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Santosa A, Oras J, Li H, Nwaru C, Kirui B, Nyberg F. Survival of Critically Ill COVID-19 Patients in Sweden During the First Two and a Half Years of the Pandemic. Crit Care Med 2024; 52:1194-1205. [PMID: 38546287 PMCID: PMC11239088 DOI: 10.1097/ccm.0000000000006271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Some studies have examined survival trends among critically ill COVID-19 patients, but most were case reports, small cohorts, and had relatively short follow-up periods. We aimed to examine the survival trend among critically ill COVID-19 patients during the first two and a half years of the pandemic and investigate potential predictors across different variants of concern periods. DESIGN Prospective cohort study. SETTING Swedish ICUs, between March 6, 2020, and December 31, 2022. PATIENTS Adult COVID-19 ICU patients of 18 years old or older from the Swedish Intensive Care Register (SIR) that were linked to multiple other national registers. MEASUREMENT AND MAIN RESULTS Survival probability and predictors of COVID-19 death were estimated using Kaplan-Meier and Cox regression analysis. Of 8975 patients, 2927 (32.6%) died. The survival rate among COVID-19 critically ill patients appears to have changed over time, with a worse survival in the Omicron period overall. The adjusted hazard ratios (aHRs) comparing older and younger ages were consistently strong but slightly attenuated in the Omicron period. After adjustment, the aHR of death was significantly higher for men, older age (40+ yr), low income, and with comorbid chronic heart disease, chronic lung disease, impaired immune disease, chronic renal disease, stroke, and cancer, and for those requiring invasive or noninvasive respiratory supports, who developed septic shock or had organ failures ( p < 0.05). In contrast, foreign-born patients, those with booster vaccine, and those who had taken steroids had better survival (aHR = 0.87; 95% CI, 0.80-0.95; 0.74, 0.65-0.84, and 0.91, 0.84-0.98, respectively). Observed associations were similar across different variant periods. CONCLUSIONS In this nationwide Swedish cohort covering over two and a half years of the pandemic, ICU survival rates changed over time. Older age was a strong predictor across all periods. Furthermore, most other mortality predictors remained consistent across different variant periods.
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Affiliation(s)
- Ailiana Santosa
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
- Department of Anaesthesiology and Intensive Care, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Västra Götaland, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
| | - Chioma Nwaru
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Brian Kirui
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
| | - Fredrik Nyberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Västra Götaland, Sweden
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Liu X, Sun Y, Song H, Zhang W, Liu T, Chu Z, Gu X, Ma Z, Jin W. Nanomaterials-based electrochemical biosensors for diagnosis of COVID-19. Talanta 2024; 274:125994. [PMID: 38547841 DOI: 10.1016/j.talanta.2024.125994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 03/15/2024] [Accepted: 03/24/2024] [Indexed: 05/04/2024]
Abstract
Since the outbreak of corona virus disease 2019 (COVID-19), this pandemic has caused severe death and infection worldwide. Owing to its strong infectivity, long incubation period, and nonspecific symptoms, the early diagnosis is essential to reduce risk of the severe illness. The electrochemical biosensor, as a fast and sensitive technique for quantitative analysis of body fluids, has been widely studied to diagnose different biomarkers caused at different infective stages of COVID-19 virus (SARS-CoV-2). Recently, many reports have proved that nanomaterials with special architectures and size effects can effectively promote the biosensing performance on the COVID-19 diagnosis, there are few comprehensive summary reports yet. Therefore, in this review, we will pay efforts on recent progress of advanced nanomaterials-facilitated electrochemical biosensors for the COVID-19 detections. The process of SARS-CoV-2 infection in humans will be briefly described, as well as summarizing the types of sensors that should be designed for different infection processes. Emphasis will be supplied to various functional nanomaterials which dominate the biosensing performance for comparison, expecting to provide a rational guidance on the material selection of biosensor construction for people. Finally, we will conclude the perspective on the design of superior nanomaterials-based biosensors facing the unknown virus in future.
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Affiliation(s)
- Xinxin Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China
| | - Yifan Sun
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China
| | - Huaiyu Song
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China
| | - Wei Zhang
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China
| | - Tao Liu
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China.
| | - Zhenyu Chu
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China
| | - Xiaoping Gu
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China.
| | - Zhengliang Ma
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210008, PR China
| | - Wanqin Jin
- State Key Laboratory of Materials-Oriented Chemical Engineering, College of Chemical Engineering, Nanjing Tech University, NO.30 Puzhu Road(S), Nanjing, 211816, PR China.
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Dos Santos L, Silva LL, Pelloso FC, Maia V, Pujals C, Borghesan DH, Carvalho MD, Pedroso RB, Pelloso SM. Use of machine learning to identify protective factors for death from COVID-19 in the ICU: a retrospective study. PeerJ 2024; 12:e17428. [PMID: 38881861 PMCID: PMC11179634 DOI: 10.7717/peerj.17428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/29/2024] [Indexed: 06/18/2024] Open
Abstract
Background Patients in serious condition due to COVID-19 often require special care in intensive care units (ICUs). This disease has affected over 758 million people and resulted in 6.8 million deaths worldwide. Additionally, the progression of the disease may vary from individual to individual, that is, it is essential to identify the clinical parameters that indicate a good prognosis for the patient. Machine learning (ML) algorithms have been used for analyzing complex medical data and identifying prognostic indicators. However, there is still an urgent need for a model to elucidate the predictors related to patient outcomes. Therefore, this research aimed to verify, through ML, the variables involved in the discharge of patients admitted to the ICU due to COVID-19. Methods In this study, 126 variables were collected with information on demography, hospital length stay and outcome, chronic diseases and tumors, comorbidities and risk factors, complications and adverse events, health care, and vital indicators of patients admitted to an ICU in southern Brazil. These variables were filtered and then selected by a ML algorithm known as decision trees to identify the optimal set of variables for predicting patient discharge using logistic regression. Finally, a confusion matrix was performed to evaluate the model's performance for the selected variables. Results Of the 532 patients evaluated, 180 were discharged: female (16.92%), with a central venous catheter (23.68%), with a bladder catheter (26.13%), and with an average of 8.46- and 23.65-days using bladder catheter and submitted to mechanical ventilation, respectively. In addition, the chances of discharge increase by 14% for each additional day in the hospital, by 136% for female patients, 716% when there is no bladder catheter, and 737% when no central venous catheter is used. However, the chances of discharge decrease by 3% for each additional year of age and by 9% for each other day of mechanical ventilation. The performance of the training data presented a balanced accuracy of 0.81, sensitivity of 0.74, specificity of 0.88, and the kappa value was 0.64. The test performance had a balanced accuracy of 0.85, sensitivity 0.75, specificity 0.95, and kappa value of 0.73. The McNemar test found that there were no significant differences in the error rates in the training and test data, suggesting good classification. This work showed that female, the absence of a central venous catheter and bladder catheter, shorter mechanical ventilation, and bladder catheter duration were associated with a greater chance of hospital discharge. These results may help develop measures that lead to a good prognosis for the patient.
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Affiliation(s)
- Lander Dos Santos
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Lincoln Luis Silva
- Department of Emergency Medicine, Duke University School of Medicine, Durham, NC, United States of America
| | | | | | - Constanza Pujals
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | | | - Maria Dalva Carvalho
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Raíssa Bocchi Pedroso
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
| | - Sandra Marisa Pelloso
- State University of Maringá, Graduate Program in Health Sciences, Maringá, Paraná, Brazil
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Almeida-Junior ERD, Brito-de-Sousa JP, Silva EFD, Ribas RM. An another perspective of face masks in emotion recognition: Comment on Shepherd and Rippon (2022). Q J Exp Psychol (Hove) 2024; 77:1137-1139. [PMID: 37646397 DOI: 10.1177/17470218231195325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In a recent article, Shepherd and Rippon (2022) investigated the impact of widespread face mask use on emotion recognition. They found that mask-wearing led to reduced accuracy in identifying emotions such as fear, sadness, and disgust when participants were exposed to brief facial stimuli. Their study highlights the significance of masks in concealing facial areas crucial for non-verbal communication, potentially affecting emotional well-being. Here in this comment, we have argued that despite concerns about impaired emotional recognition and social interactions, balancing COVID-19 protection and effective communication is essential. We stress the importance of adhering to mask guidelines while enhancing alternative cues and communication strategies. In public health emergencies like COVID-19, such research should acknowledge the whole complexity and prioritize safety aspects in a manner that prevents controversial issues.
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Affiliation(s)
| | - Joaquim Pedro Brito-de-Sousa
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | | | - Rosineide Marques Ribas
- Laboratory of Molecular Microbiology, Institute of Biomedical Sciences, Universidade Federal de Uberlândia, Uberlândia, Brazil
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Moser CH, Budhathoki C, Allgood SJ, Haut ER, Brenner MJ, Pandian V. Global predictors of tracheostomy-related pressure injury in the COVID-19 era: A study of secondary data. Intensive Crit Care Nurs 2024:103720. [PMID: 38802295 DOI: 10.1016/j.iccn.2024.103720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/17/2024] [Accepted: 05/04/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES To determine the incidence and risk factors of tracheostomy-related pressure injuries (TRPI) and examine the COVID-19 pandemic's impact on TRPI incidence. DESIGN Secondary analysis of Global Tracheostomy Collaborative database and a multi-center hospital system's electronic medical records. SETTING 27 hospitals, primarily in the United States, United Kingdom, and Australasia. PATIENTS 6,400 adults and 2,405 pediatric patients hospitalized with tracheostomy between 1 January 2019 and 31 December 2021. MEASUREMENT TRPI as a binary outcome, reported as odds ratios. RESULTS TRPI incidence was 4.69 % in adults and 5.65 % in children. For adults, associated risks were female sex (OR: 0.64), severe obesity (OR: 2.62), ICU admission (OR: 2.05), cuffed tracheostomy (OR: 1.49), fenestrated tracheostomy (OR: 15.37), percutaneous insertion (OR: 2.03) and COVID-19 infection (OR: 1.66). For children, associated risks were diabetes mellitus (OR: 4.31) and ICU admission (OR: 2.68). TRPI odds increased rapidly in the first 60 days of stay. Age was positively associated with TRPI in adults (OR: 1.014) and children (OR: 1.060). Black patients had higher TRPI incidence than white patients; no moderating effects of race were found. Hospital cluster effects (adults ICC: 0.227; children ICC: 0.138) indicated unmeasured hospital-level factors played a significant role. CONCLUSIONS Increasing age and length of stay up to 60 days are TRPI risk factors. Other risks for adults were female sex, severe obesity, cuffed/fenestrated tracheostomy, percutaneous insertion, and COVID-19; for children, diabetes mellitus and FlexTend devices were risks. Admission during the COVID-19 pandemic had contrasting effects for adults and children. Additional research is needed on unmeasured hospital-level factors. IMPLICATIONS FOR CLINICAL PRACTICE These findings can guide targeted interventions to reduce TRPI incidence and inform tracheostomy care during public health crises. Hospital benchmarking of tracheostomy-related pressure injuries is needed.
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Affiliation(s)
- Chandler H Moser
- Center for Nursing Science and Clinical Inquiry, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, United States.
| | - Chakra Budhathoki
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States; Biostatistics and Epidemiology, Johns Hopkins Center for AIDS Research, Baltimore, MD, United States
| | - Sarah J Allgood
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Elliott R Haut
- Division of Acute Care Surgery, Department of Surgery, Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, United States; The Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD, United States; Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Vinciya Pandian
- School of Nursing, Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States
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Rakhshani T, Ghalehgolab F, Bahrami MA, Karimi S, Hamrah H, Jafari F, Khani Jeihooni A. Exploration of the Challenges of COVID-19 from the Perspective of Emergency Medicine Specialists. Emerg Med Int 2024; 2024:5536103. [PMID: 38828399 PMCID: PMC11144065 DOI: 10.1155/2024/5536103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 04/16/2024] [Accepted: 04/30/2024] [Indexed: 06/05/2024] Open
Abstract
Background Emergency physicians are at the forefront of the medical system in the face of the COVID-19 crisis. Identifying the challenges, along with the strategies and effective measures implemented by them in the face of the COVID-19 crisis, can be a roadmap for future crisis management planning. This study aims to explain the challenges faced by emergency physicians regarding COVID-19. Methods This study is a qualitative content analysis. Data were collected using individual and semistructured interviews. Twenty-seven emergency medical specialists in Fars University of Medical Sciences, Iran, participated in the study by purposive sampling method and were interviewed using semistructured interviews. Results Participants' experience of COVID-19 led to the extraction of four main themes, including structural factors, threats to the health of the medical team, fluctuations of extremism and wastage in the face of COVID-19, and the country's policymaking hierarchy. Conclusions Emergency physicians face challenges such as structural factors, health threats, extreme fluctuations, and national policymaking. To avoid surprises and threats, they must predict acute scenarios, provide necessary equipment, address skilled manpower shortages, and adopt appropriate management policies. This includes culture-building, cross-sector coordination, planning, and efficient management to prevent virus spread.
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Affiliation(s)
- Tayebeh Rakhshani
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Mohammad Amin Bahrami
- Department of Health Services Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shahnaz Karimi
- Department of Nursing, School of Nursing, Fasa University of Medical Sciences, Fasa, Iran
| | - Hadid Hamrah
- Department of Emergency Medicine, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Jafari
- Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Khani Jeihooni
- Nutrition Research Center, Department of Public Health, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
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Tizianel I, Ruggiero E, Torchio M, Simonato M, Seresin C, Bigolin F, Botta IP, Bano G, Lo Storto MR, Scaroni C, Ceccato F. A schedule for tapering glucocorticoid treatment in patients with severe SARS-CoV 2 infection can prevent acute adrenal insufficiency in the geriatric population. Hormones (Athens) 2024:10.1007/s42000-024-00564-9. [PMID: 38758491 DOI: 10.1007/s42000-024-00564-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE AND DESIGN Glucocorticoids (GCs) have been widely used in symptomatic patients for the treatment of COVID-19. The risk for adrenal insufficiency must be considered after GC withdrawal given that it is a life-threatening condition if left unrecognized and untreated. Our study aimed to diagnose adrenal insufficiency early on through a GC reduction schedule in patients with COVID-19 infection. PATIENTS AND MEASUREMENTS From November 2021 to May 2022, 233 patients were admitted to the Geriatric Division of the University Hospital of Padova with COVID-19 infection. A total of 122 patients were treated with dexamethasone, after which the GC tapering was performed according to a structured schedule. It consists of step-by-step GC tapering with prednisone, from 25 mg to 2.5 mg over 2 weeks. Morning serum sodium, potassium, and cortisol levels were assessed 3 days after the last dose of prednisone. RESULTS At the end of GC withdrawal, no adrenal crisis or signs/symptoms of acute adrenal insufficiency were reported. Median serum cortisol, sodium, and potassium levels after GC discontinuation were, respectively, 427 nmol/L, 140 nmol/L, and 4 nmol/L (interquartile range 395-479, 138-142, and 3.7-4.3). A morning serum cortisol level below the selected threshold of 270 nmol/L was observed in two asymptomatic cases (respectively, 173 and 239 nmol/L, reference range 138-690 nmol/L). Mild hyponatremia (serum sodium 132 to 134 nmol/L, reference range 135-145 nmol/L) was detected in five patients, without being related to cortisol levels. CONCLUSIONS A structured schedule for the tapering of GC treatment used in patients with severe COVID-19 can reduce the risk of adrenal crisis and acute adrenal insufficiency.
