Profile of women substance users seeking treatment at tertiary care treatment center in India: A retrospective chart review study

Introduction: Among substance users, women represent a small, unique subpopulation. Studying their socio-demographic and substance-use profile helps us understand their concerns and formulate management strategies. Materials and Methods: In this retrospective chart review, all the available records of outpatient treatment seekers at National Drug Dependence Treatment Centre (NDDTC), All India Institute of Medical Sciences (AIIMS), Ghaziabad, from 1 January 2011 to 31 December 2015 were screened. Data from the women substance users were entered into a specially designed MS Excel format and analyzed. Results: In these 5 years, 217 women (mean age 36.75 ± 11.84 years) sought treatment. Majority were married (75.6%), housewife (53.5%), educated (59.4%), from an urban background (70.0%). Most common primary substance used was opioid (61.3%), including heroin (30.0%) and pentazocine (16.1%). About 20.3% reported injectable opioid use. The mean duration of opioid use was 5.44 ± 4.68 years. History of prior treatment seeking was reported by 4.6% and no prior significant abstinence attempts by 77.4%. Discussion and Conclusion: Majority of female treatment seekers, are young, married urban women and seek treatment for opioid use, particularly heroin (as opposed to pentazocine, suggested by previous studies). Prior treatment seeking and abstinence rates are low. Data indicates the need of specialized services for this population.     

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.     

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 and patient-reported outcomes of chronic and episodic migraine patients at a US tertiary headache center: A retrospective observational study

Objective

To describe differences in clinical and demographic characteristics between patients with episodic migraine (EM) or chronic migraine (CM) and determine the effect of migraine subtype on patient-reported outcome measures (PROM).

Background

Prior studies have characterized migraine in the general population. While this provides a basis for our understanding of migraine, we have less insight into the characteristics, comorbidities, and outcomes of migraine patients who present to subspecialty headache clinics. These patients represent a subset of the population that bears the greatest burden of migraine disability and are more representative of migraine patients who seek medical care. Valuable insights can be gained from a better understanding of CM and EM in this population.

Methods

We conducted a retrospective observational cohort study of patients with CM or EM seen in the Cleveland Clinic Headache Center between January 2012 and June 2017. Demographics, clinical characteristics, and patient-reported outcome measures (3-Level European Quality of Life 5-Dimension [EQ-5D-3L], Headache Impact Test-6 [HIT-6], Patient Health Questionnaire-9 [PHQ-9]) were compared between groups.

Results

Eleven thousand thirty-seven patients who had 29,032 visits were included. More CM patients reported being on disability 517/3652 (14.2%) than EM patients 249/4881 (5.1%) and had significantly worse mean HIT-6 (67.3 ± 7.4 vs. 63.1 ± 7.4, p < 0.001) and median [interquartile range] EQ-5D-3L (0.77 [0.44–0.82] vs. 0.83 [0.77–1.00], p < 0.001), and PHQ-9 (10 [6–16] vs. 5 [2–10], p < 0.001).

Conclusions

There are multiple differences in demographic characteristics and comorbid conditions between patients with CM and EM. After adjustment for these factors, CM patients had higher PHQ-9 scores, lower quality of life scores, greater disability, and greater work restrictions/unemployment.     

Missed nursing care before and during the COVID-19 pandemic: A comparative cross-sectional study

Aim

This study aimed to compare perception of nurses about missed care for the patients before and during the coronavirus disease 2019 (COVID-19) in Jordan. It also examined how nurses differed in terms of the type of missed care and the factors that contributed to it before and during the COVID-19 pandemic. Additionally, socio-demographic factors, including gender, educational level, length of clinical experience, work position, age, and type of shift, were examined to evaluate their association with missed nursing care.

Background

Missed nursing care refers to omission of any aspect of required patient care. Missed care lowers patient satisfaction and also leads to adverse hospital outcomes.

Methods

We adopted a cross-sectional design among 260 nurses working in medical/surgical wards and intensive care units. Views of 130 nurses before COVID-19 were compared with views of 130 nurses during the COVID-19 pandemic. We used the Arabic version of the MISSCARE survey. Data were collected between November 2019 and May 2020.

