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1.
Isr Med Assoc J ; 23(7): 432-436, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251126

RESUMO

BACKGROUND: Screening for asymptomatic urinary retention (AUR) in older adult men at hospital admission to the internal medicine department has never been studied. OBJECTIVES: To assess the incidence of AUR in older adult men at hospital admission, its risk factors, and its outcome. METHODS: The study comprised 111 older adult men aged ≥ 75 years who were admitted to three internal medicine departments. All men underwent post-void residual (PVR) urine volume measurement on the morning following admission by using a portable ultrasound bladder scan. AUR was defined as a PVR urine volume of ≥ 200 ml without symptoms. Men with AUR had a follow-up phone call concerning symptoms and urinary catheter status30 days following hospitalization. RESULTS: Seven (6.3%) men had AUR. Relative to the 104 men without AUR, they had significantly higher prevalence of severe dependency (6/7 vs. 33/104, 85.7% vs. 31.7%, (P = 0.007), cognitive impairment (5/7 vs. 19/104, 71.4% vs. 18.3%, P = 0.005), and use of anticholinergic agents (4/7 vs. 19/104, 57.1% vs. 18.3%, P = 0.033). A urinary catheter was inserted in one man (14.3%), but it was removed later during hospitalization. No symptoms were reported and no urinary catheter was inserted following hospitalization in men with AUR. CONCLUSIONS: AUR in older adult men at hospital admission is uncommon and has a favorable outcome. Hence, screening for AUR in all older adult men at admission is not recommended, but it may be considered in severely dependent older adult men with cognitive impairment who use anticholinergic agents.


Assuntos
Doenças Assintomáticas , Hiperplasia Prostática/diagnóstico , Ultrassonografia/métodos , Bexiga Urinária/diagnóstico por imagem , Retenção Urinária , Idoso de 80 Anos ou mais , Doenças Assintomáticas/epidemiologia , Doenças Assintomáticas/terapia , Antagonistas Colinérgicos/uso terapêutico , Disfunção Cognitiva/diagnóstico , Disfunção Cognitiva/epidemiologia , Estado Funcional , Humanos , Incidência , Masculino , Programas de Rastreamento/métodos , Avaliação de Resultados em Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , Quartos de Pacientes , Testes Imediatos , Hiperplasia Prostática/epidemiologia , Fatores de Risco , Retenção Urinária/diagnóstico , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Retenção Urinária/terapia
2.
N Z Med J ; 134(1538): 111-119, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239150

RESUMO

AIM: To determine the impact on the Capital & Coast District Health Board (CCDHB) urology service of the implementation of nationwide healthcare restrictions in response to the COVID-19 pandemic. METHODS: This is an observational retrospective study over a 21 working day period during the implementation of National Hospital Response Framework Alert (NHRFA) level 2. We obtained patient data during this period and a corresponding control period prior to the pandemic. The data was focussed on the volume of operating theatre cases, outpatient consultations, procedural clinic appointments and the estimated avoided outpatient travel. RESULTS: Total urology admissions decreased by 27% during the 21-day NHRFA level 2 period. However, acute surgical procedures increased by 30% whereas elective surgical procedures decreased by 32%. Outpatient consultations overall decreased by 32% during NHRFA level 2 despite virtual phone consultations increasing by 274%. Procedural clinic appointments decreased by 85%. The virtual platform also saved each patient an estimated 22.7km of average travel. CONCLUSION: The data demonstrate the effects of restrictions in response to a crisis and set a precedent for future management in such scenarios. The data also show how service efficiency can be optimised while providing an environmentally friendly alternative for routine clinical practice.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Urológicos/estatística & dados numéricos , Urologia/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Humanos , Nova Zelândia , Visita a Consultório Médico/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Telemedicina/estatística & dados numéricos , Viagem/estatística & dados numéricos
3.
Sci Rep ; 11(1): 13535, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34188137

RESUMO

As the novel coronavirus (COVID-19) has spread globally, a significant portion of pregnant and delivering women were infected with COVID-19. While emerging studies examined birth outcomes in COVID-19 positive women, knowledge of the psychological experience of childbirth and maternal wellness remains lacking. This matched-control survey-based study included a sample of women recruited during the first wave of the pandemic in the US who gave birth in the previous six months. Women reporting confirmed/suspected COVID-19 (n = 68) during pregnancy or childbirth were matched on background factors with women reporting COVID-19 negativity (n = 2,276). We found nearly 50% of COVID positive women endorsed acute traumatic stress symptoms at a clinical level in response to childbirth. This group was more than twice as likely to endorse acute stress and to have no visitors during maternity hospitalization than COVID negative women; they were also less likely to room-in with newborns. The COVID positive group reported higher levels of pain in delivery, lower newborn weights, and more infant admission to neonatal intensive care units. Our findings suggest COVID-19 affected populations are at increased risk for traumatic childbirth and associated risk for psychiatric morbidity. Attention to delivering women's wellbeing is warranted during the pandemic.


