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1.
Texto & contexto enferm ; 29: e20200191, Jan.-Dec. 2020. graf
Artículo en Inglés | LILACS, BDENF - Enfermería | ID: biblio-1127489

RESUMEN

ABSTRACT Objective: to submit the experience lived in the care transition for hospital discharge of patients undergoing liver transplantation due to the COVID-19 pandemic. Method: an experience report on hospital discharge planning and care transition for patients undergoing liver transplantation at a teaching hospital. Results: after COVID-19 pandemic has been declared, several technological means were used to support self-care strategies at the time of the hospital-home transition, as well as remote care for patients focusing on doubts about the routine of care and treatments. In addition, new counterreferral strategies were structured, prioritizing safety and social isolation. Conclusion: the adjustments in care transition with the support of the technologies provided transplanted patients access to all the information that guides self-care. Likewise, they regulated the flow of the support network and the health network, decreasing the possibility for COVID-19 spread, infection and development.


RESUMEN Objetivo: presentar la experiencia en la transición del cuidado para el alta hospitalaria de pacientes sometidos a trasplante hepático en vistas de la pandemia del COVID-19. Método: informe de experiencia sobre la planificación del alta hospitalaria y la transición del cuidado de pacientes sometidos a trasplante hepático en un hospital escuela. Resultados: después de declarada la pandemia del COVID-19 se utilizaron diversos medios tecnológicos para respaldar las estrategias de autocuidado al momento de la transición entre el hospital y el domicilio, al igual que la asistencia remota a los pacientes enfocada en dudas acerca de la rutina de cuidados y tratamientos. También se estructuraron nuevas estrategias de contra-derivación, priorizando la seguridad y el aislamiento social. Conclusión: los ajustes en la transición del cuidado con el respaldo de las tecnologías viabilizaron el acceso de los pacientes trasplantados a todas las informaciones que guían el autocuidado. De igual manera, regularon el flujo de la red de apoyo y de la red de salud, reduciendo así la posibilidad de propagación, infección y desarrollo del COVID-19.


RESUMO Objetivo: apresentar a experiência vivenciada na transição do cuidado para alta hospitalar de pacientes submetidos ao transplante hepático em razão da pandemia da COVID-19. Método: relato de experiência sobre planejamento da alta hospitalar e transição do cuidado de pacientes submetidos ao transplante hepático em um hospital-escola. Resultados: após a declaração da pandemia da COVID-19 foram utilizados diversos meios tecnológicos para apoiar as estratégias de autocuidado no momento da transição entre hospital e domicílio. Assim como, atendimento remoto aos pacientes com foco em dúvidas acerca da rotina de cuidados e tratamentos. Além disso, novas estratégias de contrarreferência foram estruturadas, priorizando a segurança e o isolamento social. Conclusão: os ajustes na transição de cuidado com apoio das tecnologias oportunizaram acesso aos pacientes transplantados a todas as informações que orientam o autocuidado. Igualmente, regularam o fluxo da rede de apoio e rede de saúde, diminuindo a possibilidade de propagação, infecção e desenvolvimento da COVID-19.


Asunto(s)
Humanos , Alta del Paciente , Trasplante de Hígado , Enfermería , Infecciones por Coronavirus , Continuidad de la Atención al Paciente
2.
Rev. enferm. UERJ ; 28: e44488, jan.-dez. 2020.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1096023

RESUMEN

Objetivo: identificar dúvidas de puérperas e familiares sobre cuidados domiciliares com o recém-nascido de baixo risco e analisar a roda de conversa, mediada por simulador realístico de baixa fidelidade, como uma tecnologia educativa para o preparo de famílias no processo de alta da maternidade. Método: pesquisa qualitativa, incluindo dezenove familiares de recém-nascidos de baixo risco em um hospital municipal de Rio das Ostras, Rio de Janeiro, de maio a outubro de 2018, por entrevista semiestruturada. Dados submetidos à Análise Temática. Resultados: as dúvidas dos familiares versaram sobre cuidados com higiene, alimentação, ambiente, afeto, saúde, sono e doenças. A roda de conversa com simulador de baixa fidelidade foi considerada uma estratégia positiva para mediar o aprendizado. Conclusão: a tecnologia educativa revelou-se útil na instrumentalização de famílias no processo de alta da maternidade, visto que o cuidador fortalece suas potencialidades, retira dúvidas e troca informações e experiências no grupo.


