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1.
Scand J Trauma Resusc Emerg Med ; 29(1): 30, 2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33557923

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), an emerging virus, has caused a global pandemic. Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has led to high hospitalization rates worldwide. Little is known about the occurrence of in-hospital cardiac arrest (IHCA) and high mortality rates have been proposed. The aim of this study was to investigate the incidence, characteristics and outcome of IHCA during the pandemic in comparison to an earlier period. METHODS: This was a retrospective analysis of data prospectively recorded during 3-month-periods 2019 and 2020 at the University Medical Centre Hamburg-Eppendorf (Germany). All consecutive adult patients with IHCA were included. Clinical parameters, neurological outcomes and organ failure/support were assessed. RESULTS: During the study period hospital admissions declined from 18,262 (2019) to 13,994 (2020) (- 23%). The IHCA incidence increased from 4.6 (2019: 84 IHCA cases) to 6.6 (2020: 93 IHCA cases)/1000 hospital admissions. Median stay before IHCA was 4 (1-9) days. Demographic characteristics were comparable in both periods. IHCA location shifted towards the ICU (56% vs 37%, p < 0.01); shockable rhythm (VT/VF) (18% vs 29%, p = 0.05) and defibrillation were more frequent in the pandemic period (20% vs 35%, p < 0.05). Resuscitation times, rates of ROSC and post-CA characteristics were comparable in both periods. The severity of illness (SAPS II/SOFA), frequency of mechanical ventilation and frequency of vasopressor therapy after IHCA were higher during the 2020 period. Overall, 43 patients (12 with & 31 without COVID-19), presented with respiratory failure at the time of IHCA. The Horowitz index and resuscitation time were significantly lower in patients with COVID-19 (each p < 0.01). Favourable outcomes were observed in 42 and 10% of patients with and without COVID-19-related respiratory failure, respectively. CONCLUSION: Hospital admissions declined during the pandemic, but a higher incidence of IHCA was observed. IHCA in patients with COVID-19 was a common finding. Compared to patients with non-COVID-19-related respiratory failure, the outcome was improved.


Assuntos
/epidemiologia , Parada Cardíaca/epidemiologia , Idoso , Reanimação Cardiopulmonar/estatística & dados numéricos , Estudos de Coortes , Uso de Medicamentos/tendências , Cardioversão Elétrica/tendências , Feminino , Alemanha/epidemiologia , Parada Cardíaca/terapia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Escores de Disfunção Orgânica , Pandemias , Admissão do Paciente/tendências , Respiração Artificial/tendências , Insuficiência Respiratória/epidemiologia , Estudos Retrospectivos , Vasoconstritores/uso terapêutico
2.
Respir Res ; 22(1): 13, 2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33435973

RESUMO

BACKGROUND: It is essential to avoid admission of patients with undetected corona virus disease 2019 (COVID-19) to hospitals' general wards. Even repeated negative reverse transcription polymerase chain reaction (RT-PCR) results do not rule-out COVID-19 with certainty. The study aimed to evaluate a rule-out strategy for COVID-19 using chest computed tomography (CT) in adults being admitted to the emergency department and suspected of COVID-19. METHODS: In this prospective, single centre, diagnostic accuracy cohort study, consecutive adults (≥ 18 years) presenting with symptoms consistent with COVID-19 or previous contact to infected individuals, admitted to the emergency department and supposed to be referred to general ward were included in March and April 2020. All participants underwent low-dose chest CT. RT-PCR- and specific antibody tests were used as reference standard. Main outcome measures were sensitivity and specificity of chest CT. Predictive values were calculated based on the theorem of Bayes using Fagan's nomogram. RESULTS: Of 165 participants (56.4% male, 71 ± 16 years) included in the study, the diagnosis of COVID-19 was confirmed with RT-PCR and AB tests in 13 participants (prevalence 7.9%). Sensitivity and specificity of chest CT were 84.6% (95% confidence interval [CI], 54.6-98.1) and 94.7% (95% CI, 89.9-97.7), respectively. Positive and negative likelihood ratio of chest CT were 16.1 (95% CI, 7.9-32.8) and 0.16 (95% CI, 0.05-0.58) and positive and negative predictive value were 57.9% (95% CI, 40.3-73.7) and 98.6% (95% CI, 95.3-99.6), respectively. CONCLUSION: At a low prevalence of COVID-19, chest CT could be used as a complement to repeated RT-PCR testing for early COVID-19 exclusion in adults with suspected infection before referral to hospital's general wards. Trial registration ClinicalTrials.gov: NCT04357938 April 22, 2020.


