Is Gastrointestinal Bleeding a Problem for COVID-19 Intensive Care Unit Patients?

The objective of this study was to describe the COVID-19 intensive care unit population and analyze the characteristics and outcomes of gastrointestinal bleeding patients. An observational prospective study design was used following the STROBE checklist. All patients admitted between February and April 2020 to the intensive care unit were included. Main outcome measures were first bleeding event timing, sociodemographic and clinical data before admission, and gastrointestinal symptoms. A total of 116 COVID-19 patients were included; 16 (13.8%) developed gastrointestinal bleeding, 15 were males (93.7%), and the median age was 65.64 ± 7.33 years. All 16 patients were mechanically ventilated, one (6.3%) already had gastrointestinal symptoms, 13 (81.3%) had at least one concomitant disease, and six (37.5%) died. Bleeding episodes occurred on a mean of 16.9 ± 9.5 days after admission. Nine cases (56.3%) had effects on their hemodynamics, hemoglobin levels, or transfusion requirements; six (37.5%) required diagnostic imaging; and two (12.5%) underwent endoscopy procedures. The Mann-Whitney test showed statistically significant differences between the two groups of patients concerning comorbidities. Gastrointestinal bleeding can occur in critically ill patients with COVID-19. Having a solid tumor or chronic liver disease seems to increase that risk. Nurses caring for COVID-19 patients are urged to individualize patients at higher risk in order to improve safety.

Moral Distress Scores of Nurses Working in Intensive Care Units for Adults Using Corley's Scale: A Systematic Review.

BACKGROUND: No systematic review in the literature has analyzed the intensity and frequency of moral distress among ICU nurses. No study seems to have mapped the leading personal and professional characteristics associated with high levels of moral distress. This systematic review aimed to describe the intensity and frequency of moral distress experienced by nurses in ICUs, as assessed by Corley's instruments on moral distress (the Moral Distress Scale and the Moral Distress Scale-Revised). Additionally, this systematic review aimed to summarize the correlates of moral distress. METHODS: A systematic search and review were performed using the following databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), the National Library of Medicine (MEDLINE/PubMed), and Psychological Abstracts Information Services (PsycINFO). The review methodology followed PRISMA guidelines. The quality assessment of the included studies was conducted using the Newcastle-Ottawa Scale. RESULTS: Findings showed a moderate level of moral distress among nurses working in ICUs. The findings of this systematic review confirm that there are a lot of triggers of moral distress related to patient-level factors, unit/team-level factors, or system-level causes. Beyond the triggers of moral distress, this systematic review showed some correlates of moral distress: those nurses working in ICUs with less work experience and those who are younger, female, and intend to leave their jobs have higher levels of moral distress. This systematic review's findings show a positive correlation between professional autonomy, empowerment, and moral distress scores. Additionally, nurses who feel supported by head nurses report lower moral distress scores. CONCLUSIONS: This review could help better identify which professionals are at a higher risk of experiencing moral distress, allowing the early detection of those at risk of moral distress, and giving the organization some tools to implement preventive strategies.

Gastrointestinal Bleeding in COVID-19 Patients: A Rapid Review.

The incidence of COVID-19 gastrointestinal manifestations has been reported to range from 3% to 61%. There are limited data on the incidence rates and risk factors associated with gastrointestinal bleeding (GIB) in patients with COVID-19. A rapid review has been designed to investigate whether there is a relationship between COVID-19 and GIB in adult patients. PubMed, CINAHL, EMBASE, Cochrane Library, and Scopus databases have been analyzed. A total of 129 studies were found; 29 full texts were analyzed, and of these, 20 were found to be relevant to the topic. The key findings of the included studies present an overall GIB rate in COVID-19 patients ranging from 1.1% to 13%. The bleeding involves mucosal damage of the duodenum, stomach, colon, and rectum. The management of gastrointestinal bleeding could be conservative. The use of fecal diversion systems for the management of diarrhea in COVID-19 patients should be minimized and closely evaluated for the risk of rectal mucosal damages and erosions. It is recommended to provide an accurate nutritional assessment; an early setting up of enteral nutrition, if not contraindicated, can help protect the gut mucosa of patients and restore normal intestinal flora. Larger cohort studies are needed to increase the information about this topic.