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Affiliation(s)
- Irene Tizianel
- Endocrine Unit-Department of Medicine DIMED, Via Ospedale Civile, Padova, 105 - 35128, Italy
- Endocrine Unit, University Hospital of Padova, Padova, Italy
| | - Elena Ruggiero
- Geriatric Division, University Hospital of Padova, Padova, Italy
- Pain Therapy and Palliative Care, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | | | - Matteo Simonato
- Geriatric Division, University Hospital of Padova, Padova, Italy
| | - Chiara Seresin
- Geriatric Division, University Hospital of Padova, Padova, Italy
| | | | | | - Giulia Bano
- Geriatric Division, University Hospital of Padova, Padova, Italy
| | | | - Carla Scaroni
- Endocrine Unit-Department of Medicine DIMED, Via Ospedale Civile, Padova, 105 - 35128, Italy
- Endocrine Unit, University Hospital of Padova, Padova, Italy
| | - Filippo Ceccato
- Endocrine Unit-Department of Medicine DIMED, Via Ospedale Civile, Padova, 105 - 35128, Italy.
- Endocrine Unit, University Hospital of Padova, Padova, Italy.
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Abdallah AM, Doudin A, Sulaiman TO, Jamil O, Arif R, Sada FA, Yassine HM, Elrayess MA, Elzouki AN, Emara MM, Thillaiappan NB, Cyprian FS. Metabolic predictors of COVID-19 mortality and severity: a survival analysis. Front Immunol 2024; 15:1353903. [PMID: 38799469 PMCID: PMC11127595 DOI: 10.3389/fimmu.2024.1353903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction The global healthcare burden of COVID-19 pandemic has been unprecedented with a high mortality. Metabolomics, a powerful technique, has been increasingly utilized to study the host response to infections and to understand the progression of multi-system disorders such as COVID-19. Analysis of the host metabolites in response to SARS-CoV-2 infection can provide a snapshot of the endogenous metabolic landscape of the host and its role in shaping the interaction with SARS-CoV-2. Disease severity and consequently the clinical outcomes may be associated with a metabolic imbalance related to amino acids, lipids, and energy-generating pathways. Hence, the host metabolome can help predict potential clinical risks and outcomes. Methods In this prospective study, using a targeted metabolomics approach, we studied the metabolic signature in 154 COVID-19 patients (males=138, age range 48-69 yrs) and related it to disease severity and mortality. Blood plasma concentrations of metabolites were quantified through LC-MS using MxP Quant 500 kit, which has a coverage of 630 metabolites from 26 biochemical classes including distinct classes of lipids and small organic molecules. We then employed Kaplan-Meier survival analysis to investigate the correlation between various metabolic markers, disease severity and patient outcomes. Results A comparison of survival outcomes between individuals with high levels of various metabolites (amino acids, tryptophan, kynurenine, serotonin, creatine, SDMA, ADMA, 1-MH and carnitine palmitoyltransferase 1 and 2 enzymes) and those with low levels revealed statistically significant differences in survival outcomes. We further used four key metabolic markers (tryptophan, kynurenine, asymmetric dimethylarginine, and 1-Methylhistidine) to develop a COVID-19 mortality risk model through the application of multiple machine-learning methods. Conclusions Metabolomics analysis revealed distinct metabolic signatures among different severity groups, reflecting discernible alterations in amino acid levels and perturbations in tryptophan metabolism. Notably, critical patients exhibited higher levels of short chain acylcarnitines, concomitant with higher concentrations of SDMA, ADMA, and 1-MH in severe cases and non-survivors. Conversely, levels of 3-methylhistidine were lower in this context.
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Affiliation(s)
| | - Asmma Doudin
- Biomedical Research Center (BRC), Qatar University, Doha, Qatar
| | - Theeb Osama Sulaiman
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Omar Jamil
- Department of Radiology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rida Arif
- Emergency Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fatima Al Sada
- Neurosurgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hadi M. Yassine
- Biomedical Research Center (BRC), Qatar University, Doha, Qatar
| | - Mohamed A. Elrayess
- College of Medicine, Qatar University (QU) Health, Qatar University, Doha, Qatar
- Biomedical Research Center (BRC), Qatar University, Doha, Qatar
| | - Abdel-Naser Elzouki
- College of Medicine, Qatar University (QU) Health, Qatar University, Doha, Qatar
- Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed M. Emara
- College of Medicine, Qatar University (QU) Health, Qatar University, Doha, Qatar
| | | | - Farhan S. Cyprian
- College of Medicine, Qatar University (QU) Health, Qatar University, Doha, Qatar
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Al Oweidat K, Toubasi AA, Khraisat FA, Aldahabi MN, Alghrabli A, Khater Y, Saleh N, Al-Sayegh TN, Albtoosh AS. The impact of COVID-19 on antibiotic resistance and clinical outcomes among critically ill patients. Am J Infect Control 2024; 52:546-551. [PMID: 38142778 DOI: 10.1016/j.ajic.2023.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND There is conflicting evidence regarding the impact of the Coronavirus 2019 (COVID-19) pandemic on antimicrobial resistance, with few studies conducted in low- and middle-income countries. We investigated the impact of the COVID-19 pandemic on multidrug resistant organisms (MDROs) among critically ill patients and their clinical outcomes. METHODS This was a retrospective observational study of patients admitted to the medical Intensive Care Unit at Jordan University Hospital and had blood, urine, or bronchoalveolar bacterial cultures taken during 2 time periods: prepandemic (ie, 1/2016 to 1/2019) and pandemic (ie, 1/2020 to 1/2023). We compared the clinical outcomes (ie, in-hospital deaths, the need for O2 devices, intubation, the length of hospital stay, and the occurrence of complications) and prevalence of MDROs between the 2 periods and conducted multivariate analyses. RESULTS There were 1,254 patients (479 prepandemic and 775 postpandemic. The percentage of patients who had MDROs was significantly higher among patients with a culture taken during the pandemic (82.4%) compared to before it (17.6%) (P-value=.000). Multivariate analysis demonstrated that patients cultured during the pandemic were more than 3 times as likely to have an MDRO (odds ratio = 3.210; 95% confidence interval: 2.236-4.609). CONCLUSIONS The increase in MDROs during the COVID-19 pandemic is an alarming threat to public health; thus, investigating the antibiotic resistance situation as the pandemic subsides is crucial.
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Affiliation(s)
- Khaled Al Oweidat
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Ahmad A Toubasi
- Faculty of Medicine, The University of Jordan, Amman, Jordan.
| | | | | | - Ahmad Alghrabli
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Yasmeen Khater
- Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | - Noor Saleh
- Critical Care Fellow at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Asma S Albtoosh
- Associate Professor at the Department of Respiratory and Sleep Medicine, Department of Internal Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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Tarnate PSO, Ong-Lim ALT. Strategic Optimization of Patient Flow and Staffing Schemes during the COVID-19 Pandemic through Operations Management in a Neonatal Intensive Care Unit. ACTA MEDICA PHILIPPINA 2024; 58:90-102. [PMID: 38882916 PMCID: PMC11168953 DOI: 10.47895/amp.v58i7.6334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The COVID-19 pandemic posed challenges in making time-bound hospital management decisions. The University of the Philippines -Philippine General Hospital (UP-PGH) is a tertiary COVID-19 referral center located in Manila, Philippines. The mismatch of increasing suspected or confirmed COVID-19 infected mothers with few documented cases of infected infants has caused significant patient overflow and manpower shortage in its NICU. Objective We present an evaluated scheme for NICU bed reallocation to maximize capacity performance, staff rostering, and resource conservation, while preserving COVID-19 infection prevention and control measures. Methods Existing process workflows translated into operational models helped create a solution that modified cohorting and testing schemes. Staffing models were transitioned to meet patient flow. Outcome measurements were obtained, and feedback was monitored during the implementation phase. Results The scheme evaluation demonstrated benefits in (a) achieving shorter COVID-19 subunit length of stay; (b) better occupancy rates with minimal overflows; (c) workforce shortage mitigation with increased non-COVID workforce pool; (d) reduced personal protective equipment requirements; and (e) zero true SARS-CoV-2 infections. Conclusion Designed for hospital operations leaders and stakeholders, this operations process can aid in hospital policy formulation in modifying cohorting schemes to maintain quality NICU care and service during the COVID-19 pandemic.
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Affiliation(s)
- Paul Sherwin O Tarnate
- Division of Infectious and Tropical Diseases in Pediatrics, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
| | - Anna Lisa T Ong-Lim
- Division of Infectious and Tropical Diseases in Pediatrics, Department of Pediatrics, Philippine General Hospital, University of the Philippines Manila
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AbouNader K, Abou Mourad G, Chalouhi G, Rady A, Von Schreeb J, Halmin M. Assessing quality of critical care during an ongoing health emergency-a novel approach to evaluate quality of care at Lebanese public ICUs during COVID-19. Int J Qual Health Care 2024; 36:mzae028. [PMID: 38581654 PMCID: PMC11060481 DOI: 10.1093/intqhc/mzae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 02/26/2024] [Accepted: 04/03/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND Quality of care has been systematically monitored in hospitals in high-income countries to ensure adequate care. However, in low- and middle-income countries, quality indicators are not readily measured. The primary aim of this study was to assess to what extent it was feasible to monitor the quality of intensive care in an ongoing health emergency, and the secondary aim was to assess a quality of care intervention (twinning project) focused on Intensive Care Unit (ICU) quality of care in public hospitals in Lebanon. METHODS We conducted a retrospective cohort study nested within an intervention implemented by the World Health Organization (WHO) together with partners. To assess the quality of care throughout the project, a monitoring system framed in the Donabedian model and included structure, process, and outcome indicators was developed and implemented. Data collection consisted of a checklist performed by external healthcare workers (HCWs) as well as collection of data from all admitted patients performed by each unit. The association between the number of activities within the interventional project and ICU mortality was evaluated. RESULTS A total of 1679 patients were admitted to five COVID-19 ICUs during the study period. The project was conducted fully across four out of five hospitals. In these hospitals, a significant reduction in ICU mortality was found (OR: 0.83, P < 0.05, CI: 0.72-0.96). CONCLUSION We present a feasible way to assess quality of care in ICUs and how it can be used in assessing a quality improvement project during ongoing crises in resource-limited settings. By implementing a quality of care intervention in Lebanon's public hospitals, we have shown that such initiatives might contribute to improvement of ICU care. The observed association between increased numbers of project activities and reduced ICU mortality underscores the potential of quality assurance interventions to improve outcomes for critically ill patients in resource-limited settings. Future research is needed to expand this model to be applicable in similar settings.
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Affiliation(s)
- Karim AbouNader
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Ghada Abou Mourad
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Georges Chalouhi
- Middle East Academy for Learning Health Systems, Beirut, Lebanon
| | - Alissar Rady
- The World Health Organization, Bloc left 4th floor, Glass building, Museum Square, Beirut 5391, Lebanon
| | - Johan Von Schreeb
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
| | - Märit Halmin
- Department of Global Public Health, Karolinska Institutet, Solnavägen, Stockholm 171 77, Sweden
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Gelpi F, Wu MA, Bari V, Cairo B, De Maria B, Fossali T, Colombo R, Porta A. Autonomic Function and Baroreflex Control in COVID-19 Patients Admitted to the Intensive Care Unit. J Clin Med 2024; 13:2228. [PMID: 38673501 PMCID: PMC11050480 DOI: 10.3390/jcm13082228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Autonomic function and baroreflex control might influence the survival rate of coronavirus disease 2019 (COVID-19) patients admitted to the intensive care unit (ICU) compared to respiratory failure patients without COVID-19 (non-COVID-19). This study describes physiological control mechanisms in critically ill COVID-19 patients admitted to the ICU in comparison to non-COVID-19 individuals with the aim of improving stratification of mortality risk. Methods: We evaluated autonomic and baroreflex control markers extracted from heart period (HP) and systolic arterial pressure (SAP) variability acquired at rest in the supine position (REST) and during a modified head-up tilt (MHUT) in 17 COVID-19 patients (age: 63 ± 10 years, 14 men) and 33 non-COVID-19 patients (age: 60 ± 12 years, 23 men) during their ICU stays. Patients were categorized as survivors (SURVs) or non-survivors (non-SURVs). Results: We found that COVID-19 and non-COVID-19 populations exhibited similar vagal and sympathetic control markers; however, non-COVID-19 individuals featured a smaller baroreflex sensitivity and an unexpected reduction in the HP-SAP association during the MHUT compared to the COVID-19 group. Nevertheless, none of the markers of the autonomic and baroreflex functions could distinguish SURVs from non-SURVs in either population. Conclusions: We concluded that COVID-19 patients exhibited a more preserved baroreflex control compared to non-COVID-19 individuals, even though this information is ineffective in stratifying mortality risk.
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Affiliation(s)
- Francesca Gelpi
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
| | - Maddalena Alessandra Wu
- Department of Biomedical and Clinical Sciences, University of Milan, 20157 Milan, Italy;
- Division of Internal Medicine, ASST Fatebenefratelli Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Vlasta Bari
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
| | - Beatrice Cairo
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
| | | | - Tommaso Fossali
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (T.F.); (R.C.)
| | - Riccardo Colombo
- Department of Anesthesiology and Intensive Care, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (T.F.); (R.C.)
| | - Alberto Porta
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy; (F.G.); (B.C.); (A.P.)
- Department of Cardiothoracic, Vascular Anaesthesia and Intensive Care, IRCCS Policlinico San Donato, 20097 Milan, Italy
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Causby B, Jakimowicz S, Levett-Jones T. Upskill training and preparedness of non-critical-care registered nurses deployed to intensive care units during the COVID-19 pandemic: A scoping review. Aust Crit Care 2024:S1036-7314(24)00032-8. [PMID: 38582624 DOI: 10.1016/j.aucc.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 01/16/2024] [Accepted: 02/06/2024] [Indexed: 04/08/2024] Open
Abstract
BACKGROUND The increase in intensive care unit (ICU) capacity compelled by the COVID-19 pandemic required the rapid deployment of non-critical-care registered nurses to the ICU setting. The upskill training needed to prepare these registered nurses for deployment was rapidly assembled due to the limited timeframe associated with the escalating pandemic. Scoping the literature to identify the content, structure, and effectiveness of the upskill education provided is necessary to identify lessons learnt during the COVID-19 pandemic response so that they may guide workforce preparation for future surge planning. AIM The aim of this scoping review was to map the literature to identify the available information regarding upskill training and preparedness of non-critical-care registered nurses deployed to the ICU during the COVID-19 pandemic. METHODS This scoping review was conducted in accordance with JBI methodology. A protocol outlined the review questions and used the participants, concept, and context framework to define the inclusion and exclusion criteria. A search of healthcare databases MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCO), Cochrane, and Scopus was supplemented with a grey literature search via Google. RESULTS Screening and review found 32 manuscripts that met the inclusion criterion for examination. Analysis revealed variation in duration of programs, theoretical versus practical content, face-to-face or online mode of delivery, and duration of preparation time at the bedside in the ICU setting. Data on contributors to preparedness for deployment were sparse but included training, support, peer education, buddy time, and clarity around responsibilities and communication. DISCUSSION Evaluation of upskill education was mostly limited to post-training surveys. Few studies explored the preparedness of deployed registered nurses as an outcome of their upskill training or described measures of effectiveness of ICU deployment. CONCLUSION There is limited evidence describing preparedness of non-critical-care registered nurses on deployment to the ICU. Further research is needed to identify what elements of upskill education led to preparedness and effective deployment to the ICU setting.