Assuntos
/diagnóstico por imagem , Serviço Hospitalar de Emergência/tendências , Admissão do Paciente/tendências , Quarentena/tendências , Tomografia Computadorizada por Raios X/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Quarentena/métodos , Tomografia Computadorizada por Raios X/métodos
3.
J Nurs Adm ; 51(1): 19-25, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278197

RESUMO

BACKGROUND: Hospital flow disruptions have been linked to treatment delays, longer length of stay (LOS), poor patient outcomes, and overburdened staff leading to disengagement. OBJECTIVE: This project was designed to evaluate and determine if the bed reaggregation was successful at meeting its goals. METHODS: Donabedian's framework guided the following evaluation points: 1) patient placement accuracy, 2) LOS variance, 3) emergency department (ED) boarding times, 4) hospital bypass hours, 5) operational declination rates, 6) patient satisfaction, and 7) RN engagement. Data were analyzed using pre-post percent change and χ analysis. RESULTS: Primary placement of patients, LOS variance, and operational declinations improved. Hours on bypass and ED boarding times were not reduced. RN engagement scores varied widely with significant decreases on 2 of the reaggregated units. Patient satisfaction scores varied, but overall did not decrease. CONCLUSION: Further consideration is needed for improving hospital bypass, ED boarding times, and RN engagement.


Assuntos
Centros Médicos Acadêmicos/tendências , Admissão do Paciente/normas , Centros Médicos Acadêmicos/organização & administração , Humanos , Tempo de Internação/tendências , Admissão do Paciente/tendências , Fatores de Tempo , População Urbana
4.
Epilepsy Behav ; 115: 107497, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33317939

RESUMO

This is a territory-wide study to investigate the impact of coronavirus disease 2019 (COVID-19) pandemic on Accident and Emergency Department (A&E) attendances and acute ward admissions for seizures. Adult patients who presented to the A&E with seizures from January 23, 2020 to March 24, 2020 (study period) were included and compared with parallel intervals from 2015 to 2019 (control periods). Preexisting time trend in control periods and potential changes during COVID-19 were analyzed by Poisson, negative and logistic regression models. Accident and Emergency Department attendances and ward admissions for seizures decreased significantly during the COVID-19 pandemic. A total of 319 and 230 recorded ward admissions and A&E attendances for seizures were identified during the study period in 2020, compared with 494 and 343 per annum, respectively in the control periods. The ratio of acute ward admission per A&E attendance for seizures did not change significantly. Intensive care utility and mortality rates remained stable. For some patients, delaying medical attention due to fear of nosocomial COVID-19 cross-infection may lead to severe or even life-threatening consequences. This change in medical help-seeking behavior calls for new medical care models to meet the service gap. Education to patients with epilepsy and their caregivers is of utmost importance during this pandemic.


