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2.
J Wound Care ; 30(Sup2): S12-S17, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1083226

ABSTRACT

COVID-19 is highly contagious and its rapid spread burdens the healthcare system. As the number of confirmed cases goes up, the shortage of medical resources has become a challenge. To avoid the collapse of the healthcare system during the fight with COVID-19, all healthcare workers, including wound care practitioners, should adapt to new roles and use any appropriate methods available to slow the spread of the virus. Integrating telemedicine into wound care during the outbreak helps maintain social distancing, preserve personal protective equipment and medical resources, and eliminate unnecessary exposure for both vulnerable patients and high-risk healthcare workers.


Subject(s)
Ambulatory Care , Diabetic Foot/therapy , Telemedicine , Triage , Wounds and Injuries/therapy , Cross Infection/prevention & control , Elective Surgical Procedures , Hospitalization , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control
3.
J Wound Care ; 30(Sup2): S8-S11, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1081455

ABSTRACT

The Sars-CoV-2 (COVID-19) pandemic has resulted in significant and unprecedented shifts in the delivery of health care services in the United States. Although wound care remains an essential service during the COVID-19 pandemic, the financial consequences and infectious disease ramifications of the pandemic have resulted in closure or limitation of hours in many outpatient wound and hyperbaric oxygen therapy (HBOT) centers. As HBOT patients often require daily treatment sessions for a period of months, it is necessary for facilities providing HBOT services to adjust to the COVID-19 pandemic while still maintaining availability of this important service. Modification of HBOT session timing and chamber decontamination procedures, utilisation of telehealth services for initial patient evaluations, and acceptance of novel patient populations and diagnoses are mechanisms by which HBOT centers can adapt to the evolving model of health care delivery throughout a pandemic. While COVID-19 is not a currently accepted indication for HBOT, patients may be referred for HBOT consultation due to the post-infectious sequelae of the virus, and thus HBOT facilities must be aware of the potential uses of this treatment for post-viral complications. By redefining paradigms for health care delivery during the COVID-19 pandemic, HBOT and wound centers can continue to provide high-quality and uninterrupted care to vulnerable patient populations.


Subject(s)
Delivery of Health Care/methods , Hyperbaric Oxygenation/methods , Wounds and Injuries/therapy , Appointments and Schedules , Disinfection , Environment Design , Health Services Accessibility , Humans , Infection Control/methods , Telemedicine , Triage/methods , United States
4.
Rev Bras Enferm ; 74(suppl 1): e20200687, 2021.
Article in English, Portuguese | MEDLINE | ID: covidwho-1076301

ABSTRACT

OBJECTIVE: To analyze the change in the clinical-epidemiological profile of patients attended at the specialized triage service for COVID-19 (COVID-19 tent) in the first three months of operation. METHODS: Cross-sectional study, with users attended from March 2020 to May 2020 (n=379) at the COVID-19 tent in the city of Ponta Grossa, Paraná. Data collection was retrieved from an electronic form fed by tent professionals, which included sociodemographic characteristics, symptoms, risk factors of exposure, means of search and clinical conduct. Trend tests and chi-square tests were performed. RESULTS: March showed a greater demand (n=197), motivated by mild symptoms and direct search (p<0.05). In the following months, there was a decrease in demand (n=93; n=89), however the search for referrals, ambulances and conditions that required medical attention, observation and hospitalization increased (p<0.05). The search resulting from exposure to risk factors has not changed (p>0.05). CONCLUSION: the profile has changed over time, reflecting, in the end, severe and critical symptoms, requiring intervention.