Objective: to identify puerperal and family members' questions about home care with low-risk newborns and to analyze the conversation circle, mediated by a realistic low fidelity simulator, as an educational technology for the preparation of families in the maternity discharge process. Method: qualitative research conducted with nineteen relatives of low-risk newborns in the municipal hospital in Rio das Ostras, Rio de Janeiro, Brazil, from May to October 2018, through semi-structured interview. Data submitted to thematic analysis. Results: the family members' doubts were about care with hygiene, food, environment, affection, health, sleep and diseases. The conversation wheel with low fidelity simulator was considered a positive strategy to mediate learning. Conclusion: the educational technology proved to be useful in the instrumentalization of families in the maternity discharge process, as the caregiver strengthens their potential, removes doubts and exchanges information and experiences in the group.


Objetivo: identificar dudas puerperales y familiares sobre atención domiciliaria con recién nacidos de bajo riesgo y analizar el círculo de conversación, mediado por simulador realista de baja fidelidad, como una tecnología educativa de preparación de familias en el proceso de alta de la maternidad. Método: investigación cualitativa, con diecinueve familiares de recién nacidos de bajo riesgo en un hospital municipal en Río das Ostras, Río de Janeiro, de mayo a octubre de 2018, a través de entrevistas semiestructuradas. Se utilizó a Análisis temático. Resultados: las dudas fueron sobre higiene, alimentación, medio ambiente, afecto, salud, sueño y enfermedades. El círculo de conversación con simulador se consideró una estrategia positiva para mediar en el aprendizaje. Conclusión: la tecnología educativa demostró ser útil en la instrumentalización de familias en el proceso de alta de la maternidad, porque el cuidador fortalece su potencial, elimina dudas e intercambia información y experiencias en el grupo.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Adulto Joven , Alta del Paciente , Recién Nacido , Familia , Cuidadores/educación , Tecnología Educacional , Atención Domiciliaria de Salud/educación , Brasil , Tecnología Educacional/métodos , Investigación Cualitativa , Entrenamiento Simulado , Maternidades , Hospitales Municipales
4.
BMC Health Serv Res ; 20(1): 997, 2020 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-33129316

RESUMEN

BACKGROUND: A minority of individuals use a large portion of health system resources, incurring considerable costs, especially in acute-care hospitals where a significant proportion of deaths occur. We sought to describe and contrast the characteristics, acute-care use and cost in the last year of life among high users and non-high users who died in hospitals across Canada. METHODS: We conducted a population-based retrospective-cohort study of Canadian adults aged ≥18 who died in hospitals across Canada between fiscal years 2011/12-2014/15. High users were defined as patients within the top 10% of highest cumulative acute-care costs in each fiscal year. Patients were categorized as: persistent high users (high-cost in death year and year prior), non-persistent high users (high-cost in death year only) and non-high users (never high-cost). Discharge abstracts were used to measure characteristics and acute-care use, including number of hospitalizations, admissions to intensive-care-unit (ICU), and alternate-level-of-care (ALC). RESULTS: We identified 191,310 decedents, among which 6% were persistent high users, 41% were non-persistent high users, and 46% were non-high users. A larger proportion of high users were male, younger, and had multimorbidity than non-high users. In the last year of life, persistent high users had multiple hospitalizations more often than other groups. Twenty-eight percent of persistent high users had ≥2 ICU admissions, compared to 8% of non-persistent high users and only 1% of non-high users. Eleven percent of persistent high users had ≥2 ALC admissions, compared to only 2% of non-persistent high users and < 1% of non-high users. High users received an in-hospital intervention more often than non-high users (36% vs. 19%). Despite representing only 47% of the cohort, persistent and non-persistent high users accounted for 83% of acute-care costs. CONCLUSIONS: High users - persistent and non-persistent - are medically complex and use a disproportionate amount of acute-care resources at the end of life. A greater understanding of the characteristics and circumstances that lead to persistently high use of inpatient services may help inform strategies to prevent hospitalizations and off-set current healthcare costs while improving patient outcomes.


