新型冠状病毒肺炎疫情期间手术室应急管理策略

总结了在近期出现的新型冠状病毒肺炎及疫情迅速蔓延期间,手术室在应对新型冠状病毒感染制订的护理应急预防管理策略。主要包括加强护理人员及工勤人员相关知识培训,做好人力资源调配及物资储备,制订并启动手术相关应急处理流程等,旨在为今后手术室出现类似突发性公共卫生事件提供参考。     

新冠肺炎疫情下消化内镜中心管理策略

目的探讨新冠肺炎疫情下消化内镜中心管理策略,使内镜中心能够根据疫情控制要求结合内镜操作的特殊性、人员的复杂性、内镜本身感控的高要求性,落实可行性的人、机、料、法、环等不同环节的管理,确保内镜感控安全,人员安全。方法2020年1月24日至3月27日某综合医院消化内镜中心根据新冠肺炎疫情下总体防控要求,结合消化内镜中心人、机、料、法、环等不同环节管理特点进行分析与总结,找出适合内镜中心管理的策略。结果完成内镜检查治疗共510例,其中非急诊普通胃镜59例,非急诊普通肠镜40例,非急诊无痛胃镜44例,非急诊无痛肠镜43例,急诊普通胃镜72例,急诊普通肠镜25例,非急诊经内镜逆行胰胆管造影术(ERCP)54例,急诊ERCP 60例,内镜黏膜下剥离术(ESD)/内镜黏膜切除术(EMR)3例,超声或放大内镜52例,其他内镜下治疗操作58例。无新冠肺炎感染病例发生,无内镜治疗手术相关并发症发生,所有内镜检查及内镜下治疗手术未发现医源性感染和交叉感染,无医护人员感染事件发生。结论消化内镜中心的管理策略正确,既保证了新冠肺炎疫情下内镜中心的工作任务,又保障了所有人员的安全,管理措施得当值得推广。     

Challenges in platelet inventory management at a tertiary care oncology center during the novel coronavirus disease (COVID-19) pandemic lockdown in India

The novel coronavirus disease (COVID-19) has been declared a pandemic by the world health organization and to limit the spread of the disease, many countries in the world, including India, had enforced a lockdown. Despite no restriction over the platelet donation activities, plateletpheresis donors became apprehensive regarding the possible risk of spread of the COVID-19 during the platelet donation and in the hospital premises. Many of them started hesitating for platelet donations. With this, the blood center started having an acute shortage of platelets. Various confidence-building steps were implemented by the blood center to promote voluntary plateletpheresis. The blood center staff and individual donors were educated to prevent the spread of COVID-19. The donor organizations and plateletpheresis donors were informed about the steps to be taken by the blood center during the donation and necessary steps for the prevention of the possible spread of COVID-19. With the help of these measures, the confidence of the individual platelet donors and the donor organizations was restored in the blood center and regular plateletpheresis was continued. These measures may also be useful to other blood centers in the COVID-19 pandemic and this experience may be useful if a similar pandemic lockdown happens in the future.     

Clinical characteristics of the coronavirus disease 2019 (COVID-19) outbreak on a cruise ship

BackgroundA large COVID-19 outbreak occurred on the cruise ship Diamond Princess in February 2020. Little information has been reported about the clinical characteristics of the patients.MethodsThis single-center, retrospective, observational study was conducted in Yokohama, Japan. We included symptomatic patients who were infected on the ship and admitted to our hospital between 5 and 19 February 2020. All the cases were confirmed with SARS-CoV-2 infection by polymerase chain reaction (PCR).ResultsWe confirmed 17 cases. The average age was 69 years; 10 patients were Asian and 7 were Caucasian. Eleven patients had one or more chronic diseases. The major symptoms were cough and fever. Chest computed tomography (CT) scans found bilateral ground-glass opacities predominantly in the peripheral area, which were similar to reports from cases in China. C-reactive protein (CRP) levels were higher in severe and critical cases than in mild to moderate cases. The moderate to severe cases reached symptomatic resolution; one of the three critical cases resulted in death due to multiple organ failure. SARS-CoV-2 was detected by PCR at an average of 7 days after symptomatic resolution.ConclusionsCough and fever, increased blood CRP levels, and CT findings of bilateral ground-glass opacities predominantly in the peripheral lung were characteristic of the COVID-19 cases in this study. These findings were compatible with those of previous reports.     

