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1.
N C Med J ; 82(1): 21-28, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33397750

RESUMEN

BACKGROUND An integrated nonprofit health care system with 13 North Carolina medical centers conducted a time-pressured quality improvement simulation of its plan to implement the "North Carolina Protocol for Allocating Scarce Inpatient Critical Care Resources in a Pandemic" attendant to pandemic scenario planning. Simulation objectives included assessing the plan in terms of a) efficiency and effectiveness; b) comorbidity scoring validity; c) impact by race/ethnicity, gender, age, and payer status; and d) simulation participant impressions of potential impact on clinicians.METHOD The simulation scenario involved scoring 14 patients with the constraint that only 10 could be afforded critical care resources. Also included were independent scoring validation by four clinicians, structured debriefs with simulation participants and observers, and tracking patient outcomes for 30 days.RESULTS Triage scoring was identical among four triage teams. Lack of concordance in clinician comorbidity scoring did not alter patient prioritization for withdrawal of treatment in this small cohort. Protocol scoring was not correlated with resource utilization or near-term mortality.LIMITATIONS The simulation sample was small and selected when COVID-19 census was temporarily waning. No protocol for pediatric patients was tested.CONCLUSIONS The simulation yielded resource allocation concordance using comorbidity scoring by attending physicians, which significantly accelerated triage team decision-making and did not result in notable disparities by race/ethnicity, gender, or advanced age. Qualitative findings surfaced tensions in balancing de-identified data with individualized assessment and in trusting the clinical judgments of other physicians. Additional research is needed to validate the protocol's predictive value related to patient outcomes.


Asunto(s)
Cuidados Críticos , Pandemias , Niño , Prestación de Atención de Salud , Hospitales , Humanos , Pacientes Internos , North Carolina/epidemiología
2.
J Cardiothorac Vasc Anesth ; 35(2): 578-584, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33298370

RESUMEN

OBJECTIVES: Efficacy and safety of corticosteroids in patients with 2019-nCoV (novel coronavirus 2019) infection still are debated. Because large randomized clinical trials (RCTs) and a well-conducted meta-analysis on the use of corticosteroids, focused on patients with coronavirus disease (COVID-19) in intensive care units, recently were published, a meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity was performed to evaluate the effect on survival. DESIGN: A meta-analyses of RCTs was performed. SETTING: Patients admitted to hospital. PARTICIPANTS: Patients with coronavirus disease. INTERVENTIONS: Administration of corticosteroids. MEASUREMENTS AND MAIN RESULTS: A search was performed for RCTs of adult patients with acute hypoxemic failure related to 2019-nCoV infection who received corticosteroids versus any comparator. The primary endpoint was mortality rate. Five RCTs involving 7,692 patients were included. Overall mortality of patients treated with corticosteroids was slightly but significantly lower than mortality of controls (26% v 28%, relative risk {RR} = 0.89 [95% confidence interval {CI} 0.82-0.96], p = 0.003). The same beneficial effect was found in the subgroup of patients requiring mechanical ventilation (RR = 0.85 [95% CI 0.72-1.00], p = 0.05 number needed to treat {NNT} = 19). Remarkably, corticosteroids increased mortality in the subgroup of patients not requiring oxygen (17% v 13%, RR = 1.23 [95% CI 1.00-1.62], p = 0.05 number needed to harm {NNH} = 29). Tests for comparison between mechanically ventilated subgroups and those not requiring oxygen confirmed that treatment with corticosteroids had a statistically significant different effect on survival. Patients treated with corticosteroids had a significantly lower risk of need for mechanical ventilation. CONCLUSIONS: Corticosteroids may be considered in severe critically ill patients with COVID-19 but must be discouraged in patients not requiring oxygen therapy. Urgently, further trials are warranted before implementing this treatment worldwide.


