A short therapeutic regimen based on hydroxychloroquine plus azithromycin for the treatment of COVID-19 in patients with non-severe disease. A strategy associated with a reduction in hospital admissions and complications.

The new SARS-CoV-2 infection named COVID-19 has severely hit our Health System. At the time of writing this paper no medical therapy is officially recommended or has shown results in improving the outcomes in COVID-19 patients. With the aim of diminishing the impact in Hospital admissions and reducing the number of medical complications, we implemented a strategy based on a Hospital Home-Care Unit (HHCU) using an easy-to-use treatment based on an oral administration regimen outside the hospital with hydroxychloroquine (HCQ) plus azithromycin (AZM) for a short period of 5 days. Patients and methods: Patients ≥ 18 years old visiting the emergency room at the Hospital Universitario San Pedro de Logrono (La Rioja) between March, 31st and April, 12th diagnosed with COVID-19 with confirmed SARS-CoV-2 infection by a specific PCR, as follows: Patients with pneumonia (CURB ≤ 1) who did not present severe comorbidities and had no processes that contraindicated this therapeutic regime. Olygosimptomatic patients without pneumonia aged ≥ 55 years. Patients ≥ 18 years old without pneumonia with significant comorbidities. We excluded patients with known allergies to some of the antimicrobials used and patients treated with other drugs that increase the QTc or with QTc >450msc. The therapeutic regime was: HCQ 400 mg every twice in a loading dose followed by 200 mg twice for 5 days, plus AZM 500 mg on the first day followed by 250 mg daily for 5 days. A daily telephone follow-up was carried out from the hospital by the same physician. The end-points of our study were: 1.- To measure the need for hospital admission within 15 days after the start of treatment. 2.- To measure the need to be admitted to the intensive care unit (ICU) within 15 days after the start of the treatment. 3.- To describe the severity of the clinical complications developed. 4.- To measure the mortality within 30 days after starting treatment (differentiating if the cause is COVID-19 or something else). 5.-To describe the safety and adverse effects of the therapeutic regime. Results: During the 13 days studied a total of 502 patients were attended in the emergency room due to COVID-19. Forty-two were sent at home; 80 were attended by the HHCU (patients on this study) and 380 were admitted to the Hospital. In our series there were a group of 69 (85.18%) patients diagnosed with pneumonia (37 males and 32 females). Most of them, 57 (82.60%) had a CURB65 score of <1 (average age 49) and 12 (17.40%) a CURB score of 1 (average age 63). Eighteen (22.50%) of the pneumonia patients also had some morbidity as a risk factor. 11 patients (13.75%) without pneumonia were admitted to the HHCU because comorbidities or age ≥ 55 years. Six patients with pneumonia had to be hospitalized during the observation period, 3 of them because side effects and 3 because of worsening. One of these patients, with morbid obesity and asthma, had clinical worsening needing mechanical ventilation at ICU and developed acute distress respiratory syndrome. With the exception of the patient admitted to the ICU, the rest of the patients were discharged at home in the following 8 days (3 to 8 days). Twelve patients (15%), 11 of whom had pneumonia, experienced side effects affecting mainly the digestive. In another patient a QTc interval prolongation (452 msc) was observed. In total 3 of these patients had to be admitted in the Hospital, 2 because of vomiting and 1 because a QTc interval lengthening. None of the patients needed to stop the HCQ or AZM and all the 80 patients finished the therapeutic strategy. From the group without pneumonia only a patient developed diarrhea that did not require hospitalization or stop the medication. Conclusions: Our strategy has been associated with a reduction in the burden of hospital pressure, and it seems to be successful in terms of the number of patients who have developed serious complications and / or death. None of the patients died in the studied period and only 6 have to be admitted in conventional hospitalization area.

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Biomarkers-based personalized follow-up in chronic heart failure improves patient’s outcomes and reduces care associate cost

Health and Quality of Life Outcomes ◽

10.1186/s12955-021-01779-9 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Antonio Leon-Justel ◽

Jose I. Morgado Garcia-Polavieja ◽

Ana Isabel Alvarez-Rios ◽

Francisco Jose Caro Fernandez ◽

Pedro Agustin Pajaro Merino ◽

...

