Strategies for children's hospital in response to COVID-19 pandemic: perspective and practice at a designated pediatric hospital in Shanghai, China.
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ABSTRACT:
SUBMITTER: Zhang XB
PROVIDER: S-EPMC7561227 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Strategies for children's hospital in response to COVID-19 pandemic: perspective and practice at a designated pediatric hospital in Shanghai, China.
Zhang Xiao-Bo XB Hu Xiao-Jing XJ Zhai Xiao-Wen XW Gu Ying Y Yuan Lin L Shi Peng P Ge Xiao-Lin XL Liu Gong-Bao GB Shen Guo-Mei GM Wang Chuan-Qing CQ Xia Ai-Mei AM Zeng Mei M Huang Guo-Ying GY
World journal of pediatrics : WJP 20201015 6
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| S-EPMC10105610 | biostudies-literature
Project description:Since early December 2019, patients with unknown pneumonia have been found in Wuhan City, Hubei Province, China. The pathogen in these cases was quickly identified as a new type of coronavirus. The World Health Organization named it 2019 novel coronavirus (2019-nCoV), and the disease caused by the pathogen was called 2019 Coronavirus Disease (COVID-19), which was characterized by higher pathogenicity, transmission of human to human. So it has rapidly spread to more than 190 countries all over the world. With the sudden outbreak of COVID-19, preventing the spread of COVID-19 is the primary problem. Despite fewer children than adults have been affected by the COVID-19, Pediatric Intensive Care Unit (PICU), as a ward for critically ill patients, is also confronted with high risk of 2019-nCoV infection. It is necessary for PICU managers to thoroughly carry out scientific and effective department management and carefully execute of infection control measures to prevent the transmission. According to recommendations for the COVID-19 prevention and control, the relevant guidelines and the authors' work experience, this paper proposes and optimizes the strategic plan for the management of COVID-19 outbreak in PICU, and emphasizes that department managers should conduct comprehensive risk assessments, manage the pediatric patients and healthcare workers meticulously, strengthen the implementation of infection control measures, and use risk management and process control to effectively manage the department as well as to protect the safety of both the patients and the staff.
| S-EPMC7804477 | biostudies-literature
Project description:BACKGROUND:Pattern mining utilizes multiple algorithms to explore objective and sometimes unexpected patterns in real-world data. This technique could be applied to electronic medical record data mining; however, it first requires a careful clinical assessment and validation. OBJECTIVE:The aim of this study was to examine the use of pattern mining techniques on a large clinical dataset to detect treatment and medication use patterns for childhood pneumonia. METHODS:We applied 3 pattern mining algorithms to 680,138 medication administration records from 30,512 childhood inpatients with diagnosis of pneumonia during a 6-year period at a children's hospital in China. Patients' ages ranged from 0 to 17 years, where 37.53% (11,453/30,512) were 0 to 3 months old, 86.55% (26,408/30,512) were under 5 years, 60.37% (18,419/30,512) were male, and 60.10% (18,338/30,512) had a hospital stay of 9 to 15 days. We used the FP-Growth, PrefixSpan, and USpan pattern mining algorithms. The first 2 are more traditional methods of pattern mining and mine a complete set of frequent medication use patterns. PrefixSpan also incorporates an administration sequence. The newer USpan method considers medication utility, defined by the dose, frequency, and timing of use of the 652 individual medications in the dataset. Together, these 3 methods identified the top 10 patterns from 6 age groups, forming a total of 180 distinct medication combinations. These medications encompassed the top 40 (73.66%, 500,982/680,138) most frequently used medications. These patterns were then evaluated by subject matter experts to summarize 5 medication use and 2 treatment patterns. RESULTS:We identified 5 medication use patterns: (1) antiasthmatics and expectorants and corticosteroids, (2) antibiotics and (antiasthmatics or expectorants or corticosteroids), (3) third-generation cephalosporin antibiotics with (or followed by) traditional antibiotics, (4) antibiotics and (medications for enteritis or skin diseases), and (5) (antiasthmatics or expectorants or corticosteroids) and (medications for enteritis or skin diseases). We also identified 2 frequent treatment patterns: (1) 42.89% (291,701/680,138) of specific medication administration records were of intravenous therapy with antibiotics, diluents, and nutritional supplements and (2) 11.53% (78,390/680,138) were of various combinations of inhalation of antiasthmatics, expectorants, or corticosteroids. Fleiss kappa for the subject experts' evaluation was 0.693, indicating moderate agreement. CONCLUSIONS:Utilizing a pattern mining approach, we summarized 5 medication use patterns and 2 treatment patterns. These warrant further investigation.