Experience of 101 patients with coronavirus infectious disease 2019 (COVID-19) at a tertiary care center in Japan

IntroductionClusters of novel coronavirus infectious disease of 2019 (COVID-19) have spread to become a global pandemic imposing a significant burden on healthcare systems. The lack of an effective treatment and the emergence of varied and complicated clinical courses in certain populations have rendered treatment of patients hospitalized for COVID-19 difficult.MethodsTokyo Metropolitan Tama Medical Center, a public tertiary acute care center located in Tokyo, the epicenter of COVID-19 in Japan, has been admitting patients with COVID-19 since February 2020. The present, retrospective, case-series study aimed to investigate the clinical course and outcomes of patients with COVID-19 hospitalized at the study institution.ResultsIn total, 101 patients with COVID-19 were admitted to our hospital to receive inpatient care. Eleven patients (10.9%) received ECMO, and nine patients (8.9%) died during hospitalization after COVID-19 was diagnosed. A history of smoking and obesity were most commonly encountered among patients with a complicated clinical course. Most patients who died requested to be transferred to advanced palliative care in the early course of their hospitalization.ConclusionsOur experience of caring for these patients demonstrated a relatively lower mortality rate and higher survival rate in those with extracorporeal membrane oxygenation placement than previous reports from other countries and underscored the importance of proactive, advanced care planning in the early course of hospitalization.     

Impact of colchicine on mortality and morbidity in COVID-19: a systematic review

IntroductionColchicine, because of its anti-inflammatory and possible anti-viral properties, has been proposed as potential therapeutic option for COVID-19. The role of colchicine to mitigate “cytokine storm” and to decrease the severity and mortality associated with COVID-19 has been evaluated in many studies.ObjectiveTo evaluate the role of colchicine on morbidity and mortality in COVID-19 patients.MethodsThis systematic review was conducted in accordance with the PRISMA recommendations. The literature search was conducted in 6 medical databases from inception to February 17, 2021 to identify studies evaluating colchicine as a therapeutic agent in COVID-19. All included studies were evaluated for risk of bias (ROB) using the Revised Cochrane ROB tool for randomised controlled trials (RCTs) and Newcastle-Ottawa Scale (NOS) for case-control and cohort studies.ResultsFour RCTs and four observational studies were included in the final analysis. One study evaluated colchicine in outpatients, while all others evaluated inpatient use of colchicine. There was significant variability in treatment protocols for colchicine and standard of care in all studies. A statistically significant decrease in all-cause mortality was observed in three observational studies. The risk of mechanical ventilation was significantly reduced only in one observational study. Length of hospitalisation was significantly reduced in two RCTs. Risk for hospitalisation was not significantly decreased in the study evaluating colchicine in outpatients. Very few studies had low risk of bias.ConclusionBased on the available data, colchicine shall not be recommended to treat COVID-19. Further high-quality and multi-center RCTs are required to assess the meaningful impact of this drug in COVID-19.

KEY MESSAGES

• Colchicine, an anti-inflammatory agent has demonstrated anti-viral properties in in-vitro studies by degrading the microtubules, as well as by inhibiting the production of pro-inflammatory cytokines.
• Colchicine has been studied as a potential therapeutic option for COVID-19, with variable results.
• Until further research can establish the efficacy of colchicine in COVID-19, the use of colchicine in COVID-19 shall be restricted to clinical trials.