Assuntos
COVID-19/psicologia , Parto/psicologia , Gestantes/psicologia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Adulto , Ansiedade/diagnóstico , Peso ao Nascer , COVID-19/diagnóstico , COVID-19/virologia , Feminino , Hospitais , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Dor/patologia , Admissão do Paciente/estatística & dados numéricos , Gravidez , SARS-CoV-2/isolamento & purificação , Estresse Psicológico , Inquéritos e Questionários
4.
Front Immunol ; 12: 665329, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122423

RESUMO

Infection by novel coronavirus SARS-CoV-2 causes different presentations of COVID-19 and some patients may progress to a critical, fatal form of the disease that requires their admission to ICU and invasive mechanical ventilation. In order to predict in advance which patients could be more susceptible to develop a critical form of COVID-19, it is essential to define the most adequate biomarkers. In this study, we analyzed several parameters related to the cellular immune response in blood samples from 109 patients with different presentations of COVID-19 who were recruited in Hospitals and Primary Healthcare Centers in Madrid, Spain, during the first pandemic peak between April and June 2020. Hospitalized patients with the most severe forms of COVID-19 showed a potent inflammatory response that was not translated into an efficient immune response. Despite the high levels of effector cytotoxic cell populations such as NK, NKT and CD8+ T cells, they displayed immune exhaustion markers and poor cytotoxic functionality against target cells infected with pseudotyped SARS-CoV-2 or cells lacking MHC class I molecules. Moreover, patients with critical COVID-19 showed low levels of the highly cytotoxic TCRγδ+ CD8+ T cell subpopulation. Conversely, CD4 count was greatly reduced in association to high levels of Tregs, low plasma IL-2 and impaired Th1 differentiation. The relative importance of these immunological parameters to predict COVID-19 severity was analyzed by Random Forest algorithm and we concluded that the most important features were related to an efficient cytotoxic response. Therefore, efforts to fight against SARS-CoV-2 infection should be focused not only to decrease the disproportionate inflammatory response, but also to elicit an efficient cytotoxic response against the infected cells and to reduce viral replication.


Assuntos
COVID-19/epidemiologia , COVID-19/imunologia , Citotoxicidade Imunológica , Unidades de Terapia Intensiva , Leucócitos Mononucleares/imunologia , Admissão do Paciente/estatística & dados numéricos , SARS-CoV-2/imunologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticorpos Antivirais/sangue , Anticorpos Antivirais/imunologia , Biomarcadores , COVID-19/diagnóstico , COVID-19/virologia , Comorbidade , Citocinas/metabolismo , Feminino , Humanos , Imunofenotipagem , Leucócitos Mononucleares/metabolismo , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo
6.
Ann R Coll Surg Engl ; 103(7): 496-498, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192485

RESUMO

As the COVID-19 pandemic progressed across the UK and Northern Ireland in March 2020, our otolaryngology department began to make preparations and changes in practice to accommodate for potentially large numbers of patients with COVID-19 related respiratory illness in the hospital. We retrospectively reviewed the number of non-elective admissions to our department between the months of January and May in 2019 and 2020. A significant reduction in admissions of up to 94% during the months of the pandemic was observed. Our practice shifted to manage patients with epistaxis and peritonsillar abscess on an outpatient basis, and while prospectively collecting data on this, we did not observe any significant adverse events. We view this as a positive learning point and change in our practice as a result of the COVID-19 pandemic.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/tendências , COVID-19/prevenção & controle , Procedimentos Cirúrgicos Otorrinolaringológicos/tendências , Admissão do Paciente/tendências , Centro Cirúrgico Hospitalar/tendências , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/transmissão , Epistaxe/cirurgia , Humanos , Controle de Infecções/normas , Irlanda do Norte/epidemiologia , Procedimentos Cirúrgicos Otorrinolaringológicos/normas , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Pandemias/prevenção & controle , Admissão do Paciente/normas , Admissão do Paciente/estatística & dados numéricos , Abscesso Peritonsilar/cirurgia , Estudos Retrospectivos , Centro Cirúrgico Hospitalar/normas , Centro Cirúrgico Hospitalar/estatística & dados numéricos
7.
Endocrinol Metab (Seoul) ; 36(3): 582-589, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34107601

