Exploring the accessibility of primary health care data in Europe's COVID-19 response: developing key indicators for managing future pandemics (Eurodata study).

BACKGROUND: Primary Health Care (PHC) plays a crucial role in managing the COVID-19 pandemic, with only 8% of cases requiring hospitalization. However, PHC COVID-19 data often goes unnoticed on European government dashboards and in media discussions. This project aims to examine official information on PHC patient care during the COVID-19 pandemic in Europe, with specific objectives: (1) Describe PHC's clinical pathways for acute COVID-19 cases, including long-term care facilities, (2) Describe PHC COVID-19 pandemic indicators, (3) Develop COVID-19 PHC activity indicators, (4) Explain PHC's role in vaccination strategies, and (5) Create a PHC contingency plan for future pandemics. METHODS: A mixed-method study will employ two online questionnaires to gather retrospective PHC data on COVID-19 management and PHC involvement in vaccination strategies. Validation will occur through focus group discussions with medical and public health (PH) experts. A two-wave Delphi survey will establish a European PHC indicators dashboard for future pandemics. Additionally, a coordinated health system action plan involving PHC, secondary care, and PH will be devised to address future pandemic scenarios. ANALYSIS: Quantitative data will be analysed using STATA v16.0 for descriptive and multivariate analyses. Qualitative data will be collected through peer-reviewed questionnaires and content analysis of focus group discussions. A Delphi survey and multiple focus groups will be employed to achieve consensus on PHC indicators and a common European health system response plan for future pandemics. The Eurodata research group involving researchers from 28 European countries support the development. DISCUSSION: While PHC manages most COVID-19 acute cases, data remains limited in many European countries. This study collects data from numerous countries, offering a comprehensive perspective on PHC's role during the pandemic in Europe. It pioneers the development of a PHC dashboard and health system plan for pandemics in Europe. These results may prove invaluable in future pandemics. However, data may have biases due to key informants' involvement and may not fully represent all European GP practices. PHC has a significant role in the management of the COVID-19 pandemic, as most of the cases are mild or moderate and only 8% needed hospitalization. However, PHC COVID-19 activity data is invisible on governments' daily dashboards in Europe, often overlooked in media and public debates.

Primary care indicators for disease burden, monitoring and surveillance of COVID-19 in 31 European countries: Eurodata Study.

BACKGROUND: During the COVID-19 pandemic, the majority of patients received ambulatory treatment, highlighting the importance of primary health care (PHC). However, there is limited knowledge regarding PHC workload in Europe during this period. The utilization of COVID-19 PHC indicators could facilitate the efficient monitoring and coordination of the pandemic response. The objective of this study is to describe PHC indicators for disease surveillance and monitoring of COVID-19's impact in Europe. METHODS: Descriptive, cross-sectional study employing data obtained through a semi-structured ad hoc questionnaire, which was collectively agreed upon by all participants. The study encompasses PHC settings in 31 European countries from March 2020 to August 2021. Key-informants from each country answered the questionnaire. Main outcome: the identification of any indicator used to describe PHC COVID-19 activity. RESULTS: Out of the 31 countries surveyed, data on PHC information were obtained from 14. The principal indicators were: total number of cases within PHC (Belarus, Cyprus, Italy, Romania and Spain), number of follow-up cases (Croatia, Cyprus, Finland, Spain and Turkey), GP's COVID-19 tests referrals (Poland), proportion of COVID-19 cases among respiratory illnesses consultations (Norway and France), sick leaves issued by GPs (Romania and Spain) and examination and complementary tests (Cyprus). All COVID-19 cases were attended in PHC in Belarus and Italy. CONCLUSIONS: The COVID-19 pandemic exposes a crucial deficiency in preparedness for infectious diseases in European health systems highlighting the inconsistent recording of indicators within PHC organizations. PHC standardized indicators and public data accessibility are urgently needed, conforming the foundation for an effective European-level health services response framework against future pandemics.

The role of primary health care in long-term care facilities during the COVID-19 pandemic in 30 European countries: a retrospective descriptive study (Eurodata study).

BACKGROUND AND AIM: Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in Europe during the early phase of the pandemic. METHODS: Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care. RESULTS: Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom's follow-up was performed mainly by PHC. CONCLUSION: PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.

Clinical pathway of COVID-19 patients in primary health care in 30 European countries: Eurodata study.

BACKGROUND: Most COVID-19 patients were treated in primary health care (PHC) in Europe. OBJECTIVES: To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's clinical pathways in Europe. METHODS: Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020. RESULTS: COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30). CONCLUSION: In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.