| S-EPMC6450478 | biostudies-literature
Project description:BackgroundCharacterized by rapid transmission but lower severity, the new Omicron wave brought about an acute increase in local corona virus disease 2019 (COVID-19) cases in Shanghai, followed by stricter infection prevention and control strategies. Inevitably, more time was required for emergency consultation and treatment of children with critical illnesses. Therefore, a multidimensional approach was designed to streamline the emergency service and reduce the incidence of nosocomial infection of sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the Omicron wave for the emergency department (ED) at the Children's Hospital of Fudan University (CHFU).MethodsA multidimensional approach was implemented in the ED to help achieve a balance between the demand for emergency services and pandemic control, consisting of ED layout adjustment; electronic screening (E-screening) measures; standard management processes for patients, medical staff, and goods transfer; reliable disinfection measures; and a surveillance system for infection prevention and control. To evaluate the effect of the management strategy, the data on nosocomial infection cases and occupational exposure episodes among staff in the ED were collected. The demographic and clinical characteristics of level I/II children by the five-level pediatric triage tool and their mean duration of stay in the resuscitation room were collected.ResultsThere were 12,114 ED visitors from March 1 to May 31 in 2022, among which 53.24% were medical emergencies (6,449/12,114) and 46.76% were surgical emergencies (5,665/12,114). Twenty-nine patients were sent to the buffer zone, four of whom were transferred to the pediatric intensive care unit (PICU) because of the critical situation. Six patients tested positive for COVID-19 after entering ED, including three in the buffer zone and three in the ED clinic, causing a temporary closure of the ED for disinfection. There were no reports on medical care delays, unintended deaths, staff with COVID-19 infection, or occupational exposures to COVID-19.ConclusionsOur findings highlight the effectiveness of the multidimensional approach, which can simultaneously meet the emergency care needs of patients as well as pandemic prevention and control. However, the results were obtained against the proportional decrease in clinic visitors due to the Shanghai lockdown. Dynamic assessment and further optimization may be adopted to cope with the pre-pandemic visit volume.
| S-EPMC9986790 | biostudies-literature
Project description:BackgroundOff-label drug use is widespread in pediatric drug treatment, and the implementation of guidelines on this topic remains challenging. The objective of this study was to evaluate current practice and awareness of healthcare professionals towards pediatric off-label drug use, as well as the barriers to guideline implementation among pediatric healthcare professionals in Shanghai, China.MethodsA validated questionnaire was issued to representatives of pediatricians, pharmacists, nurses and administrators from hospitals with pediatric qualification in Shanghai.ResultsA total of 679 completed questionnaires from 69 hospitals were included in the analysis. Nearly half (47.9%) of the pediatricians acknowledged that they had prescribed off-label drugs. Most (88.4%) of the pharmacists acknowledged that they had dispensed off-label medicines. The main reason for off-label prescribing was the lack of pediatric dosage information. The most common category of off-label prescribing in children was dosage. Nearly half (42.0%) of the participating hospitals had developed internal protocols for off-label drug use. However, approximately half of the respondents reported that they did not adhere to the guidance and that it had barriers to implementation. Most respondents (84.5%) declared that they were familiar with the term "off-label drug use". However, the awareness rate of the Chinese Expert Consensus of Pediatric Off-Label Drug Use was low (45.7%). More than half (55.4%) of the respondents declared that they did not adhere to the process proposed in the consensus and that barriers existed for its utilization.ConclusionsPediatric off-label drug use is widespread in Shanghai, China, and barriers exist to the implementation of the guideline. A legally recognized national guideline with a broad scope of application for off-label drug use is urgently needed; at the same time, more education and training on off-label drug use should be provided to targeted healthcare professionals.
| S-EPMC6691537 | biostudies-literature
Project description:BackgroundIn the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people's health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances.ObjectiveThis study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children's hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis.MethodsSelecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children's hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations.ResultsA total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children's hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period.ConclusionsThe COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies.
| S-EPMC11252617 | biostudies-literature
Project description:ObjectivesThe coronavirus disease (COVID) 2019 pandemic and resultant stay-at-home orders altered caregivers' responsibilities and children's daily environments. We aimed to compare the epidemiology and morbidity of foreign body ingestions (FBIs) during the COVID pandemic and the prior year.MethodsWe performed a retrospective review of children cared for at our tertiary care children's hospital for FBI from March to July 2019 (pre-COVID) and March to July 2020 (COVID). Cases were identified via a search of all diagnoses of foreign bodies (FBs) in the alimentary tract. Charts were reviewed to determine the types of FBs ingested and the patients' clinical courses.ResultsA total of 71 encounters were identified. Thirty ingestions occurred in the pre-COVID cohort and 42 in the COVID cohort. One patient ingested 2 different FBs. There was a significantly higher rate of FBIs per day in May 2020 (COVID) compared with May 2019 (pre-COVID; 0.387 versus 0.161; P = 0.046). The median age at presentation was not significantly different between the two groups (pre-COVID, 63.8 months; COVID, 62.5 months; P = 0.78). FBs were located in the esophagus less frequently in the COVID cohort than in the pre-COVID cohort (P < 0.01). Endoscopies were less frequently performed in the COVID cohort (52.4% versus 70.0%; odds ratio, 0.47; 95% CI, 0.15-1.40).ConclusionsThe frequency of FBIs trended higher in the COVID cohort, with significantly more FBIs in May 2020 when compared with May 2019. Patients in the COVID cohort more frequently had FBs located beyond the esophagus, indicating later presentation and a lesser need for urgent endoscopic removal.