RESUMO

BACKGROUND: The occurrence of Graves' disease and Hashimoto thyroiditis after coronavirus disease 2019 (COVID-19) raised concerns that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may trigger thyroid autoimmunity. We aimed to address the current uncertainties regarding incident thyroid dysfunction and autoimmunity among COVID-19 survivors. METHODS: We included consecutive adult COVID-19 patients without known thyroid disorders, who were admitted to Queen Mary Hospital from July 21 to September 21, 2020 and had serum levels of thyroid-stimulating hormone, free thyroxine, free triiodothyronine (fT3), and anti-thyroid antibodies measured both on admission and at 3 months. RESULTS: In total, 122 patients were included. Among 20 patients with abnormal thyroid function tests (TFTs) on admission (mostly low fT3), 15 recovered. Among 102 patients with initial normal TFTs, two had new-onset abnormalities that could represent different phases of thyroiditis. Among 104 patients whose anti-thyroid antibody titers were reassessed, we observed increases in anti-thyroid peroxidase (TPO) (P<0.001) and anti-thyroglobulin (P<0.001), but not anti-thyroid stimulating hormone receptor titers (P=0.486). Of 82 patients with negative anti-TPO findings at baseline, 16 had a significant interval increase in anti-TPO titer by >12 U, and four became anti-TPO-positive. Worse baseline clinical severity (P=0.018), elevated C-reactive protein during hospitalization (P=0.033), and higher baseline anti-TPO titer (P=0.005) were associated with a significant increase in anti-TPO titer. CONCLUSION: Most patients with thyroid dysfunction on admission recovered during convalescence. Abnormal TFTs suggestive of thyroiditis occurred during convalescence, but infrequently. Importantly, our novel observation of an increase in anti-thyroid antibody titers post-COVID-19 warrants further follow-up for incident thyroid dysfunction among COVID-19 survivors.


Assuntos
COVID-19/epidemiologia , Sobreviventes/estatística & dados numéricos , Doenças da Glândula Tireoide/epidemiologia , Glândula Tireoide/imunologia , Glândula Tireoide/fisiologia , Adulto , Autoimunidade/fisiologia , COVID-19/complicações , COVID-19/imunologia , China/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Estudos Prospectivos , SARS-CoV-2/fisiologia , Doenças da Glândula Tireoide/etiologia , Testes de Função Tireóidea , Tireoidite Autoimune/epidemiologia , Tireoidite Autoimune/etiologia
8.
Isr J Health Policy Res ; 10(1): 36, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34140034

RESUMO

BACKGROUND: During the COVID-19 outbreak, (March 1 - June 15, 2020) citizens expressed sympathy and gratitude towards medical staff through the media, while the entire hospital staff faced the same danger of infection as other citizens. This might have made hospital staff develop sympathy, understanding for the patients` and family's needs, and a better communication. OBJECTIVES: To investigate if there is a relation between the mutual change in attitude between citizens and hospital staff during the first COVID-19 outbreak, and the incidence of violence cases. MATERIALS AND METHODS: This is a cross sectional study conducted at Rambam Medical Center (RMC) in Israel. The data about the number of violence cases were collected from the security department, and the data about hospital wards activity were collected from the hospital Business Intelligence (BI) software. The number of violence cases in relation to the number of Emergency Department (ED) visits, admissions to hospital wards, and length of stay (LOS) were compared during the COVID-19 outbreak to the corresponding period in 2019 using the T- test. The difference in the incidence of violence between general population and people with a psychiatric or social disorder (like drug abuse and criminal background) in both periods were also compared using the Fisher exact test. RESULTS: During the first COVID-19 outbreak, there were 6 violence cases against medical staff out of 24,740 visits to the ED, vs. 21 cases out of 30,759 visits during the same periods in 2019 (P < 0.05). There were 19 violence cases in the whole hospital with 14,482 admissions in 2020 vs. 51 violence cases of 17,599 admissions in 2019 (P < 0.05). Violence against security guards in the entire hospital dropped from 20 to 11 cases, and in the set of the ED, from 13 to 4 cases in both periods respectively. A 20 % decrease in the number of visits to the ED, might have influenced the average LOS during the study period, 2020 compared to 2019 (4.4 + 0.45 vs. 5.4 + 0.36 h. (P < 0.001). The ratio of violence among general population vs. people with a psychiatric or social background revealed a non-significant change in both periods (P = 0.75 and P = 0.69) respectively. DISCUSSION: The COVID-19 outbreak supplied some evidence that a change in environmental conditions, trust, waiting time, personal attitude and communication might have reduced violence against hospital staff. CONCLUSIONS: Except for violence coming from patients with psychiatric or social disorders, most other violence cases might be reduced if the environment conditions and attitudes of both citizens and staff are improved.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Recursos Humanos em Hospital , Violência no Trabalho/estatística & dados numéricos , Estudos Transversais , Surtos de Doenças , Humanos , Israel , Tempo de Internação/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Admissão do Paciente/estatística & dados numéricos
9.
J Trauma Acute Care Surg ; 91(1): 241-246, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34144567

