COVID-19 Triage and Test Center: Safety, Feasibility, and Outcomes of Low-Threshold Testing

This prospective observational study evaluated the safety and feasibility of a low threshold testing process in a Triage and Test Center (TTC) during the early course of the coronavirus disease 19 (COVID-19) pandemic. In addition, we aimed to identify clinical predictors for a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) swab result. Patients underwent informal triage, standardized history taking, and physician evaluation, only where indicated. Patients were observed for 30 days. Safety was the primary outcome and was defined as a COVID-19-related 30 day re-presentation rate <5% and mortality rate <1% in patients presenting to the TTC. Feasibility was defined as an overruling of informal triage <5%. Among 4815 presentations, 572 (11.9%) were tested positive for SARS-CoV-2, and 4774 were discharged. Mortality at 30-days was 0.04% (2 patients, one of which related to COVID-19). Fever (OR 2.03 [95% CI 1.70;2.42]), myalgia (OR 1.94 [1.63;2.31]), chills (OR 1.77 [1.44;2.16]), headache (OR 1.61 [1.34;1.94]), cough (OR 1.50 [1.24;1.83]), weakness (OR 1.46 [1.21;1.76]), and confusion (OR 1.39 [1.06;1.80]) were associated with test positivity. Re-presentation rate was 8% overall and 1.4% in COVID-19 related re-presentation (69 of 4774). The overruling rate of informal triage was 1.5%. According to our study, a low-threshold testing process in a TTC appeared to be safe (low re-presentation and low mortality) and is feasible (low overruling of informal triage). A COVID-19 diagnosis based on clinical parameters only does not appear possible.

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Clinical Predictors of Vibrator-Assisted Ejaculation following Spinal Cord Injury: A Prospective Observational Study

Journal of Neurosciences in Rural Practice ◽

10.1055/s-0041-1735819 ◽

2021 ◽

Author(s):

Sivaram Alisseril ◽

Navin B. Prakash ◽

Bobeena Rachel Chandy ◽

George Tharion

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Observational Study ◽

Prospective Observational Study ◽

Statistical Significance ◽

Successful Outcome ◽

Clinical Parameters ◽

Clinical Predictors ◽

Cord Injury ◽

Assisted Ejaculation

Abstract Introduction Infertility in men with spinal cord injury (SCI) occurs due to combination of factors like erectile dysfunction, ejaculatory failure, and semen abnormalities. Penile vibratory stimulation (PVS) is a known method of treatment for anejaculation. Predicting successful outcome of PVS depends on several clinical factors, which assess the intactness of the neural arc pertaining to the spinal ejaculation pattern generator. This study reports the clinical predictors for successful candidacy for a PVS trial in males with SCI. Methods Twenty-three males with SCI, satisfying the inclusion criteria, were recruited in this prospective observational study. Participants underwent two trials of PVS with single high-amplitude vibrator. The clinical predictors recorded were neurological level, superficial abdominal reflex, cremasteric reflex, bulbocavernosus reflex, plantar reflex, ankle jerk, knee jerk, lower abdominal sensation, and hip flexor response. In addition, somatic responses during PVS were recorded and corelated. Participants who had successful ejaculation were “responders” and the others were termed as “nonresponders.” Binary logistic regression analysis of the clinical parameters was done to compare responders against nonresponders. Results Of the twenty-three males (mean age 33.2 ± 6.8 years) with paraplegia, all four persons with neurological level above T9 had successful ejaculation with PVS. Among all the clinical parameters in the study, presence of somatic responses showed statistical significance in predicting successful ejaculation (p-value = 0.02). Conclusion This study reports that in men with SCI, along with the level of injury, somatic responses and other clinical reflexes, should be considered concurrently to predict the outcome of vibrator assisted ejaculation.