Subject(s)
/diagnosis , Emergency Service, Hospital/organization & administration , Emergency Service, Hospital/statistics & numerical data , Medical History Taking/methods , Medical History Taking/statistics & numerical data , Triage/methods , Triage/statistics & numerical data , Adult , Aged , Aged, 80 and over , Brazil , Cross-Sectional Studies , Female , Humans , Male , Middle Aged
5.
Epidemiol Prev ; 44(5-6 Suppl 2): 208-215, 2020.
Article in English | MEDLINE | ID: covidwho-1068141

ABSTRACT

BACKGROUND: the emergency due to SARS-CoV-2 pandemic struck the national and regional health system that needed an effort to reorganise and increase resources to cope with a sudden, uncertain, and previously unknown situation. This study was conducted in the immediate aftermath of this difficult period. OBJECTIVES: to describe clinical characteristics, short-term outcomes, and management of SARS-CoV-2 positive patients that accessed the emergency department (ED) of the San Luigi Gonzaga hospital of Orbassano (Turin district, Piedmont Region, Northern Italy) in March and April 2020. Furthermore, this study aimed at investigating if a difference in patients characteristics, clinical management, and outcomes was present during time. DESIGN: comparison of different periods in a clinical cohort. SETTING AND PARTICIPANTS: for each patient who accessed the ED and tested positive for SARS-CoV-2 swab, the ED medical record was collected and a descriptive analysis was performed on demographical characteristics, pre-existing comorbidities, parameters measured at triage, imaging exams results, lab tests results, separately for patients admitted at the ED in four different periods. MAIN OUTCOME MEASURES: discharge from ED, admission to hospital wards (low and high intensity of care), short term in-hospital mortality, hospital length of stay. The association between patients' characteristics and the main outcomes was measured using multivariable logistic models. RESULTS: age of patients increased significantly from March to April, together with female prevalence and associated comorbid conditions. A significant difference in symptoms at presentation was not observed nor it was in laboratory test results. Severity at triage and need of intensive care resources were higher in the first weeks, together with the typical clinical presentation with respiratory failure and imaging with signs of bilateral interstitial pneumonia. Accordingly, in-hospital mortality was higher in the first period. Nevertheless, nearly half of patients in the first period were discharged directly from ED showing mild COVID-19 cases. On the contrary, in April an increasing need of hospitalisation in low intensity of care beds was observed, whereas mild cases stopped to access the ED. CONCLUSIONS: the results of this study suggest that in few weeks of COVID-19 epidemic both management of the patients at the hospital level - and probably at territorial level resulting in a different population who accessed to the ED - and the clinical characteristics of the COVID-19 patients changed.


Subject(s)
/epidemiology , Emergency Service, Hospital/statistics & numerical data , Pandemics , Age Distribution , Aged , Aged, 80 and over , /drug therapy , Comorbidity , Disease Management , Female , Hospital Mortality , Hospitals, Urban/statistics & numerical data , Humans , Italy/epidemiology , Male , Middle Aged , Mutation , Patient Discharge , Retrospective Studies , /isolation & purification , Sex Distribution , Symptom Assessment , Time Factors , Treatment Outcome , Triage
7.
Dan Med J ; 68(2)2021 01 07.
Article in English | MEDLINE | ID: covidwho-1063690

ABSTRACT

INTRODUCTION: Tools to quickly triage and evaluate patients with suspected COVID-19 in an emergency department (ED) can improve patient care and reduce risk of overcrowding. The aim of this study was to evaluate if lung ultrasound (LUS) may provide valuable prognostic information in adult patients suspected of COVID-19. METHODS: A prospective cohort study of adult patients in an ED was conducted. LUS was performed within one hour of the patients' arrival; COVID-19 was defined by a respiratory syndrome coronavirus 2 RNA positive test. The primary outcome was the proportion of patients suspected of COVID-19 and normal LUS with critical outcomes during follow-up, defined as one or more of the following: need of non-invasive ventilation (NIV), invasive mechanical ventilation, intensive care unit (ICU) stay or death. Follow-up was 14 days. RESULTS: A total of 83 patients were included between 9 March and 12 April 2020. In all, 47 (57%; 95% confidence interval (CI): 45.3-67.5%) had a normal LUS, 46 (98%; 95% CI: 88.7-99.9%) of whom had no critical outcomes. A total of 36 (43%; 95% CI: 32.5-54.7%) had an abnormal LUS, eight of whom (22%; 95% CI: 10.1-39.2%) had critical outcomes. Nine (11%; 95%: CI 5.1-19.6%) had one or more critical outcomes: three on NIV, five in ICUs, four on invasive mechanical ventilation and two died. Among the 12 patients (14%; 95% CI: 7.7-23.9%) tested positive for COVID-19, 11 (92%; 95% CI: 61.5-99.8%) had an abnormal LUS. CONCLUSIONS: Among adult ED patients suspected of COVID-19, a normal LUS is associated with a low risk of critical outcomes. LUS might be considered for routine use as a prognostic tool in patients suspected of COVID-19. FUNDING: none. TRIAL REGISTRATION: not relevant.


