RESUMO
BACKGROUND: In March 2020, the World Health Organisation (WHO) declared the novel coronavirus (COVID-19) outbreak a global pandemic. Healthcare professionals directly involved in diagnosing, treating and caring for patients with COVID-19 are at risk of developing post-traumatic stress disorder (PTSD). OBJECTIVE: This study investigated the prevalence of PTSD among nurses working in a COVID hospital and evaluated associated factors. METHODS: A descriptive cross-sectional study was conducted at Crema Hospital and the Impact of Event Scale - Revised (IES-R) was administered. Data collection took place from July to September 2020, during which 275 questionnaires were distributed. RESULTS: Of the total sample, 39.88% received a provisional PTSD diagnosis deserving of further analysis. Nurses stated that they were predominantly overwhelmed by intrusive thoughts (M = 1.55). Working in the emergency department during the COVID-19 pandemic (OR=2.40; p=0.02), irregular work shifts (OR=5.41; p=0.01) and coming from a mental health ward (OR=3.80; p=0.02) increased the risk of receiving a provisional PTSD diagnosis. Our findings showed significantly higher IES-R scores among women than among men (p = 0.01). The activities that caused the most distress were related to technical skills required for managing ventilation and intubation devices. CONCLUSIONS: The results of the study highlighted the presence of considerable psychological distress in the sample. There is an urgent need to monitor the short- and long-term consequences of the COVID-19 pandemic and implement early intervention measures.
Assuntos
COVID-19 , Enfermeiras e Enfermeiros , Transtornos de Estresse Pós-Traumáticos , Estudos Transversais , Feminino , Hospitais , Humanos , Masculino , Pandemias , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
We report onset, course, correlations with comorbidities, and diagnostic accuracy of nasopharyngeal swab in 539 individuals suspected to carry SARS-COV-2 admitted to the hospital of Crema, Italy. All individuals underwent clinical and laboratory exams, SARS-COV-2 reverse transcriptase-polymerase chain reaction on nasopharyngeal swab, and chest X-ray and/or computed tomography (CT). Data on onset, course, comorbidities, number of drugs including angiotensin converting enzyme (ACE) inhibitors and angiotensin-II-receptor antagonists (sartans), follow-up swab, pharmacological treatments, non-invasive respiratory support, ICU admission, and deaths were recorded. Among 411 SARS-COV-2 patients (67.7% males) median age was 70.8 years (range 5-99). Chest CT was performed in 317 (77.2%) and showed interstitial pneumonia in 304 (96%). Fatality rate was 17.5% (74% males), with 6.6% in 60-69 years old, 21.1% in 70-79 years old, 38.8% in 80-89 years old, and 83.3% above 90 years. No death occurred below 60 years. Non-invasive respiratory support rate was 27.2% and ICU admission 6.8%. Charlson comorbidity index and high C-reactive protein at admission were significantly associated with death. Use of ACE inhibitors or sartans was not associated with outcomes. Among 128 swab negative patients at admission (63.3% males) median age was 67.7 years (range 1-98). Chest CT was performed in 87 (68%) and showed interstitial pneumonia in 76 (87.3%). Follow-up swab turned positive in 13 of 32 patients. Using chest CT at admission as gold standard on the entire study population of 539 patients, nasopharyngeal swab had 80% accuracy. Comorbidity network analysis revealed a more homogenous distribution 60-40 aged SARS-COV-2 patients across diseases and a crucial different interplay of diseases in the networks of deceased and survived patients. SARS-CoV-2 caused high mortality among patients older than 60 years and correlated with pre-existing multiorgan impairment.
