513 research outputs found
Impact of COVID-19 pandemic on emergency medical service response to emergency calls — a retrospective analysis of data from Emergency Medical Service station in Bydgoszcz
Introduction: Emergency medical systems, as the first line of management of infectious patients, were affected by the 2019 coronavirus acute respiratory disease (COVID-19) pandemic. The aim of the study was to analyze the impact of the COVID-19 pandemic on the Emergency Medical Service (EMS) with emphasis on response time.
Material and methods: Retrospective analysis of dispatch card from EMS in Bydgoszcz between January 2018 and December 2020. The differences regarding the EMS response were analyzed between the pre-pandemic (2018–2019) and the pandemic (2020) period in three time-points: from call to Emergency Medical Team (EMT) departure (T1), from departure to arrival at the scene (T2), and from arrival to reaching the emergency department (T3).
Results: There were 47783 EMT departures in 2018, 47113 in 2019 and 40835 in 2020. In 2020 mean (SD) monthly number of interventions was significantly lower [3403 (349) vs. 3954 (182), p < 0.001) compared to the 2018–2019 period. During the pandemic period the mean T1 [0.9 (1.49) vs. 0.63 (1.12) min, p < 0.001], T2 [9.91 (6.33) vs. 8.25 (5.07) min, p < 0.001], and T3 interval [40.45 (19.84) vs. 36.56 (14.63) min, p < 0.001] were prolonged in comparison to the pre-pandemic period. The differences in response time were the largest in October–December.
Conclusions: During the first year of the pandemic, the number of EMT interventions decreased and the response time was prolonged compared to the pre-pandemic period. The largest differences were observed at the end of the year, which overlapped with the peak of the second wave of COVID-19 infections in Poland
Pre-endoscopy SARS-CoV-2 testing strategy during COVID-19 pandemic: the care must go on
Background: In response to the COVID-19 pandemic, endoscopic societies initially recommended reduction of
endoscopic procedures. In particular non-urgent endoscopies should be postponed. However, this might lead to
unnecessary delay in diagnosing gastrointestinal conditions.
Methods: Retrospectively we analysed the gastrointestinal endoscopies performed at the Central Endoscopy Unit
of Saarland University Medical Center during seven weeks from 23 March to 10 May 2020 and present our real-world
single-centre experience with an individualized rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy. We also
present our experience with this strategy in 2021.
Results: Altogether 359 gastrointestinal endoscopies were performed in the initial period. The testing strategy enabled us to conservatively handle endoscopy programme reduction (44% reduction as compared 2019) during the frst
wave of the COVID-19 pandemic. The results of COVID-19 rtPCR from nasopharyngeal swabs were available in 89%
of patients prior to endoscopies. Apart from six patients with known COVID-19, all other tested patients were negative. The frequencies of endoscopic therapies and clinically signifcant fndings did not difer between patients with
or without SARS-CoV-2 tests. In 2021 we were able to unrestrictedly perform all requested endoscopic procedures
(>5000 procedures) by applying the rtPCR-based pre-endoscopy SARS-CoV-2 testing strategy, regardless of next
waves of COVID-19. Only two out-patients (1893 out-patient procedures) were tested positive in the year 2021.
Conclusion: A structured pre-endoscopy SARS-CoV-2 testing strategy is feasible in the clinical routine of an endoscopy unit. rtPCR-based pre-endoscopy SARS-CoV-2 testing safely allowed unrestricted continuation of endoscopic
procedures even in the presence of high incidence rates of COVID-19. Given the low frequency of positive tests, the
absolute efect of pre-endoscopy testing on viral transmission may be low when FFP-2 masks are regularly used
Surgical interventions in patients hospitalised with COVID-19 : a review of seven months of experience working in a COVID-19 dedicated centre
The Coronavirus Disease 2019 (COVID-19) pandemic has made changes to the traditional way of performing surgical consultations. The aim of the present study was to assess the need for surgical care performed by various surgical specialties among patients infected with COVID-19 hospitalized in a COVID-19 dedicated hospital. All surgical consultations performed for patients infected with COVID-19 in a COVID dedicated hospital in a seven month period were evaluated. Data on demographics, surgical specialty, consult reason, procedure performed, and whether it was a standard face to face or teleconsultation were gathered. Out of 2359 COVID-19 patients admitted to the hospital in the seven month period, 229 (9.7%) required surgical care. Out of those 108 consultations that did not lead to surgery, 71% were managed by telemedicine. A total of 36 patients were operated on while suffering from COVID-19. Out of them, only three patients admitted primarily for COVID-19 pneumonia underwent emergency surgery. The overall mortality among those operated on was 16.7%. Conclusions: Patients hospitalised with COVID-19 may require surgical care from various surgical specialties, especially during peaks of the pandemic. However, they rarely require a surgical procedure and only occasionally require major surgery. A significant portion of potentially surgical problems could be managed by teleconsultations
Effect of the pandemic on prehospital management of patients with mental and behavioral disorders: a retrospective cohort study
The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and the accompanying coronavirus disease (Covid-19) have shifted the priority of human and technical resources toward their handling, thus affecting the usual standards of care for populations diagnosed with other clinical entities. The phenomenon becomes even more apparent in patients with presenting symptoms of mental and behavioral disorders, a category already vulnerable and underrepresented in regard to its prehospital approach and management. For the purposes of the current retrospective cohort study, we used records of the Polish National Emergency Medical Service Command Support System for the time period between April 1, 2019 and April 30, 2021, the official register of medical interventions delivered in Poland by Emergency Medical Services (EMS). We aimed to examine the potential impact of the COVID-19 pandemic across the Masovian Voivodeship on individuals seeking medical care for mental and behavioral disorders pertaining in the “F” category of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). We examined the individuals’ baseline characteristics, prehospital vital parameters and EMS processing times in a population of 59,651 adult patients (04/2019–03/2020, 28,089 patients, 04/2020–03/2021, 31,562 patients) handled by EMS teams. Compared to pre-COVID-19, EMS personnel handled fewer patients, but more patients required mental and behavioral care. Throughout the duration of the pandemic, all prehospital time periods were significantly delayed due to the increased time needed to prepare crew, vehicles, and technical equipment to ensure COVID-19 prevention and overcrowding in Emergency Departments (EDs)