RESUMO

BACKGROUND: During the coronavirus disease 2019 pandemic, New York instituted a statewide stay-at-home mandate to lower viral transmission. While public health guidelines advised continued provision of timely care for patients, disruption of safety-net health care and public fear have been proposed to be related to indirect deaths because of delays in presentation. We hypothesized that admissions for emergency general surgery (EGS) diagnoses would decrease during the pandemic and that mortality for these patients would increase. METHODS: A multicenter observational study comparing EGS admissions from January to May 2020 to 2018 and 2019 across 11 NYC hospitals in the largest public health care system in the United States was performed. Emergency general surgery diagnoses were defined using International Classification Diseases, Tenth Revision, codes and grouped into seven common diagnosis categories: appendicitis, cholecystitis, small/large bowel, peptic ulcer disease, groin hernia, ventral hernia, and necrotizing soft tissue infection. Baseline demographics were compared including age, race/ethnicity, and payor status. Outcomes included coronavirus disease (COVID) status and mortality. RESULTS: A total of 1,376 patients were admitted for EGS diagnoses from January to May 2020, a decrease compared with both 2018 (1,789) and 2019 (1,668) (p < 0.0001). This drop was most notable after the stay-at-home mandate (March 22, 2020; week 12). From March to May 2020, 3.3%, 19.2%, and 6.0% of EGS admissions were incidentally COVID positive, respectively. Mortality increased in March to May 2020 compared with 2019 (2.2% vs. 0.7%); this difference was statistically significant between April 2020 and April 2019 (4.1% vs. 0.9%, p = 0.045). CONCLUSION: Supporting our hypothesis, the coronavirus disease 2019 pandemic and subsequent stay-at-home mandate resulted in decreased EGS admissions between March and May 2020 compared with prior years. During this time, there was also a statistically significant increase in mortality, which peaked at the height of COVID infection rates in our population. LEVEL OF EVIDENCE: Epidemiological, level IV.


Assuntos
COVID-19/prevenção & controle , Emergências/epidemiologia , Mortalidade Hospitalar/tendências , Admissão do Paciente/estatística & dados numéricos , Doença Aguda/mortalidade , Doença Aguda/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicite/diagnóstico , Apendicite/mortalidade , Apendicite/cirurgia , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/transmissão , Colecistite/diagnóstico , Colecistite/mortalidade , Colecistite/cirurgia , Serviço Hospitalar de Emergência , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/mortalidade , Hérnia Inguinal/cirurgia , Hérnia Ventral/diagnóstico , Hérnia Ventral/mortalidade , Hérnia Ventral/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico , Necrose/mortalidade , Necrose/cirurgia , New York/epidemiologia , Pandemias/prevenção & controle , Admissão do Paciente/tendências , Úlcera Péptica/diagnóstico , Úlcera Péptica/mortalidade , Úlcera Péptica/cirurgia , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/cirurgia , Tempo para o Tratamento/estatística & dados numéricos , Tempo para o Tratamento/tendências , Adulto Jovem
10.
Indian Heart J ; 73(3): 379-381, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34154762

RESUMO

Covid-19 Nationwide lockdown for social containment was implemented on the 23rd of March 2020. The objective of this study was to look at the impact of lockdown on STEMI (<24hrs window period). This study was done in 2 phases, 43 days before (phase1) and 43 days during lockdown (phase 2). During the lockdown, there was a 31% decrease in hospital admission rates, 11.5% and 9.38% proportional increase in diabetics and hypertensive patients presenting with STEMI. The public must be educated about the existing important health problems in the community along with the pandemic warnings.


Assuntos
Admissão do Paciente/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Bloqueio Atrioventricular/epidemiologia , COVID-19 , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Insuficiência Renal/epidemiologia , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
11.
Ann R Coll Surg Engl ; 103(7): 478-480, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34192500