Assuntos
/epidemiologia , Serviço Hospitalar de Emergência/tendências , Aceitação pelo Paciente de Cuidados de Saúde , Admissão do Paciente/tendências , Convulsões/epidemiologia , Convulsões/terapia , Adulto , Feminino , Hong Kong/epidemiologia , Hospitalização/tendências , Humanos , Masculino , Pandemias/prevenção & controle
5.
N Z Med J ; 133(1527): 95-103, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332331

RESUMO

AIM: To evaluate rates of unplanned ICU admissions before, during and after New Zealand's COVID-19 Alert Level 4/3 lockdown, and to describe the characteristics and outcomes of patients admitted to Wellington ICU during lockdown in comparison to historical controls. METHOD: We conducted a retrospective cohort study using the Wellington Hospital ICU database and included patients with an unplanned ICU admission during the first 35 weeks of the year from 2015 to 2020 inclusive. The primary variable of interest was the rate of unplanned ICU admission in 2020 compared with historical controls. We also described the characteristics and outcomes of patients with unplanned admissions to ICU during the 2020 COVID-19 lockdown compared to historical controls. RESULTS: During the five weeks of Alert Level Four, and the subsequent two weeks of Alert Level Three, the number of unplanned ICU admissions per day fell to 1.65±1.52 compared to a historical average of 2.56±1.52 ICU unplanned ICU admissions per day (P<0.0001). The observed reduction in ICU admission rates appeared to occur for most categories of ICU admission diagnosis but was not evident for patients with neurologic disorders. The characteristics and outcomes of patients who had unplanned admissions to Wellington ICU during the COVID-19 lockdown were broadly similar to historical controls. The rate of unplanned ICU admissions in 2020 before and after the lockdown period were similar to historical controls. CONCLUSION: In this study, we observed a reduction in unplanned admissions to Wellington Hospital ICU associated with New Zealand's initial COVID-19 lockdown.


Assuntos
/epidemiologia , Controle de Doenças Transmissíveis/métodos , Unidades de Terapia Intensiva/estatística & dados numéricos , Admissão do Paciente/tendências , Quarentena , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Estudos Retrospectivos
6.
Indian Heart J ; 72(6): 541-546, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33357642

RESUMO

BACKGROUND: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. METHODS: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. CONCLUSIONS: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.


Assuntos
/epidemiologia , Cardiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Infarto do Miocárdio/epidemiologia , Pandemias , Admissão do Paciente/tendências , Sociedades Médicas , Adulto , Comorbidade , Estudos Transversais , Feminino , Humanos , Incidência , Índia/epidemiologia , Masculino , Infarto do Miocárdio/terapia , Estudos Retrospectivos
7.
Medicina (Kaunas) ; 56(10)2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33019514

RESUMO

Background and objectives: the emergency department (ED) is frequently identified by patients as a possible solution for all healthcare problems, leading to a high rate of misuse of the ED, possibly causing overcrowding. The coronavirus disease 2019 (COVID-19) pandemic started in China; it then spread throughout Italy, with the first cases confirmed in Lombardy, Italy, in February 2020. This has totally changed the type of patients referred to EDs. The aim of this study was to analyze the reduction of ED admissions at a Second level urban teaching (Fondazione Policlinico Universitario Agostino Gemelli IRCCS) during the COVID-19 pandemic. Materials and Methods: in this retrospective observational cross-sectional study, we reviewed and compared clinical records of all the patients consecutively admitted to our ED over a 40-day period (21 February -31 March) in the last three years (2018-2019-2020). Mean age, sex, triage urgency level, day/night admission, main presentation symptom, and final diagnosis, according to different medical specialties, hospitalization, and discharge rate, were analyzed. Results: we analyzed 16,281 patient clinical records. The overall reduction in ED admissions in 2020 was 37.6% compared to 2019. In 2020, we observed an increase in triage urgency levels for ED admissions (the main presentation symptom was a fever). We noticed a significant drop in admissions for cardio-thoracic, gastroenterological, urological, otolaryngologic/ophthalmologic, and traumatological diseases. Acute neurological conditions registered only a slight, but significant, reduction. Oncology admissions were stable. Admissions for infectious diseases were 30% in 2020, compared to 5% and 6% in 2018 and 2019, respectively. In 2020, the hospitalization rate increased to 42.9% compared to 27.7%, and 26.4% in previous years. Conclusions: the drastic reduction of ED admissions during the pandemic may be associated with fear of the virus, suggesting that patients with serious illnesses did not go to the emergency room. Moreover, there was possible misuse of the ED in the previous year. In particular, worrisome data emerged regarding a drop in cardiology and neurology admissions. Those patients postponed medical attention, possibly with fatal consequences, just for fear of exposure to COVID-19, leading to unnecessary morbidity and mortality.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pandemias , Admissão do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência/tendências , Oftalmopatias/epidemiologia , Feminino , Gastroenteropatias/epidemiologia , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Otorrinolaringopatias/epidemiologia , Admissão do Paciente/tendências , Estudos Retrospectivos , Doenças Torácicas/epidemiologia , Doenças Urológicas/epidemiologia , Ferimentos e Lesões/epidemiologia , Adulto Jovem
8.
Clin Med (Lond) ; 20(6): e229-e233, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32962974

