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1.
J Diabetes Sci Technol ; 16(4): 955-961, 2022 Jul.
Статья в английский | MEDLINE | ID: covidwho-2194856

Реферат

BACKGROUND: Hospitalization of persons with diabetes in an inpatient diabetes unit is challenging, notably for patients having different profiles. We aimed to evaluate the feasibility and the benefit of a continuous glucose monitoring (CGM) telemetry system to control glucose excursions in hospitalized patients with diabetes, according to their diabetes type and the reasons for their hospitalization. METHOD: A prospective pilot study was conducted in 53 insulin-requiring diabetes patients hospitalized in the general ward. Glucose was monitored using Guardian Connect (GC, Medtronic) to adopt insulin therapy. The time in range (TIR, target 70-180 mg/dL), the time below range (TBR), and the time above range (TAR) were recorded by GC between the start of hospitalization (SH) and end of hospitalization (EH), and analyzed according to the diabetes type (type 1 diabetes n = 28, type 2 diabetes n = 25) and the reasons for hospitalization (acute complications n = 35, therapeutic education n = 18). Patient and caregiver satisfaction was also assessed. RESULTS: In patients with type 2 diabetes and those hospitalized for acute complications, TIR significantly increased between the SH and EH, from 75.7% (95%CI 48.5-84.6) to 82.2% (95%CI 63.2-91.8) P = 0.043 and from 58.3% (95%CI 46.3-69.7) to 66.4% (95%CI 55.6-75.5) P = 0.031, respectively, and TAR significantly decreased, with no change in TBR. In patients with diabetes hospitalized for therapeutic education, TBR significantly decreased from 3.4% (95%CI 0-9.4) to 0% (95%CI 0-3.8) P = 0.037. Finally, 94% of patients and caregivers deemed the GC system useful. CONCLUSIONS: CGM telemetry system use is feasible and well accepted in patients hospitalized in diabetes care unit and could be useful to improve therapeutic education and metabolic control, especially for specific homogenous populations with diabetes.


Тема - темы
Blood Glucose Self-Monitoring , Diabetes Mellitus, Type 2 , Blood Glucose/metabolism , Diabetes Mellitus, Type 2/drug therapy , Feasibility Studies , Humans , Inpatients , Insulin/therapeutic use , Pilot Projects , Prospective Studies , Telemetry
2.
Front Public Health ; 10: 1028062, 2022.
Статья в английский | MEDLINE | ID: covidwho-2142359

Реферат

Background: This study compared patient profiles and clinical courses of SARS-CoV-2 infected inpatients over different pandemic periods. Methods: In a retrospective cross-sectional analysis, we examined administrative data of German Helios hospitals using ICD-10-codes at discharge. Inpatient cases with SARS-CoV-2 infection admitted between 03/04/2020 and 07/19/2022 were included irrespective of the reason for hospitalization. All endpoints were timely assigned to admission date for trend analysis. The first pandemic wave was defined by change points in time-series of incident daily infections and compared with different later pandemic phases according to virus type predominance. Results: We included 72,459 inpatient cases. Patients hospitalized during the first pandemic wave (03/04/2020-05/05/2020; n = 1,803) were older (68.5 ± 17.2 vs. 64.4 ± 22.6 years, p < 0.01) and severe acute respiratory infections were more prevalent (85.2 vs. 53.3%, p < 0.01). No differences were observed with respect to distribution of sex, but comorbidity burden was higher in the first pandemic wave. The risk of receiving intensive care therapy was reduced in all later pandemic phases as was in-hospital mortality when compared to the first pandemic wave. Trend analysis revealed declines of mean age and Elixhauser comorbidity index over time as well as a decline of the utilization of intensive care therapy, mechanical ventilation and in-hospital mortality. Conclusion: Characteristics and outcomes of inpatients with SARS-CoV-2 infection changed throughout the observational period. An ongoing evaluation of trends and care pathways will allow for the assessment of future demands.


