Impact of Public Health Emergency Response to COVID-19 on Management and Outcome for STEMI Patients in Beijing-A Single-Center Historic Control Study.
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ABSTRACT:
SUBMITTER: Song C
PROVIDER: S-EPMC7462598 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Introduction On April 29, 2020, China entered a normalization stage of prevention and control. By December 2021, more than 40 outbreaks had occurred in China, which reflected the shortcomings of the pandemic prevention and control measures in China at that time. As the capital city of China, Beijing faces more pressure in epidemic prevention and control. Material and Methods We used the COVID-19 cluster containment evaluation indicators to determine the effects of prevention and control measures on four COVID-19 outbreaks in Beijing. After considering the specificity and operability of evaluation indicators and the availability of evaluation data, the evaluation system in our study consisted of six dimensions: epidemic prevention and control effect, discovery and detection ability, precision prevention and control capability, public protection effect, medical treatment and nosocomial infection prevention and control ability, and information release and public opinion response ability. Results The composite scores of the prevention and control effects of the Xinfadi, Shunyi, Daxing, and Ejina Banner–associated COVID-19 outbreaks in Beijing were 62, 82, 87, and 76, respectively. In the six dimensions, the epidemic prevention and control effect, discovery and detection ability, precision prevention and control capability, and public protection effect scores for the Xinfadi outbreak were lower than those for the Shunyi, Daxing and Ejina Banner–associated outbreaks. The medical treatment and nosocomial infection prevention and control ability scores for the outbreak associated with Ejina Banner were lower than those for the Xinfadi, Shunyi, and Daxing outbreaks. Conclusion In managing cluster outbreaks, Beijing was able to detect index cases early enough to reduce the scale and duration of the outbreak and consistently release official information to reduce public panic, standardize the management of centralized quarantine sites to prevent cross-infection, adhere to the " dynamic COVID‐zero" strategy to accurately prevent and control outbreaks, reduce the societal influence of the pandemic, and coordinate the epidemic prevention and control and socio-economic development. Graphical abstract Image, graphical abstract
| S-EPMC9213041 | biostudies-literature
Project description:BACKGROUND:Many meningiomas are detected incidentally and remain asymptomatic until intervention. The goal of this study was to describe the management and outcome in this group of surgically treated asymptomatic meningiomas. METHODS:From 2004 to 2017, 45 patients with asymptomatic meningioma were surgically treated at Sahlgrenska University Hospital, and their medical records and imaging data were analyzed. The asymptomatic cases were matched with symptomatic ones with respect to age at diagnosis, location, WHO (World Health Organization) grade, and Simpson grade. RESULTS:Time from diagnosis to surgery differed between the asymptomatic and symptomatic patients (8.6 vs. 1.3 months; p?<?0.001). Of symptomatic patients, 32.6% still used anti-epileptic drugs >?1 year after surgery, compared with 7.7% of the asymptomatic (p?=?0.003). Thirty-day complication rate was significantly higher among the asymptomatic cases (35.6% vs. 24.4%; 0.001), as well as the proportion of older asymptomatic individuals (>?70 years) experiencing postoperative complication compared with symptomatic patients of the same age group. CONCLUSION:As expected, asymptomatic cases had smaller tumors and waited longer for surgery. Surprisingly, complication rate was significantly higher among asymptomatic cases compared with their symptomatic control. Taken into account that many asymptomatic tumors are removed surgically due to patient's wish, one might suggest a more restrictive approach, especially in the elderly.
| S-EPMC7415028 | biostudies-literature
Project description:The benefit gained by replacing physicians in the prehospital service is still controversial. The present study compared the difference of achievements of pre-hospital emergency between the physicians from public hospitals and those from the Emergency Medical Center.We included prehospital emergency patients who were sent to the hospital by ambulance after emergency calls from February 1 to May 31, 2016, in Shanghai (24,250,000 inhabitants). Cohort characteristics and diagnoses were described, and the data were analyzed using the Shanghai Emergency Medical Center's database software. We determined whether the physicians from public hospitals were associated with greater success rate of cardiopulmonary resuscitation (CPR) and examined the diseases category and the number of patients with cardiac arrest in prehospital emergency patients.During February 1, 2016, to May 31, 2016, the total turnout of ambulances in the urban area of Shanghai was 107,341 times, among which, first aid was 55,053 times. The number of patients with cardiac arrest was 3012, the 3 principal causes for cardiac arrest were Unknown diagnosis (45.19%), Cardiovascular disease (28.02%) and Respiratory diseases (11.09%), and the successful rate of CPR was 1.56%. The number of critically ill patients, encountered by the physicians from public hospitals, was 10.33% as compared to those from the Emergency Medical Center, which was 11.77% (P?<?.001). Although the success rate of CPR of the physicians from public hospitals was lower than that of the physicians from the Emergency Medical Center (1.22-1.58%), it did not achieve statistical significance (P?>?.05).Transferring the physicians from public hospitals to work in Emergency Medical Center showed no improvement in the success rates of resuscitation.