RESUMO

INTRODUCTION: COVID-19 has had a profound effect on the NHS. Little information has been published as to how the unselected medical take has been affected. METHODS: We retrospectively reviewed patients who were referred to general medicine during March 2020. We compared clinical outcomes of patients with and without COVID-19. RESULTS: 814 patients were included, comprising 777 unique patients. On average, 26 patients were admitted per day. 38% of admitted patients were suspected of COVID-19, with greater numbers of COVID-19 patients in the second half compared to the first half of the month (p<0.001). Logistic regression analyses showed suspected COVID-19 was an independent predictor for inpatient mortality (odds ratio [OR] = 6.09, p<0.001) and 30-day mortality (OR = 4.66, p<0.001). CONCLUSIONS: COVID-19 patients had worse clinical outcomes and increased healthcare use compared to non-COVID-19 patients. Our study highlights some of the challenges in healthcare provision faced during this pandemic.


Assuntos
Infecções por Coronavirus , Necessidades e Demandas de Serviços de Saúde , Pandemias , Admissão do Paciente , Pneumonia Viral , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Estudos Retrospectivos , Resultado do Tratamento , Reino Unido
9.
Health Aff (Millwood) ; 39(11): 2010-2017, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32970495

RESUMO

Hospital admissions in the US fell dramatically with the onset of the coronavirus disease 2019 (COVID-19) pandemic. However, little is known about differences in admissions patterns among patient groups or the extent of the rebound. In this study of approximately one million medical admissions from a large, nationally representative hospitalist group, we found that declines in non-COVID-19 admissions from February to April 2020 were generally similar across patient demographic subgroups and exceeded 20 percent for all primary admission diagnoses. By late June/early July 2020, overall non-COVID-19 admissions had rebounded to 16 percent below prepandemic baseline volume (8 percent including COVID-19 admissions). Non-COVID-19 admissions were substantially lower for patients residing in majority-Hispanic neighborhoods (32 percent below baseline) and remained well below baseline for patients with pneumonia (-44 percent), chronic obstructive pulmonary disease/asthma (-40 percent), sepsis (-25 percent), urinary tract infection (-24 percent), and acute ST-elevation myocardial infarction (-22 percent). Health system leaders and public health authorities should focus on efforts to ensure that patients with acute medical illnesses can obtain hospital care as needed during the pandemic to avoid adverse outcomes.


Assuntos
Doença Crônica/tendências , Hospitalização , Pandemias/estatística & dados numéricos , Admissão do Paciente , Idoso , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Pneumonia , Pneumonia Viral , Doença Pulmonar Obstrutiva Crônica , Infarto do Miocárdio com Supradesnível do Segmento ST , Estados Unidos
10.
J Stroke Cerebrovasc Dis ; 29(10): 105114, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912527