Results

During COVID-19, nurses had significantly higher satisfaction levels and lower levels of absence and intention to leave than nurses before the COVID-19 pandemic. Differences were observed between nurses’ perceptions of missed care before and during the COVID-19 pandemic. It was observed that missed nursing care increased during COVID-19. The inadequate number of staff nurses was the main reason for missed care activities among both groups. Additionally, age and shift type were significantly associated with an increased reason for missed nursing care among both groups.

Conclusion and implications for nursing

Nurses reported higher satisfaction levels and fewer absences and planned departures during this period. Nurse managers should pay attention by maintaining high satisfaction levels and formulating appropriate policies to reduce missed care levels and thus improve patient care quality.     

On-admission anemia predicts mortality in COVID-19 patients: A single center,retrospective cohort study

ObjectivesWe investigated the impact of anemia based on admission hemoglobin (Hb) level as a prognostic risk factor for severe outcomes in hospitalized patients with coronavirus disease 2019 (COVID-19).MethodsA single-center, retrospective cohort study was conducted from a random sample of 733 adult patients (age ≥ 18 years) obtained from a total of 4356 laboratory confirmed SARS-CoV-2 cases who presented to the Emergency Department of Montefiore Medical Center between March–June 2020. The primary outcome was a composite endpoint of in-hospital severe outcomes of COVID-19. A secondary outcome was in-hospital all-cause mortality.ResultsAmong the 733 patients included in our final analysis, 438 patients (59.8%) presented with anemia. 105 patients (14.3%) had mild, and 333 patients (45.5%) had moderate-severe anemia. Overall, 437 patients (59.6%) had a composite endpoint of severe outcomes. On-admission anemia was an independent risk factor for all-cause mortality, (Odds Ratio 1.52, 95% CI [1.01–2.30], p = 0.046) but not for composite severe outcomes. However, moderate-severe anemia (Hb < 11 g/dL) on admission was independently associated with both severe outcomes (OR1.53, 95% CI [1.05–2.23], p = 0.028) and mortality (OR 1.67, 95% CI [1.09–2.56], p = 0.019) during hospitalization.ConclusionAnemia on admission was independently associated with increased odds of all-cause mortality in patients hospitalized with COVID-19. Furthermore, moderate-severe anemia (Hb <11 g/dL) was an independent risk factor for severe COVID-19 outcomes. Moving forward, COVID-19 patient management and risk stratification may benefit from addressing anemia on admission.     

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.     

Knowledge,attitude, and practice regarding COVID-19 among COVID-19 patients and their correlation with the outcomes: A cross-sectional study

Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes.Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76％) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63％; the mean attitude scores were 2.42, with an overall correct rate of 60.50％; the mean practice scores were 5.12, with an overall correct rate of 64.00％. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.     

Mortality characteristics during the two waves of COVID-19 in India:A retrospective observational study

Objective:To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India.Methods:Data were taken from the hospital’s electronic system for COVID-19 patients from August 2020 to December 2020,and the second from January 2021 to May 2021.The mortality rate,demographic and clinical characteristics,laboratory profile,and reasons for the death of the two waves were retrieved and compared,and the risk factors of the two waves were determined.Results:In the first wave,1177 COVID-19 cases visited the hospital and 96(8.2%)died.In comparison,the death rate in the second wave was significantly higher(244/2038,12.0%)(P<0.001).No significant difference in age[60(50-69)vs.60.5(53-70),P=0.11]or gender(P=0.34)was observed between the two waves.Compared to the first wave.there were significantly more cases with fever,cough,weakness,loss of taste and smell,and sore throat during the second wave(P<0.05),but significantly fewer cases with kidney disease(6.6%vs.13.5%,P=0.038)and diabetes mellitus(35.7%vs.50.0%,P=0.015).Besides,during the second wave,more patients had abnormal X-ray findings,higher levels of lymphocytes and serum ferritin(P<0.05).In addition,there were significant differences in the rate of death cases with acidosis,septic shock,acute kidney injury,diabetes mellitus,cardiovascular events,hypothyroidism(P<0.05).Multivariate regression showed that during the first wave,age(OR:1.10;95%CI:1.02-1.21),diabetes mellitus(OR:3.16;95%CI:2.08-3.53),and abnormal X-ray(2.67;95%CI:2.32-2.87)were significant independent risk factors of mortality;while in the second wave,age(OR:1.13;95%CI:1.12-1.28),diabetes mellitus(OR:8.98;95%CI:1.79-45.67),abnormal X-ray(OR:12.83;95%CI:2.32-54.76),high D-dimer(OR:10.89;95%CI:1.56-134.53),and high IL-6(OR:7.89;95%CI:1.18-47.82)were significant independent risk factors of mortality.Conclusion:Overall mortality and incidence of severe diseases are higher in the second wave than the first wave.Demographic characteristics,co-morbidities,and laboratory inflammatory parameters,especially D-dimer and IL-6,are significant risk facors of mortality during the COVID-19 pandemic.     