Asunto(s)
Cuidados Críticos , Cuidado Terminal , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Cuidados Críticos/economía , Femenino , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Pacientes Internos , Unidades de Cuidados Intensivos/economía , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Retrospectivos , Cuidado Terminal/economía , Adulto Joven
7.
BMC Infect Dis ; 20(1): 819, 2020 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-33167874

RESUMEN

BACKGROUND: In Finland, the routine surveillance of Lyme borreliosis (LB) is laboratory-based. In addition, we have well established national health care registers where countrywide data from patient visits in public health care units are collected. In our previous study based on these registers, we reported an increasing incidence of both microbiologically confirmed and clinically diagnosed LB cases in Finland during the past years. Here, we evaluated our register data, refined LB incidence estimates provided in our previous study, and evaluated treatment practices considering LB in the primary health care. METHODS: Three national health care registers were used. The Register for Primary Health Care Visits (Avohilmo) and the National Hospital Discharge Register (Hilmo) collect physician-recorded data from the outpatient and inpatient health care visits, respectively, whereas the National Infectious Diseases Register (NIDR) represents positive findings in LB diagnostics notified electronically by microbiological laboratories. We used a personal identification number in register-linkage to identify LB cases on an individual level in the study year 2014. In addition, antibiotic purchase data was retrieved from the Finnish Social Insurance Institution in order to evaluate the LB treatment practices in the primary health care in Finland. RESULTS: Avohilmo was found to be useful in monitoring clinically diagnosed LB (i.e. erythema migrans (EM) infections), whereas Hilmo did not add much value next to existing laboratory-based surveillance of disseminated LB. However, Hilmo gave valuable information about uncertainties related to physician-based surveillance of disseminated LB and the total annual number of EM infections in our country. Antibiotic purchases associated with the LB-related outpatient visits in the primary health care indicated a good compliance with the recommended treatment guidelines. CONCLUSIONS: Avohilmo and laboratory-based NIDR together are useful in monitoring LB incidence in Finland. A good compliance was observed with the recommended treatment guidelines of clinically diagnosed LB in the primary health care. In 2018, Avohilmo was introduced in the routine surveillance of LB in Finland next to laboratory-based surveillance of disseminated LB.


Asunto(s)
Borrelia burgdorferi/inmunología , Enfermedades Transmisibles/epidemiología , Monitoreo Epidemiológico , Eritema Crónico Migrans/epidemiología , Sistema de Registros , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Niño , Preescolar , Enfermedades Transmisibles/tratamiento farmacológico , Enfermedades Transmisibles/microbiología , Eritema Crónico Migrans/tratamiento farmacológico , Eritema Crónico Migrans/microbiología , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Lactante , Recién Nacido , Laboratorios , Masculino , Cooperación del Paciente , Alta del Paciente , Médicos , Atención Primaria de Salud , Estudios Retrospectivos , Pruebas Serológicas , Adulto Joven
8.
PLoS One ; 15(11): e0240347, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33175876

RESUMEN

BACKGROUND: As a pandemic, a most-common pattern resembled organizing pneumonia (OP) has been identified by CT findings in novel coronavirus disease (COVID-19). We aimed to delineate the evolution of CT findings and outcome in OP of COVID-19. MATERIALS AND METHODS: 106 COVID-19 patients with OP based on CT findings were retrospectively included and categorized into non-severe (mild/common) and severe (severe/critical) groups. CT features including lobar distribution, presence of ground glass opacities (GGO), consolidation, linear opacities and total severity CT score were evaluated at three time intervals from symptom-onset to CT scan (day 0-7, day 8-14, day > 14). Discharge or adverse outcome (admission to ICU or death), and pulmonary sequelae (complete absorption or lesion residuals) on CT after discharge were analyzed based on the CT features at different time interval. RESULTS: 79 (74.5%) patients were non-severe and 103 (97.2%) were discharged at median day 25 (range, day 8-50) after symptom-onset. Of 67 patients with revisit CT at 2-4 weeks after discharge, 20 (29.9%) had complete absorption of lesions at median day 38 (range, day 30-53) after symptom-onset. Significant differences between complete absorption and residuals groups were found in percentages of consolidation (1.5% vs. 13.8%, P = 0.010), number of involved lobe > 3 (40.0% vs. 72.5%, P = 0.030), CT score > 4 (20.0% vs. 65.0%, P = 0.010) at day 8-14. CONCLUSION: Most OP cases had good prognosis. Approximately one-third of cases had complete absorption of lesions during 1-2 months after symptom-onset while those with increased frequency of consolidation, number of involved lobe > 3, and CT score > 4 at week 2 after symptom-onset may indicate lesion residuals on CT.