RESUMO

BACKGROUND: Little is known about the effect of the Coronavirus disease 2019 pandemic on stroke care and the impact of the epidemic on acute stroke hospitalizations has not been described. METHODS: We analyze the stroke admission rate in three hospitals in New York City from January 1, 2020 through April 17, 2020, identifying all cases of acute ischemic stroke, intraparenchymal hemorrhage and subarachnoid hemorrhage. RESULTS: We confirmed 518 cases of out-of-hospital stroke. During the baseline period up to February 25, 2020, the daily stroke admission rate was stable, with the slope of the regression describing the number of admissions over time equal to -0.33 (se = 1.21), not significantly different from 0 (p = 0.79), with daily admissions averaging 41. During the pandemic period, the slope was -4.4 (se = 1.00); i.e., the number of stroke admissions decreased an average of 4.4 per week, (p = 0.005), with weekly admissions averaging 23, a reduction of 44% versus baseline. This general result was not different by patient age, sex, or race/ethnicity. CONCLUSIONS: The weekly stroke admission rate started declining two weeks prior to the local surge of coronavirus admissions. The consequences of lack of diagnosis and treatment of a large proportion of acute stroke patients are likely severe and lasting.


Assuntos
Infecções por Coronavirus/terapia , Assistência à Saúde/tendências , Hemorragias Intracranianas/terapia , Admissão do Paciente/tendências , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Idoso , Betacoronavirus/patogenicidade , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Feminino , Interações entre Hospedeiro e Microrganismos , Humanos , Hemorragias Intracranianas/diagnóstico , Hemorragias Intracranianas/epidemiologia , Hemorragias Intracranianas/virologia , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Prognóstico , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/virologia , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Fatores de Tempo
11.
J Stroke Cerebrovasc Dis ; 29(10): 105179, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32912564

RESUMO

BACKGROUND: Approach to acute cerebrovascular disease management has evolved in the past few months to accommodate the rising needs of the 2019 novel coronavirus (COVID-19) pandemic. In this study, we investigated the changes in practices and policies related to stroke care through an online survey. METHODS: A 12 question, cross-sectional survey targeting practitioners involved in acute stroke care in the US was distributed electronically through national society surveys, social media and personal communication. RESULTS: Respondants from 39 states completed 206 surveys with the majority (82.5%) from comprehensive stroke centers. Approximately half stated some change in transport practices with 14 (7%) reporting significant reduction in transfers. Common strategies to limit healthcare provider exposure included using personal protective equipment (PPE) for all patients (127; 63.5%) as well as limiting the number of practitioners in the room (129; 64.5%). Most respondents (81%) noted an overall decrease in stroke volume. Many (34%) felt that the outcome or care of acute stroke patients had been impacted by COVID-19. This was associated with a change in hospital transport guidelines (OR 1.325, P = 0.047, 95% CI: 1.004-1.748), change in eligibility criteria for IV-tPA or mechanical thrombectomy (MT) (OR 3.146, P = 0.052, 95% CI: 0.988-10.017), and modified admission practices for post IV-tPA or MT patients (OR 2.141, P = 0.023, 95% CI: 1.110-4.132). CONCLUSION: Our study highlights a change in practices and polices related to acute stroke management in response to COVID-19 which are variable among institutions. There is also a reported reduction in stroke volume across hospitals. Amongst these changes, updates in hospital transport guidelines and practices related to IV-tPA and MT may affect the perceived care and outcome of acute stroke patients.


Assuntos
Atitude do Pessoal de Saúde , Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Conhecimentos, Atitudes e Prática em Saúde , Controle de Infecções/tendências , Pneumonia Viral/terapia , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/terapia , Betacoronavirus/patogenicidade , Tomada de Decisão Clínica , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Estudos Transversais , Definição da Elegibilidade/tendências , Pesquisas sobre Serviços de Saúde , Interações Hospedeiro-Patógeno , Humanos , Exposição Ocupacional/prevenção & controle , Pandemias , Admissão do Paciente/tendências , Transferência de Pacientes/tendências , Equipamento de Proteção Individual/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Formulação de Políticas , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/virologia , Telemedicina/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
13.
Am J Manag Care ; 26(8): 327-328, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32835458

