Short report: factors determining perceived stress among medical staff in radiology departments during the COVID-19 outbreak.

Medical staff in radiology departments faces a higher risk of infection and a heavier workload during the new coronavirus disease (COVID-19) outbreak. High perceived stress levels endanger physical and mental health and affect work efficiency and patient safety. Therefore, it is urgent to understand the perceived stress levels of medical staff and explore its risk factors. We recruited 600 medical staff from the radiology departments of 32 public hospitals in Sichuan Province, China, to evaluate perceived stress scores via a mobile app-based questionnaire. The results showed that the perceived stress level among medical staff in the radiology departments during the COVID-19 outbreak was high and a sense of tension was strongly present. A positive correlation was found between anxiety score and perceived stress. Multivariate analysis showed that risk factors for perceived stress were female, existing anxiety, and fears of being infected at work, an uncontrollable outbreak, and not being able to pay rent or mortgage. Conversely, good knowledge about COVID-19, being unmarried, and working in a higher-grade hospital were protective factors for perceived stress. Therefore, more attention should be given to medical staff in the radiology departments that present the risk factors outlined above. Timely risk assessment of psychological stress and effective intervention measures should be taken for these high-risk groups to keep their perceived stress within normal limits.

Chest CT features and progression of patients with coronavirus disease 2019.

OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a major public health emergency. It poses a grave threat to human life and health. The purpose of the study is to investigate the chest CT findings and progression of the disease observed in COVID-19 patients. METHODS: Forty-nine confirmed cases of adult COVID-19 patients with common type, severe and critically severe type were included in this retrospective single-center study. The thin-section chest CT features and progress of the disease were evaluated. The clinical and chest imaging findings of COVID-19 patients with different severity types were compared. The CT severity score and MuLBSTA score (a prediction of mortality risk) were calculated in those patients. RESULTS: Among the 49 patients, 35 patients (71%) were common type and 14 patients (28%) were severe and critically severe type. Nearly all patients (98%) had pure ground-glass opacities (GGO) in CT imaging. Of the severe and critically severe type patients, 86% exhibited GGO with consolidation, in comparison with 54% of the patients with common type. Fibrosis presented in 79% of the severe and critically severe type patients and 43% of the common type patients. The severe and critically severe type patients were significantly more prone to experience five-lobe involvement compared to the common type patients (p = 0.002). The severe and critically severe type patients also had higher CT severity and MuLBSTA scores than the common type patients (5.43 ± 2.38 vs 3.37 ± 2.40, p < 0.001;and 10.21 ± 3.83 vs 4.63 ± 3.43, p < 0.001, respectively). MuLBSTA score was positively correlated with admittance to the intensive care unit (p = 0.005, r = 0.351). Nineteen patients underwent three times CT scan. The interval between first and second CT scan was 4[4,8] days, second and third was 3[2,4] days. There were greater improvements in the third CT follow-up findings compared to the second (p = 0.002). CONCLUSIONS: The severe and critically severe type patients often experienced more severe lung lesions, including GGO with consolidation. The CT severity score and MuLBSTA score may be helpful for the assessment of COVID-19 severity and progression. ADVANCES IN KNOWLEDGE: Chest CT has the value of evaluated radiographical features of COVID-19 and allow for dynamic observation of the disease progression. Considering coagulation disorder of COVID-19, MuLBSTA score may need to be updated to increase new understanding of COVID-19.

Performance of Two Risk-Stratification Models in Hospitalized Patients With Coronavirus Disease.

Background: Despite an increase in the familiarity of the medical community with the epidemiological and clinical characteristics of coronavirus disease 2019 (COVID-19), there is presently a lack of rapid and effective risk stratification indicators to predict the poor clinical outcomes of COVID-19 especially in severe patients. Methods: In this retrospective single-center study, we included 117 cases confirmed with COVID-19. The clinical, laboratory, and imaging features were collected and analyzed during admission. The Multi-lobular infiltration, hypo-Lymphocytosis, Bacterial coinfection, Smoking history, hyper-Tension and Age (MuLBSTA) Score and Confusion, Urea, Respiratory rate, Blood pressure, Age 65 (CURB65) score were used to assess the death and intensive care unit (ICU) risks in all patients. Results: Among of all 117 hospitalized patients, 21 (17.9%) patients were admitted to the ICU care, and 5 (4.3%) patients were died. The median hospital stay was 12 (10-15) days. There were 18 patients with MuLBSTA score ≥ 12 points and were all of severe type. In severe type, ICU care and death patients, the proportion with MuLBSTA ≥ 12 points were greater than that of CURB65 score ≥ 3 points (severe type patients, 50 vs. 27.8%; ICU care, 61.9 vs. 19.0%; death, 100 vs. 40%). For the MuLBSTA score, the ROC curve showed good efficiency of diagnosis death (area under the curve [AUC], 0.956; cutoff value, 12; specificity, 89.5%; sensitivity, 100%) and ICU care (AUC, 0.875; cutoff value, 11; specificity, 91.7%; sensitivity, 71.4%). The K-M survival analysis showed that patients with MuLBSTA score ≥ 12 had higher risk of ICU (log-rank, P = 0.001) and high risk of death (log-rank, P = 0.000). Conclusions: The MuLBSTA score is valuable for risk stratification and could effectively screen high-risk patients at admission. The higher score at admission have higher risk of ICU care and death in patients infected with COVID.