Keyword(s):

Heart Failure ◽

Hospital Admissions ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Secondary Outcome ◽

Ventricular Ejection Fraction ◽

Number Of Patients ◽

Ed Visits ◽

The Impact

Abstract Background Heart failure (HF) is a major and growing medical and economic problem, with high prevalence and incidence rates worldwide. Cardiac Biomarker is emerging as a novel tool for improving management of patients with HF with a reduced left ventricular ejection fraction (HFrEF). Methods This is a before and after interventional study, that assesses the impact of a personalized follow-up procedure for HF on patient’s outcomes and care associated cost, based on a clinical model of risk stratification and personalized management according to that risk. A total of 192 patients were enrolled and studied before the intervention and again after the intervention. The primary objective was the rate of readmissions, due to a HF. Secondary outcome compared the rate of ED visits and quality of life improvement assessed by the number of patients who had reduced NYHA score. A cost-analysis was also performed on these data. Results Admission rates significantly decreased by 19.8% after the intervention (from 30.2 to 10.4), the total hospital admissions were reduced by 32 (from 78 to 46) and the total length of stay was reduced by 7 days (from 15 to 9 days). The rate of ED visits was reduced by 44% (from 64 to 20). Thirty-one percent of patients had an improved functional class score after the intervention, whereas only 7.8% got worse. The overall cost saving associated with the intervention was € 72,769 per patient (from € 201,189 to € 128,420) and €139,717.65 for the whole group over 1 year. Conclusions A personalized follow-up of HF patients led to important outcome benefits and resulted in cost savings, mainly due to the reduction of patient hospitalization readmissions and a significant reduction of care-associated costs, suggesting that greater attention should be given to this high-risk cohort to minimize the risk of hospitalization readmissions.

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Development of the Madrid Stroke Programme: Milestones and Changes in Stroke Trends and Mortality from 1997 to 2017

Neuroepidemiology ◽

10.1159/000514077 ◽

2021 ◽

pp. 1-6

Author(s):

Silvia Pastor ◽

Elena de Celis ◽

Itsaso Losantos García ◽

María Alonso de Leciñana ◽

Blanca Fuentes ◽

...

Keyword(s):

Hospital Mortality ◽

Hospital Admissions ◽

Temporal Trends ◽

Intravenous Thrombolysis ◽

Stroke Care ◽

Care Organization ◽

Stroke Units ◽

Health Region ◽

Number Of Patients ◽

The Impact

Introduction: Stroke is a serious health problem, given it is the second leading cause of death and a major cause of disability in the European Union. Our study aimed to assess the impact of stroke care organization measures (such as the development of stroke units, implementation of a regional stroke code, and treatment with intravenous thrombolysis and mechanical thrombectomy) implemented from 1997 to 2017 on hospital admissions due to stroke and mortality attributed to stroke in the Madrid health region. Methods: Epidemiological data were obtained from the National Statistics Institute public website. We collected data on the number of patients discharged with a diagnosis of stroke, in-hospital mortality due to stroke and the number of inhabitants in the Madrid health region each year. We calculated rates of discharges and mortality due to stroke and the number of inhabitants per SU bed, and we analysed temporal trends in in-hospital mortality due to stroke using the Daniels test in 2 separate time periods (before and after 2011). Figures representing annual changes in these data from 1997 to 2017 were elaborated, marking stroke care organizational measures in the year they were implemented to visualize their temporal relation with changes in stroke statistics. Results: Hospital discharges with a diagnosis of stroke have increased from 170.3/100,000 inhabitants in 1997 to 230.23/100,000 inhabitants in 2017. However, the in-hospital mortality rate due to stroke has decreased (from 33.3 to 15.2%). A statistically significant temporal trend towards a decrease in the mortality percentage and rate was found from 1997 to 2011. Conclusions: Our study illustrates how measures such as the development of stroke units, implementation of a regional stroke code and treatment with intravenous thrombolysis coincide in time with a reduction in in-hospital mortality due to stroke.