Asunto(s)
Infecciones por Coronavirus/diagnóstico por imagen , Neumonía Viral/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Betacoronavirus/aislamiento & purificación , Proteína C-Reactiva/análisis , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/patología , Infecciones por Coronavirus/virología , Femenino , Humanos , Tiempo de Internación , Pulmón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Neutrófilos/citología , Pandemias , Alta del Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/patología , Neumonía Viral/virología , Estudios Retrospectivos , Índice de Severidad de la Enfermedad
9.
BMC Infect Dis ; 20(1): 831, 2020 Nov 11.
Artículo en Inglés | MEDLINE | ID: mdl-33176701

RESUMEN

BACKGROUND: The discovery of antibiotics in the mid-twentieth century marked a major transition in tuberculosis (TB) treatment and control. There are few studies describing the duration of TB disease and its treatment from the pre-chemotherapy era and little data on how these treatments changed in response to the development of effective antibiotics. The goal of this research is to understand how inpatient treatment for high incidence populations, the First Nations peoples of Saskatchewan, Canada, changed in response to increasing availability of antibiotics effective against TB. We expected that as treatment regimens transitioned from convalescence-only to triple antibiotic therapy, the length of inpatient treatment would shorten. METHODS: Analyses were performed on records of sanatoria admissions and discharges occurring between 1933 and 1959 in Saskatchewan, Canada. Year of antibiotic discovery was taken as a proxy for treatment regimen: no chemotherapy (pre-1944), mono-therapy (Streptomycin, 1944-1946), dual-therapy (Streptomycin and PAS, 1946-1952), and triple-therapy (Streptomycin, PAS, and INH 1952-). A pooled linear regression of log-transformed length of first admission as predicted by year of admission was modeled to assess the relationship between admission length and year of admission, corrected for clinical and demographic variables. RESULTS: First admission length increased 19% in the triple-therapy era as compared to the pre-chemotherapy era, from 316 days (10.4 months) to 377 days (12.4 months). After the discovery of INH (1952), we find statistically significant increases in the proportion of successfully completed therapies (0.55 versus 0.60, p = 0.035), but also in patients who left hospital against medical advice (0.19 versus 0.29, p < 0.0001), indicating that as hospitalizations lengthened, more patients chose to discharge without the sanction of their physician. The readmission rate increased from 10 to 50% of all admissions while the province-level TB-specific death rate fell from 63.1 per 10,000 in 1933 to 4.7 per 10,000 in 1958. CONCLUSION: Counterintuitively, we find that the length of first admissions increased with the discovery of TB-treating antibiotics. Increasing admission volume and readmission rate indicate an intensification of inpatient TB treatment during this era. These analyses provide a novel estimate of the effect of changing treatment policy on sanatorium admissions in this population.


Asunto(s)
Antibacterianos/uso terapéutico , Tiempo de Internación/tendencias , Readmisión del Paciente/tendencias , Tuberculosis/tratamiento farmacológico , Tuberculosis/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Canadá/epidemiología , Niño , Preescolar , Femenino , Hospitales , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Alta del Paciente , Estudios Retrospectivos , Resultado del Tratamiento , Tuberculosis/microbiología , Adulto Joven
10.
MMWR Morb Mortal Wkly Rep ; 69(45): 1695-1699, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33180754

RESUMEN

Coronavirus disease 2019 (COVID-19) is a complex clinical illness with potential complications that might require ongoing clinical care (1-3). Few studies have investigated discharge patterns and hospital readmissions among large groups of patients after an initial COVID-19 hospitalization (4-7). Using electronic health record and administrative data from the Premier Healthcare Database,* CDC assessed patterns of hospital discharge, readmission, and demographic and clinical characteristics associated with hospital readmission after a patient's initial COVID-19 hospitalization (index hospitalization). Among 126,137 unique patients with an index COVID-19 admission during March-July 2020, 15% died during the index hospitalization. Among the 106,543 (85%) surviving patients, 9% (9,504) were readmitted to the same hospital within 2 months of discharge through August 2020. More than a single readmission occurred among 1.6% of patients discharged after the index hospitalization. Readmissions occurred more often among patients discharged to a skilled nursing facility (SNF) (15%) or those needing home health care (12%) than among patients discharged to home or self-care (7%). The odds of hospital readmission increased with age among persons aged ≥65 years, presence of certain chronic conditions, hospitalization within the 3 months preceding the index hospitalization, and if discharge from the index hospitalization was to a SNF or to home with health care assistance. These results support recent analyses that found chronic conditions to be significantly associated with hospital readmission (6,7) and could be explained by the complications of underlying conditions in the presence of COVID-19 (8), COVID-19 sequelae (3), or indirect effects of the COVID-19 pandemic (9). Understanding the frequency of, and risk factors for, readmission can inform clinical practice, discharge disposition decisions, and public health priorities such as health care planning to ensure availability of resources needed for acute and follow-up care of COVID-19 patients. With the recent increases in cases nationwide, hospital planning can account for these increasing numbers along with the potential for at least 9% of patients to be readmitted, requiring additional beds and resources.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitalización/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Readmisión del Paciente/estadística & datos numéricos , Neumonía Viral/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
11.
BMC Infect Dis ; 20(1): 841, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33187475

