Baseline clinical features of COVID-19 patients, delay of hospital admission and clinical outcome: A complex relationship

Introduction Delay between symptom onset and access to care is essential to prevent clinical worsening for different infectious diseases. For COVID-19, this delay might be associated with the clinical prognosis, but also with the different characteristics of patients. The objective was to describe characteristics and symptoms of community-acquired (CA) COVID-19 patients at hospital admission according to the delay between symptom onset and hospital admission, and to identify determinants associated with delay of admission. Methods The present work was based on prospective NOSO-COR cohort data, and restricted to patients with laboratory confirmed CA SARS-CoV-2 infection admitted to Lyon hospitals between February 8 and June 30, 2020. Long delay of hospital admission was defined as ≥6 days between symptom onset and hospital admission. Determinants of the delay between symptom onset and hospital admission were identified by univariate and multiple logistic regression analysis. Results Data from 827 patients were analysed. Patients with a long delay between symptom onset and hospital admission were younger (p<0.01), had higher body mass index (p<0.01), and were more frequently admitted to intensive care unit (p<0.01). Their plasma levels of C-reactive protein were also significantly higher (p<0.01). The crude in-hospital fatality rate was lower in this group (13.3% versus 27.6%), p<0.01. Multiple analysis with correction for multiple testing showed that age ≥75 years was associated with a short delay between symptom onset and hospital admission (≤5 days) (aOR: 0.47 95% CI (0.34–0.66)) and CRP>100 mg/L at admission was associated with a long delay (aOR: 1.84 95% CI (1.32–2.55)). Discussion Delay between symptom onset and hospital admission is a major issue regarding prognosis of COVID-19 but can be related to multiple factors such as individual characteristics, organization of care and severe pathogenic processes. Age seems to play a key role in the delay of access to care and the disease prognosis.

Assessment of stigma and prejudice in the organization of care networks for drug users

ABSTRACT Objective: To assess stigma and prejudice in the organization of the Psychosocial Care Network for drug users. Methods: this is a qualitative study, developed through Empowerment Assessment. The survey was conducted in a municipality in Rio Grande do Sul, with 42 network workers. For data collection, participant observation, semi-structured interviews and open forum were used. For data analysis, thematic analysis was used. Results: the network’s mission involved a proposal for care without prejudice and judgments for drug users. It was identified that the composition of the network with training in multidisciplinary residency and psychiatry facilitates achieving the mission, and among the difficulties, the challenges to overcome prejudice were analyzed. Strategies for continuing education, seminars, and user empowerment in the community are suggested. Final considerations: stigma and prejudice need to be problematized in the networks for the organization of more inclusive and rehabilitating psychosocial care.

Viktor Vasilievich Trusov — organizer of endocrinology service of Izhevsk

The article is devoted to the 85th anniversary of Professor Viktor Vasilyevich Trusov (19362012), one of the prominent representatives of the therapeutic, scientific school of the Izhevsk State Medical Academy. In the range of diverse scientific interests and developments of Viktor Vasilyevich, a significant part was the issues of practical support to patients with endocrinological pathology, including patients with diabetes mellitus. Professor V.V. Trusov was a member of the Board of Russian Association of Endocrinologists, a member of the European Association for the Study of Diabetes, a member of the American Diabetes Association, worked on the problems of optimizing care for patients with diabetes. The article highlights the diabetology segment of the endocrinology service in Izhevsk on the materials of the endocrinological department of the State Clinical Hospital No. 6. The role of Professor Viktor Vasilyevich Trusov in the organization of the endocrinological center of Izhevsk, the viability of the methodological guidelines and recommendations laid down by him in the organization of care for patients with diabetes mellitus was noted. The organization of the work of the endocrinology center are considered. The analysis of the main indicators of the prevalence of diabetes mellitus was carried out according to the data of the endocrinology department (20172020). The special place of the diabetic foot clinic in the work of the center is highlighted. Modern and original methods of management of such complications of diabetes mellitus as diabetic foot syndrome are presented.

Experience of Elimination of Medical and Sanitary Consequences of Emergency in Magnitogorsk: Chronology of Events

The experience of liquidation of medical and sanitary consequences of the emergency situation caused by domestic gas explosion and collapse of the entrance of a multistory building in Magnitogorsk on December 31, 2018 is presented. Actions to mobilize resources of the Government, the Ministry of Health and the Territorial Center for Disaster Medicine of Chelyabinsk region, organization of coordinated work of ambulance teams and visiting teams of specialized medical care, forensic experts and psychologists were analyzed. The important role of the Ministry of Health of Russia, of the Government and personally of the President of the Russian Federation V. Putin in the organization of care for the victims, in forming the third echelon of medical forces and means using air ambulance was noted.

Information system support for medical secretaries’ work in patient administration tasks in different phases of the care process

Medical secretaries may have several separate electronic nursing information systems in use, but regardless of the systems, their task is to make sure that the patient information is correct and usable. The purpose of this study is to describe the support provided by the hospital information systems for the work of medical secretaries in patient administration tasks in different phases of the care process. The data were collected in a central hospital where medical secretaries had long been using partly electronic information systems. The data were collected using an abridged version of the Hospital Information System Monitor (HIS-monitor). The majority of the secretaries (N=60) gave a positive assessment for the support provided by the information system for their work at patient admission, when ordering diagnostic or therapeutic examinations or procedures, and at patient discharge. In the planning and organization of care, most thought that the systems provided poor support for informing all those involved in patient care. At patient admission, nearly half considered that the support for ensuring data protection (46%) and the systems’ compliance with legal obligations (44%) was poor. In connection with ordering diagnostic and therapeutic examinations and procedures, nearly half (43%) thought that information on the availability in ancillary units was not readily and easily available. At patient discharge, 40% considered that the systems did not support the identification of missing or incorrect information. The hospital information system provides partial support for medical secretaries’ work. The implementation of fully electronic systems and their functions may improve the support.

