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1.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-686322

RESUMEN

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Presión Sanguínea , Trastornos Cerebrovasculares/epidemiología , China , Comorbilidad , Coronavirus , Enfermedad Crítica , Puntuación de Alerta Temprana , Medicina de Emergencia , Femenino , Escala de Coma de Glasgow , Humanos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Pandemias , Pronóstico , Curva ROC , Frecuencia Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad
5.
MEDICC Rev ; 22(2): 64-66, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: covidwho-459830

RESUMEN

The days are long and arduous, with end-less patients to attend, often in a foreign language, always on foreign shores. Far from family and the familiar. Sleep is fi tful at best for health profession-als serving in emergency situations-when sickness obeys no clock and patients' pain haunts even the quiet moments. The crisis scenario varies: post-earthquake, hurricane or tsunami; amid a cholera or Ebola epidemic. The countries vary: Haiti, Pakistan, Guatemala, Mozambique, Sierra Leone. What does not vary is the answer to the calls for help and Cuban professionals' commitment to care for the most vulner-able. These aren't armchair musings or a political pat on the back: they are my own conclusions after living for weeks in close-quarter tents with Cuban doctors, nurses and biomedical engineers in post-earth-quake Pakistan and Haiti, and witnessing their work.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Medicina de Emergencia , Cooperación Internacional , Pandemias , Neumonía Viral , Cuba , Humanos , Recursos Humanos
9.
Postgrad Med J ; 96(1137): 384-386, 2020 Jul.
Artículo en Inglés | MEDLINE | ID: covidwho-260512

RESUMEN

The COVID-19 pandemic has affected healthcare systems worldwide. The disruption to hospital routines has affected continuing medical education (CME) for specialty trainees (STs). We share our academic institution's experience in mitigating the disruption on the CME programme amidst the pandemic. Most specialty training programmes had switched to videoconferencing to maintain teaching. Some programmes also utilized small group teachings with precautions and e-learning modules. Surgical residencies were disproportionately affected due to reductions in elective procedures but some ways to provide continued surgical exposure include going through archived surgical videos with technical pointers from experienced faculty and usage of surgical simulators . We should adapt CME sessions to keep trainees up to date with core clinical competencies as they will continue to manage both COVID-19 and non-COVID-19 cases and this pandemic may last until year's end.


Asunto(s)
Competencia Clínica/normas , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud/organización & administración , Educación Médica Continua/tendencias , Medicina , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Medicina de Emergencia/educación , Investigación sobre Servicios de Salud , Humanos , Infectología/educación , Innovación Organizacional , Neumonía Viral/epidemiología , Medicina Preventiva/educación , Psiquiatría/educación , Neumología/educación
11.
Eur J Emerg Med ; 27(3): 174-177, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-142684

RESUMEN

The 2019 novel coronavirus acute respiratory epidemic is creating a stressed situation in all the health systems of the affected countries. Emergency medical systems and specifically the emergency departments as the front line of the health systems are suffering from overload and severe working conditions, the risk of contagion and transmission of the health professionals adds a substantial burden to their daily work. Under the perspective of European Society For Emergency Medicine, the recommendations provided by the health authorities are reviewed focus on the emergency department's activity.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Medicina de Emergencia/normas , Servicio de Urgencia en Hospital/organización & administración , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Betacoronavirus , Humanos , Control de Infecciones , Pandemias , Aislamiento de Pacientes , Equipo de Protección Personal/provisión & distribución , Triaje
15.
J Nepal Health Res Counc ; 18(1): 142-143, 2020 Apr 20.
Artículo en Inglés | MEDLINE | ID: covidwho-127689

RESUMEN

Patan Academy of Health Sciences started preparedness for COVID-19 in response to increasing number of patient in neighboring country. Outbreak preparedness in resource limited setup is challenging. Despite this, preparedness was done in reference to WHO interim guidance utilizing best available resources. During this preparedness, one patient was isolated as suspected COVID-19. This paper presents level of preparedness achieved with the limited resources and the lesson learned while isolating the patient. Keywords: COVID-19; Disaster; hospital preparedness.


Asunto(s)
Defensa Civil/métodos , Infecciones por Coronavirus/epidemiología , Coronavirus , Planificación en Desastres , Brotes de Enfermedades/prevención & control , Medicina de Emergencia/organización & administración , Neumonía Viral/epidemiología , Betacoronavirus , Salud Global , Hospitales , Humanos , Nepal , Pandemias , Salud Pública
17.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Artículo en Inglés | MEDLINE | ID: covidwho-88721

RESUMEN

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Asunto(s)
Infecciones por Coronavirus/mortalidad , Mortalidad Hospitalaria , Neumonía Viral/mortalidad , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Betacoronavirus , Presión Sanguínea , Trastornos Cerebrovasculares/epidemiología , China , Comorbilidad , Coronavirus , Enfermedad Crítica , Puntuación de Alerta Temprana , Medicina de Emergencia , Femenino , Escala de Coma de Glasgow , Humanos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Oxígeno/metabolismo , Pandemias , Pronóstico , Curva ROC , Frecuencia Respiratoria , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad
18.
West J Emerg Med ; 21(3): 538-541, 2020 04 02.
Artículo en Inglés | MEDLINE | ID: covidwho-72833

RESUMEN

The Council of Residency Directors in Emergency Medicine (CORD) Advising Students Committee in Emergency Medicine (ASC-EM) anticipates institutional and regional variability in both the spread and response to COVID-19. Travel restrictions and host institution rotation closures will impact the number of emergency medicine (EM) rotations EM-bound medical students can complete in an unprecedented manner. They may prevent students from completing any away rotations this academic cycle, challenging the students' ability to obtain EM Standardized Letters of Evaluation (SLOEs). EM's emphasis on residency group SLOEs over other letter types creates an undue burden on these vulnerable students and makes the application process intrinsically inequitable. This inequity warrants a reevaluation of the current application practice. This article outlines ASC-EM's proposed recommendations for all stakeholders, including EM program leadership, medical schools, and EM-bound medical students, to consider for the upcoming EM application cycle.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Medicina de Emergencia/educación , Internado y Residencia/métodos , Pandemias , Neumonía Viral , Viaje , Competencia Clínica/normas , Medicina de Emergencia/normas , Humanos , Política Organizacional , Facultades de Medicina , Estudiantes de Medicina , Estados Unidos
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