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) is an emerging viral disease. Here, we report the clinical features, management, and short-term outcomes of COVID-19 patients in Wenzhou, China, an area outside Wuhan. METHODS: Patients admitted to the Infectious Diseases Department of Ruian People's Hospital in Wenzhou, from January 21 to February 7, 2020, were recruited. Medical data on epidemiological history, demographics, clinical characteristics, laboratory tests, chest computerized tomography (CT) examination, treatment, and short-term outcomes were retrospectively reviewed. Blood biochemistry and routine tests were examined using standard methods and automatic machines. CT examination was performed several times during hospitalization as necessary. RESULTS: A total of 67 confirmed COVID-19 cases were diagnosed; 64 (95.4%) were common cases and three (4.5%) were severe cases. The most common symptoms at admission were fever (86.6%), cough (77.6%), productive cough (52.2%), chest distress (17.9%), and sore throat (11.9%), followed by diarrhea (7.4%), headache (7.4%), shortness of breath (6.0%), dizziness (4.5%), muscular soreness (4.5%), and running nose (4.5%). Thirty patients (47.8%) had increased C-reactive protein levels. The CT radiographs at admission showed abnormal findings in 54 (80.6%) patients. The patients were treated mainly by oxygen therapy and antiviral drugs. By March 3, 2020, all 67 patients completely recovered and had negative nucleic acid tests. The patients were discharged from the hospital and transferred to a medical observation isolation center for further observation. CONCLUSION: Cases of COVID-19 in Wenzhou are milder and have a better prognosis, compared to those in Wuhan. Timely and appropriate screening, diagnosis, and treatment are the key to achieve good outcomes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Adolescente , Adulto , Anciano , Antivirales/uso terapéutico , Betacoronavirus/genética , Betacoronavirus/aislamiento & purificación , Niño , Preescolar , China/epidemiología , Comorbilidad , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/transmisión , Tos/virología , Diarrea/virología , Femenino , Fiebre/virología , Hospitalización , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Alta del Paciente , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/transmisión , Embarazo , Frecuencia Respiratoria , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Viaje , Resultado del Tratamiento , Adulto Joven
12.
J Transl Med ; 18(1): 411, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33138834

RESUMEN

BACKGROUND: The SARS-CoV-2 RNA was detected positive again after discharged from hospital in some COVID-19 patients, with or without clinical symptoms such as fever or dry cough. METHODS: 1008 severe COVID-19 patients, with SARS-CoV-2 RNA positive detected with the mixed specimen of nasopharyngeal swab and oropharyngeal swab by real-time fluorescence quantitative PCR (RT-qPCR), were selected to monitor SARS-CoV-2 RNA with the 12 types of specimens by RT-qPCR during hospitalization. All of 20 discharged cases with COVID-19 were selected to detect SARS-CoV-2 RNA in isolation period with 7 types of specimens by RT-qPCR before releasing the isolation period. RESULTS: Of the enrolled 1008 severe patients, the nasopharyngeal swab specimens showed the highest positive rate of SARS-CoV-2 RNA (71.06%), followed by alveolar lavage fluid (66.67%), oropharyngeal swab (30.77%), sputum (28.53%), urine (16.30%), blood (12.5%), stool (12.21%), anal swab (11.22%) and corneal secretion (2.99%), and SARS-CoV-2 RNA couldn't be detected in other types of specimen in this study. Of the 20 discharged cases during the isolation period, the positive rate of SARS-CoV-2 RNA was 30% (6/20): 2 cases were positive in sputum at the eighth and ninth day after discharge, respectively, 1 case was positive in nasopharynx swab at the sixth day after discharge, 1 case was positive in anal swab at the eighth day after discharge, and 1 case was positive in 3 specimens (nasopharynx swab, oropharynx swab and sputum) simultaneously at the fourth day after discharge, and no positive SARS-CoV-2 RNA was detected in other specimens including stool, urine and blood at the discharged patients. CONCLUSIONS: SARS-CoV-2 RNA should be detected in multiple specimens, such as nasopharynx swab, oropharynx swab, sputum, and if necessary, stool and anal swab specimens should be performed simultaneously at discharge when the patients were considered for clinical cure and before releasing the isolation period.