Тема - темы
COVID-19 , Humans , COVID-19/epidemiology , Inpatients , Pandemics , Cross-Sectional Studies , Retrospective Studies , SARS-CoV-2
3.
Ann Fam Med ; 20(6): 548-550, 2022.
Статья в английский | MEDLINE | ID: covidwho-2140353

Реферат

Our objective was to externally validate 2 simple risk scores for mortality among a mostly inpatient population with COVID-19 in Canada (588 patients for COVID-NoLab and 479 patients for COVID-SimpleLab). The mortality rates in the low-, moderate-, and high-risk groups for COVID-NoLab were 1.1%, 9.6%, and 21.2%, respectively. The mortality rates for COVID-SimpleLab were 0.0%, 9.8%, and 20.0%, respectively. These values were similar to those in the original derivation cohort. The 2 simple risk scores, now successfully externally validated, offer clinicians a reliable way to quickly identify low-risk inpatients who could potentially be managed as outpatients in the event of a bed shortage. Both are available online (https://ebell-projects.shinyapps.io/covid_nolab/ and https://ebell-projects.shinyapps.io/COVID-SimpleLab/).


Тема - темы
COVID-19 , Humans , Prognosis , Canada/epidemiology , Inpatients , Outpatients
4.
BMJ Open Qual ; 11(4)2022 11.
Статья в английский | MEDLINE | ID: covidwho-2137807

Реферат

Timely contact and assessment between occupational therapists (OTs) and patients are vital to understanding their needs and creating person-centred interventions. Any delays in completing contact and assessment will likely impact patients' experience and outcomes. The aim of this study was to ensure that 90% of all patients in a male and female ward received OT initial contact within two working days of admission by the end of June 2020.With the teams working in collaboration, the first change idea of increasing the initial contact in two working days was introduced and the impact assessed on two of the five wards. The Plan-Do-Study-Act cycles used for this test of change included: Standardising the initial contact, informal training for the audit tool created to measure the admission process, increasing efficiency for documenting OT contact, updated exclusion/inclusion criteria for OT initial contact, refining documentation for contact and assessment, and the impact of COVID-19 on initial contact and admission processes.Our test of change resulted in an increase in the average initial contact from 12.5% to 71.24%. Following this success, we spread the project to the three remaining wards. Feedback from OTs using the tools we introduced ensured that we made tools as user-friendly as possible. Likewise, teams who achieved particularly high compliance noted the importance of dedicating time to conduct initial contact.Our team embarked on a quality improvement project that aimed to set a standard and increase compliance for achieving this standard. Alongside this, we developed an appropriate and pragmatic measure to track our progress. While we did not achieve 90%, we observed substantial improvements made across the participating service. Using the findings from the project, we have spread this approach to other wards and believe that it could easily be transferrable as a discreet package to other mental health settings.


Тема - темы
COVID-19 , Occupational Therapy , Humans , Male , Female , Inpatients , Quality Improvement , Mental Health
5.
Explore (NY) ; 18(6): 688-697, 2022.
Статья в английский | MEDLINE | ID: covidwho-2122470

Реферат

CONTEXT: Whole Health is an emerging healthcare framework that emphasizes wellbeing in place of illness. Conflict Analysis (CA), an online self-guided assessment, leverages innovative diagnostic and therapeutic resources that shares Whole Health objectives, including helping users explore their identity and develop a personalized health plan and helping users develop resources to optimize their health. OBJECTIVES: Paper presents CA implementation-effectiveness study in a Veteran Affairs inpatient substance recovery care. DESIGN: Patients were randomized to CA or mindfulness control. Patients completed Whole Health outcomes measures at baseline, completion (post), and three-week follow-up. Interventions took 2.5 h. Attending psychologist assessed CA protocols and completed outcome evaluation. Due to Coronavirus, recruitment and follow-up were curtailed. SETTING: Study took place in a rural northern New England Veteran Affairs inpatient substance recovery unit. OUTCOME MEASURES: Measures include The Personal Growth Initiative Scale, The Beck Cognitive Insight Scale, Perceived Stress Scale, The Patient Health Questionnaire, Perceived Psychological Wellbeing, and Perceived Therapeutic and Diagnostic Benefit. RESULTS: 12 patients were randomized, 11 completed post measures (CA=5; Mindfulness = 6), and 7 completed follow-up measures (CA=3; Mindfulness=4). CA offered significant Whole Health benefits when compared to control. Additionally, participant and clinician evaluations indicated that CA can be personally relevant, meaningful, and motivate therapeutic growth. Implications include extending CA research and expanding Whole Health related interventions. Although initial results suggest implementation feasibility and Whole Health benefit, more research is necessary to establish CA's utility within inpatient substance recovery care in particular and psychiatric rehabilitation in general.