Changes in endoscopic patterns before and during COVID-19 outbreak: Experience at a single tertiary center in Korean

BACKGROUNDThe surge of coronavirus disease 2019 (COVID-19) patients has markedly influenced the treatment policies of tertiary hospitals because of the need to protect medical staff and contain viral transmission, but the impact COVID-19 had on emergency gastrointestinal endoscopies has not been determined.AIMTo compare endoscopic activities and analyze the clinical outcomes of emergency endoscopies performed before and during the COVID-19 outbreak in Daegu, the worst-hit region in South Korea.METHODSThis retrospective cohort study was conducted on patients aged ≥ 18 years that underwent endoscopy from February 18 to March 28, 2020, at a tertiary hospital in Daegu. Demographics, laboratory findings, types and causes of emergency endoscopies, and endoscopic reports were reviewed and compared with those obtained for the same period in 2018 and 2019.RESULTSFrom February 18 to March 28, a total of 366 emergent endoscopic procedures were performed: Upper endoscopy (170, 50.6%), endoscopic retrograde cholangiopancreatography (113, 33.6%), and colonoscopy with sigmoidoscopy (53, 15.8%). The numbers of procedures performed in 2018 and 2019 dropped by 48.8% and 54.8%, respectively, compared with those in 2020. During the COVID-19 outbreak, the main indications for endoscopy were melena (36.7%), hematemesis (30.6%), and hematochezia (10.2%). Of the endoscopic abnormalities detected, gastrointestinal bleeding was the most common: 39 cases in 2018, 51 in 2019, and 35 in 2020.CONCLUSIONThe impact of COVID-19 is substantial and caused dramatic reductions in endoscopic procedures and changes in patient behaviors. Long-term follow-up studies are required to determine the effects of COVID-19 induced changes in the endoscopy field.     

Effects of hypertension on the outcomes of COVID-19: a multicentre retrospective cohort study

Objectives: Hypertension is thought to be a contributor to mortality in coronavirus disease 2019 patients; however, limited clinical data on the outcomes of COVID-19 in patients with hypertension are available.Methods: This study was designed to confirm whether hypertension affects the outcomes of COVID-19. Results: A total of 983 patients with COVID-19 (female, 48%; male, 52%) were enrolled. Significantly higher odds of 60-day mortality (p = .017) were observed in the hypertensive group. In the hypertensive group, even after adjustment in multivariate analysis, the subgroup of patients 70 years old and older had higher 28-day mortality and total 60-day mortality rates than the other age subgroups (bothp < .05). A total of 297 (89%) COVID-19 patients with hypertension survived, and 35 (11%) died. In addition, compared with hypertensive patients who survived COVID-19, non-survivors had more pre-existing conditions, including cardiovascular diseases and stroke, higher blood pressure on admission, more severe inflammation, and more liver and kidney damage.Conclusion: Hypertension does not affect the outcome of COVID-19, which is different than the conclusions drawn in other studies. However, the 28-day mortality and total 60-day mortality rates of hypertensive patients (age ≥ 70) with COVID-19 were significantly elevated, and compared with the group of survivors, non-surviving COVID-19 patients with hypertension were older, had more basic diseases and had a more severe clinical condition.     