Asunto(s)
Corticoesteroides/uso terapéutico , /tratamiento farmacológico , /mortalidad , Determinación de Punto Final , Humanos , Hipoxia/tratamiento farmacológico , Hipoxia/etiología , Pacientes Internos , Terapia por Inhalación de Oxígeno , Ensayos Clínicos Controlados Aleatorios como Asunto , Respiración Artificial
3.
J Oral Rehabil ; 48(1): 55-60, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33025615

RESUMEN

OBJECTIVE: To verify the validity of the prediction of oral intake recovery for inpatients with aspiration pneumonia using the Hyodo-Komagane score. BACKGROUND: Patients admitted for treatment of aspiration pneumonia sometimes have difficulty in resuming oral intake due to decreased swallowing function. Predicting whether the swallowing function will recover enough to achieve oral ingestion at discharge is an important factor in developing a treatment strategy. No studies have investigated the prediction of oral intake recovery using videoendoscopic examination. METHODS: Subjects were 65 patients who were admitted to an acute care hospital for the treatment of aspiration pneumonia. The patients were divided into two groups, the oral feeding group and the tube feeding group, according to their oral intake status at discharge or transfer. Logistic regression analysis was performed using the condition that tube feeding was not required as an objective variable and the items with significant differences between the two groups as explanatory variables. Additionally, the receiver operating characteristic curve was used to identify patients who could take food orally at discharge. RESULTS: The odds ratios for the Hyodo-Komagane score and the pharyngeal clearance score were 1.485 and 3.379, respectively. When the cut-off values of the Hyodo-Komagane score and the pharyngeal clearance score were 6 and 1, the sensitivity was 0.88 and 0.91, and the specificity was 0.64 and 0.70, respectively. CONCLUSION: The Hyodo-Komagane score and especially the pharyngeal clearance score are useful indices to predict oral intake recovery for inpatients with aspiration pneumonia.


Asunto(s)
Trastornos de Deglución , Neumonía por Aspiración , Deglución , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Humanos , Pacientes Internos , Japón
4.
AJR Am J Roentgenol ; 216(1): 264-270, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32845160

RESUMEN

OBJECTIVE. This article presents the perspectives of radiologists in different sub-specialties at three institutions across the United States regarding inpatient imaging of patients confirmed to have coronavirus disease (COVID-19) and persons under investigation (i.e., patients suspected to have COVID-19). CONCLUSION. The COVID-19 pandemic has prompted radiologists to become aware of imaging findings related to the disease and to develop workflows for the imaging of patients with COVID-19 and persons under investigation, to optimize care for all patients and preserve the health of health care workers.


Asunto(s)
/diagnóstico por imagen , Diagnóstico por Imagen , Pacientes Internos , Neumonía Viral/diagnóstico por imagen , Adulto , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/virología , Estados Unidos/epidemiología , Flujo de Trabajo
5.
Diabet Med ; 38(1): e14442, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33112438

RESUMEN

AIMS: Inpatient care for people with diabetes can and must be improved. The COVID-19 pandemic has impacted the way care is delivered across the UK. Diabetes UK needed to understand how inpatient care for people with diabetes has been affected and to identify opportunities, areas of concerns and recommendations for the future. METHODS: We interviewed 28 healthcare professionals and hospital teams from across the UK to find out about their experiences of delivering inpatient diabetes care during the first peak of the COVID-19 pandemic. RESULTS: We found that disruption to inpatient diabetes services created positive environments and opportunities for new ways of working, but in the minority, impacted on the quality of care clinicians felt they were able to deliver. CONCLUSIONS: It is important that these positive ways of working be maintained and as a result of these experiences we have outlined urgent recommendations for the challenging winter months ahead.


Asunto(s)
/epidemiología , Diabetes Mellitus/terapia , Personal de Salud , Pacientes Internos , Atención al Paciente/métodos , /prevención & control , Diabetes Mellitus/epidemiología , Humanos , Pandemias , Atención al Paciente/tendencias , Calidad de la Atención de Salud/tendencias , Reino Unido/epidemiología
6.
Heart Lung ; 50(1): 9-12, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33041057

