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2022 ◽  
Author(s):  
Kartika Mawar Sari Sugianto ◽  
Rr. Tutik Sri Hariyati ◽  
Hening Pujasari ◽  
Enie Novieastari ◽  
Hanny Handiyani

Background: The increase in COVID-19 cases in Indonesia has resulted in changes in the hospital workflow, including the staffing process and scheduling, especially in the isolation units. Nurse managers are working hard in the scheduling system to ensure high-quality care is provided with the best human resources. Objective: This study aimed to explore the experiences of nurse managers in managing staff nurses’ work schedules during the COVID-19 pandemic. Methods: A qualitative descriptive design was used in this study. Eleven nurse managers from three COVID-19 referral hospitals were selected using purposive sampling. Data were collected using online semi-structured interviews. Thematic analysis was used for data analysis, and data were presented using a thematic tree. Consolidated criteria for reporting qualitative research (COREQ) checklist was used as a reporting guideline of the study. Results: Four themes were developed: (i) Nurse shortage, (ii) Strategically looking for ways to fulfill the workforce, (iii) Change of shift schedule, and (iv) Expecting guidance from superiors and compliance from staff. Conclusion: The lack of nurse staff is a problem during a pandemic. Thus, managing personnel effectively, mobilizing and rotating, and recruiting volunteers are strategies to fulfill the workforce during the pandemic. Using a sedentary shift pattern and sufficient holidays could prevent nurses from falling ill and increase compliance with scheduling. In addition, a staffing calculation formula is needed, and top nursing managers are suggested to provide guidance or direction to the head nurses to reduce confusion in managing the work schedule during the pandemic.


2022 ◽  
Vol 17 (s1) ◽  
Author(s):  
Agung Syetiawan ◽  
Mira Harimurti ◽  
Yosef Prihanto

With 25% confirmed cases of the country’s total number of coronavirus disease 2019 (COVID-19) on 31 January 2021, Jakarta has the highest confirmed cases of in Indonesia. The city holds a significant role as the centre of government and national economic activity for which pandemic have had a huge impact. Spatiotemporal analysis was employed to identify the current condition of disease transmission and to provide comprehensive information on the COVID-19 outbreak in Jakarta. We applied space-time analysis to visualise the pattern of COVID-19 hotspots in each time series. We also mapped area capacity of the referral hospitals covering the entire area of Jakarta to understand the hospital service range. This research was conducted in 4 stages: i) disease mapping; ii) spatial autocorrelation analysis; iii) space-time pattern analysis; and iv) areal capacity mapping. The analysis resulted in 144 sub-districts categorised as high vulnerability. Autocorrelation studies by Moran’s I identified cluster patterns and the emerging hotspot results indicated successful interventions as the number of hotspots fell in the first period of social restrictions. The results presented should be beneficial for policy makers.


2022 ◽  
Vol Volume 15 ◽  
pp. 45-52
Author(s):  
Tsegazeab Ayele ◽  
Abinet Gebremickael ◽  
Mathewos Alemu Gebremichael ◽  
Mala George ◽  
Habtamu Wondmagegn ◽  
...  

2022 ◽  
Vol 14 (1) ◽  
pp. e2022002
Author(s):  
Madeha Abdalla Sayed ◽  
Mohamed Abdelhakeem

Back ground: A novel coronavirus which is identified as cause of pandemic situation inFebruary2020 and affecting adult and children with variable presentation and outcome. Objective: We studied the typical and atypical clinical and laboratory presentation of COVID-19 during the peak of the first wave   in two main  referral hospitals, upper Egypt El Minya governorate. Methods:  Among 88 children with suspected cases  tested for COVID-19, only 22 who proved to be  positive. Studied patients were classified into 3 groups based on age. The first group 2–5years,the second for 5–10years and the third one included those aged more than 10 years. All patients met diagnostic guidelines established by Egyptian Ministry of health. Results: out of the positive 22 (25%) patients, 13(59.1%) of them were male, while 9 (40.9%) were females. All enrolled patients have a history of near contact exposure (100%). Thrombocytopenia was the highest presenting symptom in all enrolled patients18(81.8%), while other hematological findings were anemia in 11 (50%), thrombotic symptoms in 2(9.1%), pancytopenia in 2(9.1%) while bleeding was found in 1 patient (4.5%) .Fever 16 (72.7%) the common constitutional symptoms in COVID-19 were not reported in all enrolled patients (0%) while sore throat was reported in only 2 patients (9.1%).Respiratory presentation was only dominant in positive chest CT finding rather than clinical symptoms 17(72.3%) GIT symptom were the dominant presenting feature as vomiting was found in 15 (68.2%), diarrhea in 10 (45.5%), abdominal pain in 11 (50%), jaundice in 9 (40.9%) and dehydration in 6 (27.3%).Neurological symptoms were convulsions in 4(18.2%) while encephalopathy was 2(9.1%).Nephritis was the only renal presentation in the enrolled patients3 (13.6%).Cardiac presentations were only cyanosis 8 (36.4%) and arrhythmias 6 (27.3%) Conclusion: COVID-19 has many clinical  classic presentation in children  however  other non-typical presentation like hematological. CNS and renal presentation has been reported.   