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Lactobacillus Kefiri LKF01 (Kefibios®) for Prevention of Diarrhoea in Cancer Patients Treated with Chemotherapy: A Prospective Study

Nutrients ◽

10.3390/nu13020385 ◽

2021 ◽

Vol 13 (2) ◽

pp. 385

Author(s):

Michele Ghidini ◽

Mariaceleste Nicoletti ◽

Margherita Ratti ◽

Gianluca Tomasello ◽

Veronica Lonati ◽

...

Keyword(s):

Cancer Patients ◽

Prospective Observational Study ◽

Primary Outcome ◽

Final Analysis ◽

Clinical Effectiveness ◽

High Grade ◽

Combination Therapies ◽

Grade 3 ◽

Lactobacillus Kefiri ◽

A Prospective Study

Diarrhoea is one of the main side effects that cancer patients face. The literature showsthat the incidence of chemotherapy (CT)-induced diarrhoea (grade 3–4) in treated patients is in the range of 10–20%, particularly after 5-fluorouracil (5-FU) bolus or some combination therapies of irinotecan and fluoropyrimidines. The aim of the present study was to evaluate the clinical effectiveness of Lactobacillus kefiri LKF01 (Kefibios®) in the prevention or treatment of CT-related diarrhoea in the cancer population. We conducted a prospective observational study. Patients enrolled were adults treated for at least four months with 5-FU-based CT. Kefibios® was administered to patients every day. The primary outcome was the evaluation of the incidence of grade 3–4 CT-induced diarrhoea. We included 76 patients in the final analysis. A 6.6% incidence of high-grade diarrhoea was found in the evaluated population (4.7% of patients treated with 5-FU-based therapy and 8.5% of patients treated with capecitabine-based CT). The overall incidence of high-grade diarrhoea observed was higher in the 1st and 2nd cycles (3.9%), with a subsequent sharp reduction from the 3rd cycle (1.3%) and negativisation from the 5th cycle. Lactobacillus kefiri LKF01 (Kefibios®) is safe and effective in preventing severe diarrhoea in cancer patients receiving 5-FU or capecitabine-based treatment.

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Role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome- A Prospective observational study

Asian Journal of Medical Sciences ◽

10.3126/ajms.v12i6.34643 ◽

2021 ◽

Vol 12 (6) ◽

pp. 16-22

Author(s):

Maqsood Ahmad Dar ◽

Eijaz Ahmad Bhat ◽

Muzzafer M Mir

Keyword(s):

Mechanical Ventilation ◽

Mortality Rate ◽

Acute Stroke ◽

Developed Countries ◽

Loss Of Consciousness ◽

Motor Score ◽

Clinical Predictors ◽

Focal Neurological Deficit ◽

Ventilator Support

Background: Stroke is the third leading cause of death in developed countries and the leading cause of long term disability. As the mortality during initial few days depends upon the compression of vital organs in brain stem due to raised intracranial tension and possible herniation, treatment for impending or early herniation requires intubation and mechanical ventilation and up to 10% of patients with acute stroke need mechanical ventilation due to different reasons. Aims and Objective: The aim of the study was to find the role of clinical predictors in determining the need for mechanical ventilation in patients with acute stroke and their outcome. Materials and Methods: This prospective observational cohort study was conducted from September 2017 to march 2019 of patients with acute stroke admitted either through OPD or Emergency/ Triage of Max super specialty hospital, Saket, New Delhi. Patients with acute Stroke defined as the presence of sudden onset of focal neurological deficit and admitted within 24 h of onset of symptoms with Age ≥18 years were included in the study. Patients already on ventilator support at the time of admission were excluded. Results: A total of 165 patients met the inclusion and exclusion criteria and were enrolled for the study. Out of 165 patients included in the study 43 (26.06 %) were put on the mechanical ventilation due to various reasons. Multivariate analysis of statistically significant and most clinically important variables showed the overall predictor accuracy of requirement of mechanical ventilation of 81.2% if the patients had loss of consciousness at the time of onset ( OR = 0.076) and Glasgow Coma Scale (GCS) motor score of ≤ 5 ( OR= 0.000). About 58.62% (17/29) patients who were put on ventilator support were found to have favorable outcome Modified Rankin Scale (MRS score ≤ 2) at discharge compared to 6.90% (2/29) before ventilation. Conclusion: We concluded that loss of consciousness at onset, GCS motor score ≤ 5 (OR= 0.000) were associated with overall predictor accuracy of 81.2% in determining the need for mechanical ventilation. We found overall in-hospital mortality rate of 9.1% whereas mortality rate in patients on mechanical ventilation was 32.55%.