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Aeration of premises by means of protection against respiratory infections on the basis of natural fitoncydes in the complex of prevention of influenza and SARS in the conditions of the collectives of preschool and school heats concerns

Medical Council ◽

10.21518/2079-701x-2019-11-67-73 ◽

2019 ◽

pp. 67-73

Author(s):

I. V. Sergeeva ◽

A. S. Yamshchikov ◽

Т. A. Debelova

Keyword(s):

Side Effects ◽

Environmental Factors ◽

Microbial Contamination ◽

Respiratory Infections ◽

Heating Season ◽

Dry Air ◽

Rising Incidence ◽

The Impact ◽

Positive Results ◽

At Home

The article presents the results obtained from the use of aeration with large forms of bactericidal spray (cedar) in preschool and school institutions in Krasnoyarsk in conjunction with individual aeration of small forms of bactericidal spray (cedar) at home in the season of rising incidence of influenza and ARVI. Due to a decrease in the total microbial contamination of the air environment and surface when using the harmless bactericidal spray (cedar), there is a decrease in the incidence of ARVI among children who regularly receive aeration for 4 weeks, and there is a lighter course of ARVI and the absence of complicated forms in 2 times in the observed children in comparison with the group where aeration was not applied. The positive results obtained during the 4-week observation, and the absence of any side effects from the spraying of bactericidal spray (cedar) allows us to recommend it for the prevention of influenza and ARVI during the period of epidemic or seasonal increase in morbidity in organized groups of preschool and school institutions. Considering that since the beginning of the heating season, dry air is installed in the premises, the use of aeration of bactericidal spray reduces the impact of harmful environmental factors on the child’s body, which is facilitated by the ionization and moistening of the air with phytoncide spray components.

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Barriers to the Use of Endari™ in an Urban Adult Sickle Cell Center

Blood ◽

10.1182/blood-2019-126666 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 2287-2287

Author(s):

Ugochi Olivia Ogu ◽

Merin Thomas ◽

Florence Chan ◽

Gracy Sebastian ◽

Caterina P. Minniti

Keyword(s):

Side Effects ◽

Sickle Cell ◽

Patient Population ◽

Severe Disease ◽

High Rate ◽

Phase Iii ◽

Prior Authorization ◽

Original Cohort ◽

Fda Approval ◽

Number Of Patients

Background In 2017, the US Food and Drug Administration (FDA) approved Endari (L-glutamine oral powder) for patients age five years and older with sickle cell disease (SCD) to reduce sickle cell-related acute pain events and hospitalizations1. This was applauded as the first medication approval for SCD in almost 20 years, following Hydroxyurea (HU) in 1998. We report our experience with barriers to accessibility to a new medication such as Endari, and patients' adherence in adults with SCD in an urban adult sickle cell center. Methods After prospectively establishing internal guidelines for the use of Endari, adult patients with SCD seen in clinic at a large urban adult SCD center were prescribed Endari via a local specialty pharmacy, over a 14 month period. Upon return to clinic, patients were asked about barriers to obtaining the medication and adherence to the twice a day dosing. Adherence was also evaluated by calculating the mean possession ratio (MPR) utilizing pharmacy records. Results 111 patients with SCD (57% females) were prescribed Endari over a 14 month period (Table 1): 83% with severe disease genotypes (Hb SS/Sβ0), 17% with "milder" genotypes (Hb SC/Sβ+). Mean age was 36 years old. 74% of patients were on concomitant HU and 1% on chronic transfusions (>6 months). At the end of the 14 month period, 21 patients (19%) were actively taking Endari, 47 (42%) had discontinued it, 39 (35%) never filled the prescription, and 4 (4%) had received but never initiated therapy. Of the 39 who never filled the initial prescription, barriers included denial of prior authorizations (38% of patients), high deductibles (21%), and inability of pharmacy to contact patient after approval was obtained (23%) (Table 2). Reasons for discontinuing Endari included poor adherence (36%), as defined by patients who did not refill after the initial/subsequent prescriptions (mean refill 1.79 times) and/or missed follow up appointments, side effects (13%), no perceived benefit (4%), and pregnancy/breastfeeding (4%) (Table 3). Average MPR for the 21 patients that are still taking Endari is 0.73, similar to the adherence reported in the landmark phase III trial (77.4%)1. Discussion This is the first study that addresses both acceptance of a new medication by the sickle cell population and the barriers to obtaining it. We identified significant barriers to the initiation of Endari in our urban adult SCD patient population and a high rate of self-discontinuation. Patients who discontinued Endari, did so after a median of 47 days after the initial prescription. The most common reasons for not initiating therapy, present in ~ 70% of the cases, were insurance-related issues, such as prior authorization denial or high deductible/co-pays. In 30% of the cases patients were not reachable or had other issues for not filling it, despite obtaining prior authorization, which may indicate a lack of interest on their part. A small number of patients (6) reported discontinuing due to side effects. After 14 months, only 21/111, ~20% of the original cohort of patients prescribed Endari, reported taking it. The MPR of the patients that were taking the medication was 0.73, similar to the adherence in the Endari study (77.4%)1. Prospective studies are needed to confirm if this pattern is reproducible in other patients' populations across the country and to investigate whether the introduction of a new drug affects adherence to HU. As experienced with HU, several years elapsed from initial FDA approval to its being more accepted and widely used, and adherence remains sub-optimal. From our report, it is critical to evaluate and mitigate barriers to initiation and adherence to Endari, to ensure it is available to and accepted by the patient population it gained approval and was intended for. 1. N Engl J Med.2018 Jul 19;379(3):226-235 Disclosures Ogu: Vertex Pharmaceuticals: Consultancy. Minniti:Doris Duke Foundation: Research Funding.

