scholarly journals Hospital-Acquired COVID-19: Case Discussions of Two Patients Treated at a Level I Trauma Center

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Ryan M. Desrochers ◽  
Jonathan D. Gates ◽  
Daniel Ricaurte ◽  
Jane J. Keating
Keyword(s):  
Trauma Patients ◽  
Healthcare Facilities ◽  
Consulting Services ◽  
Potential Risk Factors ◽  
History Of ◽  
Case Discussions ◽  
Level I ◽  
Prolonged Hospital ◽  
Hospital Acquired ◽  
Insight Into

The community spread of COVID-19 is well known and has been rigorously studied since the onset of the pandemic; however, little is known about the risk of transmission to hospitalized patients. Many practices have been adopted by healthcare facilities to protect patients and staff by attempting to mitigate internal spread of the disease; however, these practices are highly variable among institutions, and it is difficult to identify which interventions are both practical and impactful. Our institution, for example, adopted the most rigorous infection control methods in an effort to keep patients and staff as safe as possible throughout the pandemic. This case report details the hospital courses of two trauma patients, both of whom tested negative for the COVID-19 virus multiple times prior to producing positive tests late in their hospital courses. The two patients share many common features including history of psychiatric illness, significant injuries, ICU stays, one-to-one observers, multiple consulting services, and a prolonged hospital course prior to discharge to a rehabilitation facility. Analysis of these hospital courses can help provide a better understanding of potential risk factors for acquisition of a nosocomial COVID-19 infection and insight into which measures may be most effective in preventing future occurrences. This is important to consider not only for COVID-19 but also for future novel infectious diseases.

scholarly journals Complications of Trauma Patients Admitted to the ICU in Level I Academic Trauma Centers in the United States

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Stefania Mondello ◽  
Amy Cantrell ◽  
Domenico Italiano ◽  
Vincenzo Fodale ◽  
Patrizia Mondello ◽  
...  
Keyword(s):  
The United States ◽  
Population Based ◽  
Trauma Patients ◽  
Cns Injury ◽  
Modifiable Factors ◽  
Potential Risk Factors ◽  
Male Patients ◽  
Level I ◽  
Complications And Mortality ◽  
The Relationship

Background. The aims of this study were to evaluate the complications that occur after trauma and the characteristics of individuals who develop complications, to identify potential risk factors that increase their incidence, and finally to investigate the relationship between complications and mortality.Methods. We did a population-based retrospective study of trauma patients admitted to ICUs of a level I trauma center. Logistic regression analyses were performed to determine independent predictors for complications.Results. Of the 11,064 patients studied, 3,451 trauma patients developed complications (31.2%). Complications occurred significantly more in younger male patients. Length of stay was correlated with the number of complications(R=0.435,P<0.0001). The overall death rate did not differ between patients with or without complications. The adjusted odds ratio (OR) of developing complication for patients over age 75 versus young adults was 0.7(P<0.0001). Among males, traumatic central nervous system (CNS) injury was an important predictor for complications (adjusted OR 1.24).Conclusions. Complications after trauma were found to be associated with age, gender, and traumatic CNS injury. Although these are not modifiable factors, they may identify subjects at high risk for the development of complications, allowing for preemptive strategies for prevention.

scholarly journals Perioperative Delirium/Agitation Associated With the Use of Anesthetics and/or Adjunct Agents: A Study of Patient Behaviors, Injuries, and Interventions to Mitigate Risk

2021 ◽  
pp. 16-27
Author(s):  
Matthew Taylor ◽  
William Pileggi
Keyword(s):  
Reporting System ◽  
Cardiopulmonary Arrest ◽  
Violent Behavior ◽  
Healthcare Services ◽  
Intervention Package ◽  
Healthcare Facilities ◽  
Patients Âgés ◽  
Safety Reporting ◽  
History Of ◽  
Insight Into

