Team management in critical care units for patients with COVID-19: an experience from Hunan Province, China.
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ABSTRACT:
SUBMITTER: Tang L
PROVIDER: S-EPMC7275843 | biostudies-literature | 2020 Jun
REPOSITORIES: biostudies-literature
Publications
Team management in critical care units for patients with COVID-19: an experience from Hunan Province, China.
Tang Li L Zhao Xian-Mei XM Yu Xiao-Yan XY
Critical care (London, England) 20200606 1
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Project description:AimThis study describes antipsychotic prescription patterns for drug-naïve inpatients diagnosed with first-episode schizophrenia-spectrum (FES) disorders and factors associated with practices deviating from China's current guidelines.MethodsAll inpatients aged 7 to 45 years experiencing a first episode of schizophrenia-spectrum disorder with a duration of untreated illness of less than 18 months and admitted between 1 August 2016 and 1 August 2017 to one of eight psychiatric hospitals in Hunan were included. Demographics, clinical characteristics and prescriptions at discharge were collected from electronic medical records. Logistic regression and random forest methods were used to model relationships between demographic and clinical factors and deviations from China's guidelines.ResultsOf the 602 inpatients included in the study, 598 (99.3%) were prescribed antipsychotics, and no patients were discharged on long-acting injectable antipsychotics. Polypharmacy (more than one antipsychotic prescribed) was present in 121 (20.2%) participants. Clozapine was prescribed to 45 (7.5%) patients. Adults receiving polypharmacy were more likely to be prescribed high-dose antipsychotics than those receiving a single antipsychotic. Minors under 13 years of age were more likely to receive polypharmacy and unapproved antipsychotics than those older than 13 years.ConclusionsOur findings suggest that most of the inpatients were prescribed a single antipsychotic at discharge, consistent with China's guidelines. Minors with FES and patients discharged on polypharmacy and clozapine may require more intense monitoring and management. With the current implementation of China's National Mental Health Working Plan, these results will assist decision-makers in allocating resources and conducting reforms to facilitate best practice treatment for FES.
| S-EPMC8359180 | biostudies-literature
Project description: Not available
| S-EPMC7042184 | biostudies-literature
Project description:Tuberculosis (TB) is the leading cause of death from a bacterial pathogen worldwide. China has the third highest TB burden in the world, with a high reported burden in Hunan Province (amongst others). This study aimed to investigate the spatial distribution of TB and identify socioeconomic, demographic, and environmental drivers in Hunan Province, China. Numbers of reported cases of TB were obtained from the Tuberculosis Control Institute of Hunan Province, China. A wide range of covariates were collected from different sources, including from the Worldclim database, and the Hunan Bureau of Statistics. These variables were summarized at the county level and linked with TB notification data. Spatial clustering of TB was explored using Moran's I statistic and the Getis-Ord statistic. Poisson regression models were developed with a conditional autoregressive (CAR) prior structure, and with posterior parameters estimated using a Bayesian approach with Markov chain Monte Carlo (MCMC) simulation. A total of 323,340 TB cases were reported to the Hunan TB Control Institute from 2013 to 2018. The mean age of patients was 51.7 years (SD + 17.6 years). The majority of the patients were male (72.6%, n = 234,682) and had pulmonary TB (97.5%, n = 315,350). Of 319,825 TB patients with registered treatment outcomes, 306,107 (95.7%) patients had a successful treatment outcome. The annual incidence of TB decreased over time from 85.5 per 100,000 population in 2013 to 76.9 per 100,000 population in 2018. TB case numbers have shown seasonal variation, with the highest number of cases reported during the end of spring and the beginning of summer. Spatial clustering of TB incidence was observed at the county level, with hotspot areas detected in the west part of Hunan Province. The spatial clustering of TB incidence was significantly associated with low sunshine exposure (RR: 0.86; 95% CrI: 0.74, 0.96) and a low prevalence of contraceptive use (RR: 0.88; 95% CrI: 0.79, 0.98). Substantial spatial clustering and seasonality of TB incidence were observed in Hunan Province, with spatial patterns associated with environmental and health care factors. This research suggests that interventions could be more efficiently targeted at locations and times of the year with the highest transmission risk.
| S-EPMC8297355 | biostudies-literature
Project description:Objectives This study aims to explore the spatial and spatiotemporal distribution of pertussis in Hunan Province, and provide a scientific basis for targeting preventive measures in areas with a high incidence of pertussis. Design In this retrospective spatial and spatiotemporal (ecological) study, the surveillance and population data of Hunan Province from 2009 to 2019 were analysed. The ArcGIS V.10.3 software was used for spatial autocorrelation analysis and visual display, and SaTScan V.9.6 software was used for statistical analysis of spatiotemporal scan data. Settings Confirmed and suspected pertussis cases with current addresses in Hunan Province and onset dates between 1 January 2009 and 31 December 2019 were included in the study. Participants The study used aggregated data, including 6796 confirmed and suspected pertussis cases. Results The seasonal peak occurred between March and September, and scattered children were at high risk. The global Moran’s I was between 0.107 and 0.341 (p<0.05), which indicated that the incidence of pertussis in Hunan had a positive spatial autocorrelation. The results of local indicators of spatial autocorrelation analysis showed that the hot spots were mainly distributed in the northeast region of Hunan Province. Moreover, both purely space and spatiotemporal scans showed that the central and northeastern parts were the most likely cluster areas with an epidemic period between March and October in 2018 and 2019. Conclusion The distribution of the pertussis epidemic in Hunan Province from 2009 to 2019 shows spatiotemporal clustering. The clustering areas of the pertussis epidemic were concentrated in the central and northeastern parts of Hunan Province between March and October 2018 and 2019. In areas with low pertussis incidence, the strengthening of the monitoring system may reduce under-reporting. In areas with high pertussis incidence where we could study whether the genes of endemic pertussis strains are mutated and differ from vaccine strains.