| S-EPMC8808762 | biostudies-literature
Project description:BackgroundThe number of pediatric cases of infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant has increased. Here, we describe the clinical characteristics of children in a tertiary children's medical center in Shanghai.MethodsA total of 676 pediatric coronavirus disease 2019 (COVID-19) cases caused by the Omicron variant who were admitted to the Shanghai Children's Medical Center from March 28 to April 30, 2022 were enrolled in this single-center, prospective, observational real-world study. Patient demographics and clinical characteristics, especially COVID-19 vaccine status, were assessed.ResultsChildren of all ages appeared susceptible to the SARS-CoV-2 Omicron variant, with no significant difference between sexes. A high SARS-CoV-2 viral load upon admission was associated with leukocytopenia, neutropenia, and thrombocytopenia (P = 0.003, P = 0.021, and P = 0.017, respectively) but not with physical symptoms or radiographic chest abnormalities. Univariable linear regression models indicated that comorbidities (P = 0.001) were associated with a longer time until viral clearance, and increasing age (P < 0.001) and two doses of COVID-19 vaccine (P = 0.001) were associated with a shorter time to viral clearance. Multivariable analysis revealed an independent effect of comorbidities (P < 0.001) and age (P = 0.003). The interaction effect between age and comorbidity showed that the negative association between age and time to virus clearance remained significant only in patients without underlying diseases (P < 0.001).ConclusionThis study describes the clinical characteristics of children infected with the Omicron variant of SARS-CoV-2 and calls for additional studies to evaluate the effectiveness and safety of vaccination against COVID-19 in children.
| S-EPMC9574794 | biostudies-literature
Project description:The COVID-19 pandemic has had a significant impact on the pediatric population, particularly on their access to health services. We conducted a retrospective study to assess the influence that the pandemic, and its related containment and mitigation public health measures, had on pediatric emergencies and hospitalizations in a major tertiary pediatric hospital in Bucharest, Romania, during the first six months of the pandemic, March−August 2020, compared to the same period in 2019. In these first 6 months of the COVID-19 pandemic, the number of pediatric emergencies decreased 2.8-fold compared to the same period in 2019, but the proportion of major emergencies increased significantly (p < 0.001). The number of admissions also decreased 3.3-fold in 2020, compared to 2019, but the risk of admission for lower respiratory tract infections and respiratory failure increased 1.3- and 2.3-fold, respectively. In conclusion, the restrictions imposed by the pandemic containment and mitigation plan not only had a significant impact on reducing emergency department presentations, but also on pediatric admissions in Romania. These data highlight the importance of maintaining optimal access to child health services when confronted with a public health threat, such as the COVID-19 pandemic. Active communication with parents, involving general practitioners, pediatricians, and authorities, is essential for managing children with acute signs of illness in the case of future restrictions or lockdown measures.
| S-EPMC9028540 | biostudies-literature
Project description:IntroductionIn confronting the sudden COVID-19 epidemic, China and other countries have been under great pressure to block virus transmission and reduce fatalities. Converting large-scale public venues into makeshift hospitals is a popular response. This addresses the outbreak and can maintain smooth operation of a country or region's healthcare system during a pandemic. However, large makeshift hospitals, such as the Shanghai New International Expo Center (SNIEC) makeshift hospital, which was one of the largest makeshift hospitals in the world, face two major problems: Effective and precise transfer of patients and heterogeneity of the medical care teams.MethodsTo solve these problems, this study presents the medical practices of the SNIEC makeshift hospital in Shanghai, China. The experiences include constructing two groups, developing a medical management protocol, implementing a multi-dimensional management mode to screen patients, transferring them effectively, and achieving homogeneous quality of medical care. To evaluate the medical practice performance of the SNIEC makeshift hospital, 41,941 infected patients were retrospectively reviewed from March 31 to May 23, 2022. Multivariate logistic regression method and a tree-augmented naive (TAN) Bayesian network mode were used.ResultsWe identified that the three most important variables were chronic disease, age, and type of cabin, with importance values of 0.63, 0.15, and 0.11, respectively. The constructed TAN Bayesian network model had good predictive values; the overall correct rates of the model-training dataset partition and test dataset partition were 99.19 and 99.05%, respectively, and the respective values for the area under the receiver operating characteristic curve were 0.939 and 0.957.ConclusionThe medical practice in the SNIEC makeshift hospital was implemented well, had good medical care performance, and could be copied worldwide as a practical intervention to fight the epidemic in China and other developing countries.
| S-EPMC9853970 | biostudies-literature