Author(s):  
Maarten P. van Wiechen ◽  
Marjo J. de Ronde-Tillmans ◽  
Nicolas M. Van Mieghem

Aim: Over the past decade, transcatheter aortic valve implantation (TAVI) has matured into a valid treatment strategy for elderly patients with severe aortic stenosis. TAVI programs will grow with its adoption in low-risk patients. The aim of this study was to evaluate safety and feasibility of early discharge protocols, either home or back to a referring hospital. Methods: Consecutive patients undergoing TAVI between July 2017 and July 2019 were stratified into three discharge pathways from TAVI center: (1) early home (EXPRES); (2) early transfer to referring hospital (R-EXPRES); and (3) routine discharge (standard). Baseline, procedural, and 30-day outcomes were prospectively collected and compared per discharge pathway. Results: In total, 22 (5%) patients were enrolled in the EXPRES cohort [median age 78 (IQR: 73-81); mean Society of Thoracic Surgeons (STS) 2.4% ± 1.5%], 121 (29%) in the R-EXPRES cohort [median age 81 (IQR: 77-84); mean STS 4.3% ± 2.8%], and 269 (65%) in the routine discharge cohort [median age 80 (IQR: 75-85); mean STS 4.4% ± 3.1%]. EXPRES patients trended to be younger (P = 0.13) and had lower STS (P = 0.02). Early clinical outcome was similar through the different pathways including re-hospitalization rate. Median length of stay was one day longer for R-EXPRES vs. routine discharge patients [5 (IQR: 4-7) vs. 4 (IQR: 3-6); P < 0.01]. Median length of stay (LOS) was two days (IQR: 1-3 days) for EXPRES patients. Conclusion: Early discharge pathways home and to referral hospitals are safe and help streamline TAVI programs. LOS in referring hospitals may be further reduced.


2021 ◽  
Vol 4 (3) ◽  
pp. 398-405
Author(s):  
Innocent Twagirayezu ◽  
Bhengu Busisiwe ◽  
Emelyne Umutoni Cishahayo

BackgroundUnpredictable numbers of patients attending emergency departments highlight the need for Triage. Triage which is the prioritization of patient care based on severity of illness or injury, prognosis, and availability of resources is effective when clinicians are knowledgeable and skilled to perform it.ObjectiveTo assess knowledge and skills on triage among nurses working in emergency departments of Rwandan referral hospitals.MethodsCross-sectional analytical design was adopted. ninety-six (96) nurses working in emergency departments were selected using proportionate stratified sampling method. Each hospital was considered as a stratum. A self-administered questionnaire and observation checklist were use as instruments. Inferential and descriptive statistics were used in analysis.ResultsThe majority of participants (63.6%) demonstrated low level of triage knowledge and almost a half (47.9%) of participants had low level of triage skills. Nurses experience in emergency department, level of education and triage training were not found to significantly influence triage knowledge and skills positively (P>0.05).ConclusionDeficit in triage knowledge and skills were revealed among nurses working in emergency departments in Rwanda. Accredited continuous educational training on triage should be regularly provided to enhance knowledge and skills of emergency department nurses on Triage.Rwanda J Med Health Sci 2021;4(3):398-405


2021 ◽  
pp. 004947552110467
Author(s):  
George Paasi ◽  
Carolyne Ndila ◽  
Francis Okello ◽  
Peter Olupot-Olupot

Our study aimed at determining clinical factors associated with prolonged hospitalisation and death among children admitted with blackwater fever (BWF). We analysed 920 eligible records for the period January – December 2018 from Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. The median hospitalisation was 3 (IQR: 2–5 days) days. Prolonged hospitalisation was in 251/920 (27.3%). Clinical features independently associated with prolonged hospitalisation included abdominal tenderness, body pain and mild fever. 29/920 (3.2%) died, of these 20 (69.0%) within 48 h of admission. Features of severity associated with mortality were noisy or interrupted breathing, tachypnoea, chest pain, convulsions, delayed capillary refill time (≥3 s), severe pallor, high fever (>38.5°C), altered level of consciousness, prostration and acidotic breathing.


PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260225
Author(s):  
Arnaud Iradukunda ◽  
Emmanuel Nene Odjidja ◽  
Stephane Karl Ndayishima ◽  
Egide Ngendakumana ◽  
Gabin Pacifique Ndayishimiye ◽  
...  