| S-EPMC6221651 | biostudies-literature
Project description:BackgroundCardiac sarcoidosis (CS) and giant cell myocarditis (GCM) are rare diseases that share some similarities, but also display different clinical and histopathological features. We aimed to compare the demographics, clinical presentation, and outcome of patients diagnosed with CS or GCM.MethodWe compared the clinical data and outcome of all adult patients with CS (n = 71) or GCM (n = 21) diagnosed at our center between 1991 and 2020.ResultsThe median (interquartile range) follow-up time for patients with CS and GCM was 33.5 [6.5-60.9] and 2.98 [0.6-40.9] months, respectively. In the entire cohort, heart failure (HF) was the most common presenting manifestation (31%), followed by ventricular arrhythmias (25%). At presentation, a left ventricular ejection fraction of < 50% was found in 54% of the CS compared to 86% of the GCM patients (P = 0.014), while corresponding proportions for right ventricular dysfunction were 24% and 52% (P = 0.026), respectively. Advanced HF (NYHA ≥ IIIB) was less common in CS (31%) than in GCM (76%). CS patients displayed significantly lower circulating levels of natriuretic peptides (P < 0.001) and troponins (P = 0.014). Eighteen percent of patients with CS included in the survival analysis reached the composite endpoint of death or heart transplantation (HTx) compared to 68% of patients with GCM (P < 0.001).ConclusionGCM has a more fulminant clinical course than CS with severe biventricular failure, higher levels of circulating biomarkers and an increased need for HTx. The histopathologic diagnosis remained key determinant even after adjustment for markers of cardiac dysfunction.
| S-EPMC9044839 | biostudies-literature
Project description:BackgroundTraumatic brain injury (TBI) is a frequent cause of mortality and acquired neurological impairment in children. It is hypothesized, that with the adequate treatment of SDH in children and adolescence, excellent clinical and functional outcomes can be achieved. The aim of this study was to present the severity and outcome of traumatic SDH in children and adolescence as well as to analyze differences between patients treated surgically and conservatively.MethodsIn this study 47 infants and children with a subdural hematoma (SDH) were treated between 1992 and 2010 at a single level-one trauma center. Data regarding accident, treatment and outcomes were collected retrospectively. To classify the outcomes the Glasgow outcome scale (GOS) scores at hospital discharge and at follow-up visits were used. Severity of SDH was classified according to the Rotterdam score.ResultsIn total, 47 cases were treated (21 surgically, 26 conservatively), with 10 patients needing delayed surgery. Overall, 89% of the patients were able to leave hospital, 5 patients died, 2 patients (5%) within 24 h, another 2 (5%) after 48 h and 1 (2%) within 7 days. In 25 patients (53%) a good recovery was recorded at the last follow-up visit. Outcome was mainly influenced by the following factors: age, severity of TBI, and neurological status. Overall, in 70% good clinical and neurological outcomes could be achieved.ConclusionThe results of this study confirmed that pediatric SDH is a rare, but serious condition. Despite a poor prognosis, most patients could be treated with good outcomes, given that the choice of treatment is correct.Trial registrationResearch registry 2686.
| S-EPMC7518988 | biostudies-literature
Project description:ObjectivesThis study examines the usefulness of computed tomography (CT) scans in evaluating patients with dizziness in the emergency department (ED).MethodsMedical records of patients presented with complaints of dizziness or vertigo to the ED of a tertiary university hospital and underwent head CT scans from July 2015 to June 2018 were reviewed. The patients' demographic information, presenting symptoms, and final head CT scan and Magnetic resonance imaging (MRI) results were collected. Stepwise logistic regressions were used to analyze data.ResultsA total of 326 dizzy patients were included in this study. The majority of the patients (83.1%) were older than 44 years. Acute vertigo pattern of dizziness was detected among 50.6% of the patients and was more common among females than males (p < 0.001). Of these 326 patients who underwent head CT scans, 49 (15%) had abnormal findings with acute ischemic stroke was the most common one. A total of 191 patients underwent follow-up studies. MRI accounted for 70% of the follow-up studies. Of the 134 patients who received MRI of the brain, 36 (27%) had abnormal findings. A significant correlation of RBCs level, presence of other symptoms, and frequency of episodes with the presence of vertigo (p < 0.001) was found.ConclusionThe study's findings indicate low effectiveness of head CT scan compared to MRI for dizziness management. Future studies are suggested to provide more insights into the cost-effectiveness and utility of head CT scans and MRI in providing valuable findings.
