COVID-19 multidisciplinary high dependency unit: the Milan model.
Ontology highlight
ABSTRACT:
SUBMITTER: Aliberti S
PROVIDER: S-EPMC7545383 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:The COVID-19 pandemic has forced the health care industry to develop dynamic protocols to maximize provider safety as aerosolizing procedures, specifically intubation, increase the risk of contracting SARS-CoV-2. The authors sought to create a quality improvement framework to ensure safe practices for intubating providers, and describe a multidisciplinary model developed at an academic tertiary care facility centered on rapid-cycle improvements and real-time gap analysis to track adherence to COVID-19 intubation safety protocols. The model included an Intubation Safety Checklist, a standardized documentation template for intubations, obtaining real-time feedback, and weekly multidisciplinary team meetings to review data and implement improvements. This study captured 68 intubations in suspected COVID-19 patients and demonstrated high personal protective equipment compliance at the institution, but also identified areas for process improvement. Overall, the authors posit that an interdisciplinary workgroup and the integration of standardized processes can be used to enhance intubation safety among providers during the COVID-19 pandemic.
| S-EPMC7672671 | biostudies-literature
Project description:Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a novel coronavirus that is responsible for the 2019-2020 pandemic. In this comprehensive review, we discuss the current published literature surrounding the SARS-CoV-2 virus. We examine the fundamental concepts including the origin, virology, pathogenesis, clinical manifestations, diagnosis, laboratory, radiology, and histopathologic findings, complications, and treatment. Given that much of the information has been extrapolated from what we know about other coronaviruses including severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV), we identify and provide insight into controversies and research gaps for the current pandemic to assist with future research ideas. Finally, we discuss the global response to the coronavirus disease-2019 (COVID-19) pandemic and provide thoughts regarding lessons for future pandemics.
| S-EPMC7403483 | biostudies-literature
Project description:BackgroundForecasting models for intensive care occupancy of coronavirus disease 2019 (COVID-19) patients are important in the current pandemic for strategic planning of patient allocation and avoidance of regional overcrowding. They are often trained entirely on retrospective infection and occupancy data, which can cause forecast uncertainty to grow exponentially with the forecast horizon.MethodologyWe propose an alternative modeling approach in which the model is created largely independent of the occupancy data being simulated. The distribution of bed occupancies for patient cohorts is calculated directly from occupancy data from "sentinel clinics". By coupling with infection scenarios, the prediction error is constrained by the error of the infection dynamics scenarios. The model allows systematic simulation of arbitrary infection scenarios, calculation of bed occupancy corridors, and sensitivity analyses with respect to protective measures.ResultsThe model was based on hospital data and by adjusting only two parameters of data in the Aachen city region and Germany as a whole. Using the example of the simulation of the respective bed occupancy rates for Germany as a whole, the loading model for the calculation of occupancy corridors is demonstrated. The occupancy corridors form barriers for bed occupancy in the event that infection rates do not exceed specific thresholds. In addition, lockdown scenarios are simulated based on retrospective events.DiscussionOur model demonstrates that a significant reduction in forecast uncertainty in occupancy forecasts is possible by selectively combining data from different sources. It allows arbitrary combination with infection dynamics models and scenarios, and thus can be used both for load forecasting and for sensitivity analyses for expected novel spreading and lockdown scenarios.
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Project description:BackgroundHealthcare workers (HCWs) are commonly infected by SARS-CoV-2 and represent one of the most vulnerable groups. Adequate prevention strategies are necessary to guarantee HCWs' safety, as well as to prevent dissemination of the infection among patients.AimsTo describe a case series of SARS-CoV-2-positive HCWs in a large public healthcare organization in Milan (Italy) during the most devastating weeks of the epidemic and analyse the sources, symptoms and duration of SARS-CoV-2 infection.MethodsThis study included 172 SARS-CoV-2-positive HCWs who were infected between the 25th of February and the 7th of April 2020. A nasopharyngeal swab (NPS) and RT-PCR were used to indicate.ResultsInitially, the most common sources of infection were other positive HCWs (49%). Medical doctors and nursing assistants were most frequently infected, with infection rates of 53/1000 and 50/1000, respectively. COVID-19 departments were less affected than internal medicine, surgery, intensive care, or emergency room. The most commonly reported symptom was mild cough, while loss of smell (anosmia) and loss of taste (ageusia) were reported as moderate and severe by 30-40% of HCWs. The time necessary for 50% of workers to recover from the infection was 23 days, while it took 41 days for 95% of HCWs to become virus-free.ConclusionsHCWs are commonly infected due to close contacts with other positive HCWs, and non-COVID departments were most affected. Most HCWs were asymptomatic or subclinical but contact tracing and testing of asymptomatic HCWs help identify and isolate infected workers.
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Project description:Weekend admissions to hospital have been associated with adverse patient outcomes, including higher morbidity and mortality risk in general medicine and surgery. The reasons behind this are likely to be multifactorial and include reduced senior clinician-led care, decreased overall workforce, and ineffective or incomplete handover. With the advent of shift-work patterns, robust handover between medical teams is of paramount importance, particularly before weekends. This has been reflected in recent publications by Royal College of Physicians (acute care toolkit 1: handover, May 2011), that identified handover as an error-prone process and issued guidelines designed to optimise its effectiveness. The aim of this project was to evaluate weekend patient mortality and success of handover on the medical high dependency unit of a large teaching hospital in the United Kingdom, before and after introduction of a structured handover tool on Friday afternoons during May 2013. This unit is registrar-led at weekends. Weekend mortality decreased from 43% in March 2013 to 22% in May 2013 (odds ratio 0.37, 95% CI 0.19-0.68, p=0.07). Documentation of resuscitation status and escalation plans increased from 75% in March 2013 to 93% in May 2013. There was universal positive feedback from registrars involved with the handover tool, who provided senior cover during the weekends in May 2013. It is hoped that structured, written handover will ultimately become commonplace in this unit and will improve patient safety at weekends.