RESUMEN

AIM: To determine if D-dimers are elevated in individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who have adverse clinical outcomes including all-cause mortality, intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). METHODS: We conducted a systematic review and meta-analysis of the published literature in PubMed, Embase and Cochrane databases through April 9, 2020 for studies evaluating D-dimer levels in SARS-COV-2 infected patients with and without a composite clinical endpoint, defined as the presence of all-cause of mortality, Intensive care unit (ICU) admission or acute respiratory distress syndrome (ARDS). A total of six studies were included in the meta-analysis. RESULTS: D-dimers were significantly increased in patients with the composite clinical end point than in those without (SMD, 1.67 ug/ml (95% CI, 0.72-2.62 ug/ml). The SMD of the studies (Tang et al, Zhou et al, Chen et al), which used only mortality as an outcome measure was 2.5 ug/mL (95% CI, 0.62-4.41 ug/ml). CONCLUSION: We conclude that SARS-CoV-2 infected patients with elevated D-dimers have worse clinical outcomes (all-cause mortality, ICU admission or ARDS) and thus measurement of D-dimers can guide in clinical decision making.


Asunto(s)
Productos de Degradación de Fibrina-Fibrinógeno , /sangre , Toma de Decisiones Clínicas , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Pacientes Internos , Unidades de Cuidados Intensivos , Pronóstico
8.
Water Res ; 189: 116620, 2021 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-33212338

RESUMEN

SARS-CoV-2 was discovered among humans in Wuhan, China in late 2019, and then spread rapidly, causing a global pandemic. The virus was found to be transmitted mainly by respiratory droplets from infected persons or by direct contact. It was also shown to be excreted in feces, why we investigated whether the virus could be detected in wastewater and if so, to which extent its levels reflects its spread in society. Samples of wastewater from the city of Gothenburg, and surrounding municipalities in Sweden were collected daily from mid-February until June 2020 at the Rya wastewater treatment plant. Flow proportional samples of wastewater were collected to ensure that comparable amounts were obtained for analysis. Daily samples were pooled into weekly samples. Virus was concentrated on a filter and analyzed by RT-qPCR. The amount of SARS-CoV-2 varied with peaks approximately every four week, preceding variations in number of newly hospitalized patients by 19-21 days. At that time virus testing for COVID-19 was limited to patients with severe symptoms. Local differences in viral spread was shown by analyzing weekly composite samples of wastewater from five sampling sites for four weeks. The highest amount of virus was found from the central, eastern, and northern parts of the city. SARS-CoV-2 was also found in the treated effluent wastewater from the WWTP discharged into the recipient, the Göta River, although with a reduction of 4-log10. The viral peaks with regular temporal intervals indicated that SARS-CoV-2 may have a cluster spread, probably reflecting that the majority of infected persons only spread the disease during a few days. Our results are important for both the planning of hospital care and to rapidly identify and intervene against local spread of the virus.


Asunto(s)
Heces , Aguas Residuales , Ciudades , Heces/virología , Humanos , Pacientes Internos , Suecia
9.
J Affect Disord ; 278: 15-22, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32949869

RESUMEN

BACKGROUND: Coronavirus disease 2019 (COVID-19) continues to spread across the globe, but patient experiences are rarely documented. OBJECTIVE: To explore the psychology of COVID-19 patients during hospitalization. METHODS: A phenomenological and robust sampling approach was employed. Sixteen patients admitted to the First Affiliated Hospital of Henan University of Science and Technology with COVID-19 from 20th January to 1st March 2020 were selected. Data were collected through semi-structured interviews, phone calls, or face-to-face interviews using quarantine measures. Data were analyzed using the Colaizzi method. RESULTS: The psychological experience of COVID-19 patients during hospitalization could be summarized into five themes. Firstly, attitudes toward the disease included fear, denial, and stigma during the early stages, which gradually developed into acceptance in the later stages. Secondly, the major source of stress included the viral nature of the disease, quarantine measures, and concerns regarding the health of family members. Thirdly, reactions of body and mind included disease stage-dependent emotional responses, excessive attention to symptoms, rumination, and changes in diet, sleep, and behavior. Fourthly, supportive factors included psychological adjustments, medical care, and family and social support. Finally, the disease resulted in psychological growth and patients viewed problems with gratitude through the cherishing of life, family, bravery, and tenacity. CONCLUSION: COVID-19 patients gradually changed their attitude toward the disease and displayed emotional responses dependent on the stage of the disease. Negative emotions dominated during the early stages but gradually gave way to mixed positive and negative emotions. Active guidance of psychological growth may therefore promote physical and mental recovery in COVID-19 patients.