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Affiliation(s)
- Belinda Causby
- Faculty of Health, University of Technology Sydney, NSW, Australia; Intensive Care Unit, St Vincent's Hospital, Sydney, NSW, Australia.
| | - Samantha Jakimowicz
- Faculty of Health, University of Technology Sydney, NSW, Australia; Faculty of Science and Health, Charles Sturt University, NSW, Australia.
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Yazdanpanah F, Jackson AC, Sanaie N, Sharifi F, Shamshirgaran SM, Bahramnezhad F. The epidemiology and treatment outcomes of COVID-19 patients admitted to an intensive care unit in an Iranian hospital in Neyshabur city. Health Sci Rep 2024; 7:e2049. [PMID: 38655427 PMCID: PMC11035379 DOI: 10.1002/hsr2.2049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
Background and Aims The COVID-19 pandemic and the infection of numerous individuals from diverse societies have emerged as major global challenges. Given the limited resources in intensive care units, effective bed management and resource allocation require a deep understanding of the disease. This study aimed to assess the epidemiology and treatment outcomes of COVID-19 patients admitted to an intensive care unit in an Iranian hospital in Neyshabur city. Methods This cross-sectional study was conducted on COVID-19 patients hospitalized in intensive care units in Razavi Khorasan, Iran in 2021. Census sampling was used to include all intensive care units. Of the initial 480 cases, 54 cases were excluded based on the exclusion criteria, leaving 426 cases for the study. Data were collected with the help of a data collection form that was designed by the researcher and its content validity and reliability were measured with Cronbach's alpha coefficient (α = 89%.). Data were analyzed with SPSS version 20 software. Descriptive and inferential statistics were used to analyze the data. Mean, standard deviation, and interquartile range indicators were used for descriptive statistics, and absolute frequency and relative frequency (percentage) were used to show numbers and ratios. Results The mean (SD) age of the patients was 66.33 (15.05) years, and 49.3% were female. The results showed that arterial blood oxygen saturation, respiratory rate, and Alzheimer's disease were significant variables for predicting mortality. Furthermore, arterial blood oxygen saturation, respiratory rate, and the need for transfusion of blood products were significant variables in predicting hospitalization and the risk of acute respiratory distress syndrome (ARDS). Conclusion This study demonstrated that arterial blood oxygen saturation, respiratory rate, and Alzheimer's disease are crucial variables for predicting death. Furthermore, arterial blood oxygen saturation and respiratory rate are significant factors in predicting the risk of ARDS.
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Affiliation(s)
- Farzaneh Yazdanpanah
- Department of Critical Care Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Alun C. Jackson
- Australian Centre for Heart HealthMelbourneAustralia
- Faculty of HealthDeakin UniversityGeelongAustralia
- Centre on Behavioural HealthHong Kong UniversityHong KongChina
| | - Neda Sanaie
- Department of Medical Surgical Nursing, School of Nursing and MidwiferyShahid Beheshti University of Medical SciencesTehranIran
| | - Farshad Sharifi
- Elderly Health Research Center, Endocrine Population Sciences Institute, Endocrinology and Metabolism Research InstituteTehran University of Medical SciencesTehranIran
| | - Seyed Morteza Shamshirgaran
- Department of Epidemiology and Statistics Faculty of Health SciencesNeyshabur University of Medical SciencesNeyshaburIran
| | - Fatemeh Bahramnezhad
- Department of Critical Care Nursing, School of Nursing & Midwifery, Nursing and Midwifery Care Research CenterTehran University of Medical SciencesTehranIran
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Phua J, Kulkarni AP, Mizota T, Hashemian SMR, Lee WY, Permpikul C, Chittawatanarat K, Nitikaroon P, Arabi YM, Fang WF, Konkayev A, Hashmi M, Palo JE, Faruq MO, Shrestha BR, KC B, Mat Nor MBB, Sann KK, Ling L, Haniffa R, Al Bahrani M, Mendsaikhan N, Chan YH. Critical care bed capacity in Asian countries and regions before and during the COVID-19 pandemic: an observational study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2024; 44:100982. [PMID: 38143717 PMCID: PMC10733690 DOI: 10.1016/j.lanwpc.2023.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/08/2023] [Accepted: 11/22/2023] [Indexed: 12/26/2023]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic highlighted the importance of critical care. The aim of the current study was to compare the number of adult critical care beds in relation to population size in Asian countries and regions before (2017) and during (2022) the pandemic. Methods This observational study collected data closest to 2022 on critical care beds (intensive care units and intermediate care units) in 12 middle-income and 7 high-income economies (using the 2022-2023 World Bank classification), through a mix of methods including government sources, national critical care societies, personal contacts, and data extrapolation. Data were compared with a prior study from 2017 of the same countries and regions. Findings The cumulative number of critical care beds per 100,000 population increased from 3.0 in 2017 to 9.4 in 2022 (p = 0.003). The median figure for middle-income economies increased from 2.6 (interquartile range [IQR] 1.7-7.8) to 6.6 (IQR 2.2-13.3), and that for high-income economies increased from 11.4 (IQR 7.3-22.8) to 13.9 (IQR 10.7-21.7). Only 3 countries did not see a rise in bed capacity. Where data were available in 2022, 10.9% of critical care beds were in single rooms (median 5.0% in middle-income and 20.3% in high-income economies), and 5.3% had negative pressure (median 0.7% in middle-income and 18.5% in high-income economies). Interpretation Critical care bed capacity in the studied Asian countries and regions increased close to three-fold from 2017 to 2022. Much of this increase was attributed to middle-income economies, but substantial heterogeneity exists. Funding None.
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Affiliation(s)
- Jason Phua
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
| | - Atul Prabhakar Kulkarni
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Toshiyuki Mizota
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
| | - Seyed Mohammad Reza Hashemian
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Won-Yeon Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Chairat Permpikul
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kaweesak Chittawatanarat
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
| | - Phongsak Nitikaroon
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
| | - Yaseen M. Arabi
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
| | - Wen-Feng Fang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Aidos Konkayev
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
| | - Madiha Hashmi
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
| | - Jose Emmanuel Palo
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
| | - Mohammad Omar Faruq
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
| | - Babu Raja Shrestha
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Bijay KC
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | | | - Kyi Kyi Sann
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
| | - Lowell Ling
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Rashan Haniffa
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
| | - Maher Al Bahrani
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
| | - Naranpurev Mendsaikhan
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Asian Critical Care Clinical Trials (ACCCT) Group
- Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore
- Division of Respiratory and Critical Care Medicine, National University Hospital, National University Health System, Singapore
- Division of Critical Care Medicine, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
- Department of Anesthesia, Kyoto University Hospital, Kyoto, Japan
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
- Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Faculty of Medicine, Department of Surgery, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Chiang Mai, Thailand
- Health Administration Division, Ministry of Public Health, Nonthaburi, Thailand
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Kingdom of Saudi Arabia
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
- Anaesthesiology and Intensive Care Department, Astana Medical University, Nur-Sultan, Kazakhstan
- National Science Center of Traumatology and Orthopedia Named Batpenov, Nur-Sultan, Kazakhstan
- Department of Critical Care Medicine, Ziauddin University, Karachi, Pakistan
- Acute and Critical Care Institute, The Medical City, Pasig City, Philippines
- General Intensive Care Unit and Emergency Department, United Hospital Ltd, Dhaka, Bangladesh
- Department of Anesthesia and Intensive Care, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
- International Islamic University Malaysia Medical Centre, Kuantan, Malaysia
- Department of Anaesthesiology and Intensive Care Unit, Yangon General Hospital, University of Medicine 1, Yangon, Myanmar
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Network for Improving Critical Care Systems and Training, Colombo, Sri Lanka
- Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
- Centre for Inflammation Research, University of Edinburgh, Edinburgh, Scotland
- Department of Anesthesia and Critical Care, Royal Hospital, Muscat, Oman
- Mongolia-Japan Hospital, Mongolian National University Medical Sciences, Ulaanbaatar, Mongolia
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
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Doubravská L, Htoutou Sedláková M, Fišerová K, Klementová O, Turek R, Langová K, Kolář M. Bacterial Community- and Hospital-Acquired Pneumonia in Patients with Critical COVID-19-A Prospective Monocentric Cohort Study. Antibiotics (Basel) 2024; 13:192. [PMID: 38391578 PMCID: PMC10886267 DOI: 10.3390/antibiotics13020192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
The impact of bacterial pneumonia on patients with COVID-19 infection remains unclear. This prospective observational monocentric cohort study aims to determine the incidence of bacterial community- and hospital-acquired pneumonia (CAP and HAP) and its effect on mortality in critically ill COVID-19 patients admitted to the intensive care unit (ICU) at University Hospital Olomouc between 1 November 2020 and 31 December 2022. The secondary objectives of this study include identifying the bacterial etiology of CAP and HAP and exploring the capabilities of diagnostic tools, with a focus on inflammatory biomarkers. Data were collected from the electronic information hospital system, encompassing biomarkers, microbiological findings, and daily visit records, and subsequently evaluated by ICU physicians and clinical microbiologists. Out of 171 patients suffering from critical COVID-19, 46 (27%) had CAP, while 78 (46%) developed HAP. Critically ill COVID-19 patients who experienced bacterial CAP and HAP exhibited higher mortality compared to COVID-19 patients without any bacterial infection, with rates of 38% and 56% versus 11%, respectively. In CAP, the most frequent causative agents were chlamydophila and mycoplasma; Enterobacterales, which were multidrug-resistant in 71% of cases; Gram-negative non-fermenting rods; and Staphylococcus aureus. Notably, no strains of Streptococcus pneumoniae were detected, and only a single strain each of Haemophilus influenzae and Moraxella catarrhalis was isolated. The most frequent etiologic agents causing HAP were Enterobacterales and Gram-negative non-fermenting rods. Based on the presented results, commonly used biochemical markers demonstrated poor predictive and diagnostic accuracy. To confirm the diagnosis of bacterial CAP in our patient cohort, it was necessary to assess the initial values of inflammatory markers (particularly procalcitonin), consider clinical signs indicative of bacterial infection, and/or rely on positive microbiological findings. For HAP diagnostics, it was appropriate to conduct regular detailed clinical examinations (with a focus on evaluating respiratory functions) and closely monitor the dynamics of inflammatory markers (preferably Interleukin-6).
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Affiliation(s)
- Lenka Doubravská
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Miroslava Htoutou Sedláková
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Fišerová
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Olga Klementová
- Department of Anaesthesiology, Resuscitation and Intensive Care, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Radovan Turek
- Department of Anaesthesiology, Resuscitation and Intensive Care, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Kateřina Langová
- Department of Medical Biophysics, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
| | - Milan Kolář
- Department of Microbiology, University Hospital Olomouc, Zdravotniku 248/7, 779 00 Olomouc, Czech Republic
- Department of Microbiology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Hnevotinska 3, 779 00 Olomouc, Czech Republic
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Prajakta NG, Chougule SB, Kamat AM, Laxmi K, Ananda Kumar L, Verma R, Kamath R. Knowledge of and Self-Expressed Stigma for COVID-19 Vaccination among Pre-University Students in a College in South India: A Cross-Sectional Study. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S376-S379. [PMID: 38595472 PMCID: PMC11001030 DOI: 10.4103/jpbs.jpbs_602_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 08/29/2023] [Accepted: 09/17/2023] [Indexed: 04/11/2024] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) is a contagious infection characterized by severe acute respiratory syndrome (SARS-CoV-2). Safe and effective vaccines are game-changers in the global vision of marking an end to the challenges posed by the COVID-19 pandemic. However, vaccine hesitancy due to perceived stigma and misinformation is a grave cause of concern. Objectives To assess pre-university students' self-expressed stigma regarding COVID-19 vaccination and its association with their knowledge. Materials and Methods A cross-sectional study was adopted for this research. A structured questionnaire approach was used to gather data from 384 students purposively at the selected pre-university college. The structured questionnaire consisted of three sections that explored the socio-demographic characteristics of the study participants, knowledge of vaccination, and self-expressed stigma, respectively. A total of 384 respondents took part in the study. Results The study observes a low positive relationship (r = 0.25, P < 0.01) between knowledge and self-expressed stigma toward vaccination. Further, it was observed that participants from rural backgrounds had lower knowledge and self-expressed stigma scores than participants from urban settings. It is pertinent to note that participants with other sources of information had higher knowledge than those who used the internet, friends/peers, or newspapers. Both of the aforementioned findings are statistically significant. Conclusion The interventions should revive trust in national health authorities, structured awareness campaigns by government agencies, and media coverage about the safety and efficacy of vaccines. In addition, it is also important to support citizens in ensuring that they have access to the right information from authentic sources in times of crisis.
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Affiliation(s)
- N. G. Prajakta
- Department of Psychiatry, KAHER Institute of Nursing Sciences, KLE University, Belgaum, Karnataka, India
| | - Sanjeev B. Chougule
- Department of Hospital Administration, (MBA), JN Medical College, KAHER, KLE University, Belgaum, Karnataka, India
| | - Ashok M. Kamat
- Department of Psychiatry, KAHER Institute of Nursing Sciences, KLE University, Belgaum, Karnataka, India
| | - K. Laxmi
- Department of Obstetrics and Gynecology, KAHER Institute of Nursing Sciences, KLE University, Belgaum, Karnataka, India
| | - L. Ananda Kumar
- District Consultant, National Health Mission, Health and Welfare Department, Government of India, India
| | - Reena Verma
- Department of Dietetics and Applied Nutrition, Welcomgroup Graduate School of Hotel Administration, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Rajesh Kamath
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Chen S, Ren S, Wang G, Huang M, Xue C. Interpretable CNN-Multilevel Attention Transformer for Rapid Recognition of Pneumonia From Chest X-Ray Images. IEEE J Biomed Health Inform 2024; 28:753-764. [PMID: 37027681 DOI: 10.1109/jbhi.2023.3247949] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Chest imaging plays an essential role in diagnosing and predicting patients with COVID-19 with evidence of worsening respiratory status. Many deep learning-based approaches for pneumonia recognition have been developed to enable computer-aided diagnosis. However, the long training and inference time makes them inflexible, and the lack of interpretability reduces their credibility in clinical medical practice. This paper aims to develop a pneumonia recognition framework with interpretability, which can understand the complex relationship between lung features and related diseases in chest X-ray (CXR) images to provide high-speed analytics support for medical practice. To reduce the computational complexity to accelerate the recognition process, a novel multi-level self-attention mechanism within Transformer has been proposed to accelerate convergence and emphasize the task-related feature regions. Moreover, a practical CXR image data augmentation has been adopted to address the scarcity of medical image data problems to boost the model's performance. The effectiveness of the proposed method has been demonstrated on the classic COVID-19 recognition task using the widespread pneumonia CXR image dataset. In addition, abundant ablation experiments validate the effectiveness and necessity of all of the components of the proposed method.