RESUMO

BACKGROUND: There is limited evidence on perioperative outcomes of surgical patients during the COVID-19 pandemic to inform continued operating into the winter period. METHODS: We retrospectively analysed the rate of 30-day COVID-19 transmission and mortality of all surgical patients in the three hospitals in our trust in the East of England during the first lockdown in March 2020. All patients who underwent a swab were swabbed on or 24 hours prior to admission. RESULTS: There were 4,254 patients and an overall 30-day mortality of 0.99%. The excess surgical mortality in our region was 0.29%. There were 39 patients who were COVID-19 positive within 30 days of admission, 12 of whom died. All 12 were emergency admissions with a length of stay longer than 24 hours. There were three deaths among those who underwent day case surgery, one of whom was COVID-19 negative, and the other two were not swabbed but not suspected to have COVID-19. There were two COVID-19 positive elective cases and none in day case elective or emergency surgery. There were no COVID-19 positive deaths in elective or day case surgery. CONCLUSIONS: There was a low rate of COVID-19 transmission and mortality in elective and day case operations. Our data have allowed us to guide patients in the consent process and provided the evidence base to restart elective and day case operating with precautions and regular review. A number of regions will be similarly affected and should perform a review of their data for the winter period and beyond.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/mortalidade , COVID-19/epidemiologia , Procedimentos Cirúrgicos Eletivos/mortalidade , Tratamento de Emergência/mortalidade , Procedimentos Cirúrgicos Ambulatórios/normas , Procedimentos Cirúrgicos Ambulatórios/estatística & dados numéricos , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/transmissão , Teste para COVID-19/normas , Teste para COVID-19/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/normas , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Serviço Hospitalar de Emergência/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Tratamento de Emergência/normas , Tratamento de Emergência/estatística & dados numéricos , Inglaterra/epidemiologia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Controle de Infecções/normas , Controle de Infecções/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Admissão do Paciente/normas , Admissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2/isolamento & purificação , Medicina Estatal/normas , Medicina Estatal/estatística & dados numéricos
12.
PLoS One ; 16(6): e0252441, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34061888

RESUMO

BACKGROUND: As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. METHODS: We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). FINDINGS: There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86, p<0.001) and surgical (IRR 0.82, p<0.001) admissions through the ED in Alberta post COVID-19 public health measures. There was a significant decline in daily ED visits (IRR 0.65, p<0.001) including ACSC (IRR 0.75, p<0.001). The most common medical/surgical diagnoses for hospital admissions did not vary substantially pre and post COVID-19 public health measures, though there was a significant reduction in admissions for chronic obstructive pulmonary disease and a significant increase in admissions for mental and behavioral disorders due to use of alcohol. CONCLUSIONS: Despite a relatively low volume of COVID-19 hospital admissions in Alberta, there was an extensive impact on our healthcare system with fewer admissions to hospital and ED visits. This work generates hypotheses around causes for reduced hospital admissions and ED visits which warrant further investigation. As most publicly funded health systems struggle with health-system capacity routinely, understanding how these reductions can be safely sustained will be critical.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , SARS-CoV-2/patogenicidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/epidemiologia , COVID-19/transmissão , Canadá/epidemiologia , Feminino , Regulamentação Governamental , Humanos , Masculino , Transtornos Mentais/epidemiologia , Pessoa de Meia-Idade , Distanciamento Físico , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Estudos Retrospectivos
14.
PLoS Comput Biol ; 17(6): e1009121, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34161326

RESUMO

Identification of those at greatest risk of death due to the substantial threat of COVID-19 can benefit from novel approaches to epidemiology that leverage large datasets and complex machine-learning models, provide data-driven intelligence, and guide decisions such as intensive-care unit admission (ICUA). The objective of this study is two-fold, one substantive and one methodological: substantively to evaluate the association of demographic and health records with two related, yet different, outcomes of severe COVID-19 (viz., death and ICUA); methodologically to compare interpretations based on logistic regression and on gradient-boosted decision tree (GBDT) predictions interpreted by means of the Shapley impacts of covariates. Very different association of some factors, e.g., obesity and chronic respiratory diseases, with death and ICUA may guide review of practice. Shapley explanation of GBDTs identified varying effects of some factors among patients, thus emphasising the importance of individual patient assessment. The results of this study are also relevant for the evaluation of complex automated clinical decision systems, which should optimise prediction scores whilst remaining interpretable to clinicians and mitigating potential biases.


Assuntos
COVID-19/mortalidade , COVID-19/terapia , Unidades de Terapia Intensiva/estatística & dados numéricos , Aprendizado de Máquina , Admissão do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/virologia , Criança , Pré-Escolar , Comorbidade , Inglaterra/epidemiologia , Feminino , Humanos , Lactente , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Adulto Jovem
15.
Diabetologia ; 64(8): 1717-1724, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33966090