     

Ocular manifestations of COVID-19: facts and figures from a tertiary care center

IntroductionCOVID-19 patients presenting with ocular manifestations are from 0.8% to 32% of patients seen in the ED. The available literature is scarce regarding COVID-19 patients presenting with ocular manifestations from the Middle Eastern region.PurposeThis study aims to report the incidence of ocular signs and symptoms in COVID-19 patients and find any correlation between the occurrence of ocular manifestations and patients’ comorbidities.MethodsAll patients having the primary diagnosis of COVID-19 infection and concurrent ocular manifestations on admission to our tertiary COVID-19 health care centre were included in the study. The patient’s demographic data, comorbidities, and type of ocular manifestations were recorded from the patients’ health records retrospectively.ResultsIn our study, 39 (7.8%) patients presented with ocular manifestations. The majority of COVID-19 patients were male, and 200 (20%) patients had a history of other comorbidities. The majority of our patients had hyperaemia (13 [33.3%]), followed by eye pain (9 [23.1%]), epiphora (8 [20.5%]), burning sensation (4 [10.3%]), and photophobia (2 [5.1%]) patients. There was no statistically significant difference in the occurrence of ocular manifestations and patients’ gender or comorbidities (p > .05).ConclusionThe occurrence of ocular manifestations was lower compared to the present literature. There was no significant association between the occurrence of ocular manifestations and the patient’s gender or comorbidities.     

新冠肺炎疫情下三甲综合医院急诊影像检查变化及启示

目的分析新冠肺炎疫情下急诊工作中DR、CT的应用变化趋势,分析数据变动的意义。方法依托三甲综合医院医疗大数据平台,筛选2020年1月20日至3月20日及2019年同期就诊于急诊的患者信息,分析急诊就诊患者以及DR、CT检查数量、检查部位及占比、检查项目及占比的变化,计算急诊患者DR、CT每百人检查量;通过分层随机抽样计算检查结果阳性率、检查目的相关阳性率。结果急诊就诊人次、DR、CT检查人次显著降低,DR自22.8人次/百人降低至18.8人次/百人,同比下降17.5%,CT自22.8人次/百人显著升高至44.2人次/百人,同比大幅增长93.9%,增强检查显著提高至4.3人次/百人,同比增长50%以上。放射科工作内容显著变化,CT检查明显增多,占比高达74.7%。各类检查项目中,头部、腹盆部、胸部平扫为急诊CT主要检查项目,胸部和腹盆部平扫每百人检查量大幅升高,分别达17.4人次/百人、11.8人次/百人,同比增长296.6%、112.2%。对于检查目的相关阳性率,DR整体明显降低,CT整体稍有降低,但腹盆部、胸部及颈部平扫显著提高,同比增幅超过20%。结论新冠肺炎疫情下,CT特别是胸部CT应用意识及需求显著提升。应采取应对措施(如人工智能软件等)提高工作效率。非疫情状态下可能存在较多非必要的急诊就诊及过度使用的影像检查。     

新型冠状病毒肺炎疫情期间北京市某三甲医院儿科门诊和急诊就诊现况及启示

目的探讨新型冠状病毒肺炎疫情对儿科门诊和急诊就诊情况的影响及其可能原因,为未来优化儿童就医模式、实现儿童分级诊疗提供参考。 方法对2020年2月25日在北京大学第一医院儿科门诊和急诊就诊的儿童及其家属、接诊医师进行问卷调查。方便抽样法抽取疫情期间在儿科门诊和急诊出诊的儿科医师,采用专题小组半结构访谈法进行资料收集。 结果共回收合格问卷77份,应答率为87.5%。调查问卷结果显示,40例（51.9%,40/77）未带患儿仅家长前来门诊和急诊就诊,44例（57.2%,44/77）为了开药/咨询就诊。33例（42.8%,33/77）非开药/咨询就诊的儿童中,前5位主诉是发热、咳嗽、皮疹、黄疸和早产儿随访,前5位诊断疾病是肺炎、化脓性扁桃炎、上呼吸道感染、新生儿黄疸和早产儿随访,治疗以回家观察和口服药物为主,占75.6%（25/33）。33例患儿中,接诊医师认为没有必要来医院、可就诊于合格的初级医疗机构有13例（39.4%）,认为线上咨询能解决部分问题有21例（63.6%）,认为在线咨询完全能解决患儿的问题有5例（15.2%）。对6名出诊的儿科医师定性访谈结果显示,新型冠状病毒肺炎疫情发生后,儿科门诊和急诊患儿数量明显减少,急诊患儿病情较以往复杂,门诊患儿病情较以往简单,医患关系更加和谐,未来应采取多种措施促进三级医院儿科/儿童医院门诊和急诊患儿的分流。 结论新型冠状病毒肺炎疫情对于综合医院儿科门诊和急诊患儿及其家长的就医行为影响巨大,未来应通过加强医学科普、发展在线医疗、合理解决慢性病患者取药问题、加强医师培训、发展医联体等多种途径,优化医疗资源配置,改善儿童就医模式,推动儿童分级诊疗的实施。     