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3 Anti-TNF in patients with an early course of Crohn's disease – a prospective observational study in Germany

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(13)60004-5 ◽

2013 ◽

Vol 7 ◽

pp. S2

Author(s):

B. Bokemeyer ◽

U. Helwig ◽

A. Stallmach ◽

N. Teich ◽

R. Halle ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Observational Study ◽

Prospective Observational Study ◽

Early Course

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Clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase)

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20180078 ◽

2018 ◽

Vol 5 (1) ◽

pp. 164

Author(s):

Shiva Prasad Jagini ◽

Suresh I.

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Prospective Observational Study ◽

Primary Outcome ◽

Intravenous Thrombolysis ◽

Clinical Profile ◽

Favorable Outcome ◽

Nihss Score ◽

The Mean ◽

Centre Hospital

Background: Stroke patients are at highest risk death in the first few weeks after the event, and between 20-50% die within first month depending on type, severity, age, co-morbidities and effectiveness of treatment of complications. Objective of this study was to clinical profile of patients with acute ischemic stroke receiving intravenous thrombolysis (rtPA-alteplase).Methods: Prospective Observational study of 26 cases of acute ischemic stroke receiving IV thrombolysis using rtPA-alteplase at Kovai Medical Centre Hospital, Coimbatore over a period of 1 year 9 months.Results: 21 cases had NIHSS score of range 10 to 22. The mean NIHSS score at admission is 13.5. 15 subjects (57.7%) had achieved primary outcome in this study. MRS Score of 0 to 2 is considered as favorable outcome. In this study 20 subjects (76.92 %) had favorable outcome at the end of 3 months.Conclusions: Majority of the patients receiving rtPA-alteplase had favorable outcome.

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Meeting Calorie and Protein Needs in the Critical Care Unit: A Prospective Observational Pilot Study

Nutrition and Metabolic Insights ◽

10.1177/1178638820905992 ◽

2020 ◽

Vol 13 ◽

pp. 117863882090599

Author(s):

Shinobu Yamamoto ◽

Karen Allen ◽

Kellie R Jones ◽

Sarah S Cohen ◽

Kemuel Reyes ◽

...

Keyword(s):

Critically Ill ◽

Prospective Observational Study ◽

Primary Outcome ◽

Medical Intensive Care Unit ◽

Mechanical Ventilator ◽

Macronutrient Composition ◽

Gastrointestinal Intolerance ◽

Medical Intensive Care ◽

Secondary Outcomes ◽

Enteral Formula

Background: Inadequate calorie and protein intake during critical illness is associated with poor clinical outcomes. Unfortunately, most critically ill patients do not consume adequate levels of these nutrients. An enteral formula with appropriate macronutrient composition may assist patients in meeting nutritional goals. Design: This study was a single center, prospective, observational study of 29 adults in the medical intensive care unit who required enteral nutrition for at least 3 days. Subjects received a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula for up to 5 days to assess the ability to achieve 50% of caloric goals within the first 3 days (primary outcome), the daily percentage of protein goals attained and gastrointestinal tolerance (secondary outcomes). Result: A total of 29 subjects consented and began the study. Four subjects dropped out before first day and 25 subjects were included in analyses. Subjects were aged 55.5 ± 16.9 years with mean body mass index (BMI) of 27.9 ± 7.5 kg/m2. Most (92%) subjects were on a mechanical ventilator and experienced organ failure. At least 50% of caloric and protein goals were achieved in 78.9% and 73.7% of the subjects, respectively, during the first 3 days. Overall, 75.0 ± 26.3% and 69.3 ± 26.7% of calorie and protein goals were achieved using the study formula. Conclusions: Subjects fed enterally with a calorically dense, enzymatically hydrolyzed 100% whey peptide-based enteral formula exceeded 50% of caloric and protein goals in most critically ill subjects included in this study. Use of study formula did not lead to severe gastrointestinal intolerance.

