基于新型冠状病毒肺炎疫情防控的大型公立医院医疗流程构建

新型冠状病毒肺炎疫情的全球暴发给医院应急防控带来严峻挑战。大型公立医院作为应对新型冠状病毒肺炎的主战场,应从门诊、急诊、住院、手术、出院全流程进行把控。预检分诊作为医院的首层关卡,是疫情防控的关键节点,需重点关注并加强相关应对机制的建设,以快速遏制外源性/内源性危险因素;同时落实全员培训与考核,加强互联网诊疗等信息化建设,为医院诊疗工作的有序开展保驾护航。     

新型冠状病毒肺炎疫情期间非定点救治医院血液透析室防控措施探讨

新型冠状病毒肺炎流行期间,医院应制定科学可行的制度和流程,采取有效的防控措施,避免新型冠状病毒肺炎院内感染和疫情扩散。本文总结了非定点救治医院血液透析室应对新型冠状病毒肺炎疫情的防控措施,通过成立防控小组,制定相关制度和流程;强化全员培训,多途径宣传教育;科学排班,分级管理;对全体员工、患者及家属严格筛查,严格落实个人防护和消毒隔离措施。此外,医院应高度重视新型冠状病毒肺炎的诊疗及防控。在组织管理、制度修订、人员培训、工作和人员分配安排、患者及家属管理和健康教育等方面,要基于科室实际情况迅速作出部署,全面加强对疫情防控的集中统一领导,保障科室所有工作人员、患者及其家属的身心健康和安全。     

非定点收治新型冠状病毒肺炎医院建立发热门诊与隔离病房的应对策略

[目的]探讨非定点收治新型冠状病毒肺炎医院建立发热门诊与隔离病房的应对策略。[方法]医院应对新型冠状病毒肺炎暴发期间总体部署感染防控,通过对防控部门进行选址、布局,组建护理人力资源应急储备库与应急梯队,对护理人员采用多维度防控知识培训及考核,完善全院的疫情防控管理,加强后勤保障工作等一系列严密的防控措施健全医院防控体系。[结果]经过一系列有效的临床防控实施,在疫情防控工作方面取得了一定的成效,有效地控制了传染源、切断传播途径,防止疫情扩散蔓延,确保了医护人员和病人的安全。截至目前实现了医院内零感染,无医护人员与病人发生感染,防止了社区疫情扩散。[结论]医院在防治新型冠状病毒肺炎的特殊时期,医院领导精准施策、统一部署,通过早规划、早布置、早防控,实行全员培训,确保整个防控体系科学有序高效地进行,在传染病疫情暴发期间防止医院内感染效果明显。     

新型冠状病毒肺炎疫情期间发热门诊护理管理体会

本文总结新型冠状病毒肺炎疫情期间发热门诊的护理管理体会。疫情防控期间发热门诊应做到:合理布局发热门诊;完善发热门诊工作和感控的制度及流程;加强人力资源管理;严格落实护理及相关人员培训;加强发热门诊的信息化管理;提供强有力的后勤保障。科学有效的护理管理能有效控制新型冠状病毒肺炎在医院内的传播,同时提高护理人员对新型冠状病毒肺炎疫情的应对能力,保障护理安全。     

境外输入新型冠状病毒肺炎患者隔离观察点管理策略与建议

目前境外输入型新型冠状病毒肺炎病例不断增加,新型冠状病毒肺炎疫情进入防控关键时期。隔离观察点作为与机场、指定医疗机构的对接点,合理应对和开展隔离观察点防控工作对控制疾病传播具有重大意义,该文分析了疫情期间上海市浦东新区周浦医院第20号隔离观察点应对疫情的措施、管理方法、经验和思考,确保境外输入型新型冠状病毒肺炎的防治工作顺利进行。     

