Maintenance of Stroke Care Quality amid the Coronavirus Disease 2019 Outbreak in Taiwan.
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ABSTRACT:
SUBMITTER: Chen CH
PROVIDER: S-EPMC7568984 | biostudies-literature | 2020 Sep
REPOSITORIES: biostudies-literature
Publications
Maintenance of Stroke Care Quality amid the Coronavirus Disease 2019 Outbreak in Taiwan.
Chen Chih-Hao CH Liu Chi-Hung CH Chi Nai-Fang NF Sung Pi-Shan PS Hsieh Cheng-Yang CY Lee Meng M Tang Sung-Chun SC Jeng Jiann-Shing JS
Journal of stroke 20200929 3
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Project description:Background: Since the global pandemic of coronavirus disease 2019 (COVID-19), the process of emergency medical services has been modified to ensure the safety of healthcare professionals as well as patients, possibly leading to a negative impact on the timely delivery of acute stroke care. This study aimed to assess the impact of the COVID-19 pandemic on the acute stroke care processes and outcomes in tertiary COVID-19-dedicated centers in South Korea. Methods: We included 1,213 patients with acute stroke admitted to three centers in three cities (Seoul, Seongnam, and Daegu) through the stroke critical pathway between September 2019 and May 2020 (before and during the COVID-19 pandemic). In all three centers, we collected baseline characteristics and parameters regarding the stroke critical pathway, including the number of admitted patients diagnosed with acute stroke through the stroke critical pathway, door to brain imaging time, door to intravenous recombinant tissue plasminogen activator time, door to groin puncture time, and door to admission time. We performed an interrupted time series analysis to determine the impact of the COVID-19 outbreak on outcomes and critical pathway parameters. Results: Three centers modified the protocol of the stroke critical pathway during the COVID-19 pandemic. There was an immediate decrease in the number of patients admitted with acute ischemic stroke after the outbreak of COVID-19 in Korea, especially in the center of Daegu, an epicenter of the COVID-19 outbreak. However, the number of patients with stroke soon increased to equal that before the Covid-19 outbreak. In several critical pathway parameters, door to imaging time showed a temporary increase, and door to admission was transiently decreased after the COVID-19 outbreak. However, there was no significant effect on the timely trend. Moreover, there was no significant difference in the baseline characteristics and clinical outcomes between the periods before and during the COVID-19 pandemic. Conclusion: This study demonstrated that the COVID-19 outbreak immediately affected the management process. However, it did not have a significant overall impact on the trends of stroke treatment processes and outcomes. The stroke management process should be modified according to changing situations for optimal acute management.
| S-EPMC7710988 | biostudies-literature
Project description:The coronavirus disease 2019 (COVID-19) pandemic is a global disaster, and recent studies have shown its association with increasing mental health problems such as post-traumatic stress disorder (PTSD), depression, anxiety, and stress. Nursing students, especially nursing interns, may be shunned, harassed, and even blamed as potential COVID-19 spreaders, though they were an important reserve force against COVID-19 and other diseases. Of note, the psychological influences of COVID-19 on nursing students remained unclear. The aim of this study was to evaluate the mental health of nursing students during the COVID-19 pandemic. A cross-sectional online survey was conducted on nursing students in a vocational college from April 12 to 23, 2020. The Impact of Event Scale-Revised, 21-item Depression, Anxiety and Stress Scale, and Pittsburgh Sleep Quality Index were used to assess the degree of symptoms of PTSD, depression, anxiety, stress, and insomnia, respectively. Multivariable logistic regression analysis was performed to determine the potential risk factors for the psychological symptoms. A total of 1,780 college nursing students were asked to participate in this online survey, with 1,532 complete responses. In total, 682 (44.5%) college nursing students reported having PTSD, 358 (22.8%) students reported insomnia, and few students reported depression (n = 45, 2.9%), anxiety (n = 44, 2.9%), and stress (n = 17, 1.1%) symptoms. As compared with junior, female, and rural nursing students, the senior, male, and urban nursing students had higher rates of PTSD, depression, anxiety, stress, respectively, whereas male nursing students had a higher insomnia rate. Multivariable analysis showed that senior nursing students had higher risks of PTSD, depression, anxiety; being male was associated with higher risks of PTSD, depression, anxiety, stress, and insomnia; and urban nursing students had higher risks of PTSD, depression, anxiety, and stress. In summary, a considerable number of nursing students reported mental symptoms of PTSD and insomnia, though few reported mental symptoms of depression, anxiety, and stress. Furthermore, senior, male, and urban nursing students are at risk for developing mental symptoms. Appropriate psychological interventions should be implemented to assure the mental health of nursing students.