Asunto(s)
Actitud Frente a la Salud , Hospitalización , Pacientes Internos/psicología , Adaptación Psicológica , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Investigación Cualitativa , Adulto Joven
10.
Diagn Microbiol Infect Dis ; 99(1): 115200, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32980807

RESUMEN

The COVID-19 pandemic in the United States created a unique situation where multiple molecular SARS-CoV-2 diagnostic assays rapidly received Emergency Use Authorization by the FDA and were validated by laboratories and utilized clinically, all within a period of a few weeks. We compared the performance of four of these assays that were evaluated for use at our institution: Abbott RealTime m2000 SARS-CoV-2 Assay, DiaSorin Simplexa COVID-19 Direct, Cepheid Xpert Xpress SARS-CoV-2, and Abbott ID NOW COVID-19. Nasopharyngeal and nasal specimens were collected from 88 ED and hospital-admitted patients and tested by the four methods in parallel to compare performance. ID NOW performance stood out as significantly worse than the other 3 assays despite demonstrating comparable analytic sensitivity. Further study determined that the use of a nasal swab compared to a nylon flocked nasopharyngeal swab, as well as use in a population chronically vs. acutely positive for SARS-CoV-2, were substantial factors.


Asunto(s)
/métodos , /aislamiento & purificación , /normas , Servicio de Urgencia en Hospital , Hospitales Universitarios , Humanos , Pacientes Internos , Límite de Detección , Nasofaringe/virología , Nariz/virología , Sensibilidad y Especificidad , Estados Unidos/epidemiología
11.
J Stroke Cerebrovasc Dis ; 30(1): 105433, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33160124

RESUMEN

BACKGROUND AND PURPOSE: Delays in recognition and assessment of in-hospital strokes (IHS) can lead to poor outcomes. The aim was to examine whether reorganized IHS code protocol can reduce treatment time. METHODS: IHS code protocol was developed, educational workshops were held for medical personnel. In the protocol, any medical personnel should directly consult a stroke neurologist before any diagnostic studies. Time intervals were compared between the pre- and post-implementation periods and between direct consultation with a stroke neurologist (DC group) and non-DC group in the post-implementation period. RESULTS: A total of 145 patients were included (pre, 42; post, 103). Time from recognition to stroke neurologist assessment (91 vs. 35 min, p = 0.002) and time from recognition to neuroimaging (123 vs. 74, p = 0.013) were significantly lower in the post-implementation period. Time from stroke neurologist assessment to groin puncture was significantly lower (135 vs. 81, p = 0.037). In the post-implementation period, DC group showed significant time savings from last known well (LKW) to recognition (93 vs. 260, p = 0.001), LKW to stroke neurologist assessment (145 vs. 378, p = 0.001), and recognition to stroke neurologist assessment (16 vs. 76, p < 0.001) compared with non-DC group. CONCLUSIONS: Reorganization of IHS code protocol reduced time from stroke recognition to assessment and treatment time. Reorganized IHS code and direct consultation with a stroke neurologist improved the initial response time.


Asunto(s)
Protocolos Clínicos , Prestación Integrada de Atención de Salud , Procedimientos Endovasculares , Neuroimagen , Derivación y Consulta , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/terapia , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Pacientes Internos , Masculino , Valor Predictivo de las Pruebas , Mejoramiento de la Calidad , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento
12.
J Stroke Cerebrovasc Dis ; 30(1): 105421, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33160125

RESUMEN

BACKGROUND: Around 15.0% of all strokes occurred in hospitalised patients and studies showed significant delay in the stroke recognition and lack of awareness on thrombolytic therapy for acute ischaemic stroke (AIS) which lead to higher mortality for in-hospital stroke. We aimed to develop and validate a new instrument known as acute stroke management questionnaire (ASMaQ) to evaluate the awareness of healthcare professionals in managing acute ischaemic stroke cases. METHODS: This study consisted of 3 steps; the formulation of ASMaQ draft, content validation and construct validity. A total of 110 questions were drafted with 5-point Likert scale answers. From the list, 31 were selected and subsequently tested on 158 participants. The results were analysed and validated using exploratory factor analysis on SPSS. Components were extracted and questions with low factor loading were removed. The internal consistency was then measured with Cronbach's alpha. RESULTS: Following analysis, 3 components were extracted and named as general stroke knowledge, hyperacute stroke care and advanced stroke management. Two items were deleted leaving 29 out of 31 questions for the final validated ASMaQ. Internal consistency showed high reliability with Cronbach's alpha of 0.82. Our respondents scored a total cumulative mean of 113.62 marks or 66.6%. A sub analysis by occupation showed that medical assistants scored the lowest in the group with a score of 57% whilst specialists including neurologists scored the highest at 79.4%. CONCLUSION: The ASMaQ is a newly developed and validated questionnaire consisting of 29 questions testing the respondents' acute stroke management knowledge.