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Roos-Blom MJ, Bakhshi-Raiez F, Brinkman S, Arbous MS, van den Berg R, Bosman RJ, van Bussel BCT, Erkamp ML, de Graaff MJ, Hoogendoorn ME, de Lange DW, Moolenaar D, Spijkstra JJ, de Waal RAL, Dongelmans DA, de Keizer NF. Quality improvement of Dutch ICUs from 2009 to 2021: A registry based observational study. J Crit Care 2024; 79:154461. [PMID: 37951771 DOI: 10.1016/j.jcrc.2023.154461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/24/2023] [Accepted: 08/28/2023] [Indexed: 11/14/2023]
Abstract
PURPOSE To investigate the development in quality of ICU care over time using the Dutch National Intensive Care Evaluation (NICE) registry. MATERIALS AND METHODS We included data from all ICU admissions in the Netherlands from those ICUs that submitted complete data between 2009 and 2021 to the NICE registry. We determined median and interquartile range for eight quality indicators. To evaluate changes over time on the indicators, we performed multilevel regression analyses, once without and once with the COVID-19 years 2020 and 2021 included. Additionally we explored between-ICU heterogeneity by calculating intraclass correlation coefficients (ICC). RESULTS 705,822 ICU admissions from 55 (65%) ICUs were included in the analyses. ICU length of stay (LOS), duration of mechanical ventilation (MV), readmissions, in-hospital mortality, hypoglycemia, and pressure ulcers decreased significantly between 2009 and 2019 (OR <1). After including the COVID-19 pandemic years, the significant change in MV duration, ICU LOS, and pressure ulcers disappeared. We found an ICC ≤0.07 on the quality indicators for all years, except for pressure ulcers with an ICC of 0.27 for 2009 to 2021. CONCLUSIONS Quality of Dutch ICU care based on seven indicators significantly improved from 2009 to 2019 and between-ICU heterogeneity is medium to small, except for pressure ulcers. The COVID-19 pandemic disturbed the trend in quality improvement, but unaltered the between-ICU heterogeneity.
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Affiliation(s)
- Marie-José Roos-Blom
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands.
| | - Ferishta Bakhshi-Raiez
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - Sylvia Brinkman
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
| | - M Sesmu Arbous
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Leiden University Medical Center, Intensive Care Medicine, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Roy van den Berg
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Elisabeth TweeSteden Hospital, Intensive Care Medicine, Hilvarenbeekse Weg 60, 5022 GC, Tilburg, the Netherlands
| | - Rob J Bosman
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; OLVG, Intensive Care Medicine, Amsterdam, the Netherlands
| | - Bas C T van Bussel
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Maastricht University Medical Center, Intensive Care Medicine, 6229 HX Maastricht, the Netherlands
| | - Michiel L Erkamp
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Dijklander Ziekenhuis, Intensive Care Medicine, Purmerend, the Netherlands
| | - Mart J de Graaff
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; St. Antonius Hospital, Intensive Care Medicine, Nieuwegein, the Netherlands
| | - Marga E Hoogendoorn
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Isala, Department of Anesthesiology and Intensive Care, Zwolle, the Netherlands
| | - Dylan W de Lange
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; University Medical Center, University of Utrecht, Intensive Care Medicine, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - David Moolenaar
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Martini Hospital, Intensive Care Medicine, Groningen, the Netherlands
| | - Jan Jaap Spijkstra
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam UMC location Free University, Intensive Care Medicine, Boelelaan, 1117 Amsterdam, the Netherlands
| | - Ruud A L de Waal
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amphia Hospital, Intensive Care Medicine, Molengracht 21, 4818 CK Breda, the Netherlands
| | - Dave A Dongelmans
- National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC location University of Amsterdam, Intensive Care Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - Nicolette F de Keizer
- Amsterdam UMC location University of Amsterdam, Department of Medical Informatics, Meibergdreef 9, Amsterdam, the Netherlands; National Intensive Care Evaluation Foundation, Amsterdam, the Netherlands; Amsterdam Public Health, Quality of Care, Amsterdam, the Netherlands
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20
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Brustia R, Amaddeo G, Rhaiem R, Levesque E, Monsel A, Baaroun V, Dimmock M, Rousseau MA, Wagner-Ballon O, Botterel F, Andujar P, Sommacale D. Educational interventions to integrate surgical staff within medical units during the COVID-19 pandemic: EDUCOVID survey. Acta Chir Belg 2024; 124:12-19. [PMID: 36346005 DOI: 10.1080/00015458.2022.2145720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/05/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND The SARS-CoV-2 (COVID-19) pandemic required a rapid surge of healthcare capacity to face a growing number of critically ill patients. For this reason, a support reserve of physicians, including surgeons, were required to be reassigned to offer support. OBJECTIVE To realize a survey on the educational programs deployed (face-to-face or e-learning focusing on infective area, basic gestures, COVID clinical management and intensive care medicine), and their impact on behavior change (Kirkpatrick 3) of the target population of surgeons, measured on a five modalities Likert scale. DESIGN Cross-sectional online e-survey (NCT04732858) within surgeons from the Assistance Publique - Hôpitaux de Paris network, metropolitan area of Paris, France. RESULTS Cross-sectional e-Survey: among 382 surgeons invited, 37 (9.7%) participated. The effectiveness of the educational interventions on behavior changes was rated within the highest region of the Likert scale by 15% (n = 3) and 22% (n = 6) for 'e-learning' and 'face-to-face' delivery modes, respectively. CONCLUSIONS Despite the low response rate, this survey suggests an overall low impact on behaviour change among responders affiliated to a surgical discipline.
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Affiliation(s)
- Raffaele Brustia
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, Créteil, France
- Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", INSERM U955, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Giuliana Amaddeo
- Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", INSERM U955, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Créteil, France
- Department of Hepatology, AP-HP, Hôpital Henri-Mondor, F-94010 Créteil, France, Paris Est Créteil University, UPEC, Créteil, France
| | - Rami Rhaiem
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, Robert Debré University Hospital, Reims, France
- University Reims Champagne-Ardenne, Reims, France
| | - Eric Levesque
- Department of Anesthesia and Surgical Intensive Care-Liver ICU, AP-HP Henri Mondor Hospital, Créteil, France
- Ecole Nationale Vétérinaire d'Alfort (ENVA), Faculté de Médecine de Créteil, EA Dynamyc Université Paris-Est Créteil (UPEC), Créteil, France
| | - Antoine Monsel
- Multidisciplinary Intensive Care Unit, Department of Anaesthesiology and Critical Care, La Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Medicine Sorbonne University, Paris, France
| | - Vanessa Baaroun
- Oral Surgery Department, Pitié-Salpêtrière University Hospital, Paris Diderot University, Paris, France
| | - Mylène Dimmock
- Hôpital Henri-Mondor - Service de médecine bucco-dentaire - Groupe Henri Mondor AP-HP, Île de France Créteil, France
| | - Marc-Antoine Rousseau
- Orthopedics Department, Bichat Hospital, Paris Diderot University, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Oriane Wagner-Ballon
- Univ Paris Est Creteil, INSERM, IMRB, Creteil, France
- Département d'hématologie et d'immunologie, AP-HP, Hôpitaux Universitaires Henri Mondor, Creteil, France
| | - Francoise Botterel
- EA 7380 Dynamyc, Université Paris-Est Créteil, Ecole nationale vétérinaire d'Alfort, USC Anses, Créteil, France
- Unité de Parasitologie-Mycologie, Département de revention, diagnostic et traitement des infections, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - Pascal Andujar
- INSERM Unité U955, Equipe 4, Créteil, France
- Faculté de Médecine, Université Paris-Est Créteil, Créteil, France
- Service de Pathologie Professionnelle et de l'Environnement, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Daniele Sommacale
- Department of Digestive and Hepato-pancreatic-biliary Surgery, AP-HP, Hôpital Henri-Mondor, Paris Est Créteil University, UPEC, Créteil, France
- Team "Pathophysiology and Therapy of Chronic Viral Hepatitis and Related Cancers", INSERM U955, Créteil, France
- Assistance Publique-Hôpitaux de Paris, Créteil, France
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Niu H, Li J, Teng C, Lu X, Jin C, Cai P, Shi A, Shen X, Chen Q, Chen M, Yuan Y, Li P. The incidence and impact of atrial fibrillation on hospitalized Coronavirus disease-2019 patients. Clin Cardiol 2024; 47:e24240. [PMID: 38402574 PMCID: PMC10894524 DOI: 10.1002/clc.24240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Since 2019, Coronavirus disease-2019 (COVID-19) has raised unprecedented global health crisis. The incidence and impact of atrial fibrillation (AF) on patients with COVID-19 remain unclearly defined. METHODS We conducted a retrospective cohort study using ICD-10 codes to identify patients with a primary diagnosis of COVID-19 with or without AF in National Inpatient Sample Database 2020. We compared the outcome of COVID-19 patients with a concurrent diagnosis of AF with those without. HYPOTHESIS AF will adversely affect the prognosis of hospitalized COVID-19 patients. RESULTS A total of 211 619 patients with a primary diagnosis of COVID-19 were identified. Among these patients, 31 923 (15.08%) had a secondary diagnosis of AF. Before propensity score matching, COVID-AF cohort was older (75.8 vs. 62.2-year-old, p < .001) and had more men (57.5% vs. 52.0%, p < .001). It is associated with more comorbidities, mainly including diabetes mellitus (43.7% vs. 39.9%, p < .001), hyperlipidemia (54.6% vs. 39.8%, p < .001), chronic kidney disease (34.5% vs. 17.0%, p < .001), coronary artery disease (35.3% vs. 14.4%, p < .001), anemia (27.8% vs. 18.6%, p < .001), and cancer (4.8% vs. 3.4%, p < .001). After performing propensity score match, a total of 31 862 patients were matched within each group. COVID-AF cohort had higher inpatient mortality (22.2% vs. 15.3%, p < .001) and more complications, mainly including cardiac arrest (3.9% vs. 2.3%, p < .001), cardiogenic shock (0.9% vs. 0.3%, p < .001), hemorrhagic stroke (0.4% vs. 0.3%, p = .025), and ischemic stroke (1.3% vs. 0.7%, p < .001). COVID-AF cohort was more costly, with a longer length of stay, and a higher total charge. CONCLUSION AF is common in patients hospitalized for COVID-19, and is associated with poorer in-hospital mortality, immediate complications and increased healthcare resource utilization.
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Affiliation(s)
- Haiming Niu
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Jianwei Li
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Catherine Teng
- Division of Cardiology, Department of MedicineUniversity of Texas Health Science CenterSan AntonioTexasUSA
| | - Xiaojia Lu
- Department of Cardiology, Mount Sinai Beth IsraelIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Chengyue Jin
- Department of Cardiologythe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Peng Cai
- Department of Mathematical SciencesWorcester Polytechnic InstituteWorcesterMassachusettsUSA
| | - Ao Shi
- Faculty of MedicineSt. George University of LondonLondonUK
| | - Xiaoqing Shen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Qiqi Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Miaolian Chen
- Department of Critical Care MedicineZhongshan People's HospitalZhongshanP.R. China
| | - Yong Yuan
- Department of CardiovasculogyZhongshan People's HospitalZhongshanP.R. China
| | - Pengyang Li
- Division of Cardiology, Pauley Heart CenterVirginia Commonwealth UniversityRichmondVirginiaUSA
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Hashemi M, Atashi V, Haghighat S, Sadegh R, Sami R. Short-term Pulmonary Rehabilitation after Recovering from Severe COVID-19. Int J Prev Med 2024; 14:134. [PMID: 38449686 PMCID: PMC10916409 DOI: 10.4103/ijpvm.ijpvm_320_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 05/10/2023] [Indexed: 03/08/2024] Open
Abstract
Background Patients with severe COVID-19 suffer from various problems such as impaired lung function, decreased exercise capacity, mental disorders, and reduced quality of life. This study aimed to evaluate the effectiveness of short-term pulmonary rehabilitation in patients recovering from severe COVID-19. Methods The present study was a retrospective cohort study. This study was conducted in 2021 on 92 patients with severe COVID-19 who met the inclusion criteria. Inter-professional pulmonary rehabilitation sessions were performed for 3 weeks, twice a week (six sessions in total), for this group of patients, which included physical exercises, educational activities, and other health-related services (counseling and psychotherapy). Outcomes assessed included a 6-min walk test, the score of the Hospital Anxiety and Depression Scale, and the SF-12 Quality of Life Questionnaire, which were completed before and after pulmonary rehabilitation. Data analysis was performed using analytical and descriptive statistics. Results The statistical analyses showed that 60.86% of patients participating in the study were male and 39.14% were female, and the mean age of patients was 54.9 ± 12.3 years. The findings also showed that the average distance traveled in the 6-min walk test before pulmonary rehabilitation was 289.2174 ± 130.5 m; however, after the intervention, this rate reached 343.0870 ± 103.5 m, which demonstrated a statistically significant difference (P = 0.00). Also, significant changes were observed in anxiety and depression, the ability to perform daily activities, and the physical health of patients before and after the intervention (P < 0.05). Conclusions Short-term pulmonary rehabilitation is a safe and useful treatment without side effects that can be effective in reducing anxiety and depression, increasing the ability to perform daily activities and exercise capacity, and consequently, improving the quality of life of patients recovering from severe COVID-19.
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Affiliation(s)
- Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vajihe Atashi
- Department of Nursing and Midwifery Care Research Center, Adult Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Raheleh Sadegh
- Department of Community and Prevention, Isfahan University of Medical Science, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Sanchez-Plazas LC, García-De Jesus R, Martinez-Gonzalez KG, Amaya-Ardila CP, Almodóvar-Rivera IA. The psychological impact of the COVID-19 pandemic on physicians in Puerto Rico: a cross-sectional study after the second wave in 2021. Front Psychiatry 2024; 14:1329427. [PMID: 38323026 PMCID: PMC10845663 DOI: 10.3389/fpsyt.2023.1329427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/15/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Health care providers faced a challenge with the emergence of COVID-19 and its rapid spread. Early studies measuring the psychological impact of COVID-19 on the general population found high levels of anxiety and sleep disorders. The primary goal of this project was to assess the psychological impact of COVID-19 on physicians in Puerto Rico. Materials and methods A cross-sectional study of physicians in Puerto Rico was conducted anonymously and electronically from February 2021 through April 2021. The electronic survey included socio-demographic data and 4 self-administered assessment tools (Generalized Anxiety Disorder-7, Perceived Stress Scale-10, Pittsburgh Sleep Quality Index and COVID-19 Organizational Support) for anxiety, perceived stress, sleep disturbances, and organizational support during the COVID-19 pandemic. Results A total of 145 physicians completed the survey, with a female predominance of 53.5% and a majority practicing in the San Juan metropolitan area (50.3%). Mild anxiety symptoms were reported in 26.9% of physicians, and 33.8% had moderate to severe anxiety symptoms. Moderate to high perceived stress was found in 69.9% of participants, and women reported statistically significantly higher levels of anxiety symptoms (8.84 ± 5.99; p = 0.037) and stress (19.0 ± 6.94, p = 0.001). The Pittsburgh Sleep Quality Index reported 67.9% of physicians with global scores associated with poor sleep quality. Assessment of perceived organizational support found a high perception of work support (65.7%) but low perception of personal support (43.4%) and risk support (30.3%). A correlation analysis found a negative correlation for work and personal support, but a positive correlation for risk support, all statistically significant. Conclusion COVID-19 had a lasting psychological impact in health care providers in Puerto Rico a year after the beginning of the pandemic. Our data supports the importance of organizational support and its correlation with the development of anxiety. It is thus essential to develop strategies to identify individuals at risk of experiencing psychological disturbances and to provide effective support for medical professionals during medical emergencies for their well-being and optimal delivery of patient care.