| S-EPMC8407077 | biostudies-literature
Project description:PurposeTo describe the investigation and intervention of a cluster of Legionnaires' disease detected during the outbreak of coronavirus disease 2019 (COVID-19) pandemic.MethodsFrom June 7 to 22, 2021, 15 cases in the neighborhood near our hospital were detected. Information about residence, workplace, hospital visit, and potential exposures was collected. Sampling and decontamination were performed for potential sources.ResultsAll 15 patients had pneumonia when visiting the emergency room with negative COVID-19 test results. Most patients were male (73.3%) with the mean age of 65.7 years. The most common comorbidities were diabetes mellitus (40.0%) and hypertension (40%). The most common symptom was fever (93.3%). Two (13.3%) patients needed mechanical ventilators. Fever subsided within 2 days of treatment for most cases (85.7%). Five cases had exposure history at our hospital, and the other 10 lived or worked in the area within 2 km of our hospital, mostly in buildings A and B. Water sampling was carried out for our hospital, buildings A and B; one water sample from a cooling tower in our hospital cultured positive for Legionella bacteria. Early testing and treatment for suspected cases were carried out for the outbreak, and all cases were discharged with pneumonia resolution.ConclusionThis was a community outbreak of Legionnaires' disease near our hospital. COVID-19 tests were repeated frequently before testing for Legionnaires' disease during the COVID-19 pandemic. Early recognition of Legionnaires' disease and timely treatment improved outcome.
| S-EPMC9068600 | biostudies-literature
Project description:BackgroundThe 2019 novel coronavirus disease pandemic (COVID-19) is one of the most serious health risks facing the global population. Teachers' responses are important in the management of the outbreak in schools. The purpose of this study is to examine teachers' risk perception, self-efficacy, response efficacy, and approach to disease prevention during the COVID-19 outbreak in Taiwan.MethodsA descriptive, cross-sectional online survey was completed by 344 teachers across four levels of education. Pearson correlations between major variables were calculated. General linear model with a posthoc test was used to estimate the least squares means for each level of the independent variables and test the mean differences between the response scores.ResultsThe teachers with a higher risk perception showed a stronger adoption of disease prevention measures, but they also showed lower self-efficacy. In addition, teachers with higher self-efficacy had higher response efficiency. Female teachers had relatively stronger adoption of disease prevention measures than their male colleagues, and age was associated with a 0.040 point increase in adoption scores. Elementary school teachers were significantly stronger in this regard than teachers at junior high schools, high schools and universities in terms of behavior scores.ConclusionsHigh implementation rate of Taiwanese teachers' disease prevention measures came from their higher risk perceptions. Among them, older female teachers, especially those who teach at elementary schools, are key to implementing disease prevention measures.
| S-EPMC7833059 | biostudies-literature
Project description:ObjectivesStroke has been reported in observational series as a frequent complication of coronavirus disease 2019, but more information is needed regarding stroke prevalence and outcomes. We explored the prevalence and outcomes of acute stroke in an international cohort of patients with coronavirus disease 2019 who required ICU admission.DesignRetrospective analysis of prospectively collected database.SettingA registry of coronavirus disease 2019 patients admitted to ICUs at over 370 international sites was reviewed for patients diagnosed with acute stroke during their stay.PatientsPatients older than 18 years old with acute coronavirus disease 2019 infection in ICU.InterventionsNone.Measurements and main resultsOf 2,699 patients identified (median age 59 yr; male 65%), 59 (2.2%) experienced acute stroke: 0.7% ischemic, 1.0% hemorrhagic, and 0.5% unspecified type. Systemic anticoagulant use was not associated with any stroke type. The frequency of diabetes, hypertension, and smoking was higher in patients with ischemic stroke than in stroke-free and hemorrhagic stroke patients. Extracorporeal membrane oxygenation support was more common among patients with hemorrhagic (56%) and ischemic stroke (16%) than in those without stroke (10%). Extracorporeal membrane oxygenation patients had higher cumulative 90-day probabilities of hemorrhagic (relative risk = 10.5) and ischemic stroke (relative risk = 1.7) versus nonextracorporeal membrane oxygenation patients. Hemorrhagic stroke increased the hazard of death (hazard ratio = 2.74), but ischemic stroke did not-similar to the effects of these stroke types seen in noncoronavirus disease 2019 ICU patients.ConclusionsIn an international registry of ICU patients with coronavirus disease 2019, stroke was infrequent. Hemorrhagic stroke, but not ischemic stroke, was associated with increased mortality. Further, both hemorrhagic stroke and ischemic stroke were associated with traditional vascular risk factors. Extracorporeal membrane oxygenation use was strongly associated with both stroke and death.