Тема - темы
Mindfulness , Substance-Related Disorders , Humans , Inpatients , Outcome Assessment, Health Care , Self Care , Substance-Related Disorders/therapy
6.
Sensors (Basel) ; 22(22)2022 Nov 12.
Статья в английский | MEDLINE | ID: covidwho-2110225

Реферат

People with diabetes mellitus (DM) are at elevated risk of in-hospital mortality from coronavirus disease-2019 (COVID-19). This vulnerability has spurred efforts to pinpoint distinctive characteristics of COVID-19 patients with DM. In this context, the present article develops ML models equipped with interpretation modules for inpatient mortality risk assessments of COVID-19 patients with DM. To this end, a cohort of 156 hospitalised COVID-19 patients with pre-existing DM is studied. For creating risk assessment platforms, this work explores a pool of historical, on-admission, and during-admission data that are DM-related or, according to preliminary investigations, are exclusively attributed to the COVID-19 susceptibility of DM patients. First, a set of careful pre-modelling steps are executed on the clinical data, including cleaning, pre-processing, subdivision, and feature elimination. Subsequently, standard machine learning (ML) modelling analysis is performed on the cured data. Initially, a classifier is tasked with forecasting COVID-19 fatality from selected features. The model undergoes thorough evaluation analysis. The results achieved substantiate the efficacy of the undertaken data curation and modelling steps. Afterwards, SHapley Additive exPlanations (SHAP) technique is assigned to interpret the generated mortality risk prediction model by rating the predictors' global and local influence on the model's outputs. These interpretations advance the comprehensibility of the analysis by explaining the formation of outcomes and, in this way, foster the adoption of the proposed methodologies. Next, a clustering algorithm demarcates patients into four separate groups based on their SHAP values, providing a practical risk stratification method. Finally, a re-evaluation analysis is performed to verify the robustness of the proposed framework.


Тема - темы
COVID-19 , Diabetes Mellitus , Humans , Inpatients , Machine Learning , Hospital Mortality
7.
PLoS One ; 17(11): e0277413, 2022.
Статья в английский | MEDLINE | ID: covidwho-2118095

Реферат

INTRODUCTION: Since the late COVID-19, many countries have faced various surges and peaks within the number of infected. Iran was one of the countries that faced many surges and peaks within these years and faced many inadequacies and shortages of resources and hospital beds. Hence the healthcare system started using in-hospital medication such as Remdesivir in outpatients to reduce the load of patients admitted to the hospital. This study aimed to evaluate and compare the reported signs, symptoms, and outcomes of COVID-infected hospitalized and out-patients receiving Remdesivir. METHODS: In this retrospective cohort study, 214 patients (121 outpatient and 93 hospitalized) with moderate levels of Covid infection between October 2021 and February 2022 were studied. Both groups were treated with 200mg of Remdesivir, followed by 100 mg daily intravenous injections for five days; signs and symptoms, such as pain, shortness of breath, cough, fever and etc., of patients at the initiation and the end of treatment were recorded. Moreover, the patients' blood oxygen saturation was assessed two to three times a day, and the mean of the recorded measures was considered as the daily oxygen saturation. The outpatient group had to visit the hospital daily for treatment and assessment. At the treatment's end, mortality rates, disease signs, and symptoms alleviations were compared between the groups. RESULTS: The outpatient and hospitalized group's mean age was 40.30 ± 12.25 and 37.70 ± 12.00 years, and 51.2% and 55.9% were males, respectively. There was no statistical difference between baseline and clinical characteristics in the outpatients and hospitalized groups. After adjusting for oxygen saturation at baseline and gender in the multivariable Cox regression analysis, the risk of death did not statistically differ between the hospitalized and outpatient group (hazard ratio: 0.99, 95% confidence interval: 0.39-2.50)) at the end of the study. CONCLUSION: Based on the results of this study, the outcome, signs, and symptoms of inpatient and outpatient Remdesivir treatment groups did not differ significantly. Hence in COVID-19 surges where we have limitations in admitting patients, outpatient Remdesivir treatment for those without any underlying diseases can be a proper management method.


