社区预防保健在新型冠状病毒肺炎疫情防控中的实践经验

2020年1月新型冠状病毒感染肺炎在武汉暴发,短时间内国家出台一些列防控策略,从上到下共同参与阻击疫情,有效遏制了疫情的快速蔓延。其中,社区医院预防保健科室作为疾病预防控制的最基层组织,迅速反应,成立送样检测结果反馈组、流行病学调查组、居家隔离管理组、对外消毒杀菌组、信息采集报送和应急物资管理组以及集中观察管理和健康传播组等小组,各司其职,有效衔接,交叉补位,高效筑起了社区一线的防控堡垒。     

A meta-analysis for Lianhua Qingwen on the treatment of Coronavirus disease 2019 (COVID-19)

BackgroundTraditional Chinese medicine (TCM) has been proven to played a great important role on the treatment of COVID-19. As one of the drugs recommended in Chinese guidelines, Lianhua Qingwen Granules or Capsules (LQ) are widely used.This systematic review and meta-analysis amis to evaluate the clinical efficacy of LQ on the treatment of COVID-19.MethodsSeven databases (PubMed, EMBASE, CENTRAL, CNKI, VIP, CBM and Wanfang) were searched to include all appropriate clinical trials that explore the efficacy of LQ on the treatment of COVID-19.ResultA total of 3 trials including 245 COVID-19 patients were eventually enrolled.Compared with the control group,the LQ group showed great significant difference on reducing the rate of clinical change to severe or critical condition[RR = 0.38, 95 %CI (0.17,0.85), P < 0.05]and the fever time (SMD =-0.57,95 %CI (-0.96,-0.17), P<0.05),as well as the significant improvement on the disappearance rate of the clinical symptoms: fever [RR = 1.36,95 %CI (1.14,1.61), P < 0.05],cough[RR = 1.99,95 %CI (1.39,2.86), P < 0.05],fatigue[RR = 1.52,95 %CI (1.15,2.01), P < 0.05] and anhelation [RR = 4.18,95 %CI (1.99,8.81), P < 0.05], but no significance on expectoration[RR = 2.46,95 %CI (0.81,7.51), P < 0.05].ConclusionThe clinical application of LQ on the treatment of COVID-19 has significant efficacy in improving clinical symptoms and reducing the rate of clinical change to severe or critical condition. Nevertheless, due to the limited quantity and quality of the included studies, more and higher quality trials with more observational indicators are expected to be published.     

Awareness about Coronavirus (COVID-19) and challenges for blood services among potential blood donors

BackgroundThe Coronavirus- 19 disease pandemic had a significant impact on the blood supply around the world. Physical distancing measures and many other factors contribute to this impact. Misinformation about methods of disease transmission and lack of knowledge among potential blood donors may contribute to this.AimTo assess the knowledge and awareness of blood donors about COVID-19 as well as their reasons and fears that prevent them from donating blood during this period.MethodsThis is an exploratory; survey based cross sectional study targeting Saudi population.ResultsA total number of 3841 persons responded to the survey; 58 % were between the ages of (31–50) years. Most participants 74.5 % were males. More than 60 % of participants donated blood previously, and many were repeat donors. The majority of participants were concerned about the transmission of the virus during the blood donation process mostly secondary to concerns about contact with other blood donors.ConclusionFear of contracting COVID-19 during donating blood is an important concern for potential blood donors. Blood collection facilities must take optimum precautionary measures to minimize this risk and are encouraged to communicate these efforts to potential donors for reassurance to maintain an adequate and safe blood supply.     

早期使用羟氯喹对新型冠状病毒肺炎患者胸部影像学改变的影响

【摘要】 目的：回顾性分析包括羟氯喹的使用在内的多种治疗方案，以评估这些药物对于新型冠状病毒肺炎影像学改变的影响。 方法：收集患者的临床资料，包括一般资料、临床表现、实验室检查、影像学检查、治疗方案、病情转归及预后并进行记录分析。通过频数及百分数描述分类变量，中位数和四分位数描述连续性变量。使用二元logistic回归模型研究不同治疗方案对肺部影像学进展的影响；使用Cox比例风险模型研究不同治疗方案对影像学好转时间的影响；绘制K-M曲线研究羟氯喹的不同使用方式对影像学的预后影响。 结果：纳入本次研究的患者共498例。年龄中位数为43岁（四分位数：32-59岁），男性274例（55.02%），女性224（44.98%）例。其中早期使用羟氯喹的有176例（35.34%）。早期使用羟氯喹（95%CI 0.525-1.704,p= 0.845）对于阻止胸部影像学进展可能是一个潜在的保护性因素。早期使用羟氯喹（95% CI 0.517-0.870，p=0.003）是与其他治疗方案相比，可显著减少胸部影像学改善时间。早期使用羟氯喹影像学好转中位数时间为7天（p＜0.01），未早期使用羟氯喹及未使用羟氯喹的胸部影像学好转时间中位数为9天。 结论：早期使用羟氯喹是阻止影像学进展的潜在保护性因素，早期使用羟氯喹可显著缩短胸部影像学的改善时间。     