RESUMO

OBJECTIVES: To determine whether patients are deferring necessary care for urgent conditions during the coronavirus disease 2019 (COVID-19) pandemic and, if so, to what extent. STUDY DESIGN: Cross-sectional study. METHODS: Using billing data from 8 acute care hospitals, we identified 9 principal medical diagnoses from International Classification of Diseases, Tenth Revision codes across 4 medical specialties (cardiology, gastroenterology, neurology, and urology). In addition, we defined a combined obstetrical falsification end point. We compared daily admission rates during the pandemic period (3/1/2020-4/30/2020) with the same dates in 2019 (3/1/2019-4/30/2019). As a reference, we also compared a prepandemic period in the same years (1/1/2019-2/28/2019 and 1/1/2020-2/29/2020). We compared admission rates between years using t tests. RESULTS: There were 3219 admissions for the conditions of interest during the study period in 2019 and 2661 in 2020. There was no difference in prepandemic daily admission rates in 2020 compared with 2019 (29.04 vs 27.63 admissions per day; -4.9%; P = .50). During the pandemic period, there was a 33.7% decrease in admission rates for all conditions combined in 2020 compared with 2019 (24.68 vs 16.37; -33.7%; P = .03). By specialty, the combined gastroenterology (10.22 vs 7.20; -29.6%; P = .02) and cardiovascular (2.34 vs 1.29; -44.7%; P = .05) end points demonstrated reduction in daily admission rates. CONCLUSIONS: Daily admission rates during the COVID-19 pandemic were lower for these acute medical conditions. Public awareness campaigns are urgently needed to reassure the public about the safety of presenting for care.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Admissão do Paciente/tendências , Pneumonia Viral/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pandemias
14.
World J Surg ; 44(11): 3590-3594, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32860140

RESUMO

INTRODUCTION: Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. METHODS: A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. RESULTS: A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = < 0.05) as did severity (0 per cent > grade 1 vs 58.3 per cent > grade 1, p = < 0.05). The proportion of patients undergoing surgery increased (19.1 vs 42.3 per cent, p = < 0.05) as did the mean operating time (102.4 vs 145.7 min, p = < 0.05). Surgery was performed in 1 confirmed and 1 suspected Covid-19 patient. The latter died within 30 days. There were no 30-day readmissions with Covid-19 symptoms. CONCLUSION: Covid-19 has significantly impacted the number of admissions to emergency general surgery. However, emergency operating continues to be needed at pre-Covid-19 levels and as such provisions need to be made to facilitate this.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Cirurgia Geral/tendências , Pandemias , Admissão do Paciente/tendências , Pneumonia Viral , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Operatórios/tendências , Adulto , Idoso , Betacoronavirus/isolamento & purificação , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Emergências , Feminino , Hospitais de Distrito/tendências , Hospitais Gerais/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Readmissão do Paciente/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Estudos Prospectivos , Escócia
15.
J Stroke Cerebrovasc Dis ; 29(11): 105229, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32828638

RESUMO

BACKGROUND AND AIMS: Concerns have arisen regarding patient access and delivery of acute stroke care during the COVID-19 pandemic. We investigated key population level events on activity of the three hyperacute stroke units (HASUs) within Greater Manchester and East Cheshire (GM & EC), whilst adjusting for environmental factors. METHODS: Weekly stroke admission & discharge counts in the three HASUs were collected locally from Emergency Department (ED) data and Sentinel Stroke National Audit Programme core dataset prior to, and during the emergence of the COVID-19 pandemic (Jan 2020 to May 2020). Whilst adjusting for local traffic-related air pollution and ambient measurement, an interrupted time-series analysis using a segmented generalised linear model investigated key population level events on the rate of stroke team ED assessments, admissions for stroke, referrals for transient ischaemic attack (TIA), and stroke discharges. RESULTS: The median total number of ED stroke assessments, admissions, TIA referrals, and discharges across the three HASU sites prior to the first UK COVID-19 death were 150, 114, 69, and 76 per week. The stable weekly trend in ED assessments and stroke admissions decreased by approximately 16% (and 21% for TIAs) between first UK hospital COVID-19 death (5th March) and the implementation of the Act-FAST campaign (6th April) where a modest 4% and 5% increase per week was observed. TIA referrals increased post Government intervention (23rd March), without fully returning to the numbers observed in January and February. Trends in discharges from stroke units appeared unaffected within the study period reported here. CONCLUSION: Despite adjustment for environmental factors stroke activity was temporarily modified by the COVID-19 pandemic. Underlying motivations within the population are still not clear. This raises concerns that patients may have avoided urgent health care risking poorer short and long-term health outcomes.