Anesthetics and adjunct agents have a long history of being associated with patients engaging in delirious or agitated behavior in a perioperative setting. Prior to this study, few have explored the topic with a focus on safety for both the patient and staff. We explored the Pennsylvania Patient Safety Reporting System (PA-PSRS) database for event reports to identify bouts of delirium/ agitation associated with anesthetics and/or adjunct agents that occurred during the pre-, intra-, or postoperative period. We identified 97 event reports from 63 healthcare facilities over a two-year period. Patients’ ages ranged from 1 to 91 years and 66% of the patients were reported as male. Also, 8% of the delirium/agitation occurred preoperatively, 8% intraoperatively, and 84% postoperatively. Across all three operative periods, 62% of the reports described dangerous/nonviolent behavior and 26% described dangerous/violent behavior. Additionally, 40% of the event reports described one or more patient injuries (e.g., cardiopulmonary arrest, asphyxiation, hematoma, prolapse/dehiscence, progressive ischemia) and 36% of the patients required additional healthcare services or monitoring (e.g., intra- or interfacility transfer, additional surgical procedure). Finally, 54% of the event reports described patient behavior that created an immediate and high risk of staff harm. Overall, the current study provides novel insight into how delirium/agitation has varying safety implications depending on the operative period. We encourage readers to review Table 5, which proposes a four-phase intervention package to prevent, treat, and de-escalate bouts of delirium/agitation.

scholarly journals COVID-19 and Ventilator-Associated Event Discordance

2021 ◽  
Vol 1 (S1) ◽  
pp. s45-s45
Author(s):  
Kelly Cawcutt ◽  
Mark Rupp ◽  
Lauren Musil
Keyword(s):  
Chart Review ◽  
Respiratory Illness ◽  
The United States ◽  
Healthcare Facilities ◽  
Mechanically Ventilated ◽  
Viral Shedding ◽  
History Of ◽  
Healthcare Acquired Infections ◽  
Hospital Acquired ◽  
Present On Admission

Background: The COVID-19 pandemic has challenged healthcare facilities since its discovery in late 2019. Notably, the subsequent COVID-19 pandemic has led to an increase in healthcare-acquired infections such as ventilator associated events (VAEs). Many hospitals in the United States perform surveillance for the NHSN for VAEs by monitoring mechanically ventilated patients for metrics that are generally considered to be objective and preventable and that lead to poor patient outcomes. The VAE definition is met in a stepwise manner. Initially, a ventilator-associated condition (VAC) is met when there an increase in ventilator requirements after a period of stability or improvement. An IVAC is then met when there is evidence of an infectious process such as leukocytosis or fever and a new antimicrobial agent is started. Finally, possible ventilator-associated pneumonia (PVAP) is met when there is evidence of microbial growth or viral detection. Since the beginning of the COVID-19 pandemic, our hospital has seen an increase in VAEs, which is, perhaps, not unexpected during a respiratory illness pandemic. However, the NSHN definitions of VAE, and PVAP in particular, do not account for the novelty and nuances of COVID-19. Methods: We performed a chart review of 144 patients who had a VAE reported to the NHSN between March 1 and December 31, 2020. Results: Of the 144 patients with a VAE reported to NHSN, 39 were SARS-CoV-2 positive. Of the 39 patients, 4 patients (10.25%) met the NHSN PVAP definition due to a positive SARS-CoV-2 PCR that was collected in the prolonged viral shedding period of their illness (< 90 days). One of the four patients also had a bacterial infection in addition to their subsequent positive COVID-19 result. All these patients were admitted to the hospital with a COVID-19 diagnosis and their initial PCR swab was performed upon admission. Conclusions: We believe that the PVAP definition was inappropriately triggered by patients who were decompensating on the ventilator due to a novel respiratory virus that was present on admission. Early in the pandemic, frequent swabbing of these patients was performed to try and understand the duration of viral shedding and to determine when it would be safe to transfer patients from isolation after prolonged hospitalization. The NSHN definition should take into consideration the prolonged viral shedding period of COVID-19 and natural history of the illness, and subsequent COVID-19 testing within 90 days of an initial positive should not require classification as a hospital-acquired PVAP.Funding: NoDisclosures: None

