The COVID-19 pandemic: Reorganisation of health services and coping of health care workers in primary healthcare

Background: The COVID-19 pandemic has forced the reorganisation of healthcare services, and the implementation of contingency plans impacted Primary Health Care (PHC) workers' daily demands. The training and support of health workers staff, its clinical, psychological and social support are additional challenges. Research question: How have PHC services responded to the pandemic and how has this impacted PHC workers regarding anxiety levels? Methods: We conducted a cross-sectional survey with a convenience sample of Primary Care Services workers from 7 European countries (Portugal, Spain, Bosnia, Italy, Turkey, Ukraine and France) using an online questionnaire. Ethical aspects were guaranteed. We collected information on gender, age, professional group, perceived support, access to personal protective equipment (PPE), overall pressure felt by professionals and their anxiety levels by March 2020 and May 2021. The association between each variable and anxiety were estimated through multivariate logistic regression. Result(s): Our sample comprised 1045 PHC workers (73.8% female, mean age 44.8 years;49.6% doctors). Almost 70% of participants claimed to monitor suspected COVID-19 patients and 66.5% reported a risk management protocol was in place. In March 2020, 54% of participants reported little/no PPEs availability, whereas in May 2021 76% stated PPEs were available/very available. About 65% of the participants feel high/extreme pressure at their work. High/extreme anxiety levels were reported by 54.1% in March 2020 and 38.3% in May 2021. Multivariate logistic regression analysis showed that feeling supported regarding personal problems and encouraged to maintain social interactions was associated with lower anxiety levels (adjusted OR =0.292, p=0.009;adjusted OR =0.390, p=0.012). Conclusion(s): Despite perceived high work-related pressure levels, PHC services adapted to the pandemic demands by implementation of risk management plans. PHC workers anxiety levels reduced from March 2020 to May 2021. Feeling encouraged to maintain social interactions and supported regarding personal problems decreased the likelihood of anxiety.

Comparison of High-Risk Pulmonary Embolism Patients with and without COVID-19

Objectives: There has been a significant increase in pulmonary embolism (PE) cases during the coronavirus disease of 2019 (COVID-19) pandemic. In this study, we aimed to compare the effects of COVID-19 positivity on morbidity and mortality in patients treated with a diagnosis of high-risk PE. Method(s): In this single-center and observational study, patients who were referred to our center with the diagnosis of PE between January 1, 2019 and 2021 were retrospectively evaluated. Patients with moderate- and low-risk PE according to the European Society of Cardiology PE guidelines, those who did not undergo computed tomography pulmonary angiography (CTPA) or the ones who did not accept treatment were excluded from the study. The patients included in the study were divided into two groups, as those with and without COVID-19, and compared in terms of demographic data, comorbidities, symptoms, thromboembolism in vessels other than the pulmonary artery, laboratory parameters, treatments, and prognosis. Result(s): A total of 384 PE cases were identified during the study period. Among them, 322 cases that were in the intermediate or low-risk category, 21 cases who did not undergo CTPA, and one case who did not accept thrombolytic therapy were excluded from the study. A total of 40 cases were included in the study. The groups with and without COVID-19 consisted of 23 and 17 patients, respectively. In the group of patients with COVID-19, inflammatory markers were higher, Wells score was lower, and thromboembolism was seen in vessels other than the pulmonary artery. The two groups were similar in terms of other laboratory parameters, demographic data, comorbidities, symptoms, treatment, and prognosis. Conclusion(s): While the involvement of COVID-19 in PE etiology does not change mortality, it may cause more thrombosis development in both venous and arterial systems outside the pulmonary area by significantly increasing inflammation. However, the lower Wells scores in COVID-19 PE cases in our study indicate that new clinical assessment tools are needed to detect PE risk in COVID-19 patients.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.

Pneumothorax and Pneumomediastinum in Patients admitted to Intensive Care Unit with COVID-19 Pneumonia: A Single-Center Retrospective Analysis.

Objectives: This study aimed to examine the frequency, and clinical features of pneumothorax and pneumomediastinum cases in patients admitted to the intensive care unit due to coronavirus disease-19 (COVID- 19) pneumonia. Method(s): We retrospectively screened the COVID-19 cases hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022. Patients diagnosed as pneumothorax or pneumomediastinum were determined. The frequency and clinical features of pneumothorax and pneumomediastinum were investigated. Result(s): Seven hundred and twenty patients hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022 were screened. Twenty-four (3.3%) patients had pneumothorax or pneumomediastinum. Pneumothorax occurred 17 patients (70%), and pneumomediastinum in 14 patients (58%). The number of patients who developed pneumomediastinum and pneumothorax together was 7 (29%). COVID-19-associated pneumothorax tended to be unilateral (n=16) and right-sided (n=11). In 18 (75%) patients, pneumothorax or pneumomediastinum developed during invasive mechanical ventilation, 5 (20.8%) patients during non-invasive mechanical ventilation. One patient developed pneumothorax when mechanical ventilation was not applied. The mortality rate at 60 days was 75% (n=18) in patients who were admitted to the intensive care unit with COVID- 19 and developed pneumomediastinum or pneumothorax. Conclusion(s): Pneumothorax and pneumomediastinum are complications of COVID-19 pneumonia with high mortality rates.Copyright © 2022 Turkish Anaesthesiology and Intensive Care Society. All rights reserved.

Pneumothorax and Pneumomediastinum in Patients admitted to Intensive Care Unit with COVID-19 Pneumonia: A Single-Center Retrospective Analysis.

