Mortality and critical conditions in COVID-19 patients at private hospitals: weekend effect?

OBJECTIVE: The aim of the study was to find factors associated with the mortality of admission to the intensive care unit (ICU) in patients with COVID-19. MATERIALS AND METHODS: Retrospective observational study with a database of 1987 patients with COVID-19 who had attended the emergency department of a private hospital network between February 2020 and April 2020 were analyzed. Clinical variables and some laboratory parameters were studied. The Charlson and Elixhauser comorbidity indices were calculated. The dependent variables were mortality and admission to the ICU. A descriptive and correlational analysis was performed. Logistic regression models and Kaplan-Meier survival curves were established. RESULTS: Positive correlations were observed between age, creatinine, and D-dimer levels, as well as with the scores obtained with the Charlson and Elixhauser indices. Differences in the levels of these parameters were also observed when analyzing variables such as mortality, sex or admission to the ICU. Mortality was associated with high creatinine and D-dimer levels and advanced age. Survival curves indicated longer survival in patients not admitted to the ICU, admitted to the hospital during the week, and in those with lower creatinine and D-dimer levels. CONCLUSIONS: Mortality in Spanish patients with COVID-19 admitted to private hospitals was associated with high creatinine and D-dimer levels and advanced age. Longer survival was obtained on weekdays. This study provides valuable information on the management and nursing care of these patients in order to optimize resources in pandemic situations.

[The levels of knowledge about nonclinical areas which are characteristic of the new model of primary care]. / Grado de conocimiento en áreas no clínicas propias del nuevo modelo de atención primaria.

OBJECTIVE: To evaluate the level of knowledge about the non-clinical areas which characterise the new model of primary care among doctors and nurses who work in primary care teams (PCT); and to identify the most deficient areas of knowledge and the variables associated with these lower levels of knowledge. DESIGN: An observation study of a crossover kind. SETTING: PCTs of Health Area 1 in Madrid. PARTICIPANTS: Doctors and nurses who were working in the 23 PCTs functioning when the study was carried out (321 people). MEASUREMENTS AND MAIN RESULTS: Knowledge was measured by a self-filled, anonymous questionnaire elaborated by a panel of experts. It contained 72 items with correct (C) or false (F) double reply, grouped in 12 basic areas of knowledge relating to the non-clinical aspects which characterise the new model of primary care (PC). A pilot test was done in a PCT in another Area. The data bases were performed on DBASEIII+ and the statistical analysis on SPSS v. 4.0. The required level of knowledge through the questionnaire as a whole was attained by 41.6% of the professionals. An association with the following was noted: Age (p < 0.0001), Profession (p < 0.005), Year that training ended (p < 0.01), Type of contract (p < 0.005), Nature of access to a permanent post (p < 0.0005), postgraduate academic training for doctors (p < 0.001) and Residency in Family and Community Medicine (p < 0.009). The most deficient areas of knowledge were: Evaluation of procedures and programmes (46%), Community Participation (51.6%), the filling-out and standardisation of records (55.2%), and the Evaluation of objectives and quality control mechanisms. CONCLUSIONS: Knowledge of non-clinical areas is low.