Staphylococcus aureus nasal colonization among Vietnamese adults: prevalence, risk factors and antibiotic susceptibility profile

MedPharmRes ◽  
2018 ◽  
Vol 2 (2) ◽  
pp. 21-31
Author(s):  
Nguyen Phan ◽  
Hien Pham ◽  
Thuc Nguyen ◽  
Hoai Nguyen
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Antibiotic Susceptibility ◽  
Nasal Carriage ◽  
Resistance Rate ◽  
High Rate ◽  
Weight History ◽  
Potential Risk Factors ◽  
History Of ◽  
Vietnamese Community

Staphylococcus aureus (S. aureus) has long been recognized as an important human pathogen causing many severe diseases. It is also a part of human normal flora with its ecological niche in the human anterior nares. This study focused on screening S. aureus nasal carriage in community and its relationship to human physiological and pathological factors which have not been studied in Vietnam previously. Two hundred and five volunteers in Ho Chi Minh City from 18 to 35 and over 59 years old both male and female participated in the study. Result showed that the prevalence of S. aureus nasal carriage in southern Vietnamese community was relatively low, only 11.2% (23/205), much lower than that in other international reports on human S. aureus. In addition, nasal carriage of the older age group (> 59 years old, 13.7%) was higher than that of younger age (18-35 years old, 10.4%). Other potential risk factors such as gender, career, height, weight, history of antibiotic usage, daily nasal wash, use of nasal medication sprays, acne problems, smoking and nasal problems showed no significant impact on S. aureus carriage. The obtained S. aureus nasal isolates were all sensitive to vancomycin. Lincomycin and tetracycline had low resistance rate with 4.3 % and 17.4 %, respectively. However, the isolates showed particularly high rate of multidrug resistance (54.2%) In summary, our data provided researchers an overview on S. aureus nasal carriage and antibiotic susceptibility profile of the community- isolated S. aureus in Vietnam. This would serve as valuable information on assessing risk of community-acquired S. aureus infections.

The Subaltern Speak- A Study On The Culture Of The Arunachalis With Special Reference To Mamang Dai’s The Legends Of Pensam

2019 ◽  
Vol 5 (4) ◽  
pp. 14-20
Author(s):  
Ms. Cheryl Antonette Dumenil ◽  
Dr. Cheryl Davis
Keyword(s):  
Special Reference ◽  
Small World ◽  
Natural World ◽  
Arunachal Pradesh ◽  
North East India ◽  
North East ◽  
Shared History ◽  
History Of ◽  
And Gender ◽  
Insight Into

North- East India is an under veiled region with an awe-inspiring landscape, different groups of ethnic people, their culture and heritage. Contemporary writers from this region aspire towards a vision outside the tapered ethnic channel, and they represent a shared history. In their writings, the cultural memory is showcased, and the intensity of feeling overflows the labour of technique and craft. Mamang Dai presents a rare glimpse into the ecology, culture, life of the tribal people and history of the land of the dawn-lit mountains, Arunachal Pradesh, through her novel The Legends of Pensam. The word ‘Pensam’ in the title means ‘in-between’,  but it may also be interpreted as ‘the hidden spaces of the heart’. This is a small world where anything can happen. Being adherents of the animistic faith, the tribes here believe in co-existence with the natural world along with the presence of spirits in their forests and rivers. This paper attempts to draw an insight into the culture and gender of the Arunachalis with special reference to The Legends of Pensam by Mamang Dai.

