Efficiency of emergency service for COVID-19 patients in Indonesia: management system, public policies, and medical action

Since the implementation of physical distancing and Large-Scale Social Restrictions (PSBB) on March 20, 2020, there was a decrease in patients at Cicendo Eye Hospital as much as 67.9% from March to April 2020. Encouragement to the public to keep their distance, avoid crowds, and the advice to stay at home resulted in a flow the process of health care during the COVID-19 pandemic has changed, such as the implementation of standard precautions for all patients and ensure early identification and source control. The existence of COVID-19 policies in the form of screening, service procedures, and the changing flow of the service process is thought to also affect patient satisfaction and the quality of nursing services. To analyze the quality of nursing services during the COVID-19 pandemic at Cicendo Eye Hospital. Using the Importance Performance Analysis (IPA) method. Data collection is carried out in outpatient and inpatient settings. Cicendo Eye Hospital. Sources of data in the form of primary data through questionnaires Responsiveness, Assurance, Tangible, Empathy and Reliability (RATER) and secondary data in the form of patient satisfaction data and service quality in 2019.

ON THE ISSUE OF NUTRITION IN THE CONDITIONS OF A PANDEMIC OF A NEW CORONAVIRUS INFECTION COVID-19

Вопросы питания занимают особое место в научной медицине и практическом здравоохранении, в условиях пандемии новой коронавирусной инфекции нуждаются в дальнейшем всестороннем изучении и развитии. Статья посвящена исследованию и анализу роли и возможностей профилактического и лечебного питания при оказании медицинской помощи в разных медицинских организациях в условиях пандемии новой коронавирусной инфекции COVID-19. Определены особенности оптимальной организации питания здоровых лиц и пациентов с новой коронавирусной инфекции с течением разной тяжести при лечении в амбулаторных и стационарных условиях, включая пациентов, находящихся в критических состояниях. Обеспечение потребностей в макро- и микронутриентах, поддержание и нормализация пищевого и метаболического статуса пациента с COVID-19 во многом определят благоприятный исход для больного с новой коронавирусной инфекцией. Полученные данные следует учитывать при проведении профилактических и лечебных мероприятий отдельным категориям пациентов на всех этапах оказания медицинской помощи. Оптимизация организации профилактического и лечебного питания пациентов с новой коронавирусной инфекцией COVID-19 на всех этапах оказания медицинской помощи будет способствовать снижению первичной и общей заболеваемости, количеству осложнений, смертности; повышению качества оказания медицинской помощи Nutrition issues occupy a special place in scientific medicine and practical healthcare, in the context of a pandemic of a new coronavirus infection, they need further comprehensive study and development. The article is devoted to the study and analysis of the role and possibilities of preventive and curative nutrition in the provision of medical care in various medical organizations in the context of the pandemic of the new coronavirus infection COVID-19. The features of optimal nutrition organization of healthy individuals and patients with a new coronavirus infection with a course of varying severity during treatment in outpatient and inpatient settings, including patients in critical conditions, are determined. Ensuring the needs for macro- and micronutrients, maintaining and normalizing the nutritional and metabolic status of a patient with COVID-19 will largely determine a favorable outcome for a patient with a new coronavirus infection. The data obtained should be taken into account when carrying out preventive and curative measures for certain categories of patients at all stages of medical care. Optimization of the organization of preventive and curative nutrition of patients with the new coronavirus infection COVID-19 at all stages of medical care will contribute to reducing primary and general morbidity, the number of complications, mortality; improving the quality of medical care

COVID-19 and antibacterial therapy in the inpatient settings: to whom, when, why?

Although antibiotics (ABs) are ineffective against COVID-19, they are often prescribed to patients with the new coronavirus infection. Many of these prescriptions are uncalled for.The aim of the work is to assess the frequency of prescribing antibiotics to hospitalized patients with confirmed COVID-19, identify the most commonly prescribed ABs, and determine the significance of various biomarkers for the diagnosis of bacterial infection.Methods. A retrospective analysis of 190 inpatient cases with confirmed COVID-19 was carried out. The records of COVID-19 patients who were admitted to the intensive care unit were excluded from the analysis. Two groups were formed: 30 patients (group 1) with COVID-19, emergency or elective surgery, and exacerbation of chronic infectious diseases, and 160 patients (group 2) with manifestations of COVID-19 only.Results. ABs were prescribed to 189 patients upon admission to the hospital. The most frequently prescribed ABs included macrolides (63.5%), respiratory fluoroquinolones (49.7%), and third or fourth-generation cephalosporins (57.1%). ABs were administered starting from the first day of admission and until the discharge. The patients in group 2 were more often prescribed respiratory fluoroquinolones and, less often, III - IV generation cephalosporins. Moreover, macrolides were used in the treatment regimens of both groups. Longer administration of respiratory fluoroquinolones to patients in group 2 than patients in group 1 (p < 0,05) was noted. Group 2 also tended to receive longer therapy with macrolides. On admission, the patients with signs of bacterial infection had more significant leukocytosis with a neutrophilic shift, a more common increase in ESR of more than 20 mm/h and an increase in the level of procalcitonin > 0,5 ng/ml.Conclusion. ABs were administered to the overwhelming majority of hospitalized patients in the absence of clear therapeutic indications. The ABs are likely to have a minimal benefit as empirical treatment of COVID-19 and are associated with unintended consequences, including adverse effects and increased antibiotic resistance. According to our data, the most informative markers of a secondary bacterial infection in patients with COVID-19 are leukocytosis with a neutrophilic shift, an increase in ESR of more than 20 mm/h, and a procalcitonin level of more than 0,5 ng/ml.