Asunto(s)
Técnicas de Laboratorio Clínico/métodos , Infecciones por Coronavirus/diagnóstico , Cavidad Nasal/virología , Alta del Paciente , Neumonía Viral/diagnóstico , ARN Viral/sangre , Betacoronavirus/aislamiento & purificación , Líquidos Corporales , Hospitalización , Humanos , Pandemias , Reacción en Cadena en Tiempo Real de la Polimerasa , Reproducibilidad de los Resultados
13.
PLoS One ; 15(11): e0241896, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33147282

RESUMEN

A cluster of patients with coronavirus disease 2019 (COVID-19) underwent repeated positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA tests after they were discharged from the hospital. We referred to them as re-positive (RP) patients in this study. We aimed to describe the clinical characteristics of these patients in a retrospective cohort study. After being treated for COVID-19, the patients underwent 14 days of quarantine following their discharge from the Huangshi Hospital of Traditional Chinese Medicine and the Huangshi Hospital of Youse. Two additional sequential SARS-CoV-2 RNA tests were performed at the end of quarantine. The median age of the 368 patients was 51 years, and 184 (50%) patients were female. A total of 23 RP patients were observed at follow-up. Using multivariate Cox regression analysis, risk factors associated with RP included a higher ratio of lymphocyte/white blood cell on admission (adjusted HR 7.038; 95% CI, 1.911-25.932; P = 0.0034), lower peak temperature during hospitalization (adjusted HR, 0.203; 95% CI, 0.093-0.443; P<0.0001), and the presence of comorbidities, particularly hypertension or chronic diseases in the respiratory system (adjusted HR, 3.883; 95% CI, 1.468-10.273; P = 0.0063). Antivirus treatment with arbidol was associated with a lower likelihood of re-positive outcomes (adjusted HR, 0.178; 95% CI, 0.045-0.709; P = 0.0144).


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/virología , Neumonía Viral/diagnóstico , Neumonía Viral/virología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , China , Comorbilidad , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente , Cuarentena , ARN Viral/genética , Estudios Retrospectivos , Factores de Riesgo , Adulto Joven
14.
BMJ Case Rep ; 13(10)2020 Oct 31.
Artículo en Inglés | MEDLINE | ID: mdl-33130588

RESUMEN

An 82-year-old man with an extensive medical history presented to the emergency room with complaints of generalised weakness and cough. He tested positive for COVID-19 10 days prior to presenting to the emergency room. Although his symptoms started a week prior to diagnosis, his weakness increased, warranting emergency response. A comprehensive metabolic panel was drawn from the patient on admission, indicating markedly high liver function tests (LFTs) ≥20 times above the upper limit of normal. On day 1 of admission, the decision was still made to start remdesivir (5-day course) due to decompensated acute respiratory failure as well as dexamethasone. The patient's LFTs significantly improved throughout his hospital stay. The patient made a full recovery and was discharged on day 10 of hospitalisation.


Asunto(s)
Adenosina Monofosfato/análogos & derivados , Alanina/análogos & derivados , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Hepatopatías/diagnóstico , Neumonía Viral/diagnóstico , Neumonía Viral/tratamiento farmacológico , Insuficiencia Respiratoria/diagnóstico , Adenosina Monofosfato/administración & dosificación , Anciano de 80 o más Años , Alanina/administración & dosificación , Dexametasona/administración & dosificación , Servicio de Urgencia en Hospital , Humanos , Tiempo de Internación , Hepatopatías/complicaciones , Pruebas de Función Hepática , Masculino , Pandemias/prevención & control , Pandemias/estadística & datos numéricos , Alta del Paciente , Insuficiencia Respiratoria/terapia , Índice de Severidad de la Enfermedad , Resultado del Tratamiento
15.
JAMA Netw Open ; 3(11): e2023547, 2020 11 02.
Artículo en Inglés | MEDLINE | ID: mdl-33136133