| S-EPMC9462112 | biostudies-literature
Project description:BackgroundDrug-resistant tuberculosis (DR-TB) remains a major public health challenge in China, with varying treatment outcomes across different regions. Understanding the spatial distribution of DR-TB treatment outcomes is crucial for targeted interventions to improve treatment success in high-burden areas such as Hunan Province. This study aimed to map the spatial distribution of DR-TB treatment outcomes at a local level and identify sociodemographic and environmental factors associated with poor treatment outcomes in Hunan Province, China.MethodsA spatial analysis was conducted using DR-TB data from the Tuberculosis Control Institute of Hunan Province, covering the years 2013 to 2018. The outcome variable, the proportion of poor treatment outcomes, was defined as a composite measure of treatment failure, death, and loss to follow-up. Sociodemographic, economic, healthcare, and environmental variables were obtained from various sources, including the WorldClim database, the Malaria Atlas Project, and the Hunan Bureau of Statistics. These covariates were linked to a map of Hunan Province and DR-TB notification data using R software version 4.4.0. The spatial clustering of poor treatment outcomes was analyzed using the local Moran's I and Getis-Ord statistics. A Bayesian logistic regression model was fitted, with the posterior parameters estimated using integrated nested Laplace approximation (INLA).ResultsIn total, 1381 DR-TB patients were included in the analysis. An overall upward trend in poor DR-TB treatment outcomes was observed, peaking at 14.75% in 2018. Deaths and treatment failures fluctuated over the years, with a notable increase in deaths from 2016 to 2018, while the proportion of patients lost to follow-up significantly declined from 2014 to 2018. The overall proportion of poor treatment outcomes was 9.99% (95% credible interval (CI): 8.46% to 11.70%), with substantial spatial clustering, particularly in Anxiang (50%), Anren (50%), and Chaling (42.86%) counties. The proportion of city-level indicators was significantly associated with higher proportions of poor treatment outcomes (odds ratio (OR): 1.011; 95% CRI: 1.20 December 2024 001-1.035).ConclusionsThis study found a concerning increase in poor DR-TB treatment outcomes in Hunan Province, particularly in certain high-risk areas. Targeted public health interventions, including enhanced surveillance, focused healthcare initiatives, and treatment programs, are essential to improve treatment success.
| S-EPMC11769319 | biostudies-literature
Project description:A new species, Lysimachiafenghwaiana G.Hao & H.F.Yan (Primulaceae), from Hunan Province, China, is described and illustrated. This new species belongs to Lysimachiasubgen.Lysimachiasect.Nummularia and is morphologically similar to L.crista-galli and L.carinata, but is distinctive in its leaf shape and arrangement of flowers. It can be further distinguished from L.crista-galli by the absence of calyx lobule spur, and from L.carinata by the black glandular striates in the corolla lobes, rather than punctate.
| S-EPMC10196811 | biostudies-literature
Project description:Background: Information about critically ill patients with coronavirus disease 2019 (COVID-19) in China but outside of Wuhan is scarce. We aimed to describe the clinical features, treatment, and outcomes of patients with COVID-19 admitted to the intensive care unit (ICU) in Guangdong Province. Methods: In this multicenter, retrospective, observational study, we enrolled consecutive patients with COVID-19 who were admitted to seven ICUs in Guangdong Province. Demographic data, symptoms, laboratory findings, comorbidities, treatment, and outcomes were collected. Data were compared between patients with and without intubation. Results: A total of 45 COVID-19 patients required ICU admission in the study hospitals [mean age 56.7 ± 15.4 years, 29 males (64.4%)]. The most common symptoms at onset were fever and cough. Most patients presented with lymphopenia and elevated lactate dehydrogenase. Treatment with antiviral drugs was initiated in all patients. Thirty-six patients (80%) developed acute respiratory distress syndrome at ICU admission, and 15 (33.3%) septic shock. Twenty patients (44.4%) were intubated, and 10 (22.2%) received extracorporeal membrane oxygenation. The 60-day mortality was 4.4% (2 of 45). Conclusion: COVID-19 patients admitted to ICU were characterized by fever, lymphopenia, acute respiratory failure, and multiple organ dysfunction. The mortality of ICU patients in Guangdong Province was relatively low with a small sample size.