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Project description:Mice with a human immune system (humanized mice), generated by transplantation of human hematopoietic stem and progenitor cells (HSPCs), serve as invaluable tools to study the development and function of the human immune system in vivo. By adapting recombinant adeno-associated virus (AAV)-driven gene therapy to deliver hACE2 to the lungs, which allows infection with SARS-CoV-2 of MISTRG6 mice engrafted with HPSCs, we created a humanized mouse model of COVID-19 that recapitulates the distribution and function of the human innate and adaptive immune system and is amenable to the mechanistic study of COVID-19 and its myriad of complications. MISTRG6 mouse model was engineered by a human/mouse homolog gene-replacement strategy to provide physiological factors with regard to quantity, location and time and enable essentially all classes of human HSPCs to develop in mice. MISTRG6 (acronym for genes replaced) mice encode humanized M-CSF (enabling monocytes and tissue macrophage development), GM-CSF/IL-3 (to provide lung alveolar macrophages), SIRPa (establish macrophage tolerance to human cells), ThPO (hematopoiesis and platelets), and IL-6 (better engraftment allowing study of adult human patients and improved antigen-specific antibody responses as well as human IL-6 per se), in a Rag2/Gamma common chain deleted background. We evaluated the transcriptional landscape in uninfected and SARS-CoV-2 infected lungs of humanized mice at multiple time points (2, 4, 7, 14, 28 dpi).
2021-11-04 | GSE186794 | GEO
Project description:Environmental cleaning and disinfection are fundamental health care-associated infection prevention measures. This study aimed to evaluate the disinfection compliance of high-touch surfaces in a COVID-19-only intensive care unit, using a fluorescent marker. It was divided into 3 phases, baseline assessment, educational feedback, and post feedback. Disinfection compliance improved significantly from the first to the third phase, 14.3% to 51.4% (P < .001), respectively.
| S-EPMC9444321 | biostudies-literature
Project description:Coronavirus disease 2019 (COVID-19) has a wide spectrum of disease severity from mild upper respiratory symptoms to respiratory failure. The role of neutralizing antibody (NAb) response in disease progression remains elusive. This study determined the seroprevalence of 733 non-COVID-19 individuals from April 2018 to February 2020 in the Hong Kong Special Administrative Region and compared the neutralizing antibody (NAb) responses of eight COVID-19 patients admitted to the intensive care unit (ICU) with those of 42 patients not admitted to the ICU. We found that NAb against SARS-CoV-2 was not detectable in any of the anonymous serum specimens from the 733 non-COVID-19 individuals. The peak serum geometric mean NAb titer was significantly higher among the eight ICU patients than the 42 non-ICU patients (7280 [95% confidence interval (CI) 1468-36099]) vs (671 [95% CI, 368-1223]). Furthermore, NAb titer increased significantly at earlier infection stages among ICU patients than among non-ICU patients. The median number of days to reach the peak Nab titers after symptoms onset was shorter among the ICU patients (17.6) than that of the non-ICU patients (20.1). Multivariate analysis showed that oxygen requirement and fever during admission were the only clinical factors independently associated with higher NAb titers. Our data suggested that SARS-CoV-2 was unlikely to have silently spread before the COVID-19 emergence in Hong Kong. ICU patients had an accelerated and augmented NAb response compared to non-ICU patients, which was associated with disease severity. Further studies are required to understand the relationship between high NAb response and disease severity.
| S-EPMC7473321 | biostudies-literature
Project description:BACKGROUND:National health-system hospitals of Lombardy faced a heavy burden of admissions for acute respiratory distress syndromes associated with coronavirus disease (COVID-19). Data on patients of European origin affected by COVID-19 are limited. METHODS:All consecutive patients aged ?18 years, coming from North-East of Milan's province and admitted at San Raffaele Hospital with COVID-19, between February 25th and March 24th, were reported, all patients were followed for at least one month. Clinical and radiological features at admission and predictors of clinical outcomes were evaluated. RESULTS:Of the 500 patients admitted to the Emergency Unit, 410 patients were hospitalized and analyzed: median age was 65 (IQR 56-75) years, and the majority of patients were males (72.9%). Median (IQR) days from COVID-19 symptoms onset was 8 (5-11) days. At hospital admission, fever (? 37.5 °C) was present in 67.5% of patients. Median oxygen saturation (SpO2) was 93% (range 60-99), with median PaO2/FiO2 ratio, 267 (IQR 184-314). Median Radiographic Assessment of Lung Edema (RALE) score was 9 (IQR 4-16). More than half of the patients (56.3%) had comorbidities, with hypertension, coronary heart disease, diabetes and chronic kidney failure being the most common. The probability of overall survival at day 28 was 66%. Multivariable analysis showed older age, coronary artery disease, cancer, low lymphocyte count and high RALE score as factors independently associated with an increased risk of mortality. CONCLUSION:In a large cohort of COVID-19 patients of European origin, main risk factors for mortality were older age, comorbidities, low lymphocyte count and high RALE.
| S-EPMC7289745 | biostudies-literature
Project description: Not available
| S-BSST563 | biostudies-other