Тема - темы
COVID-19 , Male , Humans , Adult , Middle Aged , Female , COVID-19/drug therapy , Outpatients , SARS-CoV-2 , Inpatients , Prognosis , Retrospective Studies
8.
J Psychiatr Pract ; 28(6): 492-496, 2022 Nov 01.
Статья в английский | MEDLINE | ID: covidwho-2117109

Реферат

Demands for telepsychiatry have increased due to the challenges of COVID-19. The global pandemic caused a significant increase in anxiety and depression and a worsening of eating disorder symptoms, while the implementation of social distancing both exacerbated these mental health issues and disrupted the in-person delivery of mental health services. Rapid adaptation of telepsychiatry in the acute inpatient setting has been reported with favorable outcomes in patient experiences. This article reports our experience with a transition to telepsychiatry services on an acute eating disorder unit and the impact on quality of care. Forty-two inpatients on an eating disorders unit completed 410 surveys evaluating their experience with telepsychiatry. Simultaneously, surveys were distributed to physicians to identify technical and connectivity issues. Our experience showed that patients on an eating disorder unit, who had an average length of stay of 22 days, were very satisfied with telepsychiatry, with few technical or safety issues.


Тема - темы
COVID-19 , Psychiatry , Telemedicine , Humans , Inpatients/psychology , Surveys and Questionnaires
9.
Rehabil Nurs ; 47(6): 210-219, 2022.
Статья в английский | MEDLINE | ID: covidwho-2107690

Реферат

PURPOSE: The aim of this study was to identify inpatient rehabilitation quality-of-care concepts that are best understood from the patient perspective. DESIGN: We conducted 12 focus groups with 95 former patients, caregivers, and rehabilitation clinicians and asked them to describe high-quality inpatient rehabilitation care. METHODS: We independently reviewed the focus group transcripts and then used an iterative process to identify the quality measure concepts identified by participants. RESULTS: Based on participants' comments, we identified 18 quality measure concepts: respect and dignity, clinician communication with patient, clinician communication with family, organizational culture, clinician engagement with patient, clinician engagement with family, rehabilitation goals, staff expertise, responsiveness, patient safety, physical environment, care coordination, discharge planning, patient and family education, peer support, symptom management (pain, anxiety, fatigue, sadness), sleep, and functioning. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING: Rehabilitation nurses should be aware of the quality-of-care issues that are important to patients and their caregivers. CONCLUSION: Important patient-reported domains of quality of care include interpersonal relationships, patient and family engagement, care planning and delivery, access to support, and quality of life.