Asunto(s)
Competencia Clínica , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , /terapia , Encuestas y Cuestionarios , Adulto , Femenino , Humanos , Pacientes Internos , Masculino , Cuerpo Médico de Hospitales/psicología , Persona de Mediana Edad , Neurólogos/psicología , Personal de Enfermería en Hospital/psicología , Reproducibilidad de los Resultados , Especialización , Adulto Joven
13.
J Stroke Cerebrovasc Dis ; 30(1): 105453, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33188950

RESUMEN

OBJECTIVES: The aim of this study was to evaluate the associations between hemoglobin improvement and functional outcomes in anemic patients after stroke. METHODS: This retrospective cohort study included consecutive hospitalized post-stroke patients with anemia. Data on serum hemoglobin level were extracted from medical records. The "change in hemoglobin levels" was defined as the pre-discharge hemoglobin level minus the baseline hemoglobin level. Study outcomes included the Functional Independence Measure-motor (FIM-motor) efficacy, and length of stay. Multivariate analyses were used to determine whether the change in hemoglobin levels was independently associated with study outcomes, after adjusting for potential confounders. RESULTS: Of the 637 patients admitted, 194 stroke patients (mean age 75.4 years; 53.6% women) presented anemia at baseline and were included in the analysis. The mean (SD) baseline hemoglobin level was 11.2 (0.9) g/dL and the median (IQR) change was 0.4 (0.1-1.1) g/dL. In multivariate analyses, the change in hemoglobin levels was positively associated with the FIM-motor efficacy (ß = 0.114, p = 0.031), and negatively associated with length of stay (ß = -0.059, p = 0.039). Moreover, the baseline hemoglobin level was independently associated with the FIM-motor efficacy (ß = 0.267, p = 0.001). CONCLUSIONS: A lower baseline hemoglobin level is negatively associated with functional recovery, and hemoglobin improvement is positively associated with functional recovery and shorter hospital stay in stroke patients with anemia. Anemia should be assessed at baseline as a prognostic indicator and, if treatable, treated appropriately to maximize outcomes in these patients.


Asunto(s)
Anemia/sangre , Hemoglobinas/metabolismo , Rehabilitación de Accidente Cerebrovascular , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Anemia/complicaciones , Anemia/diagnóstico , Biomarcadores/sangre , Femenino , Humanos , Pacientes Internos , Longevidad , Masculino , Persona de Mediana Edad , Actividad Motora , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
14.
J Stroke Cerebrovasc Dis ; 30(1): 105437, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33197800

RESUMEN

OBJECTIVES: Stroke has become a national concern in China. Early prediction of stroke benefits patients and aids medical professionals in clinical decision making and rehabilitation plans to improve successful outcomes. To identify prediction factors influencing short-term outcomes in patients with acute ischemic stroke (AIS). MATERIALS AND METHODS: This was a hospital-based prospective observational study. Recovery of neurological improvement was represented by a percent reduction in the National Institutes of Health Stroke Scale (NIHSS) at discharge. We performed propensity score matching (PSM) to balance the NIHSS at admission and compared NIHSS scores before and after matching with PSM criteria. Finally, we assessed the prognosis of neurological improvement and patient-related variables. RESULTS: In the matched cohort, 92 pairs were matched by NIHSS admission after PSM. Modified Barthel Index, modified Rankin scale, NIHSS on admission, hypertension, sleep time, and Montreal Cognitive Assessment (MoCA) were statistically different between the two groups (P<0.05) before matching. Multivariable analysis identified two factors independently associated with neurological improvement: diabetes (P=0.030; adjusted odds ratio, 2.129; 95% confidence interval [CI] 1.078-4.026) and MoCA (P<0.001; adjusted odds ratio, 5.385; 95% CI 2.278-12.730). CONCLUSION: Consistent with previous studies, diabetes affected the short-term outcomes of AIS, while cognitive impairment had a negative effect on long-term AIS prognosis.Diabetes and early cognitive impairment have adverse effects on short-term prognosis after AIS.