新型冠状病毒肺炎疫情期间非医务工作人员防控现状调查及策略探讨

[目的]了解新型冠状病毒肺炎疫情期间非医务工作人员防控现状,探讨相应策略。[方法]采用网络问卷调查法,在疫情初期对医院非医务工作人员(120名护工、100名工人)进行新型冠状病毒肺炎相关知识、感染防控知识掌握情况及感染防控知识需求情况进行调查。[结果]护工、工人对新型冠状病毒肺炎疫情初期相关知识的认知合格率为51.6%和49.0%,感染防控知识掌握的合格率为65.0%和52.0%;非医务工作人员对职业防护知识的需求量较大,护工、工人分别为93.3%和97.0%。[结论]非医务工作人员对新型冠状病毒肺炎疫情初期感染防控知识认知情况一般,应加强对其进行新型冠状病毒肺炎疫情期间感染防控知识的培训,减少新型冠状病毒肺炎的发生。     

新型冠状病毒肺炎疫情期间血液透析中心应急管理实践

本文总结了新型冠状病毒肺炎疫情期间血液透析中心的应急管理实践,包括成立疫情防控小组,制定应急管理预案,强化医护人员自身管理,加强透析患者三级防控工作,加强患者及家属健康管理与宣教,加强普通透析区域的消毒管理,强化特殊患者的防控管理,以期为血液透析中心应对新型冠状病毒肺炎疫情提供参考。     

妇幼保健院应对2019新型冠状病毒肺炎的护理管理

总结本院在应对2019新型冠状病毒肺炎疫情突发期间护理管理的方法。护理部充分发挥职能作用,从护理人力资源应急调配、新型冠状病毒肺炎防控知识线上培训、疫情防控护理管理、防控应急物资有效使用及管控、患者及护理人员人文关怀等方面进行科学管理,全面应对突发新型冠状病毒肺炎疫情,提供高效的护理保障。     

新型冠状病毒肺炎防控体会

总结新型冠状病毒肺炎疫情暴发后的医院防控工作。根据新型冠状病毒的特性及传播途径,从制定医院感染防控体系和消毒隔离制度、出院宣教等方面着手,控制医院感染的发生,避免新型冠状病毒肺炎疫情流行。     

护理部在抗击新型冠状病毒肺炎中的应对策略

正护理部是医院的重要职能部门,在新型冠状病毒肺炎疫情突发期间,本院护理部制定护理管理的应对策略,迅速适应抗击新型冠状病毒肺炎的需要,保证了本院疫情防控工作的顺利开展,本院医、护、患人员零感染、零死亡。现将应对策略分享如下。1成立疫情防控工作组成立疫情防控工作组,护理部主任任组长,护理部副主任为副组长,成员为各科护士长及护理部干事,制定组长、副组长、成员的工作职责及任务分工。组长负责疫情防控工作总的部署,     

Coronavirus Disease 2019 Strategies,Examination Details,and Safety Procedures for Diagnostic Radiology Facilities: An Extensive Multicenter Experience in Istanbul,Turkey

This study aimed to share our experiences during the coronavirus disease 2019 (COVID-19) pandemic obtained in diagnostic radiology facilities of 5 training research hospitals in the Asian part of Istanbul (North Hospitals). Accordingly, we reported the used examination details, allocation of radiology staff and actions, and safety procedures for patients and radiology staff. As the corporate radiology team serving in these designated pandemic hospitals, examination details and safety procedures of some diagnostic radiology facilities among 5 training research hospitals have been identified in the current study. Our guidelines and preparedness protocol aimed to reduce patient morbidity and infection-related mortality through quick and proper diagnosis to prevent the spread of COVID-19 to our employees, patients, and the general public during the COVID-19 pandemic. Results showed that teamwork is a key factor while providing medical services. In addition, continuous communication efforts and individual responsibilities of radiology staff were remarkable during the COVID-19 pandemic. The recent situation also showed that co-operation of radiology facilities with device manufacturers and applicators is quite significant especially for development of special protocols in the frame of As Low As Reasonably Achievable. The COVID-19 pandemic has tackled several challenges in radiology among radiology departments. Therefore, continuous co-operation plans and motivational actions are highly recommended not only between radiology staff but also between radiology stakeholders and service providers in the future. Technical details of recent investigation can provide useful information about the management of diagnostic radiology departments during the fight with the COVID-19 pandemic in cities with high population density such as Istanbul.     