Assuntos
Infecções por Coronavirus/terapia , Prestação Integrada de Cuidados de Saúde/tendências , Meio Ambiente , Ataque Isquêmico Transitório/terapia , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral/terapia , Acidente Vascular Cerebral/terapia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Inglaterra/epidemiologia , Humanos , Análise de Séries Temporais Interrompida , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Pandemias , Admissão do Paciente/tendências , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Encaminhamento e Consulta/tendências , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Fatores de Tempo
16.
J Antimicrob Chemother ; 75(11): 3379-3385, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32812039

RESUMO

BACKGROUND: Currently no effective antiviral therapy has been found to treat COVID-19. The aim of this trial was to assess if the addition of sofosbuvir and daclatasvir improved clinical outcomes in patients with moderate or severe COVID-19. METHODS: This was an open-label, multicentre, randomized controlled clinical trial in adults with moderate or severe COVID-19 admitted to four university hospitals in Iran. Patients were randomized into a treatment arm receiving sofosbuvir and daclatasvir plus standard care, or a control arm receiving standard care alone. The primary endpoint was clinical recovery within 14 days of treatment. The study is registered with IRCT.ir under registration number IRCT20200128046294N2. RESULTS: Between 26 March and 26 April 2020, 66 patients were recruited and allocated to either the treatment arm (n = 33) or the control arm (n = 33). Clinical recovery within 14 days was achieved by 29/33 (88%) in the treatment arm and 22/33 (67%) in the control arm (P = 0.076). The treatment arm had a significantly shorter median duration of hospitalization [6 days (IQR 4-8)] than the control group [8 days (IQR 5-13)]; P = 0.029. Cumulative incidence of hospital discharge was significantly higher in the treatment arm versus the control (Gray's P = 0.041). Three patients died in the treatment arm and five in the control arm. No serious adverse events were reported. CONCLUSIONS: The addition of sofosbuvir and daclatasvir to standard care significantly reduced the duration of hospital stay compared with standard care alone. Although fewer deaths were observed in the treatment arm, this was not statistically significant. Conducting larger scale trials seems prudent.


Assuntos
Antivirais/administração & dosagem , Betacoronavirus , Infecções por Coronavirus/tratamento farmacológico , Imidazóis/administração & dosagem , Admissão do Paciente/tendências , Pneumonia Viral/tratamento farmacológico , Sofosbuvir/administração & dosagem , Adulto , Idoso , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/epidemiologia , Quimioterapia Combinada , Feminino , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/epidemiologia , Índice de Gravidade de Doença , Resultado do Tratamento
18.
PLoS Med ; 17(8): e1003188, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32760064