Subject(s)
/diagnosis , Lung/diagnostic imaging , Triage/methods , Aged , Case-Control Studies , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Pandemics , Prospective Studies , Risk Assessment , Tomography, X-Ray Computed , Ultrasonography
8.
J Transl Med ; 19(1): 56, 2021 02 05.
Article in English | MEDLINE | ID: covidwho-1067242

ABSTRACT

BACKGROUND: Clinical risk scores and machine learning models based on routine laboratory values could assist in automated early identification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients at risk for severe clinical outcomes. They can guide patient triage, inform allocation of health care resources, and contribute to the improvement of clinical outcomes. METHODS: In- and out-patients tested positive for SARS-CoV-2 at the Insel Hospital Group Bern, Switzerland, between February 1st and August 31st ('first wave', n = 198) and September 1st through November 16th 2020 ('second wave', n = 459) were used as training and prospective validation cohort, respectively. A clinical risk stratification score and machine learning (ML) models were developed using demographic data, medical history, and laboratory values taken up to 3 days before, or 1 day after, positive testing to predict severe outcomes of hospitalization (a composite endpoint of admission to intensive care, or death from any cause). Test accuracy was assessed using the area under the receiver operating characteristic curve (AUROC). RESULTS: Sex, C-reactive protein, sodium, hemoglobin, glomerular filtration rate, glucose, and leucocytes around the time of first positive testing (- 3 to + 1 days) were the most predictive parameters. AUROC of the risk stratification score on training data (AUROC = 0.94, positive predictive value (PPV) = 0.97, negative predictive value (NPV) = 0.80) were comparable to the prospective validation cohort (AUROC = 0.85, PPV = 0.91, NPV = 0.81). The most successful ML algorithm with respect to AUROC was support vector machines (median = 0.96, interquartile range = 0.85-0.99, PPV = 0.90, NPV = 0.58). CONCLUSION: With a small set of easily obtainable parameters, both the clinical risk stratification score and the ML models were predictive for severe outcomes at our tertiary hospital center, and performed well in prospective validation.


Subject(s)
/virology , Machine Learning , Severity of Illness Index , Tertiary Care Centers , Triage , Aged , Area Under Curve , Cohort Studies , Female , Humans , Male , Middle Aged , Prognosis , ROC Curve , Risk Assessment
9.
Scand J Public Health ; 49(1): 33-36, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1067144

ABSTRACT

AIMS: In three days at the beginning of the COVID-19 pandemic, the Copenhagen Emergency Medical Services developed a digital diagnostic device. The purpose was to assess and triage potential COVID-19 symptoms and to reduce the number of calls to public health-care helplines. The device was used almost 150,000 times in a few weeks and was described by politicians and administrators as a solution and success. However, high usage cannot serve as the sole criterion of success. What might be adequate criteria? And should digital triage for citizens by default be considered low risk? METHODS: This paper reflects on the uncertain aspects of the performance, risks and issues of accountability pertaining to the digital diagnostic device in order to draw lessons for future improvements. The analysis is based on the principles of evidence-based medicine (EBM), the EU and US regulations of medical devices and the taxonomy of uncertainty in health care by Han et al. RESULTS: Lessons for future digital devices are (a) the need for clear criteria of success, (b) the importance of awareness of other severe diseases when triaging, (c) the priority of designing the device to collect data for evaluation and (d) clear allocation of responsibilities. CONCLUSIONS: A device meant to substitute triage for citizens according to its own criteria of success should not by default be considered as low risk. In a pandemic age dependent on digitalisation, it is therefore important not to abandon the ethos of EBM, but instead to prepare the ground for new ways of building evidence of effect.