Тема - темы
Inpatients , Quality of Life , Humans , Quality Indicators, Health Care , Quality of Health Care , Communication
10.
Psychiatr Q ; 93(4): 1017-1030, 2022 Dec.
Статья в английский | MEDLINE | ID: covidwho-2104031

Реферат

PURPOSE: Loneliness among the elderly is a widespread phenomenon and is connected to various negative health outcomes. Nevertheless, loneliness among elderly inpatients, especially those with a psychiatric diagnosis, has hardly been examined. Our study assessed loneliness in elderly inpatients, identified predictors, and compared levels of loneliness between inpatients on psychiatric and somatic wards. METHODS: N = 100 elderly inpatients of a somatic and psychiatric ward were included. Levels of loneliness were assessed, as were potential predictors such as depression, psychological resilience, severity of mental illness, well-being, daily functioning, and psychiatric diagnosis. Analyses of group differences and hierarchical multiple regression analysis were conducted. RESULTS: 37% of all inpatients reported elevated levels of loneliness. Significant predictor variables were self-reported depressive symptoms, well-being, severity of mental illness, being single and living with a caregiver. Hierarchical multiple regression analysis revealed that the full model explained 58% of variance in loneliness. Psychiatric inpatients' loneliness was significantly higher than loneliness in somatic inpatients. When analyzing group differences between inpatients with different main psychiatric diagnoses, highest levels were found in patients with an affective disorder, followed by those treated for organic mental disorder. Since the study took place during the COVID-19 pandemic, potential influence of different measurement points (lockdown vs. no lockdown) were analyzed: Differences in loneliness depending on the phase of the pandemic were non-significant. CONCLUSION: Elderly inpatients experience high levels of loneliness, especially those with a mental disorder. Interventions to reduce loneliness in this population should address predictors of loneliness, preferably through multiprofessional interventions.


Тема - темы
COVID-19 , Inpatients , Aged , Humans , Loneliness , Pandemics , COVID-19/epidemiology , Communicable Disease Control
14.
J Periodontol ; 93(10): 1476-1485, 2022 10.
Статья в английский | MEDLINE | ID: covidwho-2094216

Реферат

BACKGROUND: Saliva, salivary glands, gingival crevicular fluid, and supragingival biofilms may harbor SARS-CoV-2 RNA. This observational study aimed to investigate the presence and load of SARS-CoV-2 RNA in supragingival, and subgingival biofilms obtained from intensive care unit (ICU) patients. METHODS: A convenience sample, composed of 52 COVID-19+ participants (48.6 ± 14.8 years, 26.9% females), were evaluated for pre-existing comorbidities, number of teeth, and periodontal data [visible plaque (VPI), bleeding on probing (BOP), periodontal probing depth (PPD), and attachment loss (AL)]. Supragingival and subgingival samples (SubDeep: four sites with the deepest PPD; SubRemain: remaining shallower sites) were analyzed by RT-qPCR with corresponding cycle quantification (Cq). Statistical analyses considered the individual (P = 5%). RESULTS: Twenty-six participants tested positive for dental biofilms (Biofilm+) with 96.2% of them being positive for subgingival samples. Pre-existing comorbidities, number of teeth examined, VPI, PPD, AL, and BOP were similar between Biofilm+ and Biofilm-. SubDeep PPD (3.72 ± 0.86), AL (4.34 ± 1.33), and % of BOP (66.0 ± 31.1) values were significantly greater compared to SubRemain values (2.84 ± 0.48, 3.37 ± 0.34, and 20.4 ± 24.1, respectively). Biofilm+ Cqs showed no association with the periodontal condition. Cqs from Nasopharynx/Oropharynx (Naso/Oro; n = 36) were similar between Biofilm+ and Biofilm- participants. Length of time since ICU intake, last Naso/Oro RT-qPCR readings, onset of COVID-19 symptoms, and biofilm samplings were greater for Biofilm-. CONCLUSIONS: ICU patients harbored SARS-CoV-2 RNA in supragingival and subgingival biofilms, irrespective of the periodontal condition, and systemic viral load. The high number of positive patients highlights the need to better understand this habit to provide adequate oral care.