COVID-19 Pandemic-Revealed Consistencies and Inconsistencies in Healthcare : A Medical and Organizational View
Funding Information: Funding: The study was supported by the Latvian Council of Science, Fundamental and Applied Research project, No. lzp‐2019/1‐0380, ‘Selection of biomarkers in ME/CFS for patient stratification and treatment surveillance/optimisation’. Publisher Copyright: © 2022 by the authors. Li-censee MDPI, Basel, Switzerland.The circumstances of the Coronavirus disease caused by the SARS-CoV-2 virus (COVID-19) pandemic have had a significant impact on global and national developments, affecting the existence of society in all its expressions, as well as the lives of people themselves. In the context of the pandemic, increased attention has been focused on acute measures, but the ending of the pandemic is expected as a resolution of the related healthcare problems. However, there are several indicators that the COVID-19 pandemic might induce long-term consequences for individual and public health. Some of the consequences are inferred and predictable, but there are also areas of medicine that have been indirectly affected by the pandemic, and these consequences have not yet been sufficiently explored. This study is focused on drawing attention to some of the COVID-19 pandemic consistencies and the pandemic-revealed inconsistencies in healthcare. Content analysis and statistical analysis were applied to achieve the aim of the study. The main findings of the study address chronic disease burden (particularly, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)), healthcare governance and organizational issues, and the synergy between health policy perspectives and innovative solutions in practice. The study provides insight into the particular healthcare issues affected by the COVID-19 pandemic, such as the increase in mortality in some diagnoses besides COVID-19 and the possible emergence of a new type of resistance— vaccine-resistance—contemporaneously supporting the identification of the tendencies and currently unnoticed indirect consistencies and inconsistencies revealed by the pandemic.publishersversionPeer reviewe
Unmasked in the Plandemic: Misinformation during the novel coronavirus (SARS-CoV-2) pandemic
This paper explores the misinformation phenomena surrounding COVID-19 on social media platforms and its potential impact on the trajectory of the COVID-19 pandemic in the US. It defines the terms misinformation and disinformation and links these to recent political phenomena of “fake news” and political disinformation campaigns. It characterizes the sources of misinformation online and seeks to analyze the psycho-social and cognitive mechanisms of online misinformation spread such as source and message credibility through research on vaccine hesitancy and misinformation online during other global pandemics and resurging epidemics. Network analysis establishes that misinformation online spreads farther and faster than factual information on social media platforms. Relationships between misinformation and impact on health are explored utilizing research based in agent-based modeling techniques. It argues for the quantification and characterization of COVID-19 online misinformation in order to develop targeted interventions to vulnerable and at-risk groups using informed risk communication practices across all levels of government to mitigate disparities in COVID-19 case rates and transmission.
Keywords: SARS-CoV-19; COVID-19; Misinformation; Disinformation; Credibility; Network Analysis; Risk Communication; Crisis Communication; Health Communicatio
Out-of-hospital cardiac arrest treated by emergency medical service teams during COVID-19 pandemic: A retrospective cohort study
Background: Out-of-hospital cardiac arrest (OHCA) is a challenge for medical personnel, especiallyin the current COVID-19 pandemic, where medical personnel should perform resuscitation wearing fullpersonal protective equipment. This study aims were to assess the characteristics and outcomes of adultswho suffered an OHCA in the COVID-19 pandemic treated by emergency medical service (EMS) teams.Methods: All EMS-attended OHCA adults over than 18 years in the Polish EMS registry were analyzed.The retrospective EMS database was conducted. EMS interventions performed between March 1,and April 30, 2020 were retrospectively screened.Results: In the study period EMS operated 527 times for OHCA cases. The average age of patientswith OHCA was 67.8 years. Statistically significantly more frequently men were involved (64.3%).298 (56.6%) of all OHCA patients had resuscitation attempted by EMS providers. Among resuscitatedpatients, 73.8% were cardiac etiology. 9.4% of patients had return of spontaneous circulation, 27.2% ofpatients were admitted to hospital with ongoing chest compression. In the case of 63.4% cardiopulmonaryresuscitation was ineffective and death was determined.Conclusions: The present study found that OHCA incidence rate in the Masovian population (centralregion of Poland) in March–April 2020 period was 12.2/100,000 adult inhabitants. Return of spontaneouscirculation in EMS was observed only in 9.4% of resuscitated patients. The presence of shockablerhythms was associated with better prognosis. The prehospital mortality, even though it was high, didnot differ from those reported by other studies
Association between number of medications and mortality in geriatric inpatients : a Danish nationwide register-based cohort study
Purpose: To explore the association between the number of medications and mortality in geriatric inpatients taking activities of daily living and comorbidities into account.