| S-EPMC7604321 | biostudies-literature
Project description:BackgroundFeline and canine babesiosis is an important tick-borne disease caused by parasites of the genus Babesia. The disease has a worldwide distribution and causes serious health problems in domestic and wild canidae and felidae.ResultsGenomic DNA was isolated from blood samples, which were randomly collected from pet dogs (n = 115) and cats (n = 25) in Changsha city of Hunan Province, China. Results of nested PCR assay targeting 18S rRNA gene and partial gene sequencing revealed that seven animals were infected with Babesia species, five dogs (5/115, 4.3%) and two cats (2/25, 8.0%). Sequence analysis showed that four dogs (3.5%) were positive for Babesia canis, and the other one for Babesia vogeli (0.87%). The two cats were infected by Babesia hongkongensis.ConclusionsThe findings of this study will expand knowledge of the distribution of Babesia species and provide important epidemiological information for the control of animal babesiosis in China.
| S-EPMC7433179 | biostudies-literature
Project description:BACKGROUND: Schistosomiasis japonica is prevalent in Asian countries and it remains a major public health problem in China. The major endemic foci are the marsh and lake regions of southern China, particularly the Dongting Lake region bordering Hunan and Hubei provinces, and the Poyang Lake region in Jiangxi province. Domestic ruminants, especially bovines, have long been considered to play a major role in the transmission of Schistosoma japonicum to humans. METHODS AND FINDINGS: A miracidial hatching technique was used to investigate the prevalence of S. japonicum infections in domestic ruminants and field feces collected from two towns located to the south and east of Dongting Lake, Hunan province, between 2005 and 2010. The overall prevalence of infection was not significantly reduced from 4.93% in 2005 to 3.64% in 2008, after which it was maintained at this level. Bovines comprised 23.5-58.2% of the total infected ruminants, while goats comprised 41.8-76.5%. Infection rates in cattle and goats were significantly higher than those found in buffalo in most study years. The prevalence in buffalo younger than three years was significantly higher than that in those aged over three years. All the positive field samples of feces were derived from bovines in Nandashan. In Matang Town, 61.22% of the positive field feces were from bovines, while the rest were from goats. The positive rates for field feces were approximately the same in April and November/October. CONCLUSIONS: The present study found that bovines and goats are major sources of S. japonicum infection in the Dongting lake region and there was age-related resistance in buffalo. Both bovines and goats should be treated equally when controlling S. japonicum infections in the Dongting lake region. It is essential to conduct an additional mass treatment in late March or early April, in addition to the original treatment scheme.
| S-EPMC3281023 | biostudies-other
Project description:The worldwide emergence of multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) has posed additional challenges for global tuberculosis (TB) control efforts, as limited treatment options are available and treatment outcomes are often sub-optimal. This study determined treatment outcomes among a cohort of MDR-TB and XDR-TB patients in Hunan Province, China, and identified factors associated with poor treatment outcomes.We conducted a retrospective study using data obtained from medical records of TB patients in Hunan Chest Hospital, and from the internet-based TB management information system managed by the Tuberculosis Control Institute of Hunan Province, for the period 2011 to 2014. Treatment outcomes were assessed for patients diagnosed with MDR-TB (TB resistant to at least isoniazid and rifampicin) and XDR-TB (MDR-TB plus resistance to any fluoroquinolone and at least 1 second-line injectable drug). Cumulative incidence functions were used to estimate time to events (i.e. poor treatment outcomes, loss to follow-up, and unfavourable treatment outcomes); and a competing-risks survival regression model was used to identify predictors of treatment outcomes.Of 481 bacteriologically-confirmed patients, with a mean age of 40 years (standard deviation SD ± 13 years), 10 (2%) had XDR-TB and the remainder (471; 98%) had MDR-TB. For the entire cohort, treatment success was 57% (n = 275); 58% (n = 272) for MDR-TB and 30% (n = 3) for XDR-TB. Overall, 27% were lost to follow-up (n = 130), 27% (n = 126) for MDR-TB and 40% (n = 4) for XDR-TB; and 16% had a poor treatment outcome (n = 76), 15% for MDR-TB and 30% (n = 3) for XDR-TB. Of the 10 XDR-TB patients, 3 (30%) completed treatment, 3 (30%) died and 4 (40%) were lost to follow-up. Of the 471 MDR-TB patients, 258 (57%) were cured, 16 (3%) completed treatment, 13 (3%) died, 60 (13%) experienced treatment failure, and 126 (27%) were lost to follow-up. Resistance to ofloxacin was an independent predictor of poor (AHR = 3.1; 95%CI = 1.5, 6.3), and unfavourable (AHR = 1.7; 95%CI = 1.07, 2.9) treatment outcomes. Patients who started treatment during 2011-2012 (AHR = 2.8; 95% CI = 1.5, 5.3) and 2013 (AHR = 2.1; 95% CI = 1.2, 3.9) had poorer treatment outcomes compared to patients who started treatment during 2014.Patients with MDR-TB and XDR-TB had low rates of treatment success in Hunan Province, especially among patients who started treatment during 2011 to 2013, with evidence of improved treatment outcomes in 2014. Resistance to ofloxacin was an independent predictor of poor treatment outcomes.
| S-EPMC5559784 | biostudies-other