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Affiliation(s)
- Liza C. Sanchez-Plazas
- Critical Care Section, Department of Pediatrics, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ricardo García-De Jesus
- Critical Care Section, Department of Pediatrics, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Claudia P. Amaya-Ardila
- Department of Biostatistics and Epidemiology, Medical Science Campus, University of Puerto Rico, San Juan, Puerto Rico
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Chakraborty R, Achour N. Setting Up a Just and Fair ICU Triage Process during a Pandemic: A Systematic Review. Healthcare (Basel) 2024; 12:146. [PMID: 38255035 PMCID: PMC10815731 DOI: 10.3390/healthcare12020146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/06/2023] [Accepted: 12/08/2023] [Indexed: 01/24/2024] Open
Abstract
INTRODUCTION Triage is a dynamic and complex decision-making process to determine fair access to medical care in mass casualty situations. Triage takes place through healthcare settings including Intensive Care Units (ICUs). Triage governing principles have been subject to ethical debates for a long time specifically with the recent global pandemic of COVID-19. This study aims to revisit the ethical principles guiding patient prioritisation during recent COVID-19 disaster triage in the Indian subcontinent and attempts to look for principles with consideration of social justice. METHODS Key electronic databases such as WHO, EMBASE, and DOAJ were used to access published literature relating to ICU triage in the Indian subcontinent. Literature on and from 2015-2022 were included in this study. The SPICE framework was used to identify the literature. The Inclusion criteria were as follows: Literature with ethical connotations focusing on India and neighbouring countries, and in an ICU setting during pandemics. The Exclusion criteria were as follows: Literature focusing on other countries, without ethical foundations, hospital admissions, and non-COVID-19 ICU admissions. The PRISMA standard was applied to screen the appropriate literature. The BOOLEAN operator "OR" was used to enhance the literature search. Finally, six papers were found suitable for this study and thus were included in the literature review. Additionally, for the second time, the frequency of certain ethical phrases was reassessed in the plans and guidelines to check the changed awareness of ethical pandemic planning, if any. A thematic analysis was applied to analyse the data and generate findings and new knowledge. RESULTS The findings highlight gaps in knowledge around ICU triaging in the region which indicates the scope of better ethical pandemic preparation at the regional level. The findings show that there is a debate between researchers on prioritisation from available resources and ethical perspectives and principles associated with fair access to healthcare even during pandemic times. The literature also highlights enhancing the regional capacity and building equitable approaches to reduce existing health inequities and the need of the social justice framework for ICU triaging during a pandemic. CONCLUSIONS ICU triaging in five South Asian neighbour nations was studied for the presence of a guided ethical framework. Additionally, for the second time, certain ethical phrases were reassessed in the plans and guidelines; however, usage of those terms was found to be significantly low. The discussion shows that the plans and guidelines have the scope to improve ethical ICU triaging in these countries and in the specific region. After analysing different ethical guidelines, this study emphasises that there is a need for a just and fair framework, specifically a social justice framework in ICU triage in the subcontinent to address the underlying health inequities.
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Affiliation(s)
- Rhyddhi Chakraborty
- School of Allied Health and Social Care, Anglia Ruskin University, Cambridge CB1 1PT, UK;
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25
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Fernández-Castillo RJ, González-Caro MD, Arroyo-Muñoz FJ, Garnacho-Montero J. National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study). ENFERMERIA INTENSIVA 2024; 35:35-44. [PMID: 37558544 DOI: 10.1016/j.enfie.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.
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Affiliation(s)
- R-J Fernández-Castillo
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | - M-D González-Caro
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - F-J Arroyo-Muñoz
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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26
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Forsberg T, Isaksson M, Schelin C, Lyngå P, Schandl A. Family members' experiences of COVID-19 visiting restrictions in the intensive care unit-A qualitative study. J Clin Nurs 2024; 33:215-223. [PMID: 36710394 DOI: 10.1111/jocn.16637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden. BACKGROUND In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated. DESIGN This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist. RESULTS Two categories-dealing with uncertainty and being involved at a distance-described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact. CONCLUSIONS Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home. RELEVANCE TO CLINICAL PRACTICE This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU. PATIENT AND PUBLIC CONTRIBUTION None in the conceptualisation or design of the study.
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Affiliation(s)
- Tomas Forsberg
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
| | - Maria Isaksson
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
| | - Caroline Schelin
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Mejía-Granda CM, Fernández-Alemán JL, Carrillo-de-Gea JM, García-Berná JA. Security vulnerabilities in healthcare: an analysis of medical devices and software. Med Biol Eng Comput 2024; 62:257-273. [PMID: 37789249 PMCID: PMC10758361 DOI: 10.1007/s11517-023-02912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 08/14/2023] [Indexed: 10/05/2023]
Abstract
The integration of IoT in healthcare has introduced vulnerabilities in medical devices and software, posing risks to patient safety and system integrity. This study aims to bridge the research gap and provide valuable insights for addressing healthcare vulnerabilities and their mitigation mechanisms. Software vulnerabilities related to health systems from 2001 to 2022 were collected from the National Vulnerability Database (NVD) systematized by software developed by the researchers and assessed by a medical specialist for their impact on patient well-being. The analysis revealed electronic health records, wireless infusion pumps, endoscope cameras, and radiology information systems as the most vulnerable. In addition, critical vulnerabilities were identified, including poor credential management and hard-coded credentials. The investigation provides some insights into the consequences of vulnerabilities in health software products, projecting future security issues by 2025, offers mitigation suggestions, and highlights trends in attacks on life support and health systems are also provided. The healthcare industry needs significant improvements in protecting medical devices from cyberattacks. Securing communication channels and network schema and adopting secure software practices is necessary. In addition, collaboration, regulatory adherence, and continuous security monitoring are crucial. Industries, researchers, and stakeholders can utilize these findings to enhance security and safeguard patient safety.
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Affiliation(s)
- Carlos M Mejía-Granda
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, 30100, Murcia, Spain.
| | - José L Fernández-Alemán
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, 30100, Murcia, Spain
| | - Juan M Carrillo-de-Gea
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, 30100, Murcia, Spain
| | - José A García-Berná
- Department of Informatics and Systems, Faculty of Computer Science, University of Murcia, 30100, Murcia, Spain
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Arian A, Mehrabi Nejad MM, Zoorpaikar M, Hasanzadeh N, Sotoudeh-Paima S, Kolahi S, Gity M, Soltanian-Zadeh H. Accuracy of artificial intelligence CT quantification in predicting COVID-19 subjects' prognosis. PLoS One 2023; 18:e0294899. [PMID: 38064442 PMCID: PMC10707659 DOI: 10.1371/journal.pone.0294899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 11/11/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Artificial intelligence (AI)-aided analysis of chest CT expedites the quantification of abnormalities and may facilitate the diagnosis and assessment of the prognosis of subjects with COVID-19. OBJECTIVES This study investigates the performance of an AI-aided quantification model in predicting the clinical outcomes of hospitalized subjects with COVID-19 and compares it with radiologists' performance. SUBJECTS AND METHODS A total of 90 subjects with COVID-19 (men, n = 59 [65.6%]; age, 52.9±16.7 years) were recruited in this cross-sectional study. Quantification of the total and compromised lung parenchyma was performed by two expert radiologists using a volumetric image analysis software and compared against an AI-assisted package consisting of a modified U-Net model for segmenting COVID-19 lesions and an off-the-shelf U-Net model augmented with COVID-19 data for segmenting lung volume. The fraction of compromised lung parenchyma (%CL) was calculated. Based on clinical results, the subjects were divided into two categories: critical (n = 45) and noncritical (n = 45). All admission data were compared between the two groups. RESULTS There was an excellent agreement between the radiologist-obtained and AI-assisted measurements (intraclass correlation coefficient = 0.88, P < 0.001). Both the AI-assisted and radiologist-obtained %CLs were significantly higher in the critical subjects (P = 0.009 and 0.02, respectively) than in the noncritical subjects. In the multivariate logistic regression analysis to distinguish the critical subjects, an AI-assisted %CL ≥35% (odds ratio [OR] = 17.0), oxygen saturation level of <88% (OR = 33.6), immunocompromised condition (OR = 8.1), and other comorbidities (OR = 15.2) independently remained as significant variables in the models. Our proposed model obtained an accuracy of 83.9%, a sensitivity of 79.1%, and a specificity of 88.6% in predicting critical outcomes. CONCLUSIONS AI-assisted measurements are similar to quantitative radiologist-obtained measurements in determining lung involvement in COVID-19 subjects.
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Affiliation(s)
- Arvin Arian
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad-Mehdi Mehrabi Nejad
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Zoorpaikar
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Navid Hasanzadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Saman Sotoudeh-Paima
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Shahriar Kolahi
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Gity
- Department of Radiology, School of Medicine, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Soltanian-Zadeh
- Control and Intelligent Processing Center of Excellence (CIPCE), School of Electrical and Computer Engineering, College of Engineering, University of Tehran, Tehran, Iran
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Jacquier M, Labruyère M, Ecarnot F, Roudaut JB, Andreu P, Voizeux P, Save Q, Pedri R, Rigaud JP, Quenot JP. Ventilatory Management of Patients with Acute Respiratory Distress Syndrome Due to SARS-CoV-2. J Clin Med 2023; 12:7509. [PMID: 38137578 PMCID: PMC10743400 DOI: 10.3390/jcm12247509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/20/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023] Open
Abstract
The emergence of the new SARS-CoV-2 in December 2019 caused a worldwide pandemic of the resultant disease, COVID-19. There was a massive surge in admissions to intensive care units (ICU), notably of patients with hypoxaemic acute respiratory failure. In these patients, optimal oxygen therapy was crucial. In this article, we discuss tracheal intubation to provide mechanical ventilation in patients with hypoxaemic acute respiratory failure due to SARS-CoV-2. We first describe the pathophysiology of respiratory anomalies leading to acute respiratory distress syndrome (ARDS) due to infection with SARS-CoV-2, and then briefly review management, focusing particularly on the ventilation strategy. Overall, the ventilatory management of ARDS due to SARS-CoV-2 infection is largely the same as that applied in ARDS from other causes, and lung-protective ventilation is recommended. The difference lies in the initial clinical presentation, with profound hypoxaemia often observed concomitantly with near-normal pulmonary compliance.
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Affiliation(s)
- Marine Jacquier
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
| | - Marie Labruyère
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
| | - Fiona Ecarnot
- Department of Cardiology, University Hospital Besancon, 25030 Besançon, France;
- EA3920, University of Franche-Comté, 25000 Besançon, France
| | - Jean-Baptiste Roudaut
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pascal Andreu
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Pierre Voizeux
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Quentin Save
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Romain Pedri
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
| | - Jean-Philippe Rigaud
- Department of Intensive Care, Centre Hospitalier de Dieppe, 76202 Dieppe, France;
- Espace de Réflexion Éthique de Normandie, University Hospital Caen, 14000 Caen, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, François Mitterrand, University Hospital, 21000 Dijon, France; (M.J.); (M.L.); (J.-B.R.); (P.A.); (P.V.); (Q.S.); (R.P.)
- Lipness Team, INSERM Research Centre LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, 21000 Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, 21000 Dijon, France
- DRCI, USMR, CHU Dijon Bourgogne, 21000 Dijon, France
- Espace de Réflexion Éthique Bourgogne Franche-Comté (EREBFC), University of Burgundy, 21000 Dijon, France
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Bagheri-Hosseinabadi Z, Pirsadeghi A, Ostadebrahimi H, Taghipour Khaje Sharifi G, Abbasifard M. Correlation of iron and related factors with disease severity and outcomes and mortality of patients with Coronavirus disease 2019. J Trace Elem Med Biol 2023; 80:127285. [PMID: 37660574 DOI: 10.1016/j.jtemb.2023.127285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 08/06/2023] [Accepted: 08/18/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Iron is a trace element that possesses immunomodulatory properties and modulates the proneness to the course and outcome of a diverse viral diseases. This study intended to investigate the correlation of different iron-related factors with disease severity and outcomes as well as the mortality of coronavirus disease 2019 (COVID-19) patients. METHODS Blood serum samples were obtained from 80 COVID-19 cases and 100 healthy controls. Concentrations of ferritin, transferrin, total iron binding capacity (TIBC) was measured by Enzyme-linked immunosorbent assay (ELISA) and iron level was measured by immunoturbidometric method. RESULTS Concentrations of iron, transferrin, and TIBC were low, while ferritin level was high in the COVID-19 cases in comparison to controls. In non-survivor (deceased) patients as well as severe subjects, the levels of iron, ferritin, transferrin, and TIBC were significantly different than survivors (discharged) and mild cases. Significant correlations were found between iron and related factors and the clinicopathological features of the patients. Based on ROC curve analysis, iron, ferritin, transferrin, and TIBC had potential to estimate disease severity in COVID-19 subjects. CONCLUSION Iron metabolism is involved in the pathogenesis of COVID-19. Iron and related factors correlate with disease outcomes and might serve as biomarker in diagnosis of the disease severity and estimation of mortality in the COVID-19 subjects.
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Affiliation(s)
- Zahra Bagheri-Hosseinabadi
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Department of Clinical Biochemistry, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Ali Pirsadeghi
- Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamid Ostadebrahimi
- Department of Pediatrics, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | | | - Mitra Abbasifard
- Immunology of Infectious Diseases Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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Utzet M, Villar R, Díaz P, Rodríguez Arjona MD, Ramada JM, Serra C, G Benavides F. Dealing with the unknown: perceptions, fears and worries of SARS-CoV-2 infection among hospital workers. GACETA SANITARIA 2023; 37:102335. [PMID: 37992460 DOI: 10.1016/j.gaceta.2023.102335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE This study explores fears and worries regarding SARS-CoV-2 risk of infection and transmission to relatives, co-workers, and patients in relation to non-pharmacological preventive interventions among healthcare workers (including physicians, nurses, aides, cleaners, maintenance, and security staff) in a healthcare institution in Barcelona (Spain), during the first and second waves of the SARS-CoV-2 pandemic. METHOD The research used an explorative qualitative approach. Six focus groups and ten individual interviews were conducted online and audio-recorded, transcribed verbatim and analysed using thematic analysis and mixed coding. RESULTS Forty professionals participated in the study. Four common themes emerged in all groups: challenges related to the lack of pandemic preparedness, concerns about personal protective equipment, unclear guidelines for case and contact tracing, and communication-related difficulties. CONCLUSIONS This study emphasizes the key recommendations to improve non-pharmacological preventive interventions to reduce workers' fears and worries about the risk of infection and spreading the infection to others, including families. Above all, these should include ensuring the availability, and correct use of adequate personal protective equipment, improve guidelines on case and contact tracing, and setting effective communication channels for all workers of the organization. These recommendations must be reinforced in maintenance and security personnel, as well as night shift nurses and aides, to also reduce health inequalities.