Collected Documents on the History of the Pskov Orthodox Mission: A Recent Publication

2018 ◽  
pp. 306-312
Author(s):  
Veniamin F. Zima ◽  
Keyword(s):  
Personal Data ◽  
Prisoners Of War ◽  
Inner Life ◽  
Great Patriotic War ◽  
Occupied Territories ◽  
History Of ◽  
Underground Resistance ◽  
The Baltic ◽  
The Church ◽  
Insight Into

The reviewed work is devoted to a significant, and yet little-studied in both national and foreign scholarship, issue of the clergy interactions with German occupational authorities on the territory of the USSR in the days of the Great Patriotic War. It introduces into scientific use historically significant complex of documents (1941-1945) from the archive of the Office of the Metropolitan Sergius (Voskresensky) of Vilnius and Lithuania, patriarchal exarch in Latvia and Estonia, and also records from the investigatory records on charges against clergy and employees concerned in the activities of the Pskov Orthodox Mission (1944-1990). Documents included in the publication are stored in the archives of Moscow, St. Petersburg, Estonia, Lithuania, Leningrad, Novgorod, and Pskov regions. They allow some insight into nature, forms, and methods of the Nazi occupational regime policies in the conquered territories (including policies towards the Church). The documents capture religious policies of the Nazis and inner life of the exarchate, describe actual situation of population and clergy, management activities and counterinsurgency on the occupied territories. The documents bring to light connections between the exarchate and German counterintelligence and reveal the nature of political police work with informants. They capture the political mood of population and prisoners of war. There is information on participants of partisan movement and underground resistance, on communication net between the patriarchal exarchate in the Baltic states and the German counterintelligence. Reports and dispatches of the clergy in the pay of the Nazis addressed to the Metropolitan Sergius (Voskresensky) contain detailed activity reports. Investigatory records contain important biographical information and personal data on the collaborators. Most of the documents, being classified, have never been published before.

The History of the Judahite Bench Tomb

2018 ◽  
Author(s):  
Matthew Suriano
Keyword(s):  
Iron Age ◽  
Hebrew Bible ◽  
Cultural Practices ◽  
Seventh Century ◽  
Mortuary Practices ◽  
Iron Age Ii ◽  
Gradual Development ◽  
History Of ◽  
The Dead ◽  
Insight Into

The history of the Judahite bench tomb provides important insight into the meaning of mortuary practices, and by extension, death in the Hebrew Bible. The bench tomb appeared in Judah during Iron Age II. Although it included certain burial features that appear earlier in the Middle and Late Bronze Ages, such as burial benches, and the use of caves for extramural burials, the Judahite bench tomb uniquely incorporated these features into a specific plan that emulated domestic structures and facilitated multigenerational burials. During the seventh century, and continuing into the sixth, the bench tombs become popular in Jerusalem. The history of this type of burial shows a gradual development of cultural practices that were meant to control death and contain the dead. It is possible to observe within these cultural practices the tomb as a means of constructing identity for both the dead and the living.

Galileo Unbound

2018 ◽  
Author(s):  
David D. Nolte
Keyword(s):  
Free Fall ◽  
The Sun ◽  
Quantum Field ◽  
Many Worlds ◽  
Quantum Particles ◽  
Light Rays ◽  
History Of ◽  
And Control ◽  
The Universe ◽  
Insight Into

Galileo Unbound: A Path Across Life, The Universe and Everything traces the journey that brought us from Galileo’s law of free fall to today’s geneticists measuring evolutionary drift, entangled quantum particles moving among many worlds, and our lives as trajectories traversing a health space with thousands of dimensions. Remarkably, common themes persist that predict the evolution of species as readily as the orbits of planets or the collapse of stars into black holes. This book tells the history of spaces of expanding dimension and increasing abstraction and how they continue today to give new insight into the physics of complex systems. Galileo published the first modern law of motion, the Law of Fall, that was ideal and simple, laying the foundation upon which Newton built the first theory of dynamics. Early in the twentieth century, geometry became the cause of motion rather than the result when Einstein envisioned the fabric of space-time warped by mass and energy, forcing light rays to bend past the Sun. Possibly more radical was Feynman’s dilemma of quantum particles taking all paths at once—setting the stage for the modern fields of quantum field theory and quantum computing. Yet as concepts of motion have evolved, one thing has remained constant, the need to track ever more complex changes and to capture their essence, to find patterns in the chaos as we try to predict and control our world.

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