Subject(s)
/diagnosis , Emergency Medical Services , Pandemics , Triage/methods , /epidemiology , Denmark/epidemiology , Evidence-Based Medicine , Humans , Physicians , Robotics
10.
Bioethics ; 35(2): 125-134, 2021 02.
Article in English | MEDLINE | ID: covidwho-1066621

ABSTRACT

In March 2020, the rapid increase in severe COVID-19 cases overwhelmed the healthcare systems in several European countries. The capacities for artificial ventilation in intensive care units were too scarce to care for patients with acute respiratory disorder connected to the disease. Several professional associations published COVID-19 triage recommendations in an extremely short time: in 21 days between March 6 and March 27. In this article, we compare recommendations from five European countries, which combine medical and ethical reflections on this situation in some detail. Our aim is to provide a detailed overview on the ethical elements of the recommendations, the differences between them and their coherence. In more general terms we want to identify shortcomings in regard to a common European response to the current situation.


Subject(s)
/therapy , Health Care Rationing , Standard of Care/ethics , Triage/ethics , Age Factors , Europe/epidemiology , Health Personnel/ethics , Health Personnel/psychology , Health Priorities , Hospitalization , Human Rights , Humans , Intensive Care Units/ethics , Practice Guidelines as Topic , Treatment Outcome , Ventilators, Mechanical/supply & distribution , Withholding Treatment/ethics
12.
Am J Respir Crit Care Med ; 203(3): 287-295, 2021 02 01.
Article in English | MEDLINE | ID: covidwho-1058133

ABSTRACT

The burdens of the coronavirus disease (COVID-19) pandemic have fallen disproportionately on disadvantaged groups, including the poor and Black, Latinx, and Indigenous communities. There is substantial concern that the use of existing ICU triage protocols to allocate scarce ventilators and critical care resources-most of which are designed to save as many lives as possible-may compound these inequities. As governments and health systems revisit their triage guidelines in the context of impending resource shortages, scholars have advocated a range of alternative allocation strategies, including the use of a random lottery to give all patients in need an equal chance of ICU treatment. However, both the save-the-most-lives approach and random allocation are seriously flawed. In this Perspective, we argue that ICU triage policies should simultaneously promote population health outcomes and mitigate health inequities. These ethical goals are sometimes in conflict, which will require balancing the goals of maximizing the number of lives saved and distributing health benefits equitably across society. We recommend three strategies to mitigate health inequities during ICU triage: introducing a correction factor into patients' triage scores to reduce the impact of baseline structural inequities; giving heightened priority to individuals in essential, high-risk occupations; and rejecting use of longer-term life expectancy and categorical exclusions as allocation criteria. We present a practical triage framework that incorporates these strategies and attends to the twin public health goals of promoting population health and social justice.


Subject(s)
/epidemiology , Critical Care/organization & administration , Healthcare Disparities/organization & administration , Triage/organization & administration , Vulnerable Populations/statistics & numerical data , Health Status Disparities , Humans
13.
Ital J Pediatr ; 47(1): 19, 2021 Jan 29.
Article in English | MEDLINE | ID: covidwho-1054827

