COVID-19 in critically ill patients in North Brabant, the Netherlands: Patient characteristics and outcomes.

PURPOSE: Since the SARS-CoV-2 pandemic, countries are overwhelmed by critically ill Coronavirus disease 2019 (COVID-19) patients. As ICU capacity becomes limited we characterized critically ill COVID-19 patients in the Netherlands. METHODS: In this case series, COVID-19 patients admitted to the ICU of the Jeroen Bosch Hospital were included from March 9 to April 7, 2020. COVID-19 was confirmed by a positive result by a RT-PCR of a specimen collected by nasopharyngeal swab. Clinical data were extracted from medical records. RESULTS: The mean age of the 50 consecutively included critically ill COVID-19 patients was 65 ± 10 years, the mean BMI was 29 ± 4.7 and 66% were men. Seventy-eight percent of patients had ≥1 comorbidity, 34% had hypertension. Ninety-six percent of patients required mechanical ventilation and 80% were ventilated in prone position. Venous thromboembolism was recognized in 36% of patients. Seventy-four percent of patients survived and were successfully discharged from the ICU, the remaining 26% died (median follow up 86 days). The length of invasive ventilation in survivors was 15 days (IQR 12-31). CONCLUSIONS: The survival rate of COVID-19 critically ill patients in our population is considerably better than previously reported. Thrombotic complications are commonly found and merit clinical attention. TRIAL REGISTRATION NUMBER: NL2020.07.04.01.

Using quality indicators in anaesthesia: feeding back data to improve care.

After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. Anaesthesia poses certain challenges in the identification of valid outcome indicators sensitive to variations in anaesthetic care. Metrics collected during the immediate post-anaesthetic recovery period, such as patient temperature, patient-reported quality of recovery, and pain and nausea, provide potentially useful information for the anaesthetist, yet this information is not routinely fed back. Reviews of the effects of feeding back performance data to healthcare providers suggest that this may result in small to moderate positive effects upon outcomes and professional practice, with stronger effects where feedback is integrated within a broader quality improvement strategy. The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.

Dental anxiety in Fiji.

Despite the technological advances in dentistry, anxiety about dental treatment and the fear of pain associated with dentistry remains globally widespread and is considered a major barrier to dental treatment. This can have detrimental consequences to people's oral health and pose a serious epidemiological challenge to oral health care professionals. Dental anxiety is well described in the Western world however there is little literature on the situation in the developing world. The purpose of the study was to evaluate the levels of dental anxiety in Fijians using Corah's DentalAnxiety Scale (DAS). 120 adults, aged 18-45 years were randomly selected from the capital city of Suva until there were 60 Indigenous and 60 IndoFijians, with 30 males and 30 females from each group responding to questions from Corah's Dental Anxiety Scale. The average DAS for all the participants was 8.8. The average DAS for IndoFijians was 9.8 and was significantly higher than for Indigenous Fijians ie 78. IndoFijians only reported less anxiety with increasing age as the Indigenous Fijians generally displayed low levels of anxiety. There was no significant difference in DAS between the genders. A considerable proportion of IndoFijians (28%) were anxious with 13% being highly anxious. Young IndoFijian adults are more likely to possess dental anxiety and should be managed appropriately which may include behavioural and/or pharmacological therapy. This may require referral to dental specialists or involve a multidisciplinary approach to the management of these people.