RESUMO

AIMS/HYPOTHESIS: The aim of this work was to describe the clinical characteristics of adults with type 1 diabetes admitted to hospital and the risk factors associated with severe coronavirus disease-2019 (COVID-19) in the UK. METHODS: A retrospective cohort study was performed using data collected through a nationwide audit of people admitted to hospital with diabetes and COVID-19, conducted by the Association of British Clinical Diabetologists from March to October 2020. Prespecified demographic, clinical, medication and laboratory data were collected from the electronic and paper medical record systems of the participating hospitals by local clinicians. The primary outcome of the study, severe COVID-19, was defined as death in hospital and/or admission to the adult intensive care unit (AICU). Logistic regression models were used to generate age-adjusted ORs. RESULTS: Forty UK centres submitted data. The final dataset included 196 adults who were admitted to hospital and had both type 1 diabetes and COVID-19 on admission (male sex 55%, white 70%, with mean [SD] age 62 [19] years, BMI 28.3 [7.3] kg/m2 and last recorded HbA1c 76 [31] mmol/mol [9.1 (5.0)%]). The prevalence of pre-existing microvascular disease and macrovascular disease was 56% and 39%, respectively. The prevalence of diabetic ketoacidosis on admission was 29%. A total of 68 patients (35%) died or were admitted to AICU. The proportions of people that died were 7%, 38% and 38% of those aged <55, 55-74 and ≥75 years, respectively. BMI, serum creatinine levels and having one or more microvascular complications were positively associated with the primary outcome after adjusting for age. CONCLUSIONS/INTERPRETATION: In people with type 1 diabetes and COVID-19 who were admitted to hospital in the UK, higher BMI, poorer renal function and presence of microvascular complications were associated with greater risk of death and/or admission to AICU. Risk of severe COVID-19 is reassuringly very low in people with type 1 diabetes who are under 55 years of age without microvascular or macrovascular disease. IN PEOPLE WITH TYPE 1 DIABETES AND COVID-19 ADMITTED TO HOSPITAL IN THE UK, BMI AND ONE OR MORE MICROVASCULAR COMPLICATIONS HAD A POSITIVE ASSOCIATION AND LOW SERUM CREATINE LEVELS HAD A NEGATIVE ASSOCIATION WITH DEATH/ADMISSION TO INTENSIVE CARE UNIT AFTER ADJUSTING FOR AGE.


Assuntos
COVID-19/epidemiologia , COVID-19/patologia , Diabetes Mellitus Tipo 1/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , COVID-19/terapia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/terapia , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2/fisiologia , Índice de Gravidade de Doença , Reino Unido/epidemiologia
16.
Medicine (Baltimore) ; 100(18): e25737, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950957

RESUMO

ABSTRACT: Hospital overcrowding has led to a practice known as bedspacing (in which admitted patients are placed on a different specialty's inpatient ward), yet little is known about the impact of this practice on healthcare quality.We investigated whether hospital outcome measures differ between bedspaced general internal medicine (GIM) patients vs nonbedspaced patients.Our retrospective study included patients admitted to GIM wards at 2 academic hospitals (2012-2014), comparing bedspaced to nonbedspaced patients, and identifying adverse events from the hospital's Electronic Patient Record.We compared these groups with respect to actual length of stay vs the expected length of stay (% ELOS), which is defined as length of stay (LOS) divided by expected length of stay (ELOS), 30-day readmission, adverse events (falls, medication-related incidents, equipment-related incidents, first treatment related incidents, laboratory-related incidents, and operative/invasive events), and in-hospital mortality.There were 22,519 patients analyzed with 15,985 (71%) discharged from a medical ward and 6534 (29%) discharged from a non-medical ward. Bedspaced patients had shorter lengths of stay (4.1 vs 6.2 days, P < .001) and expected lengths of stay (ELOS) (6.1 vs 6.4 days, P < .001). Bedspaced patients had a lower percentage of ELOS (% ELOS) than nonbedspaced patients (70% vs 91%, P < .001), similar readmission rates (9.8 vs 10.3 events per 100 patients, P = .24), lower in-hospital mortality rates (2.6 vs 3.3 events per 100 patients, P = .003) and fewer adverse events (0.20 vs 0.60 events per 100 patient days, P < .01).Bedspacing of patients is common. Patients who are bedspaced to off-service wards have better outcomes. This may relate to preferential allocation practices.


Assuntos
Hospitais Universitários/organização & administração , Medicina Interna/organização & administração , Admissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Centros de Atenção Terciária/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Número de Leitos em Hospital/estatística & dados numéricos , Mortalidade Hospitalar , Hospitais Universitários/estatística & dados numéricos , Humanos , Medicina Interna/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos
17.
BJS Open ; 5(3)2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-34021327

RESUMO

BACKGROUND: The COVID-19 pandemic has had a major impact on healthcare in many countries. This study assessed the effect of a nationwide lockdown in France on admissions for acute surgical conditions and the subsequent impact on postoperative mortality. METHODS: This was an observational analytical study, evaluating data from a national discharge database that collected all discharge reports from any hospital in France. All adult patients admitted through the emergency department and requiring a surgical treatment between 17 March and 11 May 2020, and the equivalent period in 2019 were included. The primary outcome was the change in number of hospital admissions for acute surgical conditions. Mortality was assessed in the matched population, and stratified by region. RESULTS: During the lockdown period, 57 589 consecutive patients were admitted for acute surgical conditions, representing a decrease of 20.9 per cent compared with the 2019 cohort. Significant differences between regions were observed: the decrease was 15.6, 17.2, and 26.8 per cent for low-, intermediate- and high-prevalence regions respectively. The mortality rate was 1.92 per cent during the lockdown period and 1.81 per cent in 2019. In high-prevalence zones, mortality was significantly increased (odds ratio 1.22, 95 per cent c.i. 1.06 to 1.40). CONCLUSION: A marked decrease in hospital admissions for surgical emergencies was observed during the lockdown period, with increased mortality in regions with a higher prevalence of COVID-19 infection. Health authorities should use these findings to preserve quality of care and deliver appropriate messages to the population.