Тема - темы
COVID-19 , Periodontal Diseases , Female , Humans , Male , RNA, Viral , SARS-CoV-2 , Inpatients , Biofilms , Intensive Care Units
16.
Acta Clin Croat ; 61(Suppl 1): 49-52, 2022 Jun.
Статья в английский | MEDLINE | ID: covidwho-2081242

Реферат

Chronic wounds are often underestimated condition with increasingly growing inpatient and outpatient treatment costs. Since the patient population affected by chronic wounds is heterogeneous and includes diabetes, chronic venous insufficiency and peripheral artery disease patients, with additional differences in gender, age, previous medical history, treatment of chronic wounds is highly personalized and dependent on a variety of factors. This paper aims to highlight the problems that the chronic wound patient population is facing during the COVID-19 pandemic: from higher probability of an undesirable disease outcome to the fact that many of them have limited access to primary care providers and to the regular and continuous care that their condition demands. This paper describe three patients with chronic wounds. Each of the patients had a significant worsening of their chronic wounds during the COVID-19 pandemic: either following an active SARS-CoV-2 infection or due to the limited access to primary care. The cases described here highlight the necessity of providing proper and regular care for all patients during the COVID-19 pandemic, regardless of the current state of the healthcare system and the adversities and hurdles it currently faces, to prevent the pandemic from becoming a syndemic.


Тема - темы
COVID-19 , Pandemics , Humans , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Outpatients , Inpatients
17.
PLoS One ; 17(10): e0275500, 2022.
Статья в английский | MEDLINE | ID: covidwho-2079745

Реферат

OBJECTIVE: This study aims to investigate the relationship between RNs and hospital-based medical specialties staffing levels with inpatient COVID-19 mortality rates. METHODS: We relied on data from AHA Annual Survey Database, Area Health Resource File, and UnitedHealth Group Clinical Discovery Database. In phase 1 of the analysis, we estimated the risk-standardized event rates (RSERs) based on 95,915 patients in the UnitedHealth Group Database 1,398 hospitals. We then used beta regression to analyze the association between hospital- and county- level factors with risk-standardized inpatient COVID-19 mortality rates from March 1, 2020, through December 31, 2020. RESULTS: Higher staffing levels of RNs and emergency medicine physicians were associated with lower COVID-19 mortality rates. Moreover, larger teaching hospitals located in urban settings had higher COVID-19 mortality rates. Finally, counties with greater social vulnerability, specifically in terms of housing type and transportation, and those with high infection rates had the worst patient mortality rates. CONCLUSION: Higher staffing levels are associated with lower inpatient mortality rates for COVID-19 patients. More research is needed to determine appropriate staffing levels and how staffing levels interact with other factors such as teams, leadership, and culture to impact patient care during pandemics.


Тема - темы
COVID-19 , Emergency Medicine , Humans , Inpatients , COVID-19/epidemiology , Hospitals, Teaching , Workforce
18.
Transpl Infect Dis ; 24(5): e13924, 2022 Oct.
Статья в английский | MEDLINE | ID: covidwho-2078673

Реферат

BACKGROUND: Current methods for benchmarking inpatient antimicrobial use (AU) could benefit from combining AU with antimicrobial resistance (AR) information to provide metrics benchmarked to microbiological data; this may yield more instructive and better risk-adjusted measurements than AU and AR in isolation. METHODS: In this retrospective single-center study, we computed facility-wide AU/AR ratios from 2019 to 2020 for specific antimicrobial agents and corresponding AR events, and compared median monthly AU/AR ratios between March 2019 through December 2019 (pre-COVID period) and March 2020 through December 2020 (COVID period). Aggregate AU was expressed as a ratio to aggregate AR events for antimicrobials that typically have activity against the AR organism and are frequently used to treat the AR organism in clinical practice. We also computed AU/AR ratios in our surgical intensive care unit in the pre-COVID period. RESULTS: High-median facility-wide monthly AU/AR ratios were observed for intravenous vancomycin/methicillin-resistant Staphylococcus aureus, with 130.0 in the pre-COVID period and 121.3 in the COVID period (p =.520). Decreases in facility-wide median monthly AU/AR ratios were observed between periods for meropenem/ESBL Enterobacterales (20.9 vs. 7.9, p < .001), linezolid/vancomycin-resistant Enterococcus (48.5 vs. 15.8, p =.004), and daptomycin/vancomycin-resistant Enterococcus (32.2 vs. 4.8, p = .002). Increases in facility-wide median monthly AU/AR ratios were observed between periods for ceftazidime-avibactam/carbapenem-resistant Enterobacterales (0.0 vs. 3.2, p = .020) and ceftazidime-avibactam/multidrug-resistant Pseudomonas aeruginosa (0.0 vs. 4.0, p = .017). The AU/AR ratio for intravenous vancomycin/methicillin-resistant S. aureus in the surgical intensive care unit was 191.5 in the pre-COVID period. CONCLUSIONS: AU/AR ratios may be used to supplement current AU and AR metrics. Future directions should include the development of more AU metrics benchmarked to microbiological information. AU metrics more specific to transplant infectious diseases should be developed.