Biochemistry tests in hospitalized COVID-19 patients: Experience from a Canadian tertiary care centre

BackgroundCoronavirus Disease 2019 (COVID-19) has variable clinical presentation, from asymptomatic to severe disease leading to death. Biochemical markers may help with management and prognostication of COVID-19 patients; however, their utility is still under investigation.MethodsA retrospective study was conducted to evaluate alanine aminotransferase, C-reactive protein (CRP), ferritin, lactate, and high sensitivity troponin T (TnT) levels in 67 patients who were admitted to a Canadian tertiary care centre for management of COVID-19. Logistic, cause-specific Cox proportional-hazards, and accelerated failure time regression modelling were performed to assess the associations of initial analyte concentrations with in-hospital death and length of stay in hospital; joint modelling was performed to assess the associations of the concentrations over the course of the hospital stay with in-hospital death.ResultsInitial TnT and CRP concentrations were associated with length of stay in hospital. Eighteen patients died (27%), and the median initial TnT concentration was higher in patients who died (55 ng/L) than those who lived (16 ng/L; P < 0.0001). There were no survivors with an initial TnT concentration > 64 ng/L. While the initial TnT concentration was predictive of death, later measurements were not. Only CRP had prognostic value with both the initial and subsequent measurements: a 20% increase in the initial CRP concentration was associated with a 14% (95% confidence interval (CI): 1–29%) increase in the odds of death, and the hazard of death increased 14% (95% CI: 5–25%) for each 20% increase in the current CRP value. While the initial lactate concentration was not predictive of death, subsequent measurements were.ConclusionCRP, lactate and TnT were associated with poorer outcomes and appear to be useful biochemical markers for monitoring COVID-19 patients.     

新型冠状病毒肺炎疫情期间血管通路门诊运作模式（护理热点：护理门诊；新冠肺炎）

本文从患者筛查,就诊秩序,消毒隔离和特殊通道等方面介绍新型冠状病毒肺炎疫情血管通路门诊的运作模式,以期为血管通路门诊的护理人员提供参考。     

Gastroenterology and liver disease during COVID-19 and in anticipation of post-COVID-19 era: Current practice and future directions

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a major threat to global public health. The virus causes the clinical syndrome known as coronavirus disease 2019 (COVID-19), in which multiple organs can get affected. Apart from manifestations of the respiratory system, which predominate, its clinical presentation is frequently accompanied by symptoms of the gastro-intestinal (GI) tract and liver abnormalities. The correlation of symptoms and abnormalities with disease severity is discussed, leading to ambiguous results from international literature. Moreover, the disease infects patients with co-existing liver and GI disorders affecting both their health status and the availability of healthcare services provided to them. The risk of transmission of the disease during aerosol-generating procedures has changed the diagnostic approach and follow-up algorithms for liver and GI diseases. For the safety of both doctors and patients, telemedicine and distant evaluation have become everyday practice, whereas several routines and emergency visits at outpatient and emergency departments have been postponed or delayed. Vaccination against SARS-CoV-2 is underway, providing hope to humanity and the expectation that the post-COVID-19 era is near. This review aims to update knowledge about the manifestations of COVID-19 related to liver and GI diseases and the effect of the pandemic on the diagnostic and therapeutic procedures for these diseases with a special focus on how current practices have changed and what changes will possibly remain in the future.     