| S-EPMC7995485 | biostudies-literature
Project description:ObjectiveStrict control measures under the COVID epidemic have brought an inevitable impact on ST-segment elevation myocardial infarction (STEMI)'s emergency treatment. We investigated the impact of the COVID on the treatment of patients with STEMI undergoing primary PCI.MethodsIn this single center cohort study, we selected a time frame of 6 month after declaration of COVID-19 infection (Jan 24-July 24, 2020); a group of STEMI patients in the same period of 2019 was used as control. Finally, a total of 246 STEMI patients, who were underwent primary PCI, were enrolled into the study (136 non COVID-19 outbreak periods and 110 COVID-19 outbreak periods). The impact of COVID on the time of symptom onset to the first medical contact (symptom-to-FMC) and door to balloon (D-to-B) was investigated. Moreover, the primary outcome was in-hospital major adverse cardiac events (MACE), defined as a composite of cardiac death, heart failure and malignant arrhythmia.ResultsCompared with the same period in 2019, there was a 19% decrease in the total number of STEMI patients undergoing primary PCI at the peak of the pandemic in 2020. The delay in symptom-to-FMC was significantly longer in COVID Outbreak period (180 [68.75, 342] vs 120 [60,240] min, P = 0.003), and the D-to-B times increased significantly (148 [115-190] vs 84 [70-120] min, P < 0.001). However, among patients with STEMI, MACE was similar in both time periods (18.3% vs 25.7%, p = 0.168). On multivariable analysis, COVID was not independently associated with MACE; the history of diabetes, left main disease and age>65 years were the strongest predictors of MACE in the overall population.ConclusionsThe COVID pandemic was not independently associated with MACE; suggesting that active primary PCI treatment preserved high-quality standards even when challenged by a severe epidemic.Clinical trial registrationURL: https://ClinicalTrials.gov Unique identifier: NCT04427735.
| S-EPMC8611919 | biostudies-literature
Project description:BackgroundPublic hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C) largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.MethodsWe compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR) for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR), and failure-to-rescue rate (RS-FTR). The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.ResultsWe found good overall quality with large variations by hospital and condition (mean/range, in %): RSMR-AMI: 6.23 (2.37-14.48), RSMR-stroke: 4.18 (3.58-4.44), RSMR-pneumonia: 7.78 (7.20-8.59), RSMR-CABG: 1.93 (1.55-2.23), RS-CR: 11.38 (9.9-12.88), and RS-FTR: 6.41 (5.17-7.58). Hospital grade was not significantly associated with any risk-adjusted outcome measures.ConclusionsGoing to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.
| S-EPMC4592271 | biostudies-literature
Project description:Anticoagulant-related nephropathy (ARN) is a form of acute kidney injury that mainly occurs in patients with previously unrecognized glomerular disease in addition to excessive anticoagulation. Since a renal biopsy is not performed in most cases, the diagnosis is often presumptive. Here, we present the characteristics of a national Slovenian patient cohort with histologically verified ARN, from the first case in 2014 to December 2020, and a review of the current literature (Pubmed database). In Slovenia, ARN has been detected in 13 patients, seven of whom were treated with coumarins, and others with direct oral anticoagulants. In seven patients, ARN appeared after excessive anticoagulation. As many as 11 patients had underlying IgA nephropathy. Similar to the global data presented here, the pathohistological impairment associated with pre-existing glomerulopathy was mild and disproportionate to the degree of functional renal impairment. The majority of our patients with ARN experienced severe deterioration of renal function associated with histological signs of accompanying acute tubular injury, interstitial edema, and occlusive red blood cell casts. These patients were treated with corticosteroids, which (in addition to supportive treatment and discontinuation of the anticoagulant drug) led to a further improvement in renal function. Anticoagulant therapy combined with a pre-existing glomerular injury may lead to ARN. In addition to discontinuation of the anticoagulant and supportive care, corticosteroids, which are currently listed in only a few cases in the world literature, may have a positive influence on the course of treatment. However, the benefits of steroid treatment must be weighed against the risk of complications, especially life-threatening infections.
| S-EPMC7920283 | biostudies-literature
Project description: Not available
| S-EPMC7537259 | biostudies-literature