Prescription preferences of antiepileptic drugs in brain tumor patients: an international survey among EANO members

Background This study aimed at investigating antiepileptic drug (AED) prescription preferences in patients with brain tumor-related epilepsy (BTRE) among the European neuro-oncology community, the considerations that play a role when initiating AED treatment, the organization of care, and practices with regard to AED withdrawal. Methods A digital survey containing 31 questions about prescription preferences of AEDs was set out among members of the European Association of Neuro-Oncology (EANO). Results A total of 198 respondents treating patients with BTRE participated of whom 179 completed the entire survey. Levetiracetam was the first choice in patients with BTRE for almost all respondents (90% [162/181]). Levetiracetam was considered the most effective AED in reducing seizure frequency (72% [131/181]) and having the least adverse effects (48% [87/181]). Common alternatives for levetiracetam as equivalent first choice included lacosamide (33% [59/181]), lamotrigine (22% [40/181]), and valproic acid (21% [38/181]). Most crucial factors to choose a specific AED were potential adverse effects (82% [148/181]) and interactions with antitumor treatments (76% [137/181]). In the majority of patients neuro-oncologists were involved in the treatment of seizures (73% [132/181])). Other relevant findings were that a minority of respondents ever prescribe AEDs in brain tumor patients without epilepsy solely as prophylaxis (29% [53/181]), but a majority routinely considers complete AED withdrawal in BTRE patients who are seizure free after antitumor treatment (79% [141/179]). Conclusions Our results show that among European professionals treating patients with BTRE levetiracetam is considered the first choice AED, with the presumed highest efficacy and least adverse effects.

Ten-Year (2010–2019) Activity Report of the Replantation Service for Hand and Finger Amputations in Poland

Replantation of amputated hands is now considered a routine procedure in countries representing high standards of medical care. However, organization of care for patients with hand amputations is not uniform and varies from country to country, even in the European Union. This article presents organization of the Replantation Service for hand amputations in Poland, and ten-year activity report of the Service. Data to this report were obtained by mailing questionnaires to seven participating departments.A total of 974 patients, 871 men (89 %) and 103 women (11 %) at a mean age of 40 years with total or subtotal amputations or other severe upper limb-threatening injuries were admitted to the seven units participating in the Service. The most common injury was multidigital amputation – 353 (36 %), followed by the thumb – 282 (29 %), the metacarpal and wrist – 231 (24 %) and the forearm and arm – 108 (11 %) amputations. The most common operation was replantation of totally amputated hands/fingers – 368 cases (38 %), followed by revascularization of subtotal amputated hands/fingers – 344 (35 %). Primary reconstruction of a complex injury to the hand was performed in 135 patients (14 %). The rate of survival of the replanted/revascularized hands/fingers was a mean of 80 %. The report is supported by literature review about replantation services in other countries.

“It Is a Full-time Job to Be Ill”: Patient Work Involved in Attending Formal Diabetes Care Among Socially Vulnerable Danish Type 2 Diabetes Patients

Previous research has shown social inequality in type 2 diabetes prevalence and that socially vulnerable type 2 diabetes patients benefit less than average from health services. Based on ethnographic fieldwork carried out between February 2017 and March 2018 in a Danish specialized outpatient clinic, this article focuses on patient work among socially vulnerable type 2 diabetes patients. Through attending to the border zone between formal health care and self-care, we show that patients do a lot of work requiring skills, resources, and initiative, to access and benefit from formal care. This work is complex and implicit in the organization of care. Patients’ social situations, especially their employment situation, complicate getting patient work done. Attending to patient work and implicit tasks in care organization may help us to see how social inequality in type 2 diabetes outcomes develops, and may be combated.

Assessment of the Perception of People Living With HIV Regarding the Quality of Outpatient Care at a Reference Facility in the Federal District, Brazil

The effectiveness of antiretroviral treatment has transformed HIV infection into a chronic transmissible condition, requiring health systems to adapt in order to care for people living with HIV. The Chronic Care Model (CCM) is the gold standard for this type of care in many countries. Among its tools, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire gives the patient’s perspective of the care provided. The aim of the present study was to adapt and apply, for the first time, the questionnaire to people living with HIV to determine their perception of the quality of care provided at a reference hospital in the Federal District of Brazil. This is a case study conducted in 2019 at a teaching hospital, with a convenience sample of 30 individuals treated for at least 1 year at the facility. The median PACIC score (3.5 with a range of 1.0–5.0) seems to suggest that the users perceive the outpatient care provided by the hospital as being basic. The “delivery system design/decision support” component was deemed the best (5.0, with a range of 1.0–5.0) and “follow-up/coordination” the worst (1.0, with a range of 1.0–5.0). The results suggest the need to improve the organization of care and make adequate use of community resources, in line with the CCM. The questionnaire makes it possible to determine the strengths and weaknesses of the care provided to people living with HIV and can be used as a planning and monitoring tool to improve management of the condition, with the contribution of the patient, in particular, thereby strengthening self-care.

Training of Mid-Level Medical Specialists in the Peculiarities of Caring for Patients With COVID-19 in a Hospital Setting

The article presents the results achieved in the process of training mid-level medical specialists of medical organizations of the state healthcare system of the city of Moscow under the additional training program "Organization of care for patients with COVID-19 in a hospital."