Prevalence And Definitions of Polypharmacy: A Systematic Review And Meta-Analysis

INTRODUCTION: Polypharmacy is common associated with several adverse health outcomes. There are currently no systematic reviews or meta-analyses on the prevalence of polypharmacy and associated factors. We aimed to identify population-based observational studies reporting on the prevalence of polypharmacy and factors associated with polypharmacy. METHODS: MEDLINE, EMBASE, and Cochrane databases with no restriction on date. Population-based observational studies with cross-sectional, case-control, or cohort designs using administrative databases or registries to define or measure polypharmacy among individuals over 19. Using a standardized form, two reviewers independently extracted study characteristics, a crude prevalence rate of polypharmacy and its standard error with 95% confidence intervals (CIs). The risk of bias and quality of studies was assessed using the Newcastle-Ottawa Scale. The main outcome was the prevalence of polypharmacy and factors associated with polypharmacy. Using a random-effects model, pooled prevalence estimates with 95% CI was reported. Subgroup analysis was performed if significant heterogeneity was explored. Meta-regression analysis was conducted to predict polypharmacy prevalence.RESULTS: 106 full-text articles were identifies using 21 unique terms with 138 descriptive definitions of polypharmacy. The pooled estimated prevalence polypharmacy in studies reporting all medication classes was 37% (95% CI: 31%-43%). Differences in polypharmacy prevalence were reported for studies using different numerical threshold and polypharmacy was also associated with study year in meta-regression. Sex, study geography, study design and study setting were not associated with differences in polypharmacy prevalence. DISCUSSION: Our review highlights that polypharmacy is common particularly among older adults and those in inpatient settings. A variety of definitions are used to define polypharmacy and differences in polypharmacy definitions may have implications for understanding the burden or polypharmacy and outcomes associated with polypharmacy. CONCLUSIONS AND IMPLICATIONS: Clinicians should be aware of the common occurrence of polypharmacy in all populations and undertake efforts to minimize inappropriate polypharmacy whenever possible.

Biological Aging Predicts Vulnerability to COVID-19 Severity in UK Biobank Participants

Age and disease prevalence are the two biggest risk factors for COVID-19 symptom severity and death. We therefore hypothesized that increased biological age, beyond chronological age, may be driving disease-related trends in COVID-19 severity. Using the UK Biobank England data, we tested whether a biological age estimate (PhenoAge) measured more than a decade prior to the COVID-19 pandemic was predictive of two COVID-19 severity outcomes (inpatient test positivity and COVID-19 related mortality with inpatient test-confirmed COVID-19). Logistic regression models were used with adjustment for age at the pandemic, sex, ethnicity, baseline assessment centers, and pre-existing diseases/conditions. 613 participants tested positive at inpatient settings between March 16 and April 27, 2020, 154 of whom succumbed to COVID-19. PhenoAge was associated with increased risks of inpatient test positivity and COVID-19 related mortality (ORMortality=1.63 per 5 years, 95% CI: 1.43-1.86, p=4.7x10E-13) adjusting for demographics including age at the pandemic. Further adjustment for pre-existing disease s/conditions at baseline (OR_M=1.50, 95% CI: 1.30-1.73 per 5 years, p=3.1x10E-8) and at the early pandemic (OR_M=1.21, 95% CI: 1.04-1.40 per 5 years, p=0.011) decreased the association. PhenoAge measured in 2006-2010 was associated with COVID-19 severity outcomes more than 10 years later. These associations were partly accounted for by prevalent chronic diseases proximate to COVID-19 infection. Overall, our results suggest that aging biomarkers, like PhenoAge may capture long-term vulnerability to diseases like COVID-19, even before the accumulation of age-related comorbid conditions.

Influence of Depression and Personality on Social Functioning in Older Adults

Among older adults there is significant comorbodity between depression and personality pathology and both are associated with poorer social functioning. Personality pathology is associated with greater prevalence, poorer recovery, and a higher likelihood of recurrence of depression in older adults. This study is a secondary analysis examining the relationships between personality traits associated with personality pathology (i.e. high neuroticism and low agreeableness), depression, and social functioning across older adults surveyed in primary care and psychiatric inpatient settings (N = 227). Individual variable as well as interaction models were examined. Higher neuroticism (FChange [1,217] = 40.119, p &lt; .001), lower agreeableness (FChange [1,217] = 20.614, p &lt; .001), and clinical status (i.e. primary care vs. psychiatric inpatient) (FChange [1,217] = 19.817, p &lt; .001) were associated with poorer social functioning. Clinical status moderated the relationships between neuroticism and social functioning (B = -.0147, p = . 0341) and between agreeableness and social functioning (B = .0268, p = .0015). Interaction effects were not observed between neuroticism and depression or agreeableness and depression as they relate to social functioning. However, depression severity was observed to mediate the relationship between neuroticism and social functioning [Indirect effect = .0212, 95% CI = .0141, .0289]. These findings highlight the importance of accounting for depression and clinical status in the assessment and treatment of older adults with personality pathology. Findings warrant future research focused upon mechanisms through which personality pathology and depression influence functional status in older adults.