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Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocx077 ◽

2017 ◽

Vol 25 (4) ◽

pp. 385-392 ◽

Cited By ~ 15

Author(s):

Willem van der Veen ◽

Patricia MLA van den Bemt ◽

Hans Wouters ◽

David W Bates ◽

Jos WR Twisk ◽

...

Keyword(s):

Prospective Observational Study ◽

Primary Outcome ◽

Outcome Measure ◽

Medication Administration ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Bar Code ◽

Implementation Evaluation ◽

Medication Administration Errors ◽

Large Numbers

Abstract Objective To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors. Materials and Methods A prospective observational study in Dutch hospitals using BCMA to administer medication. Direct observation was used to collect data. Primary outcome measure was the proportion of medication administrations with one or more medication administration errors. Secondary outcome was the frequency and types of workarounds and medication administration errors. Univariate and multivariate multilevel logistic regression analysis were used to assess the association between workarounds and medication administration errors. Descriptive statistics were used for the secondary outcomes. Results We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%). Discussion Workarounds are associated with medication administration errors in hospitals using BCMA. These data suggest that BCMA needs more post-implementation evaluation if it is to achieve the intended benefits for medication safety. Conclusion In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

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Comparison of two bedside evaluation methods of dysphagia in patients with acute stroke

Stroke and Vascular Neurology ◽

10.1136/svn-2018-000170 ◽

2018 ◽

Vol 3 (4) ◽

pp. 237-244 ◽

Cited By ~ 1

Author(s):

Ting Ye ◽

Shengyan Huang ◽

Yi Dong ◽

Qiang Dong

Keyword(s):

Acute Stroke ◽

Prospective Observational Study ◽

Primary Outcome ◽

Tube Feeding ◽

Predictive Ability ◽

Secondary Outcome ◽

Test Results ◽

Volume Viscosity ◽

Registration Number ◽

Positive Results

BackgroundDysphagia is a common complication after stroke. Water swallowing test (WST) is a recognised but limited tool in providing details about dysphagia, including severity and how to adjust the diet based on the test results.MethodsWe performed a prospective observational study of comparing WST and volume–viscosity swallow test (V-VST) in patients with acute stroke within 14 days. All patients had WST and if failed would have a V-VST. The primary outcome was to compare the dysphagia levels assessed by these two test tools. The secondary outcome was to explore the predictive capability in patients who were at high risk of pneumonia by these two swallowing tests.ResultsConsecutively 276 patients with stroke were enrolled in our study, and 197 had normal WST. Among 79 patients who had both WST and V-VST, 20 showed swallowing safety and effectiveness by V-VST. The chance of being on tube feeding was strongly related to the positive results of failed WST (p<0.001). Both tests showed good predictive ability in patients with stroke for pneumonia even some of them were placed on tube feeding (p=0.001 in WST and p<0.001 in V-VST).ConclusionsV-VST performed better as a clinical screening test for dysphagia in patients with acute stroke at the bedside.Trial registration numberChiCTR1800016442.

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First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-020-01326-z ◽

2020 ◽

Vol 46 (5) ◽

pp. 1039-1045 ◽

Cited By ~ 2

Author(s):

Wim Breeman ◽

Mark G. Van Vledder ◽

Michael H. J. Verhofstad ◽

Albert Visser ◽

Esther M. M. Van Lieshout

Keyword(s):

Success Rate ◽

Endotracheal Intubation ◽

Direct Laryngoscopy ◽

Prospective Observational Study ◽

Primary Outcome ◽

Spontaneous Circulation ◽

Video Laryngoscope ◽

Video Laryngoscopy ◽

Direct Laryngoscope ◽

Positive Effect

Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.

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