行为分阶段转变理论在维持性血液透析患者手卫生健康教育中的应用

目的 应用行为分阶段转变理论模型,探讨血液透析患者手卫生的健康教育方法,促进患者建立科学的行为方式,提高自我管理能力,从而减少感染等并发症的发生.方法 选择100例血液透析患者为研究对象,采用行为分阶段转变理论模型进行干预,评价干预前后患者手卫生状况.结果 本组血液透析患者干预前手卫生认知得分为（54.7±5.7）分,干预后为（84.9±4.6）分,干预前后比较差异有统计学意义（t=-13.855,P＜0.01）;干预后患者手卫生执行率从46.8％提高到85.7％,洗手正确率从5.2％提高到80.9％,干预前后比较差异均有统计学意义（x2值分别为84.064,99.762;P ＜0.01）.干预后MHD患者手部细菌培养平均菌落数为（5.62±3.6）cfu/cm2,明显少于干预前（112.0±12.4） cfu/cm2,干预前后比较,差异有统计学意义（t=16.96,P＜0.05）.结论 运用行为分阶段转变理论能有效改善维持性血液透析患者手卫生状况.     

舒适护理模式配合健康教育在小儿手足口病感染防控护理中的应用研究

目的:探讨小儿手足口病感染防控护理中应用舒适护理模式配合健康教育的效果。方法:选择本院收治的60例手足口病患儿,所有患者均于2017年1月至2017年12月在本院接受治疗,随机分为研究组(n=30)和常规组(n=30)。常规组接受常规护理,研究组接受舒适护理配合健康教育,观察两组护理效果。结果:研究组皮疹消退时间、痊愈时间、住院时间均显著短于常规组(P<0.05)。研究组总有效率96.7%,显著高于常规组的83.3%(P<0.05)。研究组皮肤疱疹、发热、睡眠易惊、四肢抖动发生率均显著低于常规组(P<0.05)。结论:针对小儿手足口病患儿开展舒适护理配合健康教育效果显著,其能够显著缩短患儿康复时间,减少患儿临床症状。     

Coronavirus disease 2019 (COVID-19): strengthening our resolve to achieve universal palliative care

In this paper, we strongly advocate for universal palliative care access during the COVID-19 pandemic. The delivery of universal palliative care services has been called for by leading global health organizations and experts. Nurses are critical to realizing this goal. COVID-19 diagnoses and fatalities continue to rise, underscoring the importance of palliative care, particularly in the context of scant resources. To inform the writing of this paper, we undertook a review of the COVID-19 and palliative care literature and drew on our experiences. It is very clear that investment in nurses is needed to ensure appropriate palliative care services now and into the future. Avoiding futile interventions and alleviating suffering is an ethical imperative for nurses regardless of the setting. Multi-level practices and policies to foster the delivery of safe, high-quality palliative care for all are urgently needed.     

A co-design of clinical virtual care pathways to engage and support families requiring neonatal intensive care in response to the COVID-19 pandemic (COVES study)

BackgroundIn response to the COVID-19 pandemic, family presence restrictions in neonatal intensive care units (NICU) were enacted to limit disease transmission. This has resulted in communication challenges, negatively impacting family integrated care.AimTo develop clinical care pathways to ensure optimal neonatal care to support families in response to parental presence restrictions imposed during the COVID-19 pandemic.MethodsAn agile, co-design process utilizing expert consensus of a large interdisciplinary team and focus groups and semi-structured interviews with families and HCPs were used to co-design clinical virtual care pathways.ResultsThree clinical virtual care pathways were co-designed: (1) building and maintaining relationships between family and healthcare providers; (2) awareness of resources; and (3) standardized COVID-19 messaging. Modifications were made to optimize uptake and utilization in the clinical areas.ConclusionClinical care virtual pathways were successfully co-designed to meet these needs to ensure more equitable family centered care.     