Asunto(s)
Pacientes Internos , Rehabilitación de Accidente Cerebrovascular , Anciano , China , Cognición , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/epidemiología , Disfunción Cognitiva/psicología , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Evaluación de la Discapacidad , Femenino , Estado de Salud , Humanos , /epidemiología , Masculino , Pruebas de Estado Mental y Demencia , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Puntaje de Propensión , Estudios Prospectivos , Recuperación de la Función , Medición de Riesgo , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
16.
J Oral Sci ; 63(1): 79-82, 2020 Dec 23.
Artículo en Inglés | MEDLINE | ID: mdl-33281145

RESUMEN

PURPOSE: To examine the relationship between oral intake function and oral health status in convalescent inpatients. METHODS: Subjects were 222 patients admitted to a convalescent hospital between 1 January and 30 June 2018. Investigation items were age, sex, causative disease, body mass index, functional oral intake scale (FOIS), functional independence measure, occlusal contact, assistance with oral cleaning, and oral health assessment tool (OHAT) scores. Multiple regression analysis was performed with FOIS as the dependent variable, and investigation items were related to FOIS as independent variables. RESULTS: Results of multiple regression analysis for all patients suggested that saliva and denture scores were significantly associated with FOIS. However, analysis excluding non-oral feeding patients did not show a significant association between FOIS and OHAT scores. CONCLUSION: The results of this study suggest that oral health status is associated with oral intake function. In addition, the oral health status of inpatients may be strongly related to whether or not they are eating orally. Therefore, it is necessary to take good care of oral health in non-oral feeding patients in the convalescent ward.


Asunto(s)
Trastornos de Deglución , Salud Bucal , Humanos , Pacientes Internos , Saliva
18.
Med Sci Monit ; 26: e927674, 2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33342993

RESUMEN

BACKGROUND The aim of this study was to analyze the clinical features and laboratory indices of patients with coronavirus disease (COVID-19) and explore their association with the severity of the disease. MATERIAL AND METHODS A total of 61 patients with COVID-19 were divided into groups with common symptoms and with severe diseases, and clinical data were collected to analyze and compare the differences between them. RESULTS In patients with severe COVID-19, compared with the common group, lymphocyte count and albumin levels were lower, and aspartate aminotransferase (AST), blood urea, blood creatinine, lactate dehydrogenase (LDH), and C-reactive protein (CRP) levels, and prothrombin time (PT) were elevated (all P<0.05). The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume-to-lymphocyte ratio (MPVLR), and C-reactive protein-to-albumin ratio (CAR) were significantly elevated in the severe group compared with the group with common symptoms; however, the lymphocyte-to-monocyte ratio (LMR) was significantly reduced (P<0.05). Univariate logistic regression showed that lower lymphocyte count, prolonged PT, elevated CRP and LDH levels, and elevated NLR, PLR, MPVLR, and CAR were risk factors for COVID-19 severity (P<0.05). Multivariate logistic regression showed that elevated CRP levels (odds ratio [OR], 0.028; 95% confidence interval [CI]: 0.002-0.526; P=0.017), prolonged PT (OR, 0.014; 95% CI: 0.001-0.341; P=0.09), and an MPVLR >8.9 (OR, 0.026; 95% CI: 0.002-0.349; P=0.006) were independent risk factors for COVID-19 severity. CONCLUSIONS Elevated CRP and prolonged PT, and an MPVLR >8.9 were independent risk factors for COVID-19 severity.