COVID-19: An Italian Hospital Response From the Nursing Perspective.

Novel coronavirus disease-2019 (COVID-19) is a new respiratory disease that has spread widely throughout the world. On February 20, 2020, the first Italian case of COVID-19 was reported. The infection rapidly spread across the country, and by August 11, 2020, a total of 250 566 official cases with 32 205 deaths (12.8%) were reported in Italy, counting a total of 96 884 positive cases and 16 833 deaths (17.3%) in the Lombardy region only. A huge demand to handle the COVID-19 outbreak challenged both the health care providers and the ordinary work in the hospital. From the beginning of the crisis, San Raffaele Scientific Institute, a 1318-bed tertiary care university hospital located in Lombardy, Northern Italy, has played a major role in supporting the national health care system for the treatment of COVID-19 cases, and a significant reorganization of the hospital was immediately required. The reorganization was carried out both structurally and with regard to the distribution of medical and nonmedical staff. This article aims to highlight the management strategies for the health care staff subsequent to the pandemic intense workload in San Raffaele Scientific Institute.

Delirium prevalence point: an observational monocentric study in a tertiary university hospital.

BACKGROUND: Delirium is a serious and common condition that needs an upgrade of the scientific and clinical attention. AIM: To assess the delirium prevalence in an Italian university hospital. METHODS: The monocentric 1-day observational study cohort has been conducted on March 15, 2018; the population was composed of adult hospitalized patients. All the eligible patients have been evaluated for the presence of delirium with the 4AT. RESULTS: We enrolled 596 patients. Twenty-nine Acute and 3 Rehabilitation Units were involved in the study. The median age of the sample was 60 (IQR 48-74) and 52% (n = 313) were male. Patients from medical units were 42% (n = 252), from surgery units 41% (n = 249), and from rehabilitation units 15% (n = 95). Results of 4AT showed that 5.4% (n = 32) had delirium (4AT = 4), 12% (n = 73) had cognitive impairment (4AT = 1-3), and 82% (n = 491) had no delirium or cognitive impairment (4AT = 0). We found association between delirium and age, BMI, mortality at 30 days, and hospital mortality. Delirium was related with Barthel Index, dementia, and anticholinesterase inhibitors. About devices in use, we observed a correlation of delirium with central venous catheter, feeding tube, and urinary catheter. Physical restraints were also correlated to delirium. CONCLUSIONS: We confirmed the presence of delirium across the hospital units, more in medical than in surgical ones. We found associations of delirium with conditions that limit movement, such as dementia, physical restraints, or devices. The development of delirium initiates a cascade of events culminating in the loss of independence and increased morbidity.

Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools.

AIM: This paper is a report of a study comparing the effectiveness of two falls risk assessment tools (Conley Scale and Hendrich Risk Model) by using them simultaneously with the same sample of hospital inpatients. BACKGROUND: Different risk assessment tools are available in literature. However, neither recent critical reviews nor international guidelines on fall prevention have identified tools that can be generalized to all categories of hospitalized patients. METHOD: A prospective observational study was carried out in acute medical, surgical wards and rehabilitation units. From October 2007 to January 2008, 1148 patients were assessed with both instruments, subsequently noting the occurrence of falls. The sensitivity, specificity, positive and negative predictive values, and Receiver Operating Characteristics curves were calculated. RESULTS: The number of patients correctly identified with the Conley Scale (n = 41) was higher than with the Hendrich Model (n = 27). The Conley Scale gave sensitivity and specificity values of 69.49% and 61% respectively. The Hendrich Model gave a sensitivity value of 45.76% and a specificity value of 71%. Positive and negative predictive values were comparable. CONCLUSION: The Conley Scale is indicated for use in the medical sector, on the strength of its high sensitivity. However, since its specificity is very low, it is deemed useful to submit individual patients giving positive results to more in-depth clinical evaluation in order to decide whether preventive measures need to be taken. In surgical sectors, the low sensitivity values given by both scales suggest that further studies are warranted.