Biological Aging Predicts Vulnerability to COVID-19 Severity in UK Biobank Participants

Age and disease prevalence are the two biggest risk factors for COVID-19 symptom severity and death. We therefore hypothesized that increased biological age, beyond chronological age, may be driving disease-related trends in COVID-19 severity. Using the UK Biobank England data, we tested whether a biological age estimate (PhenoAge) measured more than a decade prior to the COVID-19 pandemic was predictive of two COVID-19 severity outcomes (inpatient test positivity and COVID-19 related mortality with inpatient test-confirmed COVID-19). Logistic regression models were used with adjustment for age at the pandemic, sex, ethnicity, baseline assessment centers, and pre-existing diseases/conditions. 613 participants tested positive at inpatient settings between March 16 and April 27, 2020, 154 of whom succumbed to COVID-19. PhenoAge was associated with increased risks of inpatient test positivity and COVID-19 related mortality (ORMortality=1.63 per 5 years, 95% CI: 1.43-1.86, p=4.7x10E-13) adjusting for demographics including age at the pandemic. Further adjustment for pre-existing disease s/conditions at baseline (OR_M=1.50, 95% CI: 1.30-1.73 per 5 years, p=3.1x10E-8) and at the early pandemic (OR_M=1.21, 95% CI: 1.04-1.40 per 5 years, p=0.011) decreased the association. PhenoAge measured in 2006-2010 was associated with COVID-19 severity outcomes more than 10 years later. These associations were partly accounted for by prevalent chronic diseases proximate to COVID-19 infection. Overall, our results suggest that aging biomarkers, like PhenoAge may capture long-term vulnerability to diseases like COVID-19, even before the accumulation of age-related comorbid conditions.

Identifying Practices to Promote Inpatient Adolescent and Influenza Vaccine Delivery

OBJECTIVES Many hospitalized children are underimmunized. We assessed the association between hospital immunization practices and tetanus, diphtheria, and acellular pertussis (Tdap), meningococcal, human papillomavirus (HPV), and influenza vaccine delivery. METHODS An electronic survey regarding hospital vaccine delivery practices was distributed via the Pediatric Health Information System (PHIS) and Pediatric Research in Inpatient Settings networks to PHIS hospitals. Number of vaccines delivered and total discharges in 2018 were obtained from the PHIS database to determine hospital vaccine delivery rates; patients 11 to 18 years old (adolescent vaccines) and 6 months to 18 years old (influenza vaccine) were included. Vaccine delivery rates were risk adjusted by using generalized linear mixed-effects modeling and compared with survey responses to determine associations between the number or presence of specific practices and vaccine delivery. Adjusted HPV and meningococcal vaccine delivery rates could not be calculated because of low delivery. RESULTS Twenty-nine hospitals completed a survey (57%). 152 499 and 423 046 patient encounters were included for the adolescent and influenza vaccines, respectively. Unadjusted inpatient vaccine delivery rates varied. After adjustment, the number of practices was associated only with influenza vaccine delivery (P = .02). Visual prompts (P = .02), nurse or pharmacist ordering (P = .003), and quality improvement projects (P = .048) were associated with increased influenza vaccine delivery; nurse or pharmacist ordering had the greatest impact. No practices were associated with Tdap vaccine delivery. CONCLUSIONS The number and presence of specific hospital practices may impact influenza vaccine delivery. Further research is needed to identify strategies to augment inpatient adolescent immunization.

Cardiac Monitoring for Adolescents With Eating Disorders

No relevant literature was identified regarding the comparative clinical effectiveness of cardiac monitoring devices for adolescents with eating disorders in inpatient settings. No evidence-based guidelines were identified regarding cardiac monitoring for adolescents with eating disorders in inpatient settings.

Approach to Headache

There is a very high prevalence of headache in both outpatient and inpatient settings, in the United States and worldwide, due to an abundance of possible causes. Having a practical and systematic approach to evaluating and treating headache is, therefore, key to making the correct diagnosis, or possibly overlapping diagnoses. Taking a thorough and methodical headache history is the mainstay for diagnosis of both primary and secondary headache disorders. Evaluation and workup should include a complete neurological examination, consideration of neuroimaging in specific limited situations, and serum or spinal fluid analysis if indicated. Adopting a diagnostic approach to headache ensures that cannot-miss, or potentially fatal, headache syndromes are not overlooked, while resource-intensive tests are performed only on an as-needed basis.