Asunto(s)
/epidemiología , Infecciones por Coronavirus/diagnóstico , Adulto , Aspartato Aminotransferasas/sangre , Plaquetas , Proteína C-Reactiva/análisis , China/epidemiología , Coronavirus/patogenicidad , Infecciones por Coronavirus/sangre , Creatinina/análisis , Femenino , Humanos , Pacientes Internos , L-Lactato Deshidrogenasa/sangre , Recuento de Linfocitos , Linfocitos/química , Masculino , Volúmen Plaquetario Medio , Persona de Mediana Edad , Monocitos , Neutrófilos/química , Estudios Retrospectivos , Albúmina Sérica/análisis , Índice de Severidad de la Enfermedad
19.
G Ital Dermatol Venereol ; 155(5): 632-635, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33295741

RESUMEN

BACKGROUND: The outbreak of the pandemic Coronavirus disease 2019 (COVID-19), caused by a novel coronavirus named Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), affecting a high number of patients in Italy, forced a great number of doctors, even dermatologists, to work in the first lines in the dedicated departments. We analyzed the features and the incidence of dermatological issues emerged during the hospitalization due to COVID-19 and absent before. METHODS: All the SARS-CoV-2 positive patients hospitalized in Celio Military Hospital - COVID hub no-intensive care wards from March 16, 2020 until May 4, 2020 were evaluated by dermatologists several times during the hospital stay. RESULTS: Ninety-six patients (15 civilians and 81 Italian servicepeople) were enrolled: 34 (35.4%) patients developed cutaneous manifestations; 15 (16.0%) suffered from skin dryness; 5 (5.2%) irritant contact dermatitis; 4 (4.2%) seborrheic dermatitis; 4 (4.2%) morbilliform rashes; 3 (3.1%) petechial rashes and 3 (3.1%) widespread hives. CONCLUSIONS: A deeper knowledge of cutaneous manifestations in military and civilian hospitalized COVID-19 patients could suggest more effective treatments to win the battle against SARS-CoV-2.


Asunto(s)
/complicaciones , Hospitales Militares/estadística & datos numéricos , Pandemias , Enfermedades de la Piel/etiología , Adulto , Anciano , Dermatitis/epidemiología , Dermatitis/etiología , Exantema/epidemiología , Exantema/etiología , Femenino , Humanos , Ictiosis/epidemiología , Ictiosis/etiología , Pacientes Internos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Personal Militar , Psoriasis/complicaciones , Enfermedades de la Piel/epidemiología , Urticaria/epidemiología , Urticaria/etiología , Adulto Joven
20.
J Chin Med Assoc ; 83(12): 1111-1116, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33273270

RESUMEN

BACKGROUND: As outbreak of COVID-19 infection, on April 3, 2020, it is stipulated that the number of inpatient companions is limited to one in Taiwan. All companions are required to register their real personal data with 14 days of travel history, occupation, contact history, and cluster history. We would like to evaluate the impact of the new regulations to the accompanying and visiting culture in Taiwan, via analyzing the appearance and characteristics of inpatient companions in this period. METHODS: Using intelligent technology, we designed a novel system in managing the inpatient companions (InPatients Companions Management System [IPCMS]), and the IPCMS was used to collect data about characteristics of inpatients and companions between April 27 and May 3, 2020. The database is built using MySQL software. Microsoft Excel 2016 and SPSS version 20.0 statistical software were used for data analysis, including the basic data of the companions, differential analysis of companions' gender, person-days and cumulative time, differential analysis of accompaniment-patient relationship, and frequency of accompaniment and cumulative hours. RESULTS: During study period, daily inpatient admissions ranged from 2242 to 2514, the number of companions per day ranged from 2048 to 2293, and the number of companions for one inpatient is 1 to 9 per day, with an average of 1.20 to 1.26. The companions were mostly family members, and most of them were the inpatients' children (32.9%), and spouse (26.13%). More females than males were noted in all categories of companionship with statistical significance. CONCLUSION: The data obtained in this study could be an important basis for the transformation and reform of the companions culture in Taiwan's hospitals and will also provide a glimpse into the attitudes and culture of companions who have long been ignorant and neglected. The experience gained in our IPCMS could also serve as a reference for other hospitals in Taiwan and worldwide.


Asunto(s)
/epidemiología , Visitas a Pacientes , Femenino , Humanos , Pacientes Internos , Masculino , Taiwán/epidemiología
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