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2.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: covidwho-688266

RESUMEN

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


Asunto(s)
Infecciones por Coronavirus/rehabilitación , Modalidades de Fisioterapia , Neumonía Viral/rehabilitación , Insuficiencia Respiratoria/rehabilitación , Terapia Respiratoria/métodos , Atención Ambulatoria , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Técnica Delfos , Prueba de Esfuerzo , Humanos , Unidades de Cuidados Intensivos , Italia , Estado Nutricional , Pandemias , Equipo de Protección Personal , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Calidad de Vida , Pruebas de Función Respiratoria , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Trastornos por Estrés Postraumático
3.
Arch Gerontol Geriatr ; 89: 104096, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-688201

RESUMEN

A pandemic of 2019 novel coronavirus (COVID-19) is an international problem and factors associated with increased risk of mortality have been reported. However, there exists limited statistical method to estimate a comprehensive risk for a case in which a patient has several characteristics and symptoms concurrently. We applied Boolean Monte Carlo method (BMCM) to the Novel Corona Virus 2019 Dataset to determine interrelation of patient's characteristics and symptoms. In the analyses, age, fever as an onset symptom, and sex were used as explanatory variables, and death as the objective variable. Among 265 patients included in the analysis, the interrelations for estimating death were determined as age "and" fever "and" sex (p < 0.0001 for both operators). This result indicates that satisfying the three conditions of age, fever, and sex concurrently may be associated with an increased risk of mortality.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Infecciones por Coronavirus/epidemiología , Fiebre/virología , Humanos , Italia/epidemiología , Masculino , Modelos Estadísticos , Pandemias , Neumonía Viral/epidemiología
5.
Eur Heart J ; 41(19): 1830-1832, 2020 05 14.
Artículo en Inglés | MEDLINE | ID: covidwho-687421
6.
Riv Psichiatr ; 55(3): 131-136, 2020.
Artículo en Italiano | MEDLINE | ID: covidwho-685352

RESUMEN

CoViD-19 pandemic is causing serious consequences on mental health, consequences that are considered that bad that World Health Organization has affirmed that mental health defence is priority in this particular moment of development of pandemic. In light of this alertness, what we are interested in approaching in this work, is the specific stress condition caused by pandemic, which underlies and precedes the described classification of diseases and which is going towards an increase in the entire world, including Italy. The stress caused by pandemic is a new condition in comparison with what is known in clinical practice and with what is included in the classification of mental disorder. The ongoing stress condition and the mixture of different types of unconventional stress, which not only hits the present but also disrupts the future, create an entirely new form of clinical condition given by pandemic.


Asunto(s)
Adaptación Psicológica , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/psicología , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/psicología , Estrés Psicológico/etiología , Infecciones por Coronavirus/prevención & control , Humanos , Italia/epidemiología , Salud Mental , Pandemias/prevención & control , Neumonía Viral/prevención & control
7.
8.
10.
G Ital Cardiol (Rome) ; 21(8): 565-569, 2020 Aug.
Artículo en Italiano | MEDLINE | ID: covidwho-680055

RESUMEN

In Italy, the epidemic explosion stage of COVID-19 seems to have been overcome; however, the virus has not been eradicated and the re-emergence of some outbreaks of infection substantiates the danger that the disease may persist. It is therefore necessary to keep the level of surveillance high, to maintain social distancing measures and to act in the control of disease risk factors of a serious or complicated course. Among the risk factors of severe COVID-19 in addition to age, male gender, hypertension and cardiovascular diseases, a major role seems to be played by other cardiovascular risk factors conditioned by an unhealthy lifestyle such as obesity, metabolic syndrome, diabetes and smoking. The new phase requires the maintenance of measures that avoid crowding and close interpersonal contact especially during exercise, in addition to controlled access to hospitals. This will require the reorganization of the traditional methods of cardiovascular prevention and rehabilitation activities, such as gyms and collective educational sessions, and the dilution of outpatient checks. The risk that this scenario may worsen the already suboptimal control of cardiovascular risk factors is therefore real. We do not currently know how long this new phase will last, therefore it is necessary to give impetus to new tele-health initiatives to stimulate the adoption of a healthy lifestyle in primary prevention and tele-monitoring and tele-rehabilitation programs in secondary prevention.


Asunto(s)
Enfermedades Cardiovasculares/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Infecciones por Coronavirus/epidemiología , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Telemedicina/organización & administración , Cardiólogos , Enfermedades Cardiovasculares/diagnóstico , Infecciones por Coronavirus/prevención & control , Femenino , Estudios de Seguimiento , Hospitales Universitarios , Humanos , Italia/epidemiología , Masculino , Pandemias/prevención & control , Rol del Médico , Neumonía Viral/prevención & control , Medición de Riesgo , Factores de Tiempo
11.
G Ital Cardiol (Rome) ; 21(8): 575-583, 2020 Aug.
Artículo en Italiano | MEDLINE | ID: covidwho-680054