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Effect of Seasonal Variation on Clinical Outcome in Patients with Chronic Conditions: Analysis of the Commonwealth Scientific and Industrial Research Organization (CSIRO) National Telehealth Trial (Preprint)

10.2196/preprints.9680 ◽

2017 ◽

Author(s):

Ahmadreza Argha ◽

Andrey Savkin ◽

Siaw-Teng Liaw ◽

Branko George Celler

Keyword(s):

Seasonal Variation ◽

Length Of Stay ◽

Clinical Outcome ◽

Seasonal Variations ◽

Chronic Conditions ◽

Hospital Admissions ◽

Australian Capital Territory ◽

Home Telemonitoring ◽

The Impact ◽

At Home

BACKGROUND Seasonal variation has an impact on the hospitalization rate of patients with a range of cardiovascular diseases, including myocardial infarction and angina. This paper presents findings on the influence of seasonal variation on the results of a recently completed national trial of home telemonitoring of patients with chronic conditions, carried out at five locations along the east coast of Australia. OBJECTIVE The aim is to evaluate the effect of the seasonal timing of hospital admission and length of stay on clinical outcome of a home telemonitoring trial involving patients (age: mean 72.2, SD 9.4 years) with chronic conditions (chronic obstructive pulmonary disease coronary artery disease, hypertensive diseases, congestive heart failure, diabetes, or asthma) and to explore methods of minimizing the influence of seasonal variations in the analysis of the effect of at-home telemonitoring on the number of hospital admissions and length of stay (LOS). METHODS Patients were selected from a hospital list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. A total of 114 test patients and 173 control patients were available in this trial. However, of the 287 patients, we only considered patients who had one or more admissions in the years from 2010 to 2012. Three different groups were analyzed separately because of substantially different climates: (1) Queensland, (2) Australian Capital Territory and Victoria, and (3) Tasmania. Time series data were analyzed using linear regression for a period of 3 years before the intervention to obtain an average seasonal variation pattern. A novel method that can reduce the impact of seasonal variation on the rate of hospitalization and LOS was used in the analysis of the outcome variables of the at-home telemonitoring trial. RESULTS Test patients were monitored for a mean 481 (SD 77) days with 87% (53/61) of patients monitored for more than 12 months. Trends in seasonal variations were obtained from 3 years’ of hospitalization data before intervention for the Queensland, Tasmania, and Australian Capital Territory and Victoria subgroups, respectively. The maximum deviation from baseline trends for LOS was 101.7% (SD 42.2%), 60.6% (SD 36.4%), and 158.3% (SD 68.1%). However, by synchronizing outcomes to the start date of intervention, the impact of seasonal variations was minimized to a maximum of 9.5% (SD 7.7%), thus improving the accuracy of the clinical outcomes reported. CONCLUSIONS Seasonal variations have a significant effect on the rate of hospital admission and LOS in patients with chronic conditions. However, the impact of seasonal variation on clinical outcomes (rate of admissions, number of hospital admissions, and LOS) of at-home telemonitoring can be attenuated by synchronizing the analysis of outcomes to the commencement dates for the telemonitoring of vital signs. CLINICALTRIAL Australian New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030&isReview=true (Archived by WebCite at http://www.webcitation.org/ 6xLPv9QDb)