Introduction Hypertension is a major threat to public health globally. Especially in sub-Saharan African countries, this coexists with high burden of other infectious diseases, creating a complex public health situation which is difficult to address. Tackling this will require targeted public health intervention based on evidence that well defines the at risk population. In this study, using retrospective data from two referral hospitals in Burundi, we model the risk factors of hypertension in Burundi. Materials and methods Retrospective data of a sample of 353 randomly selected from a population of 4,380 patients admitted in 2019 in two referral hospitals in Burundi: Military and University teaching hospital of Kamenge. The predictive risk factors were carried out by fixed effect logistic regression. Model performance was assessed with Area under Curve (AUC) method. Model was internally validated using bootstrapping method with 2000 replications. Both data processing and data analysis were done using R software. Results Overall, 16.7% of the patients were found to be hypertensive. This study didn’t showed any significant difference of hypertension’s prevalences among women (16%) and men (17.7%). After adjustment of the model for cofounding covariates, associated risk factors found were advanced age (40–59 years) and above 60 years, high education level, chronic kidney failure, high body mass index, familial history of hypertension. In absence of these highlighted risk factors, the risk of hypertension occurrence was about 2 per 1000 persons. This probability is more than 90% in patients with more than three risk factors. Conclusion The relatively high prevalence and associated risk factors of hypertension in Burundi raises a call for concern especially in this context where there exist an equally high burden of infectious diseases, other chronic diseases including chronic malnutrition. Targeting interventions based on these identified risk factors will allow judicious channel of resources and effective public health planning.


2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Clare Gallagher ◽  
Joseph L. Davis ◽  
Eugene Lee ◽  
Sikandar H. Khan ◽  
Anthony J. Perkins ◽  
...  

Background: Critical illness with COVID-19 is associated with increased delirium duration and severity, and delirium is associated with poor health outcomes. The pathophysiology of delirium in this population is not well understood but neuroinflammation is hypothesized to play a key role. Objective: To evaluate the relationship between biomarkers of systemic inflammation and delirium in critically ill patients with COVID-19. Design: Observational retrospective data extraction study from March 1, 2020 – June 7, 2020. Biomarker levels and delirium occurrence were assessed up to the first 14 days in the intensive care unit (ICU). Setting: Two large, urban, academic referral hospitals in Indianapolis, IN Patients: Two hundred thirty-five patients admitted to the ICU with a positive SARS-Co-V2 PCR test Methods and Main Results: A total of 235 consecutive patients admitted to the ICU were included in the analysis. The cohort had a mean age of 58.6 years (SD: 15.4), 43.4% were female, 45.9% were African American, with median Acute Physiology and Chronic Evaluation-II score of 18.0 (IQR: 13.0 -15.0). Delirium occurred in 176 (79.1%). Increased levels of C-Reactive Protein (CRP) were associated with increased odds of delirium and coma (OR: 1.27, 95% CI: 1.08, 1.49, p=0.004). Increased levels of D-dimer were not associated with increased odds of delirium/coma (OR: 0.94, 95% CI 0.76, 1.16, p=0.574). Increased levels of ferritin (OR: 1.04, 95% CI 0.84, 1.29, p=0.717) and lactate dehydrogenase (LDH) were also not associated with increased odds of delirium/coma (OR: 0.86, 95% CI 0.70, 1.06, p=0.149). Elevated levels of creatine kinase (CK) levels were associated with lower odds of delirium/coma (OR: 0.71 95% CI 0.52, 0.97, p=0.033). Conclusion: Increased levels of biomarkers of inflammation and thrombosis were associated with greater odds of delirium and coma. Further studies are needed to validate these results in a larger population. “This project was funded, in part, with support from the NIH NHLBI Short-Term Training Program in Biomedical Sciences Grantfunded, in part by T35HL110854 from the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.” 


Viruses ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 2462
Author(s):  
Fabrício Barbosa Ferreira ◽  
Galileu Barbosa Costa ◽  
Anaiá da Paixão Sevá ◽  
George Rego Albuquerque ◽  
Ana Paula Melo Mariano ◽  
...  

In December 2019, a novel coronavirus was detected in Wuhan, China, and rapidly spread worldwide. In Brazil, to date, there have been more than 20,000,000 confirmed cases of COVID-19 and more than 550,000 deaths. The purpose of the current study was to determine the clinical and epidemiological profile of the population affected by COVID-19 that have attended referral hospitals in Southern region of Bahia State, to better understand the disease and its risk factors in order to enable more appropriate conduct for patients. An observational, descriptive, cross-sectional, exploratory study was conducted using secondary data collected from the Laboratório de Farmacogenômica e Epidemiologia Molecular, Universidade Estadual de Santa Cruz (LAFEM/UESC). Chi-squared and Fisher’s exact tests were applied to determine the association between clinical symptoms and laboratory results, and to identify risk factors associated with SARS-CoV-2 infection. A total of 3135 individuals with suspected severe respiratory illness were analyzed and 41.4% of them tested positive for SARS-CoV-2 infection. Male individuals and having comorbidities were risk factors significantly associated with SARS-CoV-2 infection (OR = 1.17 and OR = 1.37, respectively). Interestingly, being a healthcare professional was a significantly protective factor (OR = 0.81, p < 0.001). Our findings highlight the importance of routinely testing the population for early identification of infected individuals, and also provide important information to health authorities and police makers to improve control measures, management, and screening protocols.


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