RESUMEN

Importance: Hospitals ceased most elective procedures during the height of coronavirus disease 2019 (COVID-19) infections. As hospitals begin to recommence elective procedures, it is necessary to have a means to assess how resource intensive a given case may be. Objective: To evaluate the development and performance of a clinical decision support tool to inform resource utilization for elective procedures. Design, Setting, and Participants: In this prognostic study, predictive modeling was used on retrospective electronic health records data from a large academic health system comprising 1 tertiary care hospital and 2 community hospitals of patients undergoing scheduled elective procedures from January 1, 2017, to March 1, 2020. Electronic health records data on case type, patient demographic characteristics, service utilization history, comorbidities, and medications were and abstracted and analyzed. Data were analyzed from April to June 2020. Main Outcomes and Measures: Predicitons of hospital length of stay, intensive care unit length of stay, need for mechanical ventilation, and need to be discharged to a skilled nursing facility. These predictions were generated using the random forests algorithm. Predicted probabilities were turned into risk classifications designed to give assessments of resource utilization risk. Results: Data from the electronic health records of 42 199 patients from 3 hospitals were abstracted for analysis. The median length of stay was 2.3 days (range, 1.3-4.2 days), 6416 patients (15.2%) were admitted to the intensive care unit, 1624 (3.8%) received mechanical ventilation, and 2843 (6.7%) were discharged to a skilled nursing facility. Predictive performance was strong with an area under the receiver operator characteristic ranging from 0.76 to 0.93. Sensitivity of the high-risk and medium-risk groupings was set at 95%. The negative predictive value of the low-risk grouping was 99%. We integrated the models into a daily refreshing Tableau dashboard to guide decision-making. Conclusions and Relevance: The clinical decision support tool is currently being used by surgical leadership to inform case scheduling. This work shows the importance of a learning health care environment in surgical care, using quantitative modeling to guide decision-making.


Asunto(s)
Infecciones por Coronavirus , Toma de Decisiones , Sistemas de Apoyo a Decisiones Clínicas , Procedimientos Quirúrgicos Electivos , Asignación de Recursos para la Atención de Salud , Hospitalización , Hospitales , Pandemias , Neumonía Viral , Anciano , Betacoronavirus , Comorbilidad , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Registros Electrónicos de Salud , Femenino , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Alta del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología , Respiración Artificial , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Instituciones de Cuidados Especializados de Enfermería
16.
J Prev Med Hyg ; 61(3): E313-E320, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-33150220

RESUMEN

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the microorganism responsible for the aggressive Coronavirus Disease (COVID-19) pandemic. During the such pandemic, discharge and community reintegration of patients are critical phases in guaranteeing public health. A review of the international and Italian experiences that represent the best available evidence was carried out, mainly focusing on the precise allocation of tasks and related responsibilities. The report provides a proposal for a systematic management pathway dedicated to COVID-19 patients. The original result is a logigramme to guide health practitioners on discharge and community reintegration of COVID-19 patients. To standardize clinical attitudes helps in ensuring quality of care and patient safety, should be a core element even during a public health emergency. The logigramme suggests, after discharge, 14 days of further isolation with regular health monitoring and, finally, the execution of a nasopharyngeal swab for identification of SARS-CoV-2 viral RNA. Home-cared patients should be placed on 7 days of further isolation after at least 2 negative RT-PCR tests for respiratory tract samples (nasopharyngeal swab). The logigramme is already used in the Department of Prevention - Local Health Agency of Lecce (Apulia) but it will be updated according to the latest research findings.


Asunto(s)
Infecciones por Coronavirus , Monitoreo Ambulatorio , Pandemias , Alta del Paciente/normas , Neumonía Viral , Cuarentena , Enfermedades Asintomáticas , Betacoronavirus , Técnicas de Laboratorio Clínico , Convalecencia , Infecciones por Coronavirus/diagnóstico , Femenino , Humanos , Italia , Masculino , Nasofaringe/virología , Factores de Tiempo
17.
Biomed Res Int ; 2020: 2138387, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33029494

RESUMEN

Coronavirus disease 2019 (COVID-19) has caused considerable morbidity and mortality worldwide since December 2019. This retrospective study determined the characteristics and prognostic factors of COVID-19 patients, focusing on inpatients who died or were discharged between 30 December 2019 and 29 February 2020 at Renmin Hospital of Wuhan University. Patients' medical histories, comorbidities, symptoms, signs, laboratory findings, computed tomography (CT) findings, and clinical management were recorded. All 293 patients were divided into the nonsurviving (n = 116) and surviving (n = 177) groups. The median age was older in the nonsurviving group than in the surviving group; most patients were older than 65 years in the nonsurviving group. The incidence rates of lymphopenia, neutrophilia, and leukocytosis were significantly higher in the nonsurviving group than in the surviving group. More patients in the nonsurviving group had increased levels of nonspecific infection markers, abnormal liver and kidney function, cardiac injury, and blood coagulation abnormalities on admission. Immune and inflammatory responses were more severely disturbed in the nonsurviving group than in the surviving group. The incidence rates of complications during hospitalization were higher in the nonsurviving group than in the surviving group. Cox regression results also showed that older age, symptoms of dyspnea, comorbidities, and complications were all predictors of death. Close monitoring and timely treatment are needed for high-risk COVID-19 patients.