Clinical Characteristics and Risk Factors of Cardiac Involvement in COVID-19.

Background Increasing studies demonstrated that the cardiac involvements are related to coronavirus disease 2019 (COVID-19). Thus, we investigated the clinical characteristics of patients with COVID-19 and further determined the risk factors for cardiac involvement in them. Methods and Results We analyzed data from 102 consecutive laboratory-confirmed and hospitalized patients with COVID-19 (52 women aged 19-87 years). Epidemiologic and demographic characteristics, clinical features, routine laboratory tests (including cardiac injury biomarkers), echocardiography, electrocardiography, chest imaging findings, management methods, and clinical outcomes were collected. Patients were divided into acute cardiac injury, with and without cardiac marker abnormities groups according to different level of cardiac markers. In this research, cardiac involvement was found in 72 of the 102 (70.6%) patients: tachycardia (n=20), electrocardiography abnormalities (n=23), echocardiography abnormalities (n=59), elevated myocardial enzymes (n=55), and acute cardiac injury (n=9). Eight patients with acute cardiac injury were aged >60 years; seven of them had ≥2 underlying comorbidities (hypertension, diabetes mellitus, cardiovascular diseases, chronic obstructive pulmonary disease, and chronic kidney disease). Novel coronavirus pneumonia was much more severe in the patients with acute cardiac injury than in patients with nondefinite acute cardiac injury (P<0.001). Multivariate analyses showed that CRP (C-reactive protein) levels, old age, novel coronavirus pneumonia severity, and underlying comorbidities were the risk factors for cardiac abnormalities in patients with COVID-19. Conclusions Cardiac involvements are common in patients with COVID-19. Elevated CRP levels, old age, underlying comorbidities, and novel coronavirus pneumonia severity are the main risk factors for cardiac involvement in patients with COVID-19. More attention should be given to cardiovascular protection during COVID-19 treatment for mortality reduction. Registration URL: https://www.chictr.org; Unique identifier: ChiCTR2000029955.

Factors Influencing Anxiety of Health Care Workers in the Radiology Department with High Exposure Risk to COVID-19.

BACKGROUND During the outbreak of COVID-19, health care workers in the radiology department frequently interact with suspected patients and face a higher risk of infection and sudden surges in workload. High anxiety levels seriously harm physical and mental health and affect work efficiency and patient safety. Therefore, it is critical to determine anxiety levels of health care workers and explore its risk factors. MATERIAL AND METHODS Self-Rating Anxiety Scale and Connor-Davidson Resilience Scale were used to evaluate the anxiety and resilience of 364 health care workers with high exposure risk from the radiology departments of 32 public hospitals in Sichuan Province, China. Multivariate linear regression was used to analyze factors related to anxiety. RESULTS The mean anxiety score was 44.28±8.93 and 23.4% of our study participants reported mild (n=63), moderate (n=19), or severe (n=3) anxiety. Multiple linear regression analysis showed that age, job position, availability of protective materials, signs of suspected symptoms, and susceptibility to emotions and behaviors of people around them were identified as risk factors for anxiety, whereas psychological resilience was identified as a protective factor. CONCLUSIONS Our study suggests that the anxiety level of health care workers in the radiology department with a high exposure risk to COVID-19 was high in the early stage of the outbreak, although the majority remained within normal limits. Timely assessment and effective intervention measures can improve the mental health of these at-risk populations.

Factors Associated with Resilience Among Medical Staff in Radiology Departments During The Outbreak of 2019 Novel Coronavirus Disease (COVID-19): A Cross-Sectional Study.

BACKGROUND A growing body of evidence suggests that in the face of life adversity, threats, or other major stressful events, resilience is more conducive to individual adaptation and growth. MATERIAL AND METHODS The Connor-Davidson Resilience Scale and the Chinese Perceived Stress Scale were used to evaluate the resilience and perceived stress of 600 medical staff members from the radiology departments in 32 public hospitals in Sichuan Province, China, respectively. Multiple linear regression was used to analyze factors related to resilience. RESULTS The total resilience score was 65.76±17.26, wherein the toughness dimension score was 33.61±9.52, the strength dimension score was 21.25±5.50, and the optimism dimension score was 10.91±3.15. There was a significant negative correlation between perceived stress and resilience (r=-0.635, P<0.001). According to multivariate analysis, the total perceived stress score (ß=-1.318, P<0.001), gender (ß=-4.738, P<0.001), knowledge of COVID-19 (ß=2.884, P=0.043), knowledge of COVID-19 protective measures (ß=3.260, P=0.042), and availability of adequate protective materials (ß=-1.268, P=0.039) were independent influencing factors for resilience. CONCLUSIONS The resilience level of the medical staff in the radiology departments during the outbreak of COVID-19 was generally low, particularly regarding toughness. More attention should be paid to resilience influence factors such as high perceived stress, female gender, lack of understanding of COVID-19 and protective measures, and lack of protective materials, and targeted interventions should be undertaken to improve the resilience level of the medical staff in the radiology departments during the outbreak of COVID-19.