RESUMEN

The new coronavirus disease 2019 (COVID-19), which is causing hundreds of thousands of deaths worldwide, is complex and can present with a multi-organ localization. One of its worst complications is an interstitial pneumonia with acute respiratory failure also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which requires non-invasive or invasive ventilation. A severe coagulopathy with poor prognosis is found in 5-10% of cases. SARS-CoV-2 is manifesting as a multi-dimensional disease and, recently, unique co-existing pathophysiological and clinical aspects are being defined: (i) an increased immune and inflammatory response with the activation of a cytokine storm and consequent coagulopathy, which promote both venous thromboembolic events and in situ thrombosis localized in small arterioles and pulmonary alveolar capillaries; (ii) a high intrapulmonary shunt, which often accounts for the severity of respiratory failure, due to reduced hypoxic pulmonary vasoconstriction with pulmonary neo-angiogenetic phenomena. Furthermore, the high incidence of venous thromboembolism in COVID-19 patients admitted to the intensive care unit and the autoptic findings of in situ micro-thrombosis at the pulmonary vascular level, suggest that in this disease coagulopathy, unlike septic disseminated intravascular coagulation, is driven towards a hyper-thrombogenic state, giving rise to a debate (with ongoing studies) about the preventive use of anticoagulant doses of heparin to reduce mortality. The aim of this position paper from the Italian Association of Hospital Cardiologists (ANMCO) is to highlight the main implications that COVID-19 infection has on the pulmonary circulation from a pathophysiological, clinical and management point of view.


Asunto(s)
Causas de Muerte , Infecciones por Coronavirus/epidemiología , Enfermedades Pulmonares Intersticiales/mortalidad , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Síndrome Respiratorio Agudo Grave/epidemiología , Tromboembolia Venosa/etiología , Cardiología , Enfermedades Transmisibles Emergentes/epidemiología , Infecciones por Coronavirus/diagnóstico , Progresión de la Enfermedad , Femenino , Humanos , Incidencia , Italia/epidemiología , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/fisiopatología , Masculino , Neumonía Viral/diagnóstico , Circulación Pulmonar/fisiología , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/diagnóstico , Sociedades Médicas , Análisis de Supervivencia , Tromboembolia Venosa/mortalidad , Tromboembolia Venosa/fisiopatología
12.
G Ital Cardiol (Rome) ; 21(8): 594-597, 2020 Aug.
Artículo en Italiano | MEDLINE | ID: covidwho-680053

RESUMEN

Severe acute respiratory syndrome coronavirus 2 may affect the cardiovascular system and cause acute cardiac injury. Other authors described cases of myocarditis with reduced systolic function and/or a life-threatening presentation. We describe the clinical course of an unusual presentation with isolated reversible high degree atrioventricular block in a patient with COVID-19. In this case, a "wait and see approach" avoided an unnecessary permanent pacemaker implantation.


Asunto(s)
Bloqueo Atrioventricular/complicaciones , Bloqueo Atrioventricular/diagnóstico por imagen , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Espera Vigilante , Infecciones por Coronavirus/diagnóstico , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Italia , Imagen por Resonancia Cinemagnética/métodos , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo
13.
G Ital Cardiol (Rome) ; 21(8): 570-574, 2020 Aug.
Artículo en Italiano | MEDLINE | ID: covidwho-680052

RESUMEN

Several important gender differences in susceptibility, clinical manifestation and response to treatments for a number of diseases are known since a long time, although they continue to be underestimated by a multiplicity of operators, especially men. The recent COVID-19 pandemic has provided a further evidence of the importance of gender medicine. The epidemiological analysis of COVID-19 data has highlighted the presence of multiple and important gender differences, with more unfavourable scenarios for the male gender. The mechanisms underlying these gender differences are varied (including socio-behavioral, immune and viral factors) and not yet fully clarified. A gender-based approach to clinical practice also in the context of this pandemic seems to be mandatory, as it could significantly contribute to health promotion by improving the effectiveness of diagnostic and/or therapeutic approaches and, therefore, leading to important benefits primarily for the patients but also for the sustainability of the National Health System.


Asunto(s)
Causas de Muerte , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/epidemiología , Susceptibilidad a Enfermedades/epidemiología , Pandemias/estadística & datos numéricos , Neumonía Viral/epidemiología , Infecciones por Coronavirus/diagnóstico , Prestación de Atención de Salud/organización & administración , Femenino , Promoción de la Salud , Humanos , Italia/epidemiología , Masculino , Neumonía Viral/diagnóstico , Prevalencia , Medición de Riesgo , Distribución por Sexo , Análisis de Supervivencia
15.
Assist Inferm Ric ; 39(2): 66-108, 2020.
Artículo en Italiano | MEDLINE | ID: covidwho-679586