Transition of Nurse Practitioner Faculty Practice and Student Clinicals to Telehealth: Response to the COVID-19 Pandemic

The COVID-19 pandemic forced the US health care system to evaluate alternative care delivery strategies to reduce the risk of coronavirus transmission to patients and health care providers. Telehealth modalities are a safe and effective alternative to face-to-face visits for primary and psychiatric care. Federal policy makers approved changes to telehealth reimbursement coverage and allowed flexibility of location for patients and providers. This article describes the transition of patient visits to telehealth by nurse practitioner faculty at an academic medical center to maintain continuity of care of underserved patient populations. This pivot facilitated resumption of clinical learning experiences for nurse practitioner students.     

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.     

Kynurenine pathway in Coronavirus disease (COVID‐19): Potential role in prognosis

BackgroundIt is known that inflammatory responses play an important role in the pathophysiology of COVID‐19.AimsIn this study, we aimed to examine the role of kynurenine (KYN) metabolism on the severity of COVID‐19 disease AQ5.Materials & MethodsSeventy COVID‐19 patients of varying severity and 30 controls were included in the study. In addition to the classical laboratory parameters, KYN, tryptophan (TRP), kynurenic acid (KYNA), 3 hydroxykynurenine (3OHKYN), quinolinic acid (QA), and picolinic acid (PA) were measured with mass spectrometry.ResultsTRP, KYN, KYN:TRP ratio, KYNA, 3OHKYN, PA, and QA results were found to be significantly different in COVID‐19 patients (p < 0.001 for all). The KYN:TRP ratio and PA of severe COVID‐19 patients was statistically higher than that of mild‐moderate COVID‐19 patients (p < 0.001 for all). When results were examined, statistically significant correlations with KYN:TRP ratio, IL‐6, ferritin, and procalcitonin were only found in COVID‐19 patients. ROC analysis indicated that highest AUC values were obtained by KYN:TRP ratio and PA (0.751 vs 0.742). In determining the severity of COVID‐19 disease, the odd ratios (and confidence intervals) of KYN:TRP ratio and PA levels that were adjusted according to age, gender, and comorbidity were determined to be 1.44 (1.1–1.87, p = 0.008) and 1.06 (1.02–1.11, p = 0.006), respectively.Discussion & ConclusionAccording to the results of this study, KYN metabolites play a role in the pathophysiology of COVID‐19, especially KYN:TRP ratio and PA could be markers for identification of severe COVID‐19 cases.     

Coronavirus disease (COVID-19) associated delayed-onset fulminant myocarditis in patient with a history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection

A healthy 35-year-old man was admitted to a rural hospital with coronavirus disease (COVID-19). During 14 days of hospitalization, he had no symptoms and was not given supplemental oxygen. About 3 weeks after discharge, he was re-admitted to the same hospital with new-onset continuous fever and general weakness. At the time of his second admission, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) RT-PCR was performed on a retro-nasal swab and the result was negative. Four days after admission, the patient was transferred to our intensive care unit (ICU) following deterioration of his respiratory and haemodynamic conditions, where he received mechanical ventilation, intra-aortic balloon pumping, and veno-arterial extracorporeal membrane oxygenation. A nasopharyngeal swab was obtained again at ICU admission, but RT-PCR was negative for SARS-CoV-2. All antibody titres measured against other viruses were low. Blood cultures were negative, and no bacteria were observed in sputum samples. However, SARS-CoV-2 RNA was detected by RT-PCR from sections obtained by myocardial biopsy. The patient's final diagnosis was delayed-onset SARS-CoV-2-induced fulminant myocarditis (FM). We strongly suggested that one of the proposed mechanisms of COVID-19-related myocardial injury will be the direct invasion of SARS-CoV-2 into cardiomyocytes even if delayed-onset. And this is the first case of delayed-onset FM in which diagnosis of active myocarditis was proven by pathological examination following endomyocardial biopsy and SARS-CoV-2 was detected in the myocardium by RT-PCR.     

The lady with the lamp: Amid the COVID-19 haze

The COVID-19 pandemic is currently the dominant public health topic across every nation. The world of health care is shrouded in the haze of the COVID-19 pandemic and is experiencing unprecedented patient loads arising from this complicated and unfamiliar viral disease. No one was prepared for this. Unsurprisingly, there are shortages of supplies and equipment, treatment space and people with the skills to respond to the containment, treatment and prevention of COVID-19. Nurses are at the front line of every nation’s response, trying to provide assessment, protection, treatment and prevention as being part of the overwhelming care demand that is occurring. Across every nation, the ongoing policy implications of the pandemic should be considered, as well as for those pandemics in the future. This includes, but is not limited to, investing in emergency systems and nurses, health research, and preparing for, managing and researching nursing practice.