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Affiliation(s)
- Mireia Utzet
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER of Epidemiology and Public Health, Spain.
| | - Rocío Villar
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER of Epidemiology and Public Health, Spain; Occupational Health Service, Parc de Salut Mar, Barcelona, Spain
| | - Pilar Díaz
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Occupational Health Service, Parc de Salut Mar, Barcelona, Spain
| | | | - José María Ramada
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER of Epidemiology and Public Health, Spain; Occupational Health Service, Parc de Salut Mar, Barcelona, Spain
| | - Consol Serra
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER of Epidemiology and Public Health, Spain; Occupational Health Service, Parc de Salut Mar, Barcelona, Spain
| | - Fernando G Benavides
- Centre for Research in Occupational Health, Department of Medicine and Life Sciences, Universitat Pompeu Fabra, Barcelona, Spain; IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER of Epidemiology and Public Health, Spain
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Castro-Avila A, Merino-Osorio C, González-Seguel F, Camus-Molina A, Muñoz-Muñoz F, Leppe J. Six-month post-intensive care outcomes during high and low bed occupancy due to the COVID-19 pandemic: A multicenter prospective cohort study. PLoS One 2023; 18:e0294631. [PMID: 37972091 PMCID: PMC10653414 DOI: 10.1371/journal.pone.0294631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic can be seen as a natural experiment to test how bed occupancy affects post-intensive care unit (ICU) patient's functional outcomes. To compare by bed occupancy the frequency of mental, physical, and cognitive impairments in patients admitted to ICU during the COVID-19 pandemic. METHODS Prospective cohort of adults mechanically ventilated >48 hours in 19 ICUs from seven Chilean public and private hospitals. Ninety percent of nationwide beds occupied was the cut-off for low versus high bed occupancy. At ICU discharge, 3- and 6-month follow-up, we assessed disability using the World Health Organization Disability Assessment Schedule 2.0. Quality of life, mental, physical, and cognitive outcomes were also evaluated following the core outcome set for acute respiratory failure. RESULTS We enrolled 252 participants, 103 (41%) during low and 149 (59%) during high bed occupancy. Patients treated during high occupancy were younger (P50 [P25-P75]: 55 [44-63] vs 61 [51-71]; p<0.001), more likely to be admitted due to COVID-19 (126 [85%] vs 65 [63%]; p<0.001), and have higher education qualification (94 [63%] vs 48 [47%]; p = 0.03). No differences were found in the frequency of at least one mental, physical or cognitive impairment by bed occupancy at ICU discharge (low vs high: 93% vs 91%; p = 0.6), 3-month (74% vs 63%; p = 0.2) and 6-month (57% vs 57%; p = 0.9) follow-up. CONCLUSIONS There were no differences in post-ICU outcomes between high and low bed occupancy. Most patients (>90%) had at least one mental, physical or cognitive impairment at ICU discharge, which remained high at 6-month follow-up (57%). CLINICAL TRIAL REGISTRATION NCT04979897 (clinicaltrials.gov).
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Affiliation(s)
- Ana Castro-Avila
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Department of Health Sciences, University of York, Heslington, United Kingdom
| | - Catalina Merino-Osorio
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Felipe González-Seguel
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Agustín Camus-Molina
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- Servicio de Medicina Física y Rehabilitación, Departamento de Medicina Interna, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | | | - Jaime Leppe
- Carrera de Kinesiología, Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile
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Zakynthinos GE, Tsolaki V, Oikonomou E, Vavouranakis M, Siasos G, Zakynthinos E. New-Onset Atrial Fibrillation in the Critically Ill COVID-19 Patients Hospitalized in the Intensive Care Unit. J Clin Med 2023; 12:6989. [PMID: 38002603 PMCID: PMC10672690 DOI: 10.3390/jcm12226989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/28/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
New-onset atrial fibrillation (NOAF) is the most frequently encountered cardiac arrhythmia observed in patients with COVID-19 infection, particularly in Intensive Care Unit (ICU) patients. The purpose of the present review is to delve into the occurrence of NOAF in COVID-19 and thoroughly review recent, pertinent data. However, the causality behind this connection has yet to be thoroughly explored. The proposed mechanisms that could contribute to the development of AF in these patients include myocardial damage resulting from direct virus-induced cardiac injury, potentially leading to perimyocarditis; a cytokine crisis and heightened inflammatory response; hypoxemia due to acute respiratory distress; disturbances in acid-base and electrolyte levels; as well as the frequent use of adrenergic drugs in critically ill patients. Additionally, secondary bacterial sepsis and septic shock have been suggested as primary causes of NOAF in ICU patients. This notion gains strength from the observation of a similar prevalence of NOAF in septic non-COVID ICU patients with ARDS. It is plausible that both myocardial involvement from SARS-CoV-2 and secondary sepsis play pivotal roles in the onset of arrhythmia in ICU patients. Nonetheless, there exists a significant variation in the prevalence of NOAF among studies focused on severe COVID-19 cases with ARDS. This discrepancy could be attributed to the inclusion of mixed populations with varying degrees of illness severity, encompassing not only patients in general wards but also those admitted to the ICU, whether intubated or not. Furthermore, the occurrence of NOAF is linked to increased morbidity and mortality. However, it remains to be determined whether NOAF independently influences outcomes in critically ill COVID-19 ICU patients or if it merely reflects the disease's severity. Lastly, the management of NOAF in these patients has not been extensively studied. Nevertheless, the current guidelines for NOAF in non-COVID ICU patients appear to be effective, while accounting for the specific drugs used in COVID-19 treatment that may prolong the QT interval (although drugs like lopinavir/ritonavir, hydrochlorothiazide, and azithromycin have been discontinued) or induce bradycardia (e.g., remdesivir).
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Affiliation(s)
- George E. Zakynthinos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Vasiliki Tsolaki
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Manolis Vavouranakis
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
| | - Gerasimos Siasos
- 3rd Department of Cardiology, “Sotiria” Chest Diseases Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (G.E.Z.); (E.O.); (M.V.); (G.S.)
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Epaminondas Zakynthinos
- Critical Care Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece;
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Atashi V, Hashemi M, Haghighat S, Sadegh R, Sami R, Bahadori M. Mobile Phone App-Based or Face-to-Face Pulmonary Rehabilitation in COVID-19 Survivors. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:699-706. [PMID: 38205421 PMCID: PMC10775877 DOI: 10.4103/ijnmr.ijnmr_337_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/17/2023] [Accepted: 07/25/2023] [Indexed: 01/12/2024]
Abstract
Background Pulmonary Rehabilitation (PR) is recommended as a standard, effective, and important treatment for COVID-19 survivors who remain symptomatic after the acute phase. Therefore, we aimed to compare the effect of mobile phone-based PR application with face-to-face PR on the quality of life, anxiety, depression, and daily life activities of COVID-19 survivors. Materials and Methods A quasi-experimental was conducted on 65 COVID-19 survivors during 2022. Convenient sampling was done based on the inclusion criteria. The intervention group (n = 31) received PR through a mobile phone application, and the control group (n = 34) received face-to-face PR. Data were collected before and after the intervention in both groups using a demographic information questionnaire, SF-12, the hospital anxiety and depression scale, and Barthel scale. For all tests, a maximum error of 5% was considered. Results The two studied groups had no statistically significant difference with respect to all the investigated variables at baseline (p > 0.05). After the intervention, the mean anxiety and depression score of the patients in the control group was significantly lower than the intervention group (t = -3.46, f = 63, p = 0.01). After our intervention, there was no statistically significant difference in the mean quality of life and daily life activity scores between the two groups (t = -0.68, f = 63, p > 0.05). Conclusions The application of PR does not show a statistically significant difference in terms of improving the quality of life and daily activities compared with the face-to-face method; we suggest that the PR application be used as a cost-effective method when face-to-face PR is not possible.
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Affiliation(s)
- Vajihe Atashi
- Nursing and Midwifery Care Research Center, Adult Health Nursing Department, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marzieh Hashemi
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shila Haghighat
- Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Sadegh
- Department of Community and Prevention Medicine, Medical Faculty, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ramin Sami
- Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mobina Bahadori
- Adult Health Nursing Department, School of Nursing and Midwifery, Qom University of Medical Science, Qom, Iran
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Zong K, Zhou H, Li W, Jiang E, Liu Y, Li S. Azvudine reduces the in-hospital mortality of COVID-19 patients: A retrospective cohort study. Acta Pharm Sin B 2023; 13:4655-4660. [PMID: 37969737 PMCID: PMC10638508 DOI: 10.1016/j.apsb.2023.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/14/2023] [Accepted: 06/30/2023] [Indexed: 11/17/2023] Open
Abstract
In our retrospective cohort study, we aim to explore whether Azvudine modifies the risk of death in COVID-19 patients. It was conducted on the medical records of patients, consecutively admitted for COVID-19 pneumonia to two hospitals in Chongqing, China. Based on Azvudine treatment exposure, the patients were divided into Azvudine group and non-Azvudine group. We used 1:2 ratio propensity score matching (PSM) in our study to adjust for confounding factors and differences between Azvudine and non-Azvudine groups. There were 1072 patients included in our original cohort. With 1:2 ratio PSM, the Azvudine group included 195 patients and non-Azvudine group included 390 patients. The results showed that Azvudine treatment was associated with improved in-hospital mortality in overall population (OR 0.375, 95% CI 0.225-0.623, P < 0.001), severe subgroup (OR 0.239, 95% CI 0.107-0.535, P = 0.001), critical subgroup (OR 0.091, 95% CI 0.011-0.769, P = 0.028) in matched cohort with univariate analysis. And there was a significantly lower in-hospital mortality in overall population (11% vs. 24%, P<0.001), severe sub-group (10% vs. 32%, P < 0.001) and critical sub-group (5% vs. 34%, P = 0.017) in matched cohort. These results suggest Azvudine can reduce in-hospital mortality in overall COVID-19 patients, severe, and critical subgroup population.
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Affiliation(s)
- Kaican Zong
- Department of Respiratory Medicine, the Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Chongqing 400054, China
| | - Hui Zhou
- Department of Respiratory Medicine, the Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Chongqing 400054, China
| | - Wen Li
- Department of Respiratory Medicine, the Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Chongqing 400054, China
| | - E Jiang
- Department of Respiratory Medicine, the Seventh People's Hospital of Chongqing (Affiliated Central Hospital of Chongqing University of Technology), Chongqing 400054, China
| | - Yi Liu
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
| | - Shiying Li
- Department of Infectious Diseases, Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, the Second Affiliated Hospital, Chongqing Medical University, Chongqing 400010, China
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McEvoy NL, Friel O, Clarke J, Browne E, Geoghegan P, Budri A, Avsar P, Connolly S, Patton D, Curley GF, Moore Z. Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study. Nurs Crit Care 2023; 28:1115-1123. [PMID: 36221908 PMCID: PMC9875092 DOI: 10.1111/nicc.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 09/08/2022] [Accepted: 09/14/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). AIM This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. STUDY DESIGN This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. RESULTS In the pre-intervention study, 20 patients were included and 80% (n = 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n = 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n = 22; 88%, n = 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n = 2 grade III, 6% n = 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n = 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). CONCLUSION The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. RELEVANCE TO CLINICAL PRACTICE The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.
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Affiliation(s)
- Natalie L. McEvoy
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Oisin Friel
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Jennifer Clarke
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Emmet Browne
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Aglecia Budri
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | - Pinar Avsar
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
| | | | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- Faculty of Science, Medicine and HealthUniversity of WollongongWollongongAustralia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
| | - Gerard F. Curley
- Department of Anaesthesia and Critical Care, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Beaumont HospitalDublinIreland
| | - Zena Moore
- School of Nursing and Midwifery, Royal College of Surgeons in IrelandUniversity of Medicine and Health SciencesDublinIreland
- Skin Wounds and Trauma (SWaT) Research Centre, Royal College of Surgeons in Ireland (RCSI)University of Medicine and Health SciencesDublinIreland
- Fakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityQueenslandAustralia
- School of Health Sciences, Faculty of Life and Health SciencesUlster UniversityNorthern IrelandUK
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- Lida InstituteShanghaiChina
- Cardiff UniversityCardiffWalesUK
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Chen X, Liu B, Li C, Wang Y, Geng S, Du X, Weng J, Lai P. Stem cell-based therapy for COVID-19. Int Immunopharmacol 2023; 124:110890. [PMID: 37688914 DOI: 10.1016/j.intimp.2023.110890] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/24/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
While The World Health Organization (WHO) has announced that COVID-19 is no longer a public health emergency of international concern(PHEIC), the risk of reinfection and new emerging variants still makes it crucial to study and work towards the prevention of COVID-19. Stem cell and stem cell-like derivatives have shown some promising results in clinical trials and preclinical studies as an alternative treatment option for the pulmonary illnesses caused by the COVID-19 and can be used as a potential vaccine. In this review, we will systematically summarize the pathophysiological process and potential mechanisms underlying stem cell-based therapy in COVID-19, and the registered COVID-19 clinical trials, and engineered extracellular vesicle as a potential vaccine for preventing COVID-19.
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Affiliation(s)
- Xiaomei Chen
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Bowen Liu
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Chao Li
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Yulian Wang
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Suxia Geng
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Xin Du
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Jianyu Weng
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China
| | - Peilong Lai
- Department of Hematology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong 510080, PR China.
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Bains SS, Hameed D, Dubin JA, Chen Z, Rizzo SA, Van Nielen DL, Delanois RE, Nace J. The temporal effects of asymptomatic COVID-19 infection on peri-operative complications in patients receiving total joint arthroplasty. Arch Orthop Trauma Surg 2023; 143:6799-6804. [PMID: 37432496 DOI: 10.1007/s00402-023-04969-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023]
Abstract
INTRODUCTION Recent coronavirus disease 2019 (COVID-19) infection may pose increased risk of post-operative complications after total joint arthroplasty (TJA). Current recommendations suggest waiting four-weeks before elective surgery in asymptomatic patients. The purpose of this study was to propensity-score-match patients who had positive COVID-19-test between (1) 0-2 weeks and (2) 2-4 weeks before TJA with a matching group without COVID-19 history to determine rates of complications at 90-days and 1-year post-operatively. MATERIALS AND METHODS We queried a national-database for patients who tested positively for COVID-19 within 1-month (n = 1749) before TJA. A propensity-score-match analysis was conducted to limit influence of confounders. They were separated into mutually exclusive asymptomatic cohorts based on time of positive COVID-19-test before TJA: within 2-weeks (n = 1749) and between 2-to-4 weeks (n = 599). Asymptomatic patients were patients with positive test without symptoms of fever, shortness of breath, nausea, vomiting, diarrhea, loss of taste or smell, cough, bronchitis, pneumonia, lung infections, septic shock, and multiple-organ-dysfunction. Complications analyzed: 90-day and 1-year periprosthetic-joint infections (PJIs), surgical-site infections(SSIs), wound complications, cardiac complications, transfusions, and venous thromboembolisms. RESULTS Asymptomatic patients who have COVID-19 demonstrated increased incidence of PJI in patients who had TJA performed within two weeks from positive test at 90-days compared to patients who did not test positive for COVID-19 (3.0 vs. 1.5%; p = 0.023). Upon totaling all 90-day post-operative complications, no significant difference was found amongst asymptomatic patients who tested positive for COVID-19 for total complications at 90-days (p = 0.936). CONCLUSIONS Asymptomatic patients who test positive for COVID-19 don't have increased risk for post-operative complications after TJA. However, two-fold increased risk in PJI for patients who tested positive for COVID-19 in first 2-weeks cannot be ignored. These results should be taken into consideration when surgeons consider performing TJA. We recommend asymptomatic patients consider waiting two-weeks before TJA to mitigate risk of PJI. Nevertheless, there's reassurance these patients are not at increased total complication risk.