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Abstract 16125: Impact of COVID-19 on Echocardiography Volume at a Large Academic Medical Center

Circulation ◽

10.1161/circ.142.suppl_3.16125 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Merilyn S Varghese ◽

Jordan B Strom ◽

Sarah Fostello ◽

Warren J Manning

Keyword(s):

Patient Outcomes ◽

Hospital Admissions ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical ◽

Hospital Systems ◽

The Impact ◽

At Home

Introduction: COVID-19 has significantly impacted hospital systems worldwide. The impact of statewide stay-at-home mandates on echocardiography volumes is unclear. Methods: We queried our institutional echocardiography database from 6/1/2018 to 6/13/2020 to examine rates of transthoracic (TTE), stress (SE), and transesophageal echocardiograms (TEE) prior to and following the COVID-19 Massachusetts stay-at-home order on March 15, 2020. Results: Among 36,377 total studies performed during the study period, mean weekly study volume dropped from 332 + 3 TTEs/week, 30 + 1 SEs/week, and 21 + 1 TEEs/week prior to the stay-at-home order (6/1/2018-3/15/2020) to 158 + 13 TTEs/week, 8 + 2 SEs/week, and 8 + 1 TEEs/week after (% change, -52%, -73%, and -62% respectively, all p < 0.001 when comparing volume prior to March 15 versus after). Weekly TTEs correlated strongly with hospital admissions throughout the study period (r = 0.93, 95% CI 0.89-0.95, p < 0.001) ( Figure ). Outpatient TTEs declined more than inpatient TTEs (% change, -74% vs. -39%, p <0.001). As of 3 weeks following the cessation of the stay-at-home order, TTE, SE, and TEE weekly volumes have increased to 73%, 66%, and 81% of pre-pandemic levels, respectively. Conclusions: Echocardiography volumes fell precipitously following the Massachusetts stay-at-home order, strongly paralleling declines in overall hospitalizations. Outpatient TTEs declined more than inpatient TTEs. Despite lifting of the order, echocardiography volumes remain substantially below pre-pandemic levels. The impact of the decreased use of echocardiographic services on patient outcomes remains to be determined.

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Impact of Extracorporeal Photochemotherapy on the Clinical and Economical Management of Patients Affected with GVHD.

Blood ◽

10.1182/blood.v104.11.5293.5293 ◽

2004 ◽

Vol 104 (11) ◽

pp. 5293-5293

Author(s):

Cesare Perotti ◽

Paola Isernia ◽

Claudia Del Fante ◽

Gianluca Viarengo ◽

Daniela Bressan ◽

...

Keyword(s):