Seguimiento de los pacientes con cardiopatía isquémica en Atención Primaria durante la pandemia por COVID-19 / Coronary heart disease follow-up in a Primary Health Care centre during the COVID-19 pandemic

Objetivo: describir el seguimiento de los factores de riesgo cardiovascular modificables (FRCM) de los pacientes con cardiopatía isquémica (CI) en un centro de salud durante el primer año la pandemia por COVID-19. Material y métodos: estudio observacional ambispectivo de un centro de salud de Madrid.Participantes: pacientes diagnosticados de CI antes de 2020, > 45 años (n: 257).Seguimiento: del 13/03/2020 al 13/03/2021.Variables: sociodemográficas, comorbilidades, análisis de sangre (AS), colesterol asociado a lipoproteínas de baja densidad (c-LDL), exploración física (tensión arterial [TA] e índice de masa corporal [IMC]), eventos cardiovasculares (ECV) y fallecimiento en el seguimiento.Se realizó en tres períodos: situación basal: registro previo al inicio de la pandemia; primer período: del 13/03/2020 al 13/09/2020; segundo período: del 14/09/2020 al 13/03/2021. Datos obtenidos de la historia clínica electrónica. Análisis: STATA16.Resultados: se hizo el seguimiento de 257 pacientes (edad: 73,14 ± 0,7; 67,3% hombres) diagnosticados de CI hace 7 años (rango intercuartílico [RIC]: 4-14). AS (al 65,6% de los pacientes se les hizo análisis en el primer período versus al 20,6% en el segundo período del estudio), TA (57,5% versus 18,6%) e IMC (29,5% versus 7,7%). Mejoraron el c-LDL hasta 2,2 mg/dL, y el IMC, 0,6 kg/m2. Empeoró la TA sistólica hasta 6,3 mmHg y la diastólica 2,5 mmHg. Un 7,7% sufrió un ECV en el primer período y un 5,8% en el segundo. Fallecieron 9 pacientes durante el seguimiento.Conclusión: casi dos tercios de los pacientes con CI habían realizado seguimiento de LDL y TA en los 6 primeros meses tras el inicio de la pandemia. El número de seguimientos caía a 1/3 al año. El IMC fue la variable menos evaluada.(AU)

Aim: to report the follow up of modifiable cardiovascular risk factors (CVRF) of patients with ischaemic heart disease in a health centre during the first year of the COVID-19 pandemic.Materials and Methods: observational follow-up study of an ambispective cohort in a Madrid health centre. Subjects: patients with CHD prior to 2020, > 45 years (n:257). Follow up: from 13/03/2020 to 13/03/2021. Variables: sociodemographic, comorbidities, blood test (BT) (LDL-c), physical examination, (blood pressure [BP] and BMI), cardiovascular events (CVE), and death during follow up. Performed over three periods: baseline period: data before the pandemic commenced. First period: 13/03/2020-13/09/2020. Second period: 14/09/2020-13/03/2021. Data collection: electronic medical record. Analysis: STATA16.Results: a total of 257 patients with CHD was followed up (age: 73.14±0.7; 67.3% male). CHD diagnosis seven years ago (IQR:4-14). BT in 65.6% of patients in the first time period vs 20.6% in the second time period, BP 57.5% vs 18.6% and BMI 29.5% vs 7.7%. LDL-c and BMI improved during follow up to 2.2 mg/dL and 0.6 kg/m2, respectively. Systolic and diastolic BP worsened up to 6.3 mmHg and 2.5 mmHg, respectively. A total of 7.7% and 5.8% suffered a CVE in the first and second time periods, respectively. In all nine patients died during follow up.Conclusion: virtually two thirds of patients with CHD had undertaken LDL-c and BP follow up in the six months since the COVID-19 pandemic started. This number decreased to one third over the year. BMI was the least evaluated variable.(AU)

Can the Cytokine Profile According to ABO Blood Groups Be Related to Worse Outcome in COVID-19 Patients? Yes, They Can.

Severe status of coronavirus disease 2019 (COVID-19) is extremely associated to cytokine release. Moreover, it has been suggested that blood group is also associated with the prevalence and severity of this disease. However, the relationship between the cytokine profile and blood group remains unclear in COVID-19 patients. In this sense, we prospectively recruited 108 COVID-19 patients between March and April 2020 and divided according to ABO blood group. For the analysis of 45 cytokines, plasma samples were collected in the time of admission to hospital ward or intensive care unit and at the sixth day after hospital admission. The results show that there was a risk of more than two times lower of mechanical ventilation or death in patients with blood group O (log rank: p = 0.042). At first time, all statistically significant cytokine levels, except from hepatocyte growth factor, were higher in O blood group patients meanwhile the second time showed a significant drop, between 20% and 40%. In contrast, A/B/AB group presented a maintenance of cytokine levels during time. Hepatocyte growth factor showed a significant association with intubation or mortality risk in non-O blood group patients (OR: 4.229, 95% CI (2.064-8.665), p < 0.001) and also was the only one bad prognosis biomarker in O blood group patients (OR: 8.852, 95% CI (1.540-50.878), p = 0.015). Therefore, higher cytokine levels in O blood group are associated with a better outcome than A/B/AB group in COVID-19 patients.