ABSTRACT

BACKGROUND: COVID-19 pandemic has markedly affected emergency care, due to sudden limitation of health care capacity by general practitioners (GP) and urgent need for infection control strategies. We evaluated the activity of the Emergency Department (ED) during the national lockdown (March 8-April 30), as well as the outcomes of our infection control strategy. RESULTS: Despite a reduction in access by one fifth, a proportion of febrile patients comparable to 2019 was seen (829/2492, 33.3% vs 4580/13.342, 34.3%, p = 0.3). Diagnostic swab for COVID-19 was performed in 25% of patients, especially in subjects with co-morbidities or multiple access. Six infected cases were identified, all presenting with febrile disease. Only two positive patients fulfilled the criteria for diagnostic swab provided by the Italian Health Authorities, because of close contact with suspected or confirmed cases. The rate of admission for febrile or respiratory conditions was higher than the same period of 2019 (33.4% vs 25.9%, p < 0.0001). None of the 105 health-care professionals working during the study time lapse exhibited anti-SARS-CoV-2 seroconversion. Among the 589 patients with information available, 54.9% declared no medical consultation at all prior to coming to ED, while only 40 (of which 27 with fever) had been examined by their GP before coming to ED. Nevertheless, 35.6% of the cases were already taking medications. None of the 9 patients requiring intensive care reported recent pediatric consultation, despite symptoms duration up to 30 days. CONCLUSION: Our results provide evidence that the reduced capacity of primary care facilities during the national lockdown may have caused a high rate of self-medication as well as a delayed provision of care in some patients. Identification of pediatric patients affected with SARS-CoV-2 infection remains a challenge because of the absence of reliable predictive factors. Finally, the use of specific triage centers, with dedicated pathways to diagnose SARS-CoV-2 infection, trace contacts and allow adequate care after swabs, is effective in preventing spreading of the infection.


Subject(s)
/prevention & control , Emergency Service, Hospital/organization & administration , Hospitals, Pediatric/organization & administration , Infection Control/organization & administration , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , /epidemiology , Child , Female , Humans , Italy/epidemiology , Male , Pneumonia, Viral/epidemiology , Pneumonia, Viral/virology , Retrospective Studies , Time-to-Treatment , Triage
14.
Lancet Digit Health ; 3(2): e78-e87, 2021 02.
Article in English | MEDLINE | ID: covidwho-1053906

ABSTRACT

BACKGROUND: The early clinical course of COVID-19 can be difficult to distinguish from other illnesses driving presentation to hospital. However, viral-specific PCR testing has limited sensitivity and results can take up to 72 h for operational reasons. We aimed to develop and validate two early-detection models for COVID-19, screening for the disease among patients attending the emergency department and the subset being admitted to hospital, using routinely collected health-care data (laboratory tests, blood gas measurements, and vital signs). These data are typically available within the first hour of presentation to hospitals in high-income and middle-income countries, within the existing laboratory infrastructure. METHODS: We trained linear and non-linear machine learning classifiers to distinguish patients with COVID-19 from pre-pandemic controls, using electronic health record data for patients presenting to the emergency department and admitted across a group of four teaching hospitals in Oxfordshire, UK (Oxford University Hospitals). Data extracted included presentation blood tests, blood gas testing, vital signs, and results of PCR testing for respiratory viruses. Adult patients (>18 years) presenting to hospital before Dec 1, 2019 (before the first COVID-19 outbreak), were included in the COVID-19-negative cohort; those presenting to hospital between Dec 1, 2019, and April 19, 2020, with PCR-confirmed severe acute respiratory syndrome coronavirus 2 infection were included in the COVID-19-positive cohort. Patients who were subsequently admitted to hospital were included in their respective COVID-19-negative or COVID-19-positive admissions cohorts. Models were calibrated to sensitivities of 70%, 80%, and 90% during training, and performance was initially assessed on a held-out test set generated by an 80:20 split stratified by patients with COVID-19 and balanced equally with pre-pandemic controls. To simulate real-world performance at different stages of an epidemic, we generated test sets with varying prevalences of COVID-19 and assessed predictive values for our models. We prospectively validated our 80% sensitivity models for all patients presenting or admitted to the Oxford University Hospitals between April 20 and May 6, 2020, comparing model predictions with PCR test results. FINDINGS: We assessed 155 689 adult patients presenting to hospital between Dec 1, 2017, and April 19, 2020. 114 957 patients were included in the COVID-negative cohort and 437 in the COVID-positive cohort, for a full study population of 115 394 patients, with 72 310 admitted to hospital. With a sensitive configuration of 80%, our emergency department (ED) model achieved 77·4% sensitivity and 95·7% specificity (area under the receiver operating characteristic curve [AUROC] 0·939) for COVID-19 among all patients attending hospital, and the admissions model achieved 77·4% sensitivity and 94·8% specificity (AUROC 0·940) for the subset of patients admitted to hospital. Both models achieved high negative predictive values (NPV; >98·5%) across a range of prevalences (≤5%). We prospectively validated our models for all patients presenting and admitted to Oxford University Hospitals in a 2-week test period. The ED model (3326 patients) achieved 92·3% accuracy (NPV 97·6%, AUROC 0·881), and the admissions model (1715 patients) achieved 92·5% accuracy (97·7%, 0·871) in comparison with PCR results. Sensitivity analyses to account for uncertainty in negative PCR results improved apparent accuracy (ED model 95·1%, admissions model 94·1%) and NPV (ED model 99·0%, admissions model 98·5%). INTERPRETATION: Our models performed effectively as a screening test for COVID-19, excluding the illness with high-confidence by use of clinical data routinely available within 1 h of presentation to hospital. Our approach is rapidly scalable, fitting within the existing laboratory testing infrastructure and standard of care of hospitals in high-income and middle-income countries. FUNDING: Wellcome Trust, University of Oxford, Engineering and Physical Sciences Research Council, National Institute for Health Research Oxford Biomedical Research Centre.