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Affiliation(s)
- Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Jeremy A Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Salvatore A Rizzo
- Department of Orthopaedic Surgery, WellSpan Health, York Hospital, York, PA, USA
| | - Dominic L Van Nielen
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, 2401 West Belvedere Avenue, Baltimore, MD, 21215, USA.
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Nuzzi A, Latorre V, Semisa D, Scozzi B. Improving the mental health care process in response to Covid-19 pandemic: The case of a penitentiary mental health division. PLoS One 2023; 18:e0293492. [PMID: 37903102 PMCID: PMC10615294 DOI: 10.1371/journal.pone.0293492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
Covid-19 outbreak led all organizations to reorganize their processes to prevent infection and contagion risk. All healthcare facilities, included penitentiary mental health services, had to redesign their processes to safely deliver care services. In this paper, the case of a Penitentiary Mental Health Division located in southern Italy is presented. Soft System Methodology and Business process management principles and techniques are adopted to analyse and redesign the detainees' mental health care process. The process, characterized by direct, close and prolonged contact with patients, exposes detainees and healthcare staff to a high Covid-19 infection risk. Through document analysis, interviews with the actors involved in the process and direct observation, the process's inefficiencies and criticalities are identified. The process is redesigned to make it compliant with Covid-19 prevention provisions and national penitentiary regulations and address the other criticalities. The proposed methodological approach-which innovatively combines Soft System Methodology and Business Process Management-constitutes a human-centered process-based redesign approach that can be used both in healthcare and other organizational settings.
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Affiliation(s)
- Angela Nuzzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
| | - Valeria Latorre
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
- Penitentiary Mental Health Service, Department of Mental Health, ASL Bari, Bari, Italy
| | - Domenico Semisa
- Complex Organization Unit Psychiatric Diagnosis and Care Service UO San Paolo, ASL Bari, Bari, Italy
| | - Barbara Scozzi
- Department of Mechanics, Mathematics, and Management, Polytechnic University of Bari, Bari, Italy
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Zhang MX, Lilien TA, van Etten-Jamaludin FS, Fraenkel CJ, Bonn D, Vlaar APJ, Löndahl J, Klompas M, Bem RA. Generation of Aerosols by Noninvasive Respiratory Support Modalities: A Systematic Review and Meta-Analysis. JAMA Netw Open 2023; 6:e2337258. [PMID: 37819660 PMCID: PMC10568354 DOI: 10.1001/jamanetworkopen.2023.37258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023] Open
Abstract
Importance Infection control guidelines have historically classified high-flow nasal oxygen and noninvasive ventilation as aerosol-generating procedures that require specialized infection prevention and control measures. Objective To evaluate the current evidence that high-flow nasal oxygen and noninvasive ventilation are associated with pathogen-laden aerosols and aerosol generation. Data Sources A systematic search of EMBASE and PubMed/MEDLINE up to March 15, 2023, and CINAHL and ClinicalTrials.gov up to August 1, 2023, was performed. Study Selection Observational and (quasi-)experimental studies of patients or healthy volunteers supported with high-flow nasal oxygen or noninvasive ventilation were selected. Data Extraction and Synthesis Three reviewers were involved in independent study screening, assessment of risk of bias, and data extraction. Data from observational studies were pooled using a random-effects model at both sample and patient levels. Sensitivity analyses were performed to assess the influence of model choice. Main Outcomes and Measures The main outcomes were the detection of pathogens in air samples and the quantity of aerosol particles. Results Twenty-four studies were included, of which 12 involved measurements in patients and 15 in healthy volunteers. Five observational studies on SARS-CoV-2 detection in a total of 212 air samples during high-flow nasal oxygen in 152 patients with COVID-19 were pooled for meta-analysis. There was no association between high-flow nasal oxygen and pathogen-laden aerosols (odds ratios for positive samples, 0.73 [95% CI, 0.15-3.55] at the sample level and 0.80 [95% CI, 0.14-4.59] at the patient level). Two studies assessed SARS-CoV-2 detection during noninvasive ventilation (84 air samples from 72 patients). There was no association between noninvasive ventilation and pathogen-laden aerosols (odds ratios for positive samples, 0.38 [95% CI, 0.03-4.63] at the sample level and 0.43 [95% CI, 0.01-27.12] at the patient level). None of the studies in healthy volunteers reported clinically relevant increases in aerosol particle production by high-flow nasal oxygen or noninvasive ventilation. Conclusions and Relevance This systematic review and meta-analysis found no association between high-flow nasal oxygen or noninvasive ventilation and increased airborne pathogen detection or aerosol generation. These findings argue against classifying high-flow nasal oxygen or noninvasive ventilation as aerosol-generating procedures or differentiating infection prevention and control practices for patients receiving these modalities.
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Affiliation(s)
- Madeline X. Zhang
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Thijs A. Lilien
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Carl-Johan Fraenkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Daniel Bonn
- Institute of Physics, Van der Waals-Zeeman Institute, University of Amsterdam, Amsterdam, the Netherlands
| | - Alexander P. J. Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Jakob Löndahl
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Reinout A. Bem
- Department of Pediatric Intensive Care, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
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Erturk Sengel B, Ekren BY, Sayin E, Tukenmez Tigen E, Seydaliyeva A, Cerikcioglu N, Cinel I, Korten V, Sezerman U, Odabasi Z. Nosocomial infection of C. auris in COVID-19 Intensive Care Unit in Türkiye and Phylogenetic Analysis of Isolates. Mycopathologia 2023; 188:765-773. [PMID: 37542203 DOI: 10.1007/s11046-023-00782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/25/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND The difficulties in the identification of C. auris and the delays in the implementation of infection control precautions contribute to outbreaks. This study analyzed 10 patients with COVID-19 and C. auris candidemia, their characteristic and clinical features and phylogenetic features, and the antifungal susceptibilities of the isolates. METHOD C. auris were detected in the COVID-19 ICU of a university hospital between January and August 2021. Identification to species level was performed using MALDI-TOF MS. Antifungal susceptibilities were determined by the Sensititre YeastOne YO10 panel. The isolates were whole genome sequenced to assess genetic relatedness and a phylogenetic tree was drawn including various C. auris clades. RESULTS The mean growth time in blood cultures was 38.8 h. C. auris candidemia developed on the average 27th day of ICU admission. All were susceptible to anidulafungin and micafungin, while they were resistant to fluconazole and amphotericin B. Only three isolates were found to be resistant to caspofungin. All patients died. With the WGS method, all isolates were found in a close resemblance to each other in terms of total nucleotide similarity (with a minimum of 96% pairwise alignment). Our isolates showed the closest similarity to South Asian clade (Clade I). CONCLUSIONS This study is the first to evaluate the phylogenetic characteristics of C. auris using WGS and to determine antifungal susceptibilities in Türkiye on COVID-19 patients. The mortality rate was very high in patients who have both COVID-19 and C. auris candidemia.
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Affiliation(s)
- Buket Erturk Sengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Berkay Yekta Ekren
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Elvan Sayin
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Elif Tukenmez Tigen
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aytan Seydaliyeva
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Nilgun Cerikcioglu
- Department of Medical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ismail Cinel
- Department of Anesthesiology and Reanimation, Critical Care, Marmara University School of Medicine, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Ugur Sezerman
- Institute of Health Sciences, Department of Biostatistics and Bioinformatics, Acibadem University, Istanbul, Turkey
| | - Zekaver Odabasi
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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Wade J, Petitpas KM, Dar W, Ali A, Radojevic JA, Lawlor MT, Hammond JA, Gluck J, Feingold AD, Jaiswal A, Ebcioglu Z, Einstein M, Morgan G, Emmanuel B, Ye X, Singh JU, Sotil EU, Swales C, Kent R, Richardson E, Cheema F, Serrano OK. Non-Lung Solid Organ Transplantation From SARS-CoV-2-Positive Donors to Uninfected Recipients. Transplant Proc 2023; 55:1793-1798. [PMID: 37487863 DOI: 10.1016/j.transproceed.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/23/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND There is a paucity of evidence on the risk of donor-recipient transmission of the SARS-CoV-2 in solid organ transplant recipients. Initial impressions suggest non-lung solid organs may be safely transplanted from SARS-CoV-2-positive donors without risk of viral transmission. METHODS We reviewed clinical results of transplants in which SARS-CoV-2-negative recipients received non-lung solid organs from SARS-CoV-2-positive donors at a single transplant center. No prisoners were used in this study, and participants were neither coerced nor paid. The manuscript was created in compliance with the Helsinki Congress and the Declaration of Istanbul. RESULTS Between June 2021 and January 2023, we transplanted 26 solid organs, including 13 kidneys, 8 livers, 3 hearts, and 1 simultaneous heart and kidney, from 23 SARS-CoV-2-positive donors into 25 SARS-CoV-2 negative recipients. Two of the recipients had a positive SARS-CoV-2 real-time polymerase chain reaction after transplantation, but otherwise, patients had no SARS-CoV-2-related complications, and all patients to date are alive with excellent allograft function. CONCLUSION Transplantation of non-lung solid organs from SARS-CoV-2-positive donors into uninfected recipients can be safely performed without adverse effects from SARS-CoV-2.
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Affiliation(s)
- Jason Wade
- Department of Surgery, Hartford Hospital, Hartford, Connecticut
| | | | - Wasim Dar
- Department of Surgery, Hartford Hospital, Hartford, Connecticut; Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Ayyaz Ali
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut
| | - Joseph A Radojevic
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael T Lawlor
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Jonathan A Hammond
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut
| | - Jason Gluck
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Andrew D Feingold
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Abhishek Jaiswal
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Center for Advanced Heart Failure and Pulmonary Vascular Disease, Hartford Hospital, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Zeynep Ebcioglu
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Michael Einstein
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Glyn Morgan
- Department of Surgery, Hartford Hospital, Hartford, Connecticut; Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Bishoy Emmanuel
- Department of Surgery, Hartford Hospital, Hartford, Connecticut; Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Xiaoyi Ye
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Joseph U Singh
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Eva U Sotil
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Colin Swales
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Rebecca Kent
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Elizabeth Richardson
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Faiqa Cheema
- Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Oscar K Serrano
- Department of Surgery, Hartford Hospital, Hartford, Connecticut; Transplant & Comprehensive Liver Center, Hartford, Connecticut; Department of Surgery, University of Connecticut School of Medicine, Farmington, Connecticut.
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Chander S, Kumari R, Sadarat F, Luhana S. The Evolution and Future of Intensive Care Management in the Era of Telecritical Care and Artificial Intelligence. Curr Probl Cardiol 2023; 48:101805. [PMID: 37209793 DOI: 10.1016/j.cpcardiol.2023.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/22/2023]
Abstract
Critical care practice has been embodied in the healthcare system since the institutionalization of intensive care units (ICUs) in the late '50s. Over time, this sector has experienced many changes and improvements in providing immediate and dedicated healthcare as patients requiring intensive care are often frail and critically ill with high mortality and morbidity rates. These changes were aided by innovations in diagnostic, therapeutic, and monitoring technologies, as well as the implementation of evidence-based guidelines and organizational structures within the ICU. In this review, we examine these changes in intensive care management over the past 40 years and their impact on the quality of care available to patients. Moreover, the current state of intensive care management is characterized by a multidisciplinary approach and the use of innovative technologies and research databases. Advancements such as telecritical care and artificial intelligence are being increasingly explored, especially since the COVID-19 pandemic, to reduce the length of hospitalization and ICU mortality. With these advancements in intensive care and ever-changing patient needs, critical care experts, hospital managers, and policymakers must also explore appropriate organizational structures and future enhancements within the ICU.
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Affiliation(s)
- Subhash Chander
- Department of Internal Medicine, Mount Sinai Beth Israel Hospital, New York, NY.
| | - Roopa Kumari
- Department of Internal Medicine, Mount Sinai Morningside and West, New York, NY
| | - Fnu Sadarat
- Department of Internal Medicine, University of Buffalo, NY, USA
| | - Sindhu Luhana
- Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Mahdavi A, Atlasi R, Ebrahimi M, Azimian E, Naemi R. Human resource management (HRM) strategies of medical staff during the COVID-19 pandemic. Heliyon 2023; 9:e20355. [PMID: 37771528 PMCID: PMC10522956 DOI: 10.1016/j.heliyon.2023.e20355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/30/2023] Open
Abstract
Healthcare workers are at the forefront of fight against COVID-19 and the managers of medical centers should develop coping strategies for the challenges caused by COVID-19, especially for health human resources in order to improve the performance of healthcare organizations. Hence, the purpose of this study is to investigate the human resource management strategies of medical staff during the COVID-19 to help them cope with the new strains of COVID-19 or epidemics of viral diseases that may occur in the future. In this study, a search was performed in the international Web of Science electronic database, using keywords such as human resource management and COVID-19. As a result, a total of 1884 articles published between January 1st, 2020 and October 22nd, 2021 were extracted. After screening the articles based on inclusion and exclusion criteria, 24 articles were selected to enter the study. Then, a scientometric analysis was performed on the content of selected articles and the results were presented in the form of tables and conceptual models. In total, 9 strategies were extracted from the selected articles including development of organizational culture, staff screening, policy-making, infection control training and monitoring the implementation of learned materials, patient management, human resource management, psychological and motivational support, communication and coordination, and digital health services. Employing comprehensive strategies to maintain the health of healthcare workers during the COVID-19 can play an effective role in reducing burnout, improving productivity and employee satisfaction, and in increasing the resilience of healthcare workers. It also has a positive effect on the patient's safety. Revision and reengineering of human resource management strategies in health and treatment organizations according to different cultures and contexts require research and investment in creative and innovative strategies.