RESUMO

BACKGROUND: The impacts of air pollution on circulatory and respiratory systems have been extensively studied. However, the associations between air pollution exposure and the risk of noncommunicable diseases of other organ systems, including diseases of the digestive, musculoskeletal, and genitourinary systems, remain unclear or inconclusive. We aimed to systematically assess the associations between short-term exposure to main air pollutants (fine particulate matter [PM2.5] and ozone) and cause-specific risk of hospital admission in China over a wide spectrum of human diseases. METHODS AND FINDINGS: Daily data on hospital admissions for primary diagnosis of 14 major and 188 minor disease categories in 252 Chinese cities (107 cities in North China and 145 cities in South China) from January 1, 2013, to December 31, 2017, were obtained from the Hospital Quality Monitoring System of China (covering 387 hospitals in North China and 614 hospitals in South China). We applied a 2-stage analytic approach to assess the associations between air pollution and daily hospital admissions. City-specific associations were estimated with quasi-Poisson regression models and then pooled by random-effects meta-analyses. Each disease category was analyzed separately, and the P values were adjusted for multiple comparisons. A total of 117,338,867 hospital admissions were recorded in the study period. Overall, 51.7% of the hospitalized cases were male, and 71.3% were aged <65 years. Robust positive associations were found between short-term PM2.5 exposure and hospital admissions for 7 major disease categories: (1) endocrine, nutritional, and metabolic diseases; (2) nervous diseases; (3) circulatory diseases; (4) respiratory diseases; (5) digestive diseases; (6) musculoskeletal and connective tissue diseases; and (7) genitourinary diseases. For example, a 10-µg/m3 increase in PM2.5 was associated with a 0.21% (95% CI 0.15% to 0.27%; adjusted P < 0.001) increase in hospital admissions for diseases of the digestive system on the same day in 2-pollutant models (adjusting for ozone). There were 35 minor disease categories significantly positively associated with same-day PM2.5 in both single- and 2-pollutant models, including diabetes mellitus, anemia, intestinal infection, liver diseases, gastrointestinal hemorrhage, renal failure, urinary tract calculus, chronic ulcer of skin, and back problems. The association between short-term ozone exposure and respiratory diseases was robust. No safety threshold in the exposure-response relationships between PM2.5 and hospital admissions was observed. The main limitations of the present study included the unavailability of data on personal air pollution exposures. CONCLUSIONS: In the Chinese population during 2013-2017, short-term exposure to air pollution, especially PM2.5, was associated with increased risk of hospitalization for diseases of multiple organ systems, including certain diseases of the digestive, musculoskeletal, and genitourinary systems; many of these associations are important but still not fully recognized. The effect estimates and exposure-response relationships can inform policy making aimed at protecting public health from air pollution in China.


Assuntos
Poluição do Ar/efeitos adversos , Poluição do Ar/análise , Material Particulado/efeitos adversos , Material Particulado/análise , Admissão do Paciente/tendências , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Bases de Dados Factuais/tendências , Feminino , Hospitalização/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores de Tempo
20.
PLoS One ; 15(7): e0236779, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32726363

RESUMO

It is paramount to expand the knowledge base and minimize the consequences of the pandemic caused by the new Coronavirus (SARS-Cov2). Spain is among the most affected countries that declared a countrywide lockdown. An ecological study is presented herein, assessing the trends for incidence, mortality, hospitalizations, Intensive Care Unit admissions, and recoveries per autonomous community in Spain. Trends were evaluated by the Joinpoint software. The timeframe employed was when the lockdown was declared on March 14, 2020. Daily percentage changes were also calculated, with CI = 95% and p<0.05. An increase was detected, followed by reduction, for the evaluated indicators in most of the communities. Approximately 18.33 days were required for the mortality rates to decrease. The highest mortality rate was verified in Madrid (118.89 per 100,000 inhabitants) and the lowest in Melilla (2.31). The highest daily percentage increase in mortality occurred in Catalonia. Decreasing trends were identified after approximately two weeks of the institution of the lockdown by the government. Immediately the lockdown was declared, an increase of up to 33.96% deaths per day was verified in Catalonia. In contrast, Ceuta and Melilla presented significantly lower rates because they were still at the early stages of the pandemic at the moment of lockdown. The findings presented herein emphasize the importance of early and assertive decision-making to contain the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Avaliação de Resultados em Cuidados de Saúde/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Quarentena/métodos , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Humanos , Incidência , Unidades de Terapia Intensiva , Mortalidade/tendências , Admissão do Paciente/tendências , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Espanha/epidemiologia
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