An international perspective of out-of-hospital cardiac arrest and cardiopulmonary resuscitation during the COVID-19 pandemic

BackgroundOut-of-hospital cardiac arrest (OHCA) accounts for a substantial proportion of sudden cardiac events globally, with hundreds of thousands of cases reported annually in the United States. The mortality rate of patients who suffer OHCA remains high despite extensive utilization of resources.ObjectivesWe aim to describe the current landscape of OHCA during the COVID-19 pandemic and provide an overview of the logistical challenges and resuscitation protocols amongst emergency medical service (EMS) personnel.DiscussionRecent studies in Italy, New York City, and France characterized a significant increase in OHCA incidence in conjunction with the arrival of the 2019 coronavirus disease (COVID-19) pandemic. The presence of the pandemic challenged existing protocols for field resuscitation of cardiac arrest patients as the pandemic necessitated prioritization of EMS personnel and other healthcare providers' safety through stringent personal protective equipment (PPE) requirements. Studies also characterized difficulties encountered by the first responder system during COVID-19, such as dispatcher overload, increased response times, and adherence to PPE requirements, superimposed on PPE shortages. The lack of guidance by governmental agencies and specialty organizations to provide unified safety protocols for resuscitation led to the development of different resuscitative protocols globally.ConclusionsThe ongoing COVID-19 pandemic modified the approach of first responders to OHCA. With the rise in OCHA during the pandemic in several geographic regions and the risks of disease transmission with superimposed equipment shortages, novel noninvasive, adjunct tools, such as point of care ultrasound, warrant consideration. Further prehospital studies should be considered to optimize OHCA and resource management while minimizing risk to personnel.     

National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

BACKGROUNDThe coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections.AIMTo describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide.METHODSA cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation.RESULTSWe report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives.CONCLUSIONSA substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.     

Management of cancer patients during the COVID-19 pandemic:A narrative review

Objective: We wrote this review with the objective of helping the physicians to manage patients with cancer during the COVID-19 pandemic. Background: In the absence of specific curative treatments, COVID-19 exerted worldwide a dramatic impact on public health and socio-economic aspects. Patients with cancer represent a vulnerable population when suffering from COVID-19 infection since they usually present a series of risk factors such as immunosuppressed state, older age, comorbidities(e.g., cardiovascular diseases, chronic lung disease, diabetes) and need for frequent hospitalizations and visits. A series of observational studies demonstrated that cancer patients infected with COVID-19, particularly with lung cancer, have a high rate of morbidity and mortality. Methods: We conducted a review of several observational studies and guidelines regarding the management of cancer patients in the context of COVID-19 infection. Conclusions: The oncologists, according to the main available recommendations, should carefully weigh risks/benefits when planning therapies and follow-up visits. They should defeat the "distraction effect" of the pandemic, which is represented by the risk of shifting attention away from standard therapeutic approach to COVID-19 only. In addition, health authorities should prioritize COVID-19 vaccinations for cancer patients with the aim of limiting the consequences of the pandemic in this particularly frail population.     

ST Segment Elevation Myocardial Infarction in the COVID-19 Era: Appraisal of the Evidence

The COVID-19 pandemic continues to present a public health challenge and has had a significant impact on the presentation, time-dependent management, and clinical outcomes of ST elevation myocardial infarction (STEMI). Patients with COVID-19 and pre-disposing cardiovascular risk factors like hypertension, hyperlipidemia, and diabetes mellitus are at a higher risk of developing STEMI, and global trends have highlighted delayed management of STEMI, which may contribute to worse clinical outcomes. Prolonged time to intervention has also resulted in an increased rate of no reflow, which is an independent risk factor for worse outcomes in these patients. Timely primary percutaneous coronary intervention (PCI) remains standard of care for STEMI and can be attained within the recommended 90 minutes timeline from hospital presentation. A coordinated, safe, standardized, algorithmic approach among emergency medical services, emergency departments, and cardiac catheterization laboratory is needed to ensure optimal patient outcome during and after the COVID-19 pandemic. The focus of this case report is to highlight the challenges of PCI for ST elevation myocardial infarction in the COVID-19 era.     