Quality Of Life ◽

Side Effects ◽

Cost Analysis ◽

Short Form ◽

Extracorporeal Photochemotherapy ◽

Short Period ◽

The Impact ◽

Economical Advantage

Abstract Extracorporeal photochemotherapy (ECP) is an effective, relatively new technique, FDA approved for cutaneous T-cell lymphoma, employed as second-third line treatment in patients affected with GVHD not or poorely responsive to standard immunosuppressive drugs. Both aGVHD and cGVHD are the major complications after stem cell transplantation (till to 50% and 80% of the patients, respectively). Corticosteroids, cyclosporine, micofenolate, tacrolimus and various experimental monoclonal antibodies (anti CD40 ligand, anti TNFα etc) are the drugs employed to control GVHD and are burdened with important short and long term side effects. Recently we revised our data about 102 pts (children and adults) treated by ECP in our Institution. The overall response was 75%, permitting to taper or suspend the immunosuppressive therapy (IST) in 67.6% of the pts. The economical and social impact (cost analysis and quality of life) of ECP vs standard IST was calculated basing on the National Price List and on Short Form Quality of Life (QoL) Scoring System. The cost of ECP comprehensive of the leukapheresis procedure, waste matherials and dedicated personnel was estimated as 684.51 Euro/procedure. On the other side, when the solely costs of the most common IST drugs (corticosteroids, cyclosporine) were considered for 5 months of treatment, an evident and obvious economical advantage emerged (120,3 E). On the contrary, when the costs of hospitalisation and day hospital regimen derived from the most common side effects related to the solely use of IST were included in our cost analysis studies, an economical advantage for long term ECP treatment (calculated on 16 procedures) was demonstrated (14952.16 E vs 17553 E). Moreover, when the “real life implication” calculated on the QoL parameters were considered, the advantages were more evident. In conclusion, the tie of respecting strictly an imposed program of budget calculated on the short period may exert an inhibitory effect in introducing new diagnostic or therapeutic procedures ignoring that the improvement or the cure of the patient has always a positive economical counterpart, expecially when the impact of a new technology is considered in a long term view.

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Simultaneous care in Italy’s Veneto Region Health District 8: Integrated assistance to provide better outcomes in end-of-life care.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e19595 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e19595-e19595

Author(s):

Fabio Girardi ◽

Paola Paiusco ◽

Paolo Manente ◽

Michela Bortolin ◽

Maria Grazia Ruggeri ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Hospital Admissions ◽

Palliative Care Unit ◽

Health District ◽

Care Plan ◽

Veneto Region ◽

Time Period ◽

Number Of Patients ◽

At Home

e19595 Background: The number of cancer patients requiring active treatment and palliation for symptoms relief is progressively increasing, due to the possibility to significantly prolong survival even in persons affected by metastatic disease. Italian Board of Health, within the National Oncological Plan 2010-2012, gave “simultaneous care” the recognition as the most qualified model to ensure the best result regarding life expectation, quality of life, adherence to therapies. Methods: In Italy’s veneto region health district 8 a unit dedicated to palliative care works in cooperation with oncology clinic, medical wards, general practitioner, social services; periodical meetings are scheduled to review all the requests; each patient is given a multidimensional evaluation, to assess the care needs. The Unit is able to provide a daily home-care, with total parenteral nutrition if needed, management of infusional devices, invasive procedures such as paracentesis, in order to minimize the number of intervening hospital admissions. We considered the percentage of patients who received a simultaneous care approach between 2008 and 2010, the number of patients who died at home or in a hospice, the average time-period of care, the number of elapsing hospital admissions. Results: In 2008 268 new patients received assistance by the Palliative Care Unit, 273 new patients in 2009 and 434 new patients in 2010; 82 (31,3%), 70 (25,6%) and 111 (25,6%) were affected by advanced cancer, respectively; in 2008 208 patients out of 262 (79,4%) died at home or in a hospice, in 2009 224 patients out of 273 (82,1%), in 2010 376 patients out of 434 (86,7%); in 2008 the average time-period of care was 93 days (calculated as the ratio between the total number of days of assistance to patients as a whole and the number of patients), 88 days in 2009; in 2008 the average number of intervening hospital admissions was 0,26 (calculated as the ratio between the number of admissions and the number of patients), 0,28 in 2009. Conclusions: Our data show that the earlier the patient affected by advanced cancer is evaluated by Palliative care Unit, the higher is the likelihood to develop an adequate home- or hospice-base care plan.