Methods: A nationwide population-based cohort study was performed including all patients aged C65 years admitted to geriatric departments in Denmark during 2005-2014. The outcome of interest was mortality. Activities of daily living using Barthel-Index (BI) were measured at admission. National health registers were used to link data on an individual level extracting data on medications, and hospital diseases. Patients were followed to the end of study (31.12.2015), death, or emigration, which ever occurred first. Kaplan-Meier survival curves were used to estimate crude survival proportions.
Univariable and multivariable analyses were performed using Cox regression. The multivariable analysis adjusted for age, marital status, period of hospital admission, BMI, and BI (model 1), and further adding either number of diseases (model 2) or Charlson comorbidity index (model 3).
Results: We included 74603 patients (62.8% women), with a median age of 83 (interquartile range [IQR] 77-88) years. Patients used a median of 6 (IQR 4-9) medications. Increasing number of medications was associated with increased overall, 30-days, and 1-year mortality in all 3 multivariable models for both men and women. For each extra medication the mortality increased by 3% in women and 4% in men in the fully adjusted model.
Conclusion: Increasing number of medications was associated with mortality in this nationwide cohort of geriatric inpatients. Our findings highlight the importance of polypharmacy in older patients with comorbidities
Physical activity and exercise in dementia : an umbrella review of intervention and observational studies
Background: Dementia is a common condition in older people. Among the potential risk factors, increasing attention has been focused on sedentary behaviour. However, synthesizing literature exploring whether physical activity/exercise can affect health outcomes in people with dementia or with mild cognitive impairment (MCI) is still limited. Therefore, the aim of this umbrella review, promoted by the European Geriatric Medicine Society (EuGMS), is to understand the importance of physical activity/exercise for improving cognitive and non-cognitive outcomes in people with dementia/MCI.
Methods: Umbrella review of systematic reviews (SR) (with or without meta-analyses) of randomized controlled trials (RCTs) and observational (prospective and case-control in people with MCI) studies based on a systematic literature search in several databases. The certainty of evidence of statistically significant outcomes attributable to physical activity/exercise interventions was evaluated using Grading of Recommendations Assessment, Development and
Evaluation (GRADE) approach.
Results: Among 1,160 articles initially evaluated, 27 systematic reviews (4 without meta-analysis) for a total of 28,205 participants with dementia/MCI were included. No observational study on physical activity/exercise in MCI for preventing dementia was included. In SRs with MAs, physical activity/exercise was effective in improving global cognition in Alzheimer’s disease and in all types of dementia (very low/low certainty of evidence). Moreover, physical activity/
exercise significantly improved global cognition, attention, executive function, and memory in MCI, with a certainty of evidence varying from low to moderate. Finally, physical activity/exercise improved non-cognitive outcomes in people with dementia including falls and neuropsychiatric symptoms. SRs, without meta-analysis, corroborated
these results.
Conclusions: Supported by very low to moderate certainty of evidence, physical activity/exercise has a positive effect on several cognitive and non-cognitive outcomes in people with dementia and MCI, but RCTs, with low risk of bias/confounding, are still needed to confirm these findings
Deprescribing tool for STOPPFall (screening tool of older persons prescriptions in older adults with high fall risk) items
Background: Health care professionals are often reluctant to deprescribe fall-risk-increasing drugs (FRIDs). Lack of knowledge and skills form a significant barrier. To support clinicians in the management of FRIDs and to facilitate the deprescribing process, a deprescribing tool was developed by a European expert group for STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) items.
Methods: STOPPFall was created using an expert Delphi consensus process in 2019 and in 2020, 24 panellists from EuGMS SIG on Pharmacology and Task and Finish on FRIDs completed deprescribing tool questionnaire. To develop the questionnaire, a Medline literature search was performed. The panellists were asked to indicate for every medication class a possible need for stepwise withdrawal and strategy for withdrawal. They were asked in which situations
withdrawal should be performed. Furthermore, panellists were requested to indicate those symptoms patients should be monitored for after deprescribing and a possible need for follow-ups.
Results: Practical deprescribing guidance was developed for STOPPFall medication classes. For each medication class, a decision tree algorithm was developed including steps from medication review to symptom monitoring after medication withdrawal.
Conclusion: STOPPFall was combined with a practical deprescribing tool designed to optimize medication review. This practical guide can help overcome current reluctance towards deprescribing in clinical practice by providing an up-to-date and straightforward source of expert knowledge
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