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Affiliation(s)
- Abdullah Mahdavi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
| | - Rasha Atlasi
- Information and Scientometrics Center at Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Iran
| | - Maryam Ebrahimi
- Department of Health Information Technology, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Ehsanollah Azimian
- Department of Linguistics and Foreign Languages, Payame Noor University, Tehran, Iran
| | - Roya Naemi
- Department of Health Information Management, School of Paramedical Sciences, Ardabil University of Medical Sciences, Iran
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Roat C, Webber-Ritchey KJ, Spurlark RS, Lee YM. Black Americans Receiving the COVID-19 Vaccine and Effective Strategies to Overcome Barriers: An Integrative Literature Review. J Racial Ethn Health Disparities 2023; 10:2577-2587. [PMID: 36469286 PMCID: PMC9734369 DOI: 10.1007/s40615-022-01437-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Black Americans have a greater likelihood of serious morbidity or mortality from contracting the coronavirus and represent the lowest percentage of vaccinated individuals by race. This integrative literature review aims to identify the major barriers to Black Americans receiving the COVID-19 vaccine and proposed solutions to improve vaccination rates among this population. METHOD Databases CINAHL and LitCovid from the National Library of Medicine were utilized to find the articles included in this review. RESULTS A total of seven articles were identified indicating five barriers preventing Black Americans from being vaccinated against COVID-19 that included (1) mistrust of the medical establishment, (2) uncertainty in vaccine safety, (3) limited access to healthcare, (4) inequitable access to resources, and (5) lower health literacy. The studies also indicated five strategies to increase the desire of Black Americans to be vaccinated including (1) utilizing trusted community leaders, (2) acknowledgment of the history of discrimination and trauma, (3) building more representative clinical trial cohorts, (4) continual investment into community-based organizations, and (5) mobile vaccine clinics. CONCLUSION The medical establishment in the USA has significant work to do to gain the trust of Black Americans. Many of the strategies to increase vaccine uptake among Black Americans have yet to be implemented which limits the conclusions that can be drawn from them. A future study should examine the outcomes of these proposed solutions to see if they do indeed work as intended and increase vaccination rates among this population.
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Affiliation(s)
- Chad Roat
- School of Nursing, DePaul University, Chicago, IL, USA
| | | | | | - Young-Me Lee
- School of Nursing, DePaul University, Chicago, IL, USA
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Sinaci S, Tanacan A, Besimoglu B, Menekse Beser D, Uyan Hendem D, Tugrul Ersak D, Atalay A, Kaya E, Ozden Tokalioglu E, Cankar Dal H, Ocal DF, Erdem D, Izdes S, Moraloglu Tekin O, Ates İ, Turan S, Sahin D. Adverse outcomes and maternal complications in pregnant women with severe-critical COVID-19: a tertiary center experience. J Perinat Med 2023; 51:874-885. [PMID: 37134274 DOI: 10.1515/jpm-2022-0564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 01/19/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES This study aimed to present perinatal outcomes, clinical challenges, and basic ICU management in pregnant women with severe-critical COVID-19 at our tertiary referral center. METHODS In this prospective cohort study, patients were divided into two groups, whether they survived or not. Clinical characteristics, obstetric and neonatal outcomes, initial laboratory test results and radiologic imaging findings, arterial blood gas parameters at ICU admission, and ICU complications and interventions were compared between groups. RESULTS 157 of the patients survived, and 34 of the patients died. Asthma was the leading health problem among the non-survivors. Fifty-eight patients were intubated, and 24 of them were weaned off and discharged healthfully. Of the 10 patients who underwent ECMO, only 1 survived (p<0.001). Preterm labor was the most common pregnancy complication. Maternal deterioration was the most common indication for a cesarean section. Higher neutrophil-to-lymphocyte-ratio (NLR) values, the need for prone positioning, and the occurrence of an ICU complication were important parameters that influenced maternal mortality (p<0.05). CONCLUSIONS Overweight pregnant women and pregnant women with comorbidities, especially asthma, may have a higher risk of mortality related to COVID-19. A worsening maternal health condition can lead to increased rates of cesarean delivery and iatrogenic prematurity.
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Affiliation(s)
- Selcan Sinaci
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Atakan Tanacan
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Berhan Besimoglu
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Dilek Menekse Beser
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Derya Uyan Hendem
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Duygu Tugrul Ersak
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Aysegul Atalay
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Ecem Kaya
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Eda Ozden Tokalioglu
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Hayriye Cankar Dal
- Clinic of Anaesthesiology and Reanimation, Department of Intensive Care, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Doga Fatma Ocal
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - Deniz Erdem
- Clinic of Anaesthesiology and Reanimation, Department of Intensive Care, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- University of Health Sciences, Ankara City Hospital, Istanbul, Türkiye
| | - Seval Izdes
- Clinic of Anaesthesiology and Reanimation, Department of Intensive Care, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- University of Health Sciences, Ankara City Hospital, Istanbul, Türkiye
| | - Ozlem Moraloglu Tekin
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- General Internal Medicine, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
| | - İhsan Ates
- General Internal Medicine, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- University of Health Sciences, Ankara City Hospital, Istanbul, Türkiye
| | - Sema Turan
- Clinic of Anaesthesiology and Reanimation, Department of Intensive Care, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- University of Health Sciences, Ankara City Hospital, Istanbul, Türkiye
| | - Dilek Sahin
- Clinic of Perinatology, Department of Obstetrics and Gynaecology, Ministry of Health, Ankara City Hospital, Ankara, Türkiye
- University of Health Sciences, Ankara City Hospital, Istanbul, Türkiye
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Burhan E, Liu K, Marwali EM, Huth S, Wulung NGHML, Juzar DA, Taufik MA, Wijaya SO, Wati DK, Kusumastuti NP, Yuliarto S, Pratomo BY, Pradian E, Somasetia DH, Rusmawatiningtyas D, Fatoni AZ, Mandei JM, Lantang EY, Perdhana F, Semedi BP, Rayhan M, Tarigan TRS, White N, Bassi GL, Suen JY, Fraser JF. Characteristics and outcomes of patients with severe COVID-19 in Indonesia: Lessons from the first wave. PLoS One 2023; 18:e0290964. [PMID: 37747884 PMCID: PMC10519602 DOI: 10.1371/journal.pone.0290964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 08/18/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Indonesia's national response to COVID-19 evolved rapidly throughout 2020. Understanding pandemic response and outcomes is crucial for better mitigation strategies ahead. This study describes the characteristics and outcomes of patients admitted to ICU during the early stages of the pandemic. METHODS This is a multi-centre prospective observational study including patients from twelve collaborating hospitals in Indonesia. All patients were clinically suspected or laboratory-confirmed COVID-19 cases admitted to ICU between January 2020 and March 2021. The primary outcome was monthly ICU mortality. Descriptive statistics of patient characteristics and treatment were generated as secondary outcomes. RESULTS From 559 subjects, the overall mortality was 68% and decreased over the study period, while the mortality of patients that received mechanical ventilation was 92%, consistently high over the study period. Fatal cases showed 2- and 4-day delays from symptoms onset to hospital admissions and ICU admissions, respectively. Evidence-backed approaches which could influence patient outcome, such as extracorporeal membrane oxygenation, prone positioning, renal replacement therapy, and neuromuscular blockade were scarcely administered. CONCLUSIONS The mortality rate of COVID-19 patients in Indonesia was extremely high during the first major outbreak of disease, particularly in those mechanically ventilated. Delayed admission and unavailability of evidence-based approaches due to high burden on health facility during COVID-19 crisis could be addressed by efficient public health measures and enhancing health infrastructure to improve the future pandemic response.
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Affiliation(s)
- Erlina Burhan
- Faculty of Medicine, Department of Pulmonology and Respiratory Medicine, Universitas Indonesia and Persahabatan Hospital, Jakarta, Indonesia
| | - Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Eva M. Marwali
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Samuel Huth
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | | | - Dafsah A. Juzar
- Departement of Cardiology and Vascular Medicine, Intensive Cardiovascular Care Unit, National Cardiovascular Center Harapan Kita and Universitas Indonesia, Jakarta, Indonesia
| | - Muhammad A. Taufik
- Anesthesiology and Critical Care Department, Fatmawati General Hospital, Jakarta, Indonesia
| | - Surya O. Wijaya
- Intensive Care Unit, Sulianti Saroso Hospital, Jakarta, Indonesia
| | - Dyah K. Wati
- Pediatric Intensive Care Unit, Sanglah Hospital, Denpasar, Bali, Indonesia
| | - Neurinda P. Kusumastuti
- Pediatric Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | - Saptadi Yuliarto
- Pediatric Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | | | - Erwin Pradian
- Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Dadang H. Somasetia
- Pediatric Intensive Care Unit, Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | | | - Arie Z. Fatoni
- Intensive Care Unit, Saiful Anwar Hospital, Malang, East Java, Indonesia
| | - Jose M. Mandei
- Pediatric Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Eka Y. Lantang
- Intensive Care Unit, RSUP Prof Dr R. D. Kandou Manado, Indonesia
| | - Fajar Perdhana
- Intensive Care Unit, Universitas Airlangga Hospital, Surabaya, East Java, Indonesia
| | | | - Muhammad Rayhan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Tiffany R. S. Tarigan
- Pediatric Cardiac Intensive Care Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | - Gianluigi L. Bassi
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Jacky Y. Suen
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John F. Fraser
- Critical Care Research Group, The Prince Charles Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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El Zahran T, Kalot N, Cheaito R, Khalifeh M, Estelly N, El Majzoub I. Predictors of intensive care unit admission in adult cancer patients presenting to the emergency department with COVID-19 infection: A retrospective study. PLoS One 2023; 18:e0287649. [PMID: 37643201 PMCID: PMC10464997 DOI: 10.1371/journal.pone.0287649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/12/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Adult cancer patients with COVID-19 were shown to be at higher risk of Intensive Care Unit (ICU) admission. Previously published prediction models showed controversy and enforced the importance of heterogeneity among different populations studied. Therefore, this study aimed to identify predictors of ICU admission (demographic, clinical, and COVID-19 targeted medications) in cancer patients with active COVID-19 infection presenting to the Emergency Department (ED). METHODS This is a retrospective cohort study. It was conducted on adult cancer patients older than 18 years who presented to the American University of Beirut Medical Center ED from February 21, 2020, till February 21, 2021, and were found to have COVID-19 infection. Relevant data were extracted from electronic medical records. The association between different variables and ICU admission was tested. Logistic regression was done to adjust for confounding variables. A p-value less than 0.05 was considered significant. RESULTS Eighty-nine distinct patients were included. About 37% were admitted to the ICU (n = 33). Higher ICU admission was seen in patients who had received chemotherapy within one month, had a respiratory rate at triage above 22 breaths per minute, oxygen saturation less than 95%, and a higher c-reactive protein upon presentation to the ED. After adjusting for confounding variables, only recent chemotherapy and higher respiratory rate at triage were significantly associated with ICU admission. CONCLUSION Physicians need to be vigilant when taking care of COVID-19 infected cancer patients. Patients who are tachypneic at presentation and those who have had chemotherapy within one month are at high risk for ICU admission.
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Affiliation(s)
- Tharwat El Zahran
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour Kalot
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rola Cheaito
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Khalifeh
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Natalie Estelly
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Imad El Majzoub
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Tahmasebi A, Masoudi Asl I, Aryankhesal A, Vatankhah S, Masoumi G. Best Practices of Hospitals in Management of Epidemic Conditions: A Scoping Review. Galen Med J 2023; 12:1-14. [PMID: 38774843 PMCID: PMC11108671 DOI: 10.31661/gmj.v12i.2824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND Many hospitals globally have valuable experiences in preparing for management and responding to infectious epidemics. Identifying and analyzing these experiences can provide comprehensive and practical data for decision-making and effective performance. This study aimed to conduct a scoping review and content analysis of the best practices of hospital (private or public) management in epidemic conditions. MATERIALS AND METHODS This research is a scoping review and content analysis, conducted in 2021. Data was collected by searching different databases, including Pubmed, Scopus, Web of Sciences, ProQuest, websites, search engines, and public reports without time limits. Content analysis was performed for data analysis. RESULTS We retrieved 8842 records from databases and other sources. Finally, 24 studies from 12 countries were selected for analysis. Most studies belonged to the United States (9 cases), and most subjects were on Coronavirus disease 2019 (Covid-19) (19 studies). We classified the results into two major categories of in-hospital executive readiness and logistic readiness. Executive readiness included 11 main categories (physical structure, resource management, exposure reduction, patients and caregivers' management, corpse management, disinfection, staff support, patient admission, instructions and guidelines, tele- communication, and education) and 26 sub-categories. Logistic readiness consisted of three major categories (leadership/team making, communication, and using capabilities) and five sub-categories. CONCLUSION Healthcare managers can use the identified categories and dimensions of managerial readiness and responsiveness as an action plan during an infectious disease epidemic.
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Affiliation(s)
- Ali Tahmasebi
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Iravan Masoudi Asl
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aidin Aryankhesal
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Soudabeh Vatankhah
- Department of Health Services Management, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Masoumi
- Department of Health in Disaster and Emergencies, School of Health Management and
Information Sciences, Iran University of Medical Sciences, Tehran, Iran
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Awoke MA, Adane A, Assefa B, Getawa S, Legese GL, Yimer M. Hematological parameters and their predictive value for assessing disease severity in laboratory-confirmed COVID-19 patients: a retrospective study. AMERICAN JOURNAL OF BLOOD RESEARCH 2023; 13:117-129. [PMID: 37736538 PMCID: PMC10509465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The coronavirus disease 19 (COVID-19) infection has spread globally and caused a substantial amount of mortality and morbidity. Early detection of severe infections will improve care and reduce deaths. The use of hematological parameters in predicting COVID-19 disease severity, patient outcomes, and early risk stratification is limited. Therefore, the study was aimed at determining hematological parameters and their predictive value for assessing disease severity in laboratory-confirmed COVID-19 patients in Northwest Ethiopia. METHODS A retrospective cross-sectional study was conducted at the University of Gondar comprehensive specialized hospital and Tibebe Ghion comprehensive specialized referral hospital on 253 patients diagnosed with COVID-19 and admitted between March 2021 and February 2022. Data were extracted, and entered into Epi-data 4.2.0.0, and analyzed using SPSS version 25 software. Hematological parameters were provided as the median and interquartile range (IQR). Categorical variables were represented by their frequency, and the χ2 test was applied to compare observed results with expected results. The receiver-operating curve (ROC) was used to establish the predictive value of hematological parameters for COVID-19 severity. A p-value < 0.05 was considered statistically significant. RESULTS On a total of 253 patients, there were 43.87% severe cases, with a mortality rate of 26.9%. The ROC analysis showed the optimal cutoff values for hematological parameters were ANC (3370), lymphocyte (680), NLR (9.34), PLR (290.77), platelets (332,000), and WBCs (4390.65). The area under the curve (AUC) values for NLR (0.679) and ANC (0.631) were high, with the highest sensitivity and specificity, and could potentially be used to predict COVID-19 severity. CONCLUSION This study proved that high NLR and high ANC have prognostic value for assessing disease severity in COVID-19. Thus, assessing and considering these hematological parameters when triaging COVID-19 patients may prevent complications and improve the patient's outcome.
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Affiliation(s)
- Mezgebu Alemayehu Awoke
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
| | - Ayinshet Adane
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
| | - Belete Assefa
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
| | - Solomon Getawa
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
| | - Gebrehiwot Lema Legese
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
| | - Mekonen Yimer
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of GondarGondar, Ethiopia
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