Intensive care burden of COVID-19 in tertiary care hospitals during the first year of outbreak in Kawasaki City,Japan: A retrospective cohort study

IntroductionThis study aimed to describe the changes in the intensive care burden of coronavirus disease 2019 (COVID-19) during the first year of outbreak in Japan.MethodsThis retrospective cohort study included COVID-19 patients who received mechanical ventilation (MV) support in two designated hospitals for critical patients in Kawasaki City. We compared the lengths of MV and stay in the intensive care unit (ICU) or high care unit (HCU) according to the three epidemic waves. We calculated in-hospital mortality rates in patients with or without MV.ResultsThe median age of the sample was 65.0 years, and 22.7% were women. There were 37, 29, and 62 patients in the first (W1), second (W2), and third waves (W3), respectively. Systemic steroids, remdesivir, and prone positioning were more frequent in W2 and W3. The median length of MV decreased from 18.0 days in W1 to 13.0 days in W3 (P = 0.019), and that of ICU/HCU stay decreased from 22.0 days in W1 to 15.5 days in W3 (P = 0.027). The peak daily number of patients receiving MV support was higher at 18 patients in W1, compared to 8 and 15 patients in W2 and W3, respectively. The mortality rate was 23.4%, which did not significantly change (P = 0.467).ConclusionsThe lengths of MV and ICU/HCU stay per patient decreased over time. Despite an increase in the number of COVID-19 patients who received MV in W3, this study may indicate that the intensive care burden during the study period did not substantially increase.     

Aggression and burnout in nurses during COVID-19: A cross-sectional study

Workplace violence against nurses, an ever-present problem in the healthcare workplace, has been increasing with COVID-19 and affects occupational health. This study analyzed the consequences of COVID-19 on violence against nurses, identifying its association with burnout, emphasizing the importance of work-related variables. A total of 1013 actively employed nurses in Spain with a mean age of 34.71 years filled out a computer-assisted web interviewing survey. Aggression as a consequence of their work was reported by 73.44% of the nurses. Those most affected were in primary care, and verbal aggression by patients and their families was the most frequent. Nurses who were attacked scored significantly higher in emotional exhaustion and depersonalization. Furthermore, 83.22% said that COVID-19 was an important factor in the increase in violence toward healthcare workers. Analysis showed that a perceived secure environment was a mediator between the belief that COVID-19 was an influential factor in the increase of violence and the depersonalization dimension of burnout. Increasing perceived security in the work environment among nurses can be effective in promoting well-being, work performance, and commitment to the profession.     

Effect of interhospital transfer on resource utilization and outcomes at a tertiary care referral center

OBJECTIVE: Mortality and length of stay are two outcome variables commonly used as benchmarks in rating the performance of medical centers. Acceptance of transfer patients has been shown to affect both outcomes and the costs of health care. Our objective was to compare observed and predicted lengths of stay, observed and predicted mortality, and resource consumption between patients directly admitted and those transferred to the intensive care unit (ICU) of a large academic medical center. DESIGN: Observational cohort study. SETTING: Mixed medical/surgical ICU of a university hospital. PATIENTS: A total of 4,569 consecutive patients admitted to a tertiary care ICU from April 1, 1997, to March 30, 2000. INTERVENTIONS: None. MEASUREMENTS: Acute Physiology and Chronic Health Evaluation (APACHE) III score, actual and predicted ICU and hospital lengths of stay, actual and predicted ICU and hospital mortality, and costs per admission. MAIN RESULTS: Crude comparison of directly admitted and transfer patients revealed that transfer patients had significantly higher APACHE III scores (mean, 60.5 vs. 49.7, p < .001), ICU mortality (14% vs. 8%, p < .001), and hospital mortality (22% vs. 14%, p < .001). Transfer patients also had longer ICU lengths of stay (mean, 6.0 vs. 3.8 days, p < .001) and hospital lengths of stay (mean, 20 vs. 15.9 days, p < .001). Stratified by disease severity using the APACHE III model, there was no difference in either ICU or hospital mortality between the two populations. However, in the transfer group with the lowest predicted mortality of 0-20%, ICU and hospital lengths of stay were significantly higher. In crude cost analysis, transfer patients' costs were $9,600 higher per ICU admission compared with nontransfer patients (95% confidence interval, $6,000-$13,400). Risk stratification revealed that the higher per-patient cost was entirely confined to the transfer patients with the lowest predicted mortality. CONCLUSIONS: Patients transferred to a tertiary care ICU are generally more severely ill and consume more resources. However, they have similar adjusted mortality outcomes when compared with directly admitted patients. The difference in resource consumption is mainly attributable to the group of patients in the lowest predicted risk bracket.     

Echocardiographic and electrocardiographic findings in COVID-19 patients: a cross-sectional study

The International Journal of Cardiovascular Imaging - There are still many gaps in our knowledge regarding the direct cardiovascular injuries due to COVID-19 infection. In this study, we tried to...