Assuntos
COVID-19/prevenção & controle , Admissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Doença Aguda , Adulto , Idoso , COVID-19/epidemiologia , Doenças do Sistema Digestório/cirurgia , Emergências , Feminino , França/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/tendências , SARS-CoV-2 , Procedimentos Cirúrgicos Operatórios/mortalidade , Cálculos Urinários/cirurgia , Ferimentos e Lesões/cirurgia
18.
EBioMedicine ; 67: 103378, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34000622

RESUMO

BACKGROUND: Mortality rates are high among hospitalized patients with COVID-19, especially in those intubated on the ICU. Insight in pathways associated with unfavourable outcome may lead to new treatment strategies. METHODS: We performed a prospective cohort study of patients with COVID-19 admitted to general ward or ICU who underwent serial blood sampling. To provide insight in the pathways involved in disease progression, associations were estimated between outcome risk and serial measurements of 64 biomarkers in potential important pathways of COVID-19 infection (inflammation, tissue damage, complement system, coagulation and fibrinolysis) using joint models combining Cox regression and linear mixed-effects models. For patients admitted to the general ward, the primary outcome was admission to the ICU or mortality (unfavourable outcome). For patients admitted to the ICU, the primary outcome was 12-week mortality. FINDINGS: A total of 219 patients were included: 136 (62%) on the ward and 119 patients (54%) on the ICU; 36 patients (26%) were included in both cohorts because they were transferred from general ward to ICU. On the general ward, 54 of 136 patients (40%) had an unfavourable outcome and 31 (23%) patients died. On the ICU, 54 out of 119 patients (45%) died. Unfavourable outcome on the general ward was associated with changes in concentrations of IL-6, IL-8, IL-10, soluble Receptor for Advanced Glycation End Products (sRAGE), vascular cell adhesion molecule 1 (VCAM-1) and Pentraxin-3. Death on the ICU was associated with changes in IL-6, IL-8, IL-10, sRAGE, VCAM-1, Pentraxin-3, urokinase-type plasminogen activator receptor, IL-1-receptor antagonist, CD14, procalcitonin, tumor necrosis factor alfa, tissue factor, complement component 5a, Growth arrest-specific 6, angiopoietin 2, and lactoferrin. Pathway analysis showed that unfavourable outcome on the ward was mainly driven by chemotaxis and interleukin production, whereas death on ICU was associated with a variety of pathways including chemotaxis, cell-cell adhesion, innate host response mechanisms, including the complement system, viral life cycle regulation, angiogenesis, wound healing and response to corticosteroids. INTERPRETATION: Clinical deterioration in patients with severe COVID-19 involves multiple pathways, including chemotaxis and interleukin production, but also endothelial dysfunction, the complement system, and immunothrombosis. Prognostic markers showed considerable overlap between general ward and ICU patients, but we identified distinct differences between groups that should be considered in the development and timing of interventional therapies in COVID-19. FUNDING: Amsterdam UMC, Amsterdam UMC Corona Fund, and Dr. C.J. Vaillant Fonds.


Assuntos
Biomarcadores/sangue , COVID-19/mortalidade , Admissão do Paciente/estatística & dados numéricos , Idoso , COVID-19/sangue , Quimiotaxia , Feminino , Humanos , Unidades de Terapia Intensiva , Interleucinas/sangue , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
19.
Lancet ; 397(10286): 1711-1724, 2021 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-33939953