Asunto(s)
Infecciones por Coronavirus/etiología , Neumonía Viral/etiología , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Femenino , Mortalidad Hospitalaria , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Pronóstico , Estudios Retrospectivos
18.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3130-3133, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-33018668

RESUMEN

With the development of advanced robotic hands, a reliable neural-machine interface is essential to take full advantage of the functional dexterity of the robots. In this preliminary study, we developed a novel method to estimate isometric forces of individual fingers continuously and concurrently during dexterous finger flexion and extension. Specifically, motor unit (MU) discharge activity was extracted from the surface high-density electromyogram (EMG) signals recorded from the finger extensors and flexors, respectively. The MU information was separated into different groups to be associated with the flexion or extension of individual fingers and was then used to predict individual finger forces during multi-finger flexion and extension tasks. Compared with the conventional EMG amplitude-based method, our method can obtain a better force estimation performance (a higher correlation and a smaller estimation error between the predicted and the measured force) when a linear regression model was used. Further exploration of our method can potentially provide a robust neural-machine interface for intuitive control of robotic hands.


Asunto(s)
Alta del Paciente , Robótica , Electromiografía , Dedos , Mano , Humanos
19.
PLoS One ; 15(10): e0240081, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33007008

RESUMEN

Given the global spread of coronavirus disease (COVID-19), strict discharge standard is of great significance for the prevention and control of the epidemic, thus, the purpose of this study is to formulate more strict and scientific discharge standards. A total of 845 patients with mild and general COVID-19 who were considered to be discharged from hospital were included in this study. The median time from the onset of COVID-19 to the occurrence of two consecutive negative nucleic acid tests of these patients was 21 days. 223 of the 845 patients were tested again after two consecutive negative nucleic acid tests and 17.49% of the patients were positive. Moreover, 82.51% (184 of 223) of these patients experienced negative results from three consecutive nucleic acid tests, the median time from the onset of COVID-19 to the occurrence of three consecutive negative nucleic acid tests was 23 days (range: 3-56 days), and 38 of which were further tested after three consecutive negative nucleic acid tests, while about 5.26% (2 of 38) patients showed positive nucleic acid test results. Thus, we suggested that the patient should be negative for at least 3 consecutive nucleic acid tests before discharge, and the test time should be no earlier than the 23rd day since the onset of the disease.


Asunto(s)
Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/diagnóstico , Alta del Paciente , Neumonía Viral/diagnóstico , ARN Viral/análisis , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , China/epidemiología , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Estudios Retrospectivos , Adulto Joven
20.
Sci Rep ; 10(1): 17365, 2020 10 15.
Artículo en Inglés | MEDLINE | ID: mdl-33060676

RESUMEN

To analyze the clinical characteristics of re-positive discharged COVID-19 patients and find distinguishing markers. The demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, illness severities and chest CT scan results of 267 patients were collected from 1st January to 15th February 2020. COVID-19 was diagnosed by RT-PCR. Clinical symptoms and nucleic acid test results were collected during the 14 days post-hospitalization quarantine. 30 out of 267 COVID-19 patients were detected re-positive during the post-hospitalization quarantine. Re-positive patients could not be distinguished by demographic features, clinical symptoms, laboratory results, comorbidities, co-infections, treatments, chest CT scan results or subsequent clinical symptoms. However, re-positive rate was found to be correlated to illness severity, according the Acute Physiology and Chronic Health Evaluation II (APACHE II) severity-of-disease classification system, and the confusion, urea, respiratory rate and blood pressure (CURB-65) score. Common clinical characteristics were not able to distinguish re-positive patients. However, severe and critical cases classified high according APACHE II and CURB-65 scores, were more likely to become re-positive after discharge.


Asunto(s)
Betacoronavirus/genética , Infecciones por Coronavirus/patología , Neumonía Viral/patología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , China , Comorbilidad , Infecciones por Coronavirus/virología , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pandemias , Alta del Paciente , Neumonía Viral/virología , Cuarentena , ARN Viral/metabolismo , Reacción en Cadena de la Polimerasa de Transcriptasa Inversa , Índice de Severidad de la Enfermedad , Tórax/diagnóstico por imagen , Tomografía Computarizada por Rayos X
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