Objectives: This study aimed to examine the frequency, and clinical features of pneumothorax and pneumomediastinum cases in patients admitted to the intensive care unit due to coronavirus disease-19 (COVID- 19) pneumonia. Method(s): We retrospectively screened the COVID-19 cases hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022. Patients diagnosed as pneumothorax or pneumomediastinum were determined. The frequency and clinical features of pneumothorax and pneumomediastinum were investigated. Result(s): Seven hundred and twenty patients hospitalized in our intensive care unit between March 11, 2020, and January 11, 2022 were screened. Twenty-four (3.3%) patients had pneumothorax or pneumomediastinum. Pneumothorax occurred 17 patients (70%), and pneumomediastinum in 14 patients (58%). The number of patients who developed pneumomediastinum and pneumothorax together was 7 (29%). COVID-19-associated pneumothorax tended to be unilateral (n=16) and right-sided (n=11). In 18 (75%) patients, pneumothorax or pneumomediastinum developed during invasive mechanical ventilation, 5 (20.8%) patients during non-invasive mechanical ventilation. One patient developed pneumothorax when mechanical ventilation was not applied. The mortality rate at 60 days was 75% (n=18) in patients who were admitted to the intensive care unit with COVID- 19 and developed pneumomediastinum or pneumothorax. Conclusion(s): Pneumothorax and pneumomediastinum are complications of COVID-19 pneumonia with high mortality rates.Copyright © 2022 Turkish Anaesthesiology and Intensive Care Society. All rights reserved.

A psychosocial perspective on unstable approach: An explanatory sequential mixed methods study

According to Safety Report 2020 published by International Air Transport Association (IATA), in 2020 a remarkable increment is seen in the number of unstable approaches. Professional pilots follow procedures thoroughly. They are not supposed to commit in PINC, except for emergency situations requiring them to do so. With the Covid-19 pandemic, it has gained importance to investigate and identify the underlying reasons for unstable approaches. Explanatory Sequential Design was employed to construct a better understanding of the issue. 2278 pilots from commercial airlines have completed the online survey consisting of demographic form, technical knowledge-scenario questions, and 20 items referring to psychosocial aspects. The results of the quantitative analysis informed the following data collection process. Pilots did not execute missed approach procedure even if stabilization criteria were not met and/or after having approach destabilized unintentionally, CRM instructors, corporate safety experts, managers of the training center and other subject matter experts participated in the semi-structured in-depth interviews. Overall findings implying possible psychological, social, cognitive, and environmental factors of unstable approach are grouped under 14 categories. This paper provides a psychosocial framework for pilots, airline operators, regulators, and other professionals to evaluate the incidence of unintentional unstable approaches profoundly. © 2022 The Author(s).

Chest computed tomography severity score in patients admitted to intensive care unit with COVID-19 pneumonia br

BACKGROUND AND AIM: This study aimed to investigate the association of the chest computed tomography severity score (CT-SS) with mortality in patients who were admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) pneumonia. METHODS: In this single-center retrospective observational study, we reviewed the radiological and medical records of 45 patients with confirmed COVID-19, requiring ICU admission during a 4 month period. The chest CT-SS was used to evaluate the severity of lung involvement. RESULTS: Forty-five patients who admitted to the ICU with COVID-19 and had undergone chest CT scans on admission were enrolled. There wasn't a significant difference in total CT-SS neither between patients who died and those who survived [median (interquartile range) 22 (11-30) vs 16 (9-18), p=0.20] nor between patients who underwent invasive mechanical ventilation and those who did not [median (interquartile range) 22 (12-30) vs 15 (8-17), p=0.17]. The median of CT-SS was 17 (2-39) (n=23 vs n=22). The area under the curve for estimation of mortality according to CT-SS was 0.611 at a 95% CI of 0.434-0.788 (p=0.20). CONCLUSIONS: The total CT-SS, obtained from the chest CT on admission to the ICU, was not associated with an increased risk of mortality in patients admitted to ICU with COVID-19 pneumonia.

Septic shock in patients admitted to intensive care unit with COVID-19 pneumonia

BACKGROUND: The aim of this study was to determine mortality rates and to evaluate clinical features of coronavirus disease 2019 (COVID-19) patients with septic shock in intensive care unit (ICU). MATERIALS AND METHODS: The medical records of COVID-19 patients requiring ICU admission were retrospectively reviewed over a 3-month period. RESULTS: Forty patients with COVID-19 admitted to the ICU were screened. Two patients died within 24 h after ICU admission. After these patients were excluded, septic shock was detected in 11 (28%) of 38 patients during the 30-day follow-up period. Ten (91%) of the 11 patients with septic shock died in the ICU. Eight (72%) of the 11 patients had nosocomial infection during 30-day follow-up period. Six (54%) of 11 septic shock patients had positive culture results for bacterial pneumonia on the day of septic shock. The median time from symptom onset to septic shock was 14 (5-34) days. The median duration from ICU admission until septic shock was 8 (1-28) days. All of the patients with septic shock underwent invasive mechanical ventilation (IMV). CONCLUSION: COVID-19 patients with septic shock have higher mortality rates, percentage of nosocomial infection, and IMV requirement.

Smoking and, COVID-19

It is known that SARS-CoV-2 affects the respiratory tract and causes pneumonia and respiratory failure in patients. Smoking increases susceptibility to many respiratory diseases, including infections, and affects the prognosis and mortality of these diseases. The increased levels of angiotensin converting enzyme-2, which is a binding receptor for SARS-CoV-2 in the lungs, suggest that smoking has negative effects on patients with COVID-19. In this review, the relationship between smoking and COVID-19 is examined with a review of current literature.