Endovascular management of splenic artery aneurysms.

Visceral aneurysms are rare clinical entities, being the most common in this group of pathology the aneurysms of the splenic artery. Its prevalence is estimated between 0.2 and 9.7%, according to different authors, however the introduction of imaging techniques to assess abdominal pathology have increased the incidental findings of these cases. Once diagnosed, treatment should be considered, when they are larger than 2 cm. in size. Conventional surgery in most cases, together with splenectomy and aneurysm resection is often required. Endovascular procedures emerge as a less aggressive and effective treatment option. Our institutional experience is presented in the treatment of 13 cases of splenic aneurysms, analyzing the profile of the patients, treatments performed and results obtained. This type of therapy and the current literature are also analysed.

Clinical and haemodynamic evolution of lesions treated by means of atherectomy with SilverHawk in the femoropopliteal sector.

UNLABELLED: The objective of the work is to study the clinical and haemodynamic evolution, over 1 year, in patients with femoropopliteal arterial pathology treated by means of atherectomy with the SilverHawk device. MATERIALS AND METHODS: Nineteen (19) patients were treated between December 2008 and May 2009, collecting data on sex, age, comorbidity and clinical degree, with prospective monitoring over 12 months of clinical symptoms, physical examination and ecodoppler, obtaining results on diameter and peak systolic velocity at different arterial levels. RESULTS: Of the 19 patients, 14 were men and 5 women, with a mean age of 70 years, hypertensive (73%), diabetic (63%) and smokers (63%). Six (6) presented disabling claudication and 13 critical ischemia with advanced distal trophic lesions in 5. A good arteriographic result was obtained in 12 cases, a stent was placed on the superficial femoral artery in 5 due to suboptimal outcome. Contrast extravasation was observed in 2, with femoropopliteal bypass performed and one exclusion with endoprosthesis for repair. In the ecodoppler after 1, 3, 6 and 12 months, a progressive reduction in lumen diameter and peak intraarterial systolic velocity was observed, particularly on the distal superficial femoral artery. After one year, 7 patients (36.8%) were symptom-free, 5 (26.3%) presented mild or moderate intermittent claudication and 1 patient (5.3%) presented localised distal trophic lesion. Four (4) major amputations were performed, in 2 the knee was preserved, there were 3 thromboses due to the procedure, a secondary endovascular procedure was performed in one case and a femoropopliteal bypass in another, and there were 2 non procedure-related deaths. DISCUSSION: atherectomy with SilverHawk achieves an improvement in clinical degree, with a good rate of extremity salvage in patients with critical ischemia. In the first year, the ecodoppler shows evolution of the arteriopathy, without this necessarily meaning a clinical worsening.

Endovascular repair in the presence of aortic infection.

The purpose of this study is to describe our experience in the endovascular management of two cases of aortoenteric and aortoesophageal fistula that were unsuccessfully treated with an aortic stent graft because of recurrent infection. Although endovascular repair appears to be a promising therapeutic modality, in the presence of infection this technique should be considered on an individual basis. Failure of treatment should be expected in a significant number of cases during follow-up, particularly in patients with signs of sepsis. A review of the literature with positive and negative results has been included for a better understanding of this condition.

Utility of intraoperative transesophageal echocardiography during endovascular stent-graft repair of acute thoracic aortic dissection.

This study was undertaken to evaluate the utility and efficacy of intraoperative transesophageal echocardiography (TEE) in the endovascular management of patients with acute type B aortic dissection. Twelve consecutive patients with acute type B aortic dissection underwent elective endoluminal stent-graft repair in the operating room under angiographic and TEE guidance. The follow-up protocol included spiral CT scanning before discharge from the hospital to assess thrombosis exclusion of the aortic false lumen, perfusion of branch vessels, and the absence of perigraft leak. No complications related to the use of TEE were encountered. TEE clearly demonstrated the presence and extent of the dissection flap in all patients. After the procedure a persistent perigraft leak or residual flow into the false lumen was diagnosed by TEE in 6 patients, whereas intraoperative angiography visualized only 3 cases. Postoperative CT scan confirmed these findings. One patient died 2 months later by aortic rupture secondary to a persistent perigraft leak not treated (8.3% mortality). No postoperative paraplegia or visceral ischaemia were registered, although an asymptomatic occlusion of left subclavian artery was observed. TEE monitoring detects perigraft leakage, identifies the entry tear, and accurately demonstrates sealing of the false lumen. TEE is essential in our practice as an adjuvant to fluoroscopy to achieve optimal results during endovascular stent-graft repair of acute thoracic aortic dissection.