RESUMEN
Background: COVID-19 syndrome is associated with high morbidity and mortality in haemodialyzed patients. Pancreatic Stone Protein (PSP) is an early biomarker of sepsis and a prognostic biomarker of disease severity in critically-ill patients and can be rapidly measured at the patient's bedside with a point-of-care-test from a small drop of whole blood. The aim of our pilot was to investigate PSP in patients requiring haemodialysis with SARS-CoV-2 infection, at different severities of COVID-19 disease. Method(s): Between February and July 2021, 23 patients (6 severe COVID-19 with Acute Kidney Injury, 6 moderate COVID-19 haemodialyzed, 2 haemodialyzed without COVID-19 and 3 healthy controls) were recruited at the University Hospital of Foggia for PSP evaluation. Biomarker's measurements were performed within 48 hours after admission or upon arrival for haemodialysis (pre-treatment). PSP was measured at the patient's bedside with "abioSCOPE", a point-of-care test capable of evaluating PSP levels in five minutes from a small drop (50mul) of whole blood or serum. Result(s): The preliminary results of this pilot study showed a trend for PSP to increase along with the severity of disease. In fact, serum PSP levels were significantly higher in Intensive Care Unit subjects than in COVID-19 negative haemodialysis subjects and controls (ANOVA p=0.032). Furthermore, PSP levels were significantly higher in subjects who died (p<0.017). Whether this increase is due to the kidney injury or COVID-19 disease remains unknown, and more research is needed to understand the relationship. Conclusion(s): Several clinical studies published in literature have shown the predictive value of PSP in the early identification of sepsis and severity of the clinical outcome. In our experience we have seen a trend for PSP to increase with disease severity also in COVID-19 patients. These results are preliminary, but PSP was significantly higher in patients who died, in accordance with the literature. This experience also has demonstrated the feasibility of a point of care system to be easily implemented in the unit and adopted by personnel and its design enables fast results and immediate decisions to be taken, especially in urgent situations.
RESUMEN
In May 2020, we implemented a home spirometry program (HSP) to facilitate remote monitoring of lung function in lung transplant recipients in response to the COVID-19 pandemic. We found enrollment and adherence rates were below the program goal of 75%. We developed a quality improvement project to optimize the HSP enrollment and onboarding in order to improve enrollment and adherence rates. Gap analysis was performed through observation and qualitative interviews of patients, nurses, and physicians. A fishbone analysis found three main opportunities to improve adherence including a variable onboarding process, no foreign language offerings, and suboptimal educational material. We developed and launched a standardized workflow, a new educational video, and educational materials in 5 languages. In-process metrics were tracked through the use of an EMR "smartphrase" and QR code to indicate use of the new workflow and educational video. Enrollment and adherence were measured by the % of patients submitting more than one FEV1 value in the first 30 days after discharge. After implementation in August 2022, we found the new onboarding process, as indicated by the use of our"smartphrase", and the new educational video, as indicated by the use of the QR code, were utilized for 100% of new patients over the first two months. We found an absolute increase of 85% of patients submitting an FEV1 value in the first month following discharge from lung transplantation (Figure 1). We were able to improve the process of onboarding and education through the development of a new standardized workflow and video. This was found to be reliably executed and resulted in an improvement in patient enrollment and adherence. Moving forward we will track the impact of our new onboarding and video educational tool on long-term adherence. [ABSTRACT FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
RESUMEN
Due to the rapid spread of the novel coronavirus pandemic, a reorganization of the health care sector was needed. Many questions arose concerning the specificity of psychiatric care in this unprecedented situation. In Geneva, Switzerland, the department of psychiatry decided to open a new ward for its infected patients. Beyond the challenge of setting it up quickly, we faced the challenges of taking care of a heterogeneous group of patients and of incorporating protection measures we were not accustomed to, which add a significant amount of time to the daily care of patients. The staff recruitment on a voluntary basis, close supervision, availability of the personal protective material as well as support from the infection prevention and control unit have enabled proper functioning of the ward.
RESUMEN
Due to the rapid spread of the novel coronavirus pandemic, a reorganization of the health care sector was needed. Many questions arose concerning the specificity of psychiatric care in this unprecedented situation. In Geneva, Switzerland, the department of psychiatry decided to open a new ward for its infected patients. Beyond the challenge of setting it up quickly, we faced the challenges of taking care of a heterogeneous group of patients and of incorporating protection measures we were not accustomed to, which add a significant amount of time to the daily care of patients. The staff recruitment on a voluntary basis, close supervision, availability of the personal protective material as well as support from the infection prevention and control unit have enabled proper functioning of the ward.