Assuntos
COVID-19/patologia , Comorbidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Proteína C-Reativa/análise , COVID-19/mortalidade , COVID-19/virologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Resultado do Tratamento , Adulto Jovem , Tratamento Farmacológico da COVID-19RESUMO
AIMS: In this work, the survival and mortality data of 54 consecutive patients admitted to the Intensive Care Unit (ICU) and suffering from severe respiratory insufficiency imputable to viral SARS - CoV - 2 infection were analyzed and shared, after a critical review of the evidence in order to optimize the most dedicated clinical and treatment strategy, for a future 'targeted' management in the care of the possible return flu outbreak. METHODS: At our Emergency Department of the Crema Hospital, from the beginning of the pandemic until the end of June 2020, 54 consecutive patients admitted to ICU suffering from severe acute respiratory infection (SARI) and severe respiratory distress (ARDS) attributable to viral SARS - CoV - 2 infection were recruited. The recruitment criterion was based on refractory hypoxia, general condition and clinical impairment, comorbidities and CT images. The incoming parameters of the blood chemistry and radiology investigations and the timing of the gold - tracheal intubation were compared. Medical therapy was based on the application of shared protocols. RESULTS: The onset of symptoms was varyng, i.e. within the range of 1-14 days. The average time from the admission to the emergency room to the admission to intensive care was approximately 120 h. The average number of days of hospitalization in the ICU was 28 days. With a majority of male patients, the most significant age group was between 60 and 69 years. There were 21 deaths and, compared to the survivors, the deceased ones were older at an average age of about 67 years (vs an average age of the survivors of about 59 years). From the available data entering the ICU, the surviving patients presented average better values of oximetry and blood gas analysis, with a lower average dosage of D-Dimer than the deceased. Ones with a presence of bilateral pneumonia in all patients, the worsening of the ARDS occurred in 31 patients. 9 out of 25 patients early intubated died, while 12 out of 23 patients died when intubation was performed after 24 h of non-invasive ventilation. The presence of multiple comorbidities was shown in 17 of 28 patients and revealed an additional adverse prognostic factor. Also, more than one complication in the same patient were detected; after respiratory worsening, renal failure was more frequently found in 16 patients. Some particular complications such as lesions induced by ventilation with barotrauma mechanism (VILI), ischemic heart disease and the appearance of central and peripheral neurological events were detected too. CONSIDERATIONS: SARS - CoV - 2 disease is caused by a new coronavirus that has its main route of transmission through respiratory droplets and close contact, resulting in a sudden onset of the clinical syndrome with acute respiratory infection (SARI) and severe respiratory distress (ARDS). But it can also appear with other symptoms such as gastrointestinal or neurological events, as to be considered as a disease with multisystem phenotype. This pathology evolves towards a serious form of systemic disease from an acute lung damage to venous and arterial thromboembolic complications and multi-organ failure, mostly associated with high mortality. All patients received empirical or targeted antibiotic therapy for prevention and control of infections of potential pathogens, together with low molecular weight heparin therapy. The majority of patients was subjected to the off - label protocol with antivirals and hydroxychloroquine therapy, we used cortisone support therapy under surveillance and in 3 cases the protocol with anti - IL6 monoclonal antibody (Tolicizumab). In a simplified classification of the tomographic examination of the chest, mostly 3D and 2C lesions were found in the deceased patients with a prevalence of severe and moderate forms, whilst in the survivors the distribution appears with a prevalence of medium and moderate forms. Among the intubated patients, 21 patients, all suffering from worsening ARDS, died whilst there was no mortality in patients subjected to non-invasive ventilation it so. The heterogeneity of the respiratory syndromes and the presence of multiple comorbidities represent an unfortunate prognostic factor. Among the complications, besides the respiratory worsening, renal failure, liver failure and the state of sepsis were most frequently found; less frequent complications were lesions induced by ventilation with a barotrauma mechanism, ischemic heart disease, the appearance of central neurological events of sensory alterations, meningo - encephalitis and cerebral hemorrhage, and peripheral neurological events with polyneuro - myopathies. Mechanical ventilation can adversely affect the prognosis due to lung damage induced, protective ventilation remains the necessary treatment during severe hypoxia in patients with SARS - CoV - 2. The essential prerequisite remains the search for optimal 'customized' values since conditions can vary from patient to patient and, in the same patient, during different times of ventilation. CONCLUSIONS: In these extraordinary circumstances, our reality was among the most affected and was able to hold the impact thanks to the immediate great response set in place by the operators, although it costed us an effort especially the one to try to guarantee a high quality level of assistance and care compared to the huge wave of patients in seriously bad conditions. Further research on this heterogeneous pathology and data sharing could help identify a more dedicated clinical decision-making and treatment pathway that, together with a resource planning, would allow us to better face any new disease outbreak.