Clinical course of 2019 novel coronavirus disease (COVID-19) in individuals present during the outbreak on the Diamond Princess cruise ship

We investigated the clinical course of individuals with 2019 novel coronavirus disease (COVID-19) who were transferred from the Diamond Princess cruise ship to 12 local hospitals. The conditions and clinical courses of patients with pneumonia were compared with those of patients without pneumonia. Among 70 patients (median age: 67 years) analyzed, the major symptoms were fever (64.3%), cough (54.3%), and general fatigue (24.3%). Forty-three patients (61.4%) had pneumonia. Higher body temperature, heart rate, and respiratory rate as well as higher of lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and C-reactive protein (CRP) levels and lower serum albumin level and lymphocyte count were associated with the presence of pneumonia. Ground-glass opacity was found in 97.7% of the patients with pneumonia. Patients were administered neuraminidase inhibitors (20%), lopinavir/ritonavir (32.9%), and ciclesonide inhalation (11.4%). Mechanical ventilation and veno-venous extracorporeal membrane oxygenation was performed on 14 (20%) and 2 (2.9%) patients, respectively; two patients died. The median duration of intubation was 12 days. The patients with COVID-19 transferred to local hospitals during the outbreak had severe conditions and needed close monitoring. The severity of COVID-19 depends on the presence of pneumonia. High serum LDH, AST and CRP levels and low serum albumin level and lymphocyte count were found to be predictors of pneumonia. It was challenging for local hospitals to admit and treat these patients during the outbreak of COVID-19. Assessment of severity was crucial to manage a large number of patients.     

The role of PoCUS in the assessment of COVID-19 patients

The Coronavirus disease 19 (COVID-19) pandemic has increased the burden of stress on the global healthcare system in 2020. Point of care ultrasound (PoCUS) is used effectively in the management of pulmonary, cardiac and vascular pathologies. POCUS is the use of traditional ultrasound imaging techniques in a focused binary manner to answer a specific set of clinical questions. This is an imaging technique that delivers no radiation, is inexpensive, ultraportable and provides results instantaneously to the physician operator at the bedside. In regard to the pandemic, PoCUS has played a significant adjunctive role in the diagnosis and management of co-morbidities associated with COVID-19. PoCUS also offers an alternative method to image obstetric patients and the pediatric population safely in accordance with the ALARA principle. Finally, there have been numerous PoCUS protocols describing the effective use of this technology during the COVID-19 pandemic.     

Iatrogenic anaemia and transfusion thresholds in ICU patients with COVID-19 disease at a tertiary care hospital

BackgroundPatients with severe COVID-19 disease frequently develop anaemia as the result of multiple mechanisms and often receive transfusions. The aims of this study were to assess the impact of repeated blood samplings on patients’ anaemic state using standard-volume tubes, in comparison with the hypothetical use of low-volume tubes and to evaluate the transfusion policy adopted.Study design and methodsTransfusion data of mechanically ventilated non-bleeding patients with COVID-19 disease hospitalized in ICU for a minimum of 20 days were recorded. The total volume of blood drawn for samplings with standard-volume tubes and the corresponding red blood cell mass (RBCM) removed during hospitalization for each patient were calculated and compared with the hypothetical use of low-volume tubes.ResultsTwenty-four patients fulfilled the inclusion criteria. Ten patients were anaemic at ICU admission (41.7 %). Overall, 6658 sampling tubes were employed, for a total of 16,786 mL of blood. The median RBCM subtracted by blood samplings per patient accounted for about one third of the total patients’ RBCM decrease until discharge.The use of low-volume tubes would have led to a median saving of about one third of the drawn RBCM.Eleven patients were transfused (45.8 %) at a mean Hb value of 7.7 (± 0.5) g/dL.ConclusionThe amount of blood drawn for sampling has a significant role in the development of anaemia and the use of low-volume tubes could minimize the problem.Large high-powered studies are warranted to assess the more appropriate transfusion thresholds in non-bleeding critically ill patients with COVID-19 disease.     

新型冠状病毒肺炎疫情期间发热门诊的护理管理

新型冠状病毒肺炎疫情防控期间,发热门诊作为疾病诊治的重点部门,其防护工作是保障医护人员安全工作的重中之重,防护用品的使用、诊治流程以及呼吸机操作等环节的护理管理均要严格规范化、科学化。