Subject(s)
Artificial Intelligence , Hematologic Tests , Mass Screening , Predictive Value of Tests , Triage , Adult , Emergency Service, Hospital , Hospitalization , Hospitals , Humans , Middle Aged , Prospective Studies
15.
Lancet Digit Health ; 3(2): e124-e134, 2021 02.
Article in English | MEDLINE | ID: covidwho-1046052

ABSTRACT

The COVID-19 pandemic has resulted in massive disruptions within health care, both directly as a result of the infectious disease outbreak, and indirectly because of public health measures to mitigate against transmission. This disruption has caused rapid dynamic fluctuations in demand, capacity, and even contextual aspects of health care. Therefore, the traditional face-to-face patient-physician care model has had to be re-examined in many countries, with digital technology and new models of care being rapidly deployed to meet the various challenges of the pandemic. This Viewpoint highlights new models in ophthalmology that have adapted to incorporate digital health solutions such as telehealth, artificial intelligence decision support for triaging and clinical care, and home monitoring. These models can be operationalised for different clinical applications based on the technology, clinical need, demand from patients, and manpower availability, ranging from out-of-hospital models including the hub-and-spoke pre-hospital model, to front-line models such as the inflow funnel model and monitoring models such as the so-called lighthouse model for provider-led monitoring. Lessons learnt from operationalising these models for ophthalmology in the context of COVID-19 are discussed, along with their relevance for other specialty domains.


Subject(s)
Delivery of Health Care , Ophthalmology , Telemedicine , Triage , Artificial Intelligence , Humans
16.
Mil Med Res ; 8(1): 7, 2021 01 24.
Article in English | MEDLINE | ID: covidwho-1045591

ABSTRACT

Novel coronavirus (2019-nCoV), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a pathogen that has caused a rapidly spreading pandemic all over the world. The primary mean of transmission is inhalation with a predilection for respiratory system involvement, especially in the distal airways. The disease that arises from this novel coronavirus is named coronavirus disease 2019 (COVID-19). COVID-19 may have a rapid and devastating course in some cases leading to severe complications and death. Radiological imaging methods have an invaluable role in diagnosis, follow-up, and treatment. In this review, radiological imaging findings of COVID-19 have been systematically reviewed based on the published literature so far. Radiologic reporting templates are also emphasized from a different point of view, considering specific distinctive patterns of involvement.