RESUMEN

. The covid-19 emergency in the words of the nurses . This special issue of AIR is dedicated to the direct professional experiences and personal testimonies of a sample of the nursing personnel during the most dramatic phase of the covid-19 pandemia in the most severely affected regions of Northern Italy (Lombardy, Piedmont, Veneto, Friuli, Trentino, Emilia Romagna Regions). The decision to adopt a research strategy aimed to give visibility and voice to colleagues representing some of the key hospitals of the regions obliged to a radical reorganisation of their structures and organisation of care, was adopted to catch from inside the crisis scenarios the expected mix of intense emotions (from anxiety, to fatigue, to personal and professional uncertainty, to the burden of impotence), and of needed technical creativity and efficiency which were requested to face a totally unexpected situation where guidelines could hardly be of help. The interview/diaries/focus groups were carefully planned not so much in terms of the contents, but with attention to the acceptance of the interviewed to enter in a free dialogue, with no Q&A, to be recorded, and to last for the time felt to be by both sides appropriate. The texts which are reported in this dossier are fragments of the recordings (overall more then 30 hours), without adjustments. It has been agreed that while all the names of the participants are provided as 'authors', the individual contributions are anonymous (not out of privacy consideration!) as they are part of a collective narrative, which reflects the great variability of the languages and of the perceived-expressed experiences and memories. The material has been organised in sections which are conceived as 'verbal snapshots' taken from the networks of care settings, but at the same time of the places and houses where the colleagues were literally full-time living, to assure unaccountable overtime working hours, and the requested 'safety distances' and lockdowns. The titles of the 8 sections coincide somehow with the principal components of the chain of activities and challenges which had to be faced: The changes in everyday's care, How to be prepared to the emergency, The teamwork, The loneliness and the isolation of the patients, The loneliness of the nurses, The difficult choices, The organization of the work and of the wards, change after covid-19. The core of the dossier is framed by boxes which provide also a minimum background of the administrative and epidemiological data on the pandemia in the regions of interest (it is interesting to remind that the central-southern areas of Italy have been far less affected), and a brief concluding reflection on reflection on the post-pandemia from the nursing point of view.


Asunto(s)
Actitud del Personal de Salud , Actitud Frente a la Salud , Infecciones por Coronavirus , Enfermeras y Enfermeros/psicología , Pandemias , Neumonía Viral , Toma de Decisiones Clínicas , Urgencias Médicas , Administración Hospitalaria , Humanos , Italia , Soledad , Enfermería/métodos , Enfermería/organización & administración , Grupo de Enfermería , Aislamiento de Pacientes
17.
J Orthop Surg Res ; 15(1): 279, 2020 Jul 23.
Artículo en Inglés | MEDLINE | ID: covidwho-671475

RESUMEN

BACKGROUND: According to the required reorganization of all hospital activities, the recent COVID-19 pandemic had dramatic consequences on the orthopedic world. We think that informing the orthopedic community about the strategy that we adopted both in our hospital and in our Department of Orthopedics could be useful, particularly for those who are facing the pandemic later than Italy. METHODS: Changes were done in our hospital by medical direction to reallocate resources to COVID-19 patients. In the Orthopedic Department, a decrease in the number of beds and surgical activity was stabilized. Since March 13, it has been avoided to perform elective surgery, and since March 16, non-urgent outpatient consultations were abolished. This activity reduction was associated with careful evaluation of staff and patients: extensive periodical swab testing of all healthcare staff and swab testing of all surgical patients were applied. RESULTS: These restrictions determined an overall reduction of all our surgical activities of 30% compared to 2019. We also had a reduction in outpatient clinic activities and admissions to the orthopedic emergency unit. Extensive swab testing has proven successful: of more than 160 people tested in our building, only three COVID-19 positives were found, and of over more than 200 surgical procedures, only two positive patients were found. CONCLUSIONS: Extensive swab test of all people (even if asymptomatic) and proactive tracing and quarantining of potential COVID-19 positive patients may diminish the virus spread.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/epidemiología , Ortopedia/organización & administración , Neumonía Viral/epidemiología , Técnicas de Laboratorio Clínico/métodos , Técnicas de Laboratorio Clínico/estadística & datos numéricos , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Infección Hospitalaria/prevención & control , Urgencias Médicas , Reforma de la Atención de Salud/organización & administración , Hospitalización , Humanos , Control de Infecciones/organización & administración , Italia/epidemiología , Procedimientos Ortopédicos/estadística & datos numéricos , Servicio Ambulatorio en Hospital/organización & administración , Servicio Ambulatorio en Hospital/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Servicio de Cirugía en Hospital/organización & administración
19.
G Ital Cardiol (Rome) ; 21(8): 594-597, 2020 Aug.
Artículo en Italiano | MEDLINE | ID: covidwho-657718

RESUMEN

Severe acute respiratory syndrome coronavirus 2 may affect the cardiovascular system and cause acute cardiac injury. Other authors described cases of myocarditis with reduced systolic function and/or a life-threatening presentation. We describe the clinical course of an unusual presentation with isolated reversible high degree atrioventricular block in a patient with COVID-19. In this case, a "wait and see approach" avoided an unnecessary permanent pacemaker implantation.


Asunto(s)
Bloqueo Atrioventricular/complicaciones , Bloqueo Atrioventricular/diagnóstico por imagen , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Espera Vigilante , Infecciones por Coronavirus/diagnóstico , Electrocardiografía/métodos , Femenino , Estudios de Seguimiento , Humanos , Italia , Imagen por Resonancia Cinemagnética/métodos , Persona de Mediana Edad , Pandemias , Neumonía Viral/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo
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