Medical research during the COVID-19 pandemic

The current pandemic of coronavirus disease 2019 (COVID-19) which was first detected in Wuhan, China in December 2019 is caused by the novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The virus has quickly spread to a large number of countries leading to a great number of deaths. Unfortunately, till today there is no specific treatment or vaccination for SARS-CoV-2. Most of the suggested treatment medications are based on in vitro laboratory investigations, experimental animal models, or previous clinical experience in treating similar viruses such as SARS-CoV-1 or other retroviral infections. The running of any clinical trial during a pandemic is affected at multiple levels. Reasons for this include patient hesitancy or inability to continue investigative treatments due to self-isolation/quarantine, or limited access to public places (including hospitals). Additional barriers relate to health care professionals being committed to other critical tasks or quarantining themselves due to contact with COVID-19 positive patients. The best research approaches are those that adapt to such external unplanned obstacles. Ongoing clinical trials before COVID-19 pandemic have the potential for identifying important therapies in the long-term if they can be completed as planned. However, these clinical trials may require modifications due a pandemic such as this one to ensure the rights, safety, and wellbeing of participants as well as medical staff involved in the conduction of clinical trials. Clinical trials initiated during the pandemic must be time-efficient and flexible due to high contagiousness of severe acute respiratory syndrome coronavirus 2, the significant number of reported deaths, and time constraints needed to perform high quality clinical trials, enrolling adequate sample sizes. Collaboration between different countries as well as implementation of innovative clinical trial designs are essential to successfully complete such initiatives during the current pandemic. Studies looking at the long term sequalae of COVID-19 are also of importance as recent publications describe multi-organ involvement. Long term follow-up of COVID-19 survivors is thus also important to identify possible physical and mental health sequellae.     

Local adaptation of laparoscopic smoke evacuator in COVID-19 pandemic situation

The pandemic of COVID-19 has been a game changer in many aspects of medical care, including laparoscopic surgery service. Uncertainty in the early pandemic has led to the fear of doing laparoscopic surgery with regard to the possibility of SARS-COV-2 transmission through surgical smoke. We carried out laparoscopic surgery during the COVID-19 pandemic with intention to test our local adaptation of a laparoscopic smoke evacuator. Twenty-five laparoscopic cases for digestive surgery were performed with uneventful results. In summary, a low cost local adaptation of laparoscopic smoke and safe surgical behavior should be the standard of care when delivering laparoscopic surgery service in the pandemic era and forward.     

Are Migraine Patients at Increased Risk for Symptomatic Coronavirus Disease 2019 Due to Shared Comorbidities?

The coronavirus disease 2019 (COVID-19) pandemic has rapidly transformed the whole world and forced us to look through comorbid diseases and risk factors from a different perspective. COVID-19 shows some inherent risk factors like cardiovascular comorbidities independent from age, gender, and geographic location. One of the most peculiar features of the COVID-19 pandemic is that severe acute respiratory syndrome coronavirus 2 respiratory infections disproportionately impact patients with hypertension, diabetes, and other cardiovascular comorbidities rather than those with allergic respiratory diseases and immune-compromised conditions. Migraine is a complex neuro-vasculo-inflammatory disorder that is also packed frequently with certain medical conditions including vascular disorders, hypertension, allergic diseases such as asthma and systemic inflammatory disorders. Accordingly, 2 different questions arise during the pandemic: (1) Do share comorbidities of cardiovascular diseases and hypertension increase the risk of symptomatic COVID-19 for migraine patients? (2) Do comorbid allergic and atopic diseases, including asthma act as opposite influencers alongside with female gender? This paper focuses on the co-existence of comorbidities of COVID-19, in comparison with migraine, based on a wide clinical dataset and available reports. Discussed mechanisms include potential strategic roles of angiotensin-converting enzyme 2, angiotensin-II, and nucleotide oligomerization domain-like receptor family, pyrin domain containing 3 inflammasome, playing remarkable parts in the pathogenesis of COVID-19 and migraine. There are also some clues about the importance of endothelial and pericyte dysfunction and neuroinflammation in COVID-19 infection, related to complications and survival of the patients. The large epidemiological studies as well as basic research, focusing on migraine patients with COVID-19 will clarify these vital questions during the upcoming periods.