Assuntos
COVID-19/terapia , Cuidados Críticos/métodos , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva , Pandemias , Respiração Artificial/métodos , SARS-CoV-2 , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosAssuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Itália , SARS-CoV-2RESUMO
AIM OF THE STUDY: To evaluate the impact of residential intermediate care (IC) on the cognitive status of post-acute older patients and its correlation with the improvement in physical independence. METHODS: This prospective observational study involved 299 subjects (116 males and 183 females; mean age 80.1 ± 8.3 years) transferred to IC. The Mini Mental State Examination (MMSE) and a panel of laboratory and functional parameters were evaluated upon admission to IC (T0) and at the time of discharge (T1). The functional evaluations included the Cumulative Illness Rating Scale, the Barthel Index (BI) and the Morse Fall Scale (MFS). Afterwards, the patients were grouped on the basis of their MMSE score at T1: those with an unchanged or worse MMSE score (group A) and those with a better MMSE score (group B). The laboratory and functional parameters of the two groups were then compared. RESULTS: There was a significant improvement between T0 and T1 in the MMSE score (18.1 ± 7.5 vs 19.6 ± 7.3, P < 0.001) and the BI (42.1 ± 27.7 vs 53.6 ± 30.0, P < 0.001), as well as brain natriuretic peptide, C-reactive protein and blood glucose levels. Group B had a significantly better BI (57.7 ± 29.1 vs 47.2 ± 31.5, P = 0.003) and a slightly better MFS. There was a close relation between the MMSE scores and BI. CONCLUSIONS: Residential IC is a type of rehabilitation that favourably affects the cognitive status and physical independence of older post-acute patients.
Assuntos
Doença Aguda/psicologia , Doença Aguda/reabilitação , Instituições para Cuidados Intermediários , Saúde Mental , Alta do Paciente , Idoso , Idoso de 80 Anos ou mais , Cognição/fisiologia , Feminino , Avaliação Geriátrica , Humanos , Vida Independente/psicologia , Testes de Inteligência , Masculino , Avaliação de Resultados em Cuidados de Saúde , Estudos ProspectivosRESUMO
The aim of this contribution is to draw considerations on the first year of activity of a cath lab on call 24/24 h for primary coronary angioplasty (PTCA) (April 2007-April 2008) of a small hospital without surgical backup. We performed 152 primary PTCA in 156 patients presenting to the emergency room with ST-elevation myocardial infarction. The mean time from arrival to the emergency room to the insertion of the arterial introducer was 48 min. Patient management included a 12-lead ECG and family history, the telephone call to the hospital cardiologist and then to the cath lab operator and nurse. Procedural success was obtained in 97% of cases. Mortality was 6%. Other complications occurred in 4% of patients. The no-reflow phenomenon occurred in 4% of patients. We used 1.9 stents/patient. Direct stenting was performed in 43% of cases. In 14% of lesions, the procedure was concluded with only balloon angioplasty. The radial access was used in 15% of patients, whereas the femoral access was used in the remainder. Drug-eluting stents were implanted in 1% only of patients with acute myocardial infarction. Glycoprotein IIb/IIIa inhibitors and clopidogrel were extensively used prior to the procedure. Our data, although obtained in a smaller population sample and referring to a relatively short period of time, are similar to those of the American registry on PTCA. In conclusion, the results obtained in our center with the invasive management of acute myocardial infarction appear consistent with those of other centers and encourage us to continue along our chosen path.