Тема - темы
Anti-Infective Agents , COVID-19 , Daptomycin , Methicillin-Resistant Staphylococcus aureus , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Benchmarking , COVID-19/drug therapy , Carbapenems , Delivery of Health Care , Drug Resistance, Bacterial , Drug Resistance, Multiple, Bacterial , Humans , Inpatients , Linezolid , Meropenem , Microbial Sensitivity Tests , Retrospective Studies , Vancomycin
19.
Am J Phys Med Rehabil ; 101(11): 1038-1041, 2022 Nov 01.
Статья в английский | MEDLINE | ID: covidwho-2077989

Реферат

ABSTRACT: The objective of this retrospective, observational study was to quantitatively study the impact of the early COVID-19 pandemic on the inpatient clinical experience of Physical Medicine and Rehabilitation resident physicians in an inpatient rehabilitation facility setting. Inpatient clinical experience as evidenced by admissions, rehabilitation diagnosis, medical emergencies, acute care transfers, and resident work hours from January to June 2019 (prepandemic) were compared January to June 2020 (immediately before and during pandemic). There was a statistically significant decrease in the mean daily admissions in April 2020 and a significant increase in medically complex admissions in June 2020, reflective of medical patterns due to the pandemic. There was a decrease in mean work hours during the pandemic, but no statistically significant difference in admission rate of other rehabilitation diagnoses, medical emergencies, or transfers to acute care. This study demonstrates no substantial pandemic-related impact on inpatient clinical experience for physical medicine and rehabilitation residents in the studied program.


Тема - темы
COVID-19 , Physical and Rehabilitation Medicine , Physicians , Humans , COVID-19/epidemiology , Pandemics , Inpatients , Retrospective Studies , Emergencies
20.
Int J Environ Res Public Health ; 19(20)2022 Oct 11.
Статья в английский | MEDLINE | ID: covidwho-2071411

Реферат

Many studies have identified predictors of outcomes for inpatients with coronavirus disease 2019 (COVID-19), especially in intensive care units. However, most retrospective studies applied regression methods to evaluate the risk of death or worsening health. Recently, new studies have based their conclusions on retrospective studies by applying machine learning methods. This study applied a machine learning method based on decision tree methods to define predictors of outcomes in an internal medicine unit with a prospective study design. The main result was that the first variable to evaluate prediction was the international normalized ratio, a measure related to prothrombin time, followed by immunoglobulin M response. The model allowed the threshold determination for each continuous blood or haematological parameter and drew a path toward the outcome. The model's performance (accuracy, 75.93%; sensitivity, 99.61%; and specificity, 23.43%) was validated with a k-fold repeated cross-validation. The results suggest that a machine learning approach could help clinicians to obtain information that could be useful as an alert for disease progression in patients with COVID-19. Further research should explore the acceptability of these results to physicians in current practice and analyze the impact of machine learning-guided decisions on patient outcomes.


Тема - темы
COVID-19 , Humans , Inpatients , Retrospective Studies , Prospective Studies , Decision Trees , Immunoglobulin M
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