RESUMO

BACKGROUND: COVID-19 has disproportionately affected minority ethnic populations in the UK. Our aim was to quantify ethnic differences in SARS-CoV-2 infection and COVID-19 outcomes during the first and second waves of the COVID-19 pandemic in England. METHODS: We conducted an observational cohort study of adults (aged ≥18 years) registered with primary care practices in England for whom electronic health records were available through the OpenSAFELY platform, and who had at least 1 year of continuous registration at the start of each study period (Feb 1 to Aug 3, 2020 [wave 1], and Sept 1 to Dec 31, 2020 [wave 2]). Individual-level primary care data were linked to data from other sources on the outcomes of interest: SARS-CoV-2 testing and positive test results and COVID-19-related hospital admissions, intensive care unit (ICU) admissions, and death. The exposure was self-reported ethnicity as captured on the primary care record, grouped into five high-level census categories (White, South Asian, Black, other, and mixed) and 16 subcategories across these five categories, as well as an unknown ethnicity category. We used multivariable Cox regression to examine ethnic differences in the outcomes of interest. Models were adjusted for age, sex, deprivation, clinical factors and comorbidities, and household size, with stratification by geographical region. FINDINGS: Of 17 288 532 adults included in the study (excluding care home residents), 10 877 978 (62·9%) were White, 1 025 319 (5·9%) were South Asian, 340 912 (2·0%) were Black, 170 484 (1·0%) were of mixed ethnicity, 320 788 (1·9%) were of other ethnicity, and 4 553 051 (26·3%) were of unknown ethnicity. In wave 1, the likelihood of being tested for SARS-CoV-2 infection was slightly higher in the South Asian group (adjusted hazard ratio 1·08 [95% CI 1·07-1·09]), Black group (1·08 [1·06-1·09]), and mixed ethnicity group (1·04 [1·02-1·05]) and was decreased in the other ethnicity group (0·77 [0·76-0·78]) relative to the White group. The risk of testing positive for SARS-CoV-2 infection was higher in the South Asian group (1·99 [1·94-2·04]), Black group (1·69 [1·62-1·77]), mixed ethnicity group (1·49 [1·39-1·59]), and other ethnicity group (1·20 [1·14-1·28]). Compared with the White group, the four remaining high-level ethnic groups had an increased risk of COVID-19-related hospitalisation (South Asian group 1·48 [1·41-1·55], Black group 1·78 [1·67-1·90], mixed ethnicity group 1·63 [1·45-1·83], other ethnicity group 1·54 [1·41-1·69]), COVID-19-related ICU admission (2·18 [1·92-2·48], 3·12 [2·65-3·67], 2·96 [2·26-3·87], 3·18 [2·58-3·93]), and death (1·26 [1·15-1·37], 1·51 [1·31-1·71], 1·41 [1·11-1·81], 1·22 [1·00-1·48]). In wave 2, the risks of hospitalisation, ICU admission, and death relative to the White group were increased in the South Asian group but attenuated for the Black group compared with these risks in wave 1. Disaggregation into 16 ethnicity groups showed important heterogeneity within the five broader categories. INTERPRETATION: Some minority ethnic populations in England have excess risks of testing positive for SARS-CoV-2 and of adverse COVID-19 outcomes compared with the White population, even after accounting for differences in sociodemographic, clinical, and household characteristics. Causes are likely to be multifactorial, and delineating the exact mechanisms is crucial. Tackling ethnic inequalities will require action across many fronts, including reducing structural inequalities, addressing barriers to equitable care, and improving uptake of testing and vaccination. FUNDING: Medical Research Council.


Assuntos
COVID-19/etnologia , Grupos Étnicos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , COVID-19/epidemiologia , COVID-19/mortalidade , Estudos de Coortes , Inglaterra , Humanos , Estudos Observacionais como Assunto , Análise de Sobrevida
20.
Medicine (Baltimore) ; 100(21): e26033, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032724

RESUMO

ABSTRACT: Infections with hepatitis C virus (HCV) represent a substantial national and international public health burden. HCV has been associated with numerous extrahepatic conditions and can lead to metabolic derangements that are associated with atherosclerosis and cardiovascular disease. We investigated whether HCV infection is associated with an increased number of acute coronary syndrome (ACS) events among hospitalized patients in an inner-city tertiary hospital.We performed a matched (age, sex, and race/ethnicity) case-control study on patients at least 18 years old admitted to inpatient medical and cardiac services at the University of Maryland Medical Center from 2015 through 2018. The primary outcome was ACS and the primary exposure was HCV infection. Covariates of interest included: alcohol use, tobacco use, illicit drug use, hypertension, diabetes mellitus, human immunodeficiency virus infection, body mass index, dyslipidemia, and family history of coronary heart disease. Covariates with significant associations with both exposure and outcome in bivariate analyses were included in the multivariable analyses of the final adjusted model.There were 1555 cases and 3110 controls included in the final sample. Almost 2% of cases and 2.4% of controls were HCV infected. In adjusted models, there was no significant association found between experiencing an ACS event in those with HCV infection compared to those without HCV infection (odds ratio 0.71, 95% confidence interval 0.45-1.11).We found no significant association between HCV infection and ACS in our study population. However, given the mixed existing literature, the association between HCV and ACS warrants further investigation in future prospective cohort and/or interventional studies.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Hepatite C/epidemiologia , Síndrome Coronariana Aguda/etiologia , Síndrome Coronariana Aguda/metabolismo , Síndrome Coronariana Aguda/terapia , Idoso , Estudos de Casos e Controles , Feminino , Hepatite C/complicações , Hepatite C/metabolismo , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Fatores de Risco , Centros de Atenção Terciária/estatística & dados numéricos
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