharmacotherapy specialists to work in ICUs. Teamwork was crucial to ensure staff safety, develop complete scheduling, maintain adequate drug inventory and sterile compounding, optimize the electronic health record and automated dispensing cabinets to help ensure appropriate prescribing and effective management of medication supplies, and streamline the pharmacy workflow to ensure that all patients received pharmacotherapeutic regimens in a timely fashion. CONCLUSION: Each hospital should view the COVID-19 crisis as an opportunity to internally review and enhance workflow processes, initiatives that can continue even after the resolution of the COVID-19 pandemic.


Subject(s)
COVID-19/drug therapy , Medication Therapy Management/organization & administration , Pharmacy Service, Hospital/organization & administration , Practice Guidelines as Topic , Academic Medical Centers/organization & administration , Academic Medical Centers/standards , COVID-19/epidemiology , Hospitals, Urban/organization & administration , Hospitals, Urban/standards , Humans , Leadership , New York/epidemiology , Pandemics/prevention & control , Personnel Staffing and Scheduling/organization & administration , Personnel Staffing and Scheduling/standards , Pharmacists/organization & administration , Pharmacy Service, Hospital/standards , Tertiary Care Centers/organization & administration , Tertiary Care Centers/standards , Workflow , Workforce/organization & administration , Workforce/standards
20.
Khirurgiia (Mosk) ; (7): 45-48, 2021.
Article in Russian | MEDLINE | ID: covidwho-1317353

ABSTRACT

OBJECTIVE: To report our experience in surgical treatment of patients with COVID-19. MATERIAL AND METHODS: There were 7815 patients with COVID-19 for the period from April 1, 2020 to December 31, 2020. During this period, 172 operations were performed in this group. RESULTS: The most common procedures were tracheostomy (n=86, 50.0%), pleural puncture and drainage (n=20, 11.6%), caesarean section (n=22, 12.7%). There were 24 (14.0%) abdominal surgeries including 11 laparoscopies, 5 appendectomies, 3 bowel resections and others. Six lower limb amputations were carried out. We should emphasize common soft tissue hematomas and effusions. This complication is associated with anticoagulation recommended for patients with COVID-19. CONCLUSION: Surgical interventions using personal protective equipment is a significant challenge. According to our experience, round-the-clock surgical care in a specialized hospital is required.


Subject(s)
COVID-19 , Cesarean Section , Female , Hospitals, Urban , Humans , Personal Protective Equipment , Pregnancy , SARS-CoV-2
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