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Admission is not Always Necessary for Patients with Community-Acquired Pneumonia in Risk Classes IV and V Diagnosed in the Emergency Room

Canadian Respiratory Journal ◽

10.1155/2007/451417 ◽

2007 ◽

Vol 14 (4) ◽

pp. 212-216 ◽

Cited By ~ 19

Author(s):

TJ Marrie ◽

JQ Huang

Keyword(s):

Emergency Room ◽

Altered Mental Status ◽

Community Acquired Pneumonia ◽

Antibiotic Administration ◽

Free Standing ◽

Laboratory Findings ◽

Risk Of Mortality ◽

Number Of Patients ◽

Abnormal Lymphocyte ◽

At Home

OBJECTIVE: To determine the factors that allow patients with community-acquired pneumonia who are at high risk of mortality (risk classes IV and V) to be treated at home.DESIGN: A prospective, observational study.SETTING: Six hospitals and one free-standing emergency room in Edmonton, Alberta.PARTICIPANTS: The present study included 2354 patients in risk classes IV and V who had a diagnosis of pneumonia made by an emergency room physician or an internist.MEASUREMENTS: Symptoms, signs and laboratory findings, as well as outcome measures of length of stay and mortality.RESULTS: Of the total study group, 319 of the patients (13.5%) were treated on an ambulatory basis. Factors predictive of admission were definite or possible pneumonia on chest radiograph as read by a radiologist, functional impairment, altered mental status, substance abuse, psychiatric disorder, abnormal white blood cell count, abnormal lymphocyte count, oxygen saturation less than 90% and antibiotic administration in the week before admission. If chest pain was present, admission was less likely. Only two of the 319 patients required subsequent admission (both had positive blood cultures) and only two died.CONCLUSIONS: A substantial number of patients in risk classes IV and V can be safely treated at home. Factors that help clinicians to select this subset of patients are discussed.

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PSYCHOLOGICAL WELLBEING PERAWAT IGD RUMAH SAKIT JIWA DALAM MASA TUGAS COVID-19: STUDI FENOMENOLOGI

Jurnal Surya Muda ◽

10.38102/jsm.v3i2.88 ◽

2021 ◽

Vol 3 (2) ◽

pp. 76-101

Author(s):

Febriana Tri Kusumawati ◽

Luky Dwiantoro ◽

Devi Nurmalia

Keyword(s):

Emergency Room ◽

Mental Hospital ◽

Health Workers ◽

Positive Impact ◽

Psychological Wellbeing ◽

Hospital Emergency ◽

Number Of Patients ◽

The Face ◽

Mutual Care ◽

The Impact

The COVID-19 pandemic experienced by people around the world has resulted in an increase in the number of patients and stressors for nurses in Mental Hospital Emergency Departments, and is exacerbated by the condition of mental patients who are unable to communicate properly. The quality of patient care in the ER is determined by the availability of the 5M element where nurses as a human element in the COVID-19 pandemic situation require more attention regarding psychological wellbeing. Psychological wellbeing of good nurses will have a positive impact on nursing services in the ER mental hospital. The purpose of this study was to explore the experiences and feelings of psychologic wellbeing of Surakarta mental hospital emergency room nurses during the COVID-19 period. The research method used a qualitative design on the emergency room nurse mental hospital used Colaizzi analysis method. The results of the analysis of the participant interviews obtained seven themes, namely the meaning of psychological wellbeing (feeling happy, grateful to accept one's own condition, comfortable, useful and productive), Feelings during the COVID-19 pandemic (feelings at the beginning of the pandemic and current feelings), How to adapt during the COVID-19 pandemic. -19 (increased self-readiness, mutual care and support for fellow nurses, fulfillment of facilities and improvement of service systems), Hope for the COVID-19 pandemic (Joking freely and the pandemic will end soon and no health workers will fall), Changes experienced during the COVID-19 pandemic 19 (changes in regulations and culture in the face of a pandemic, changes in methods of studying online), experiences during work (pleasant experiences and bad experiences), families who always support carers (spouses and children and parents), and the impact of the COVID-19 pandemic ( towards others and towards family). The conclusion now is that nurses feel more comfortable and calm in carrying out their duties. The nurses had made adaptations to reduce anxiety so as to improve the psychological wellbeing status of the nurses.

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