Subject(s)
/diagnostic imaging , Lung/diagnostic imaging , Algorithms , /epidemiology , Humans , Pandemics , Prognosis , Radiography , Real-Time Polymerase Chain Reaction , Time Factors , Tomography, X-Ray Computed , Triage/methods , Ultrasonography
18.
Eur J Endocrinol ; 184(3): 413-422, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1034947

ABSTRACT

Objective: The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. Design: The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. Methods: Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. Results: 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. Conclusion: Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.


Subject(s)
/diagnosis , Hypernatremia/diagnosis , Hypernatremia/epidemiology , Hyponatremia/diagnosis , Hyponatremia/epidemiology , Adult , Aged , /therapy , Case-Control Studies , Cohort Studies , Critical Care/statistics & numerical data , Female , Hospital Mortality , Hospitalization/statistics & numerical data , Humans , Hypernatremia/complications , Hypernatremia/therapy , Hyponatremia/complications , Hyponatremia/therapy , Length of Stay/statistics & numerical data , Male , Middle Aged , Mortality , Pandemics , Prevalence , Prognosis , Prospective Studies , Switzerland/epidemiology , Triage
20.
Nursing (Säo Paulo) ; 23(269): 4773-4780, out.2020.
Article in Portuguese | LILACS (Americas) | ID: covidwho-1022676

ABSTRACT

Objetivo: Descrever as dificuldades relatadas pelos profissionais de saúde perante a assistência a pacientes suspeitos ou confirmados da COVID-19, durante um atendimento em triagem para realização de exame. Método: Trata-se de um relato de experiência dos atendimentos em triagem de enfermagem à profissionais de saúde para coleta de amostras para o diagnóstico da COVID-19, entre abril a julho de 2020, em uma universidade pública da região central do Brasil. Resultados: As dificuldades reportadas foram: acesso limitado aos Equipamentos de Proteção Individual nos ambientes de trabalho; acesso restrito a testagem diagnóstica para COVID-19 e pouco conhecimento sobre a diferenciação e finalidade dos testes. Conclusão: A atuação da enfermagem aos profissionais da saúde na pandemia é de extrema importância. É relevante abordagens estratégicas de órgãos governamentais e de instituições de saúde acerca de capacitação para os profissionais da saúde e acesso aos equipamentos necessários para a saúde do trabalhador.(AU)


Objective: To describe the difficulties reported by health professionals during the screening service, given the difficulties in assisting suspected or confirmed patients at COVID-19. Method: This is an experience report of the care provided in nursing screening to health professionals to collect samples for the diagnosis of COVID-19, between April and July 2020, at a public university in central Brazil. Results: The difficulties reported were: limited access to Personal Protective Equipment in the workplace; restricted access to diagnostic testing for COVID-19 and poor knowledge about the differentiation and purpose of the tests. Conclusion: The performance of nursing to health professionals in the pandemic is extremely important. Strategic approaches by government agencies and health institutions regarding training for health professionals and access to equipment necessary for workers' health are relevant.(AU)


Objetivo: Describir las dificultades reportadas por los profesionales de la salud durante el servicio de cribado, dadas las dificultades para atender a pacientes sospechosos o confirmados en COVID-19. Método: Se trata de un informe de experiencia de la atención brindada en el cribado de enfermería a profesionales de la salud para recolectar muestras para el diagnóstico de COVID-19, entre abril y julio de 2020, en una universidad pública del centro de Brasil. Resultados: Las dificultades reportadas fueron: acceso limitado a Equipo de Protección Personal en el lugar de trabajo; acceso restringido a las pruebas de diagnóstico para COVID-19 y poco conocimiento sobre la diferenciación y el propósito de las pruebas. Conclusión: El desempeño de la enfermería a los profesionales de la salud en la pandemia es de suma importancia. Los enfoques estratégicos de las agencias gubernamentales y las instituciones de salud con respecto a la capacitación de los profesionales de la salud y el acceso a los equipos necesarios para la salud de los trabajadores son relevantes.(AU)


Subject(s)
Humans , Nursing Diagnosis , Triage , Coronavirus Infections , Community Health Nursing , Health Services , Pandemics
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