| S-EPMC8594524 | biostudies-literature
Project description:Background and purposeChanges to hospital systems were implemented from March 2020 in Australia in response to the coronavirus disease 2019 pandemic, including decreased resources allocated to stroke units. We investigate changes in the quality of acute care for patients with stroke or transient ischemic attack during the pandemic according to patients' treatment setting (stroke unit or alternate ward).MethodsWe conducted a retrospective cohort study of patients admitted with stroke or transient ischemic attack between January 2019 and June 2020 in the Australian Stroke Clinical Registry (AuSCR). The AuSCR monitors patients' treatment setting, provision of allied health and nursing interventions, prescription of secondary prevention medications, and discharge destination. Weekly trends in the quality of care before and during the pandemic period were assessed using interrupted time series analyses.ResultsIn total, 18,662 patients in 2019 and 8,850 patients in 2020 were included. Overall, 75% were treated in stroke units. Before the pandemic, treatment in a stroke unit was superior to alternate wards for the provision of all evidence-based therapies assessed. During the pandemic period, the proportion of patients receiving a swallow screen or assessment, being discharged to rehabilitation, and being prescribed secondary prevention medications decreased by 0.58% to 1.08% per week in patients treated in other ward settings relative to patients treated in stroke units. This change represented a 9% to 17% increase in the care gap between these treatment settings during the period of the pandemic that was evaluated (16 weeks).ConclusionsDuring the first 6 months of the pandemic, widening care disparities between stroke units and alternate wards have occurred.
| S-EPMC8829483 | biostudies-literature
Project description:BACKGROUND:The current ongoing pandemic outbreak of COVID-19 (Coronavirus Disease 2019) has globally affected 213 countries and territories with more than 2.5 million confirmed cases and thousands of casualties. The unpredictable and uncertain COVID-19 outbreak has the potential of adversely affecting the psychological health on individual and community level. Currently all efforts are focused on the understanding of epidemiology, clinical features, mode of transmission, counteract the spread of the virus, and challenges of global health, while crucially significant mental health has been overlooked in this endeavor. METHOD:This review is to evaluate past outbreaks to understand the extent of adverse effects on psychological health, psychological crisis intervention, and mental health management plans. Published previous and current articles on PubMed, EMBASE, Google Scholar, and Elsevier about psychological impact of infectious diseases outbreaks and COVID-19 has been considered and reviewed. COMMENTS:COVID-19 is leading to intense psychosocial issues and comprising mental health marking a secondary health concern all around the world. Globally implementing preventive and controlling measures, and cultivating coping and resilience are challenging factors; modified lifestyle (lockdown curfew, self-isolation, social distancing and quarantine); conspiracy theories, misinformation and disinformation about the origin, scale, signs, symptoms, transmission, prevention and treatment; global socioeconomic crisis; travel restrictions; workplace hazard control; postponement and cancellation of religious, sports, cultural and entertainment events; panic buying and hoarding; incidents of racism, xenophobia, discrimination, stigma, psychological pressure of productivity, marginalization and violence; overwhelmed medical centers and health organizations, and general impact on education, politics, socioeconomic, culture, environment and climate - are some of the risk factors to aggravate further problems.
| S-EPMC7405632 | biostudies-literature
Project description: Not available
| S-EPMC7341010 | biostudies-literature
Project description:Background and purposeVarious neurological findings including stroke in patients with coronavirus disease 2019 (COVID-19) have been described, although no clarity exists regarding the nature and pattern of this association. This systematic review aims to report the characteristics of stroke in patients with COVID-19.MethodsThree authors independently searched Web of Science, Embase, Scopus, and PubMed starting from inception up to May 22, 2020. The data for individual patients was extracted where available from published reports including clinical and laboratory parameters and analysed for any significant associations between variables.ResultsWe identified 30 relevant articles involving 115 patients with acute or subacute stroke with COVID-19. The mean±standard deviation age was 62.5±14.5 years. Stroke was ischemic in majority of the patients (101 [87.8%]). Hypertension (42 [42%]), dyslipidaemia (24 [26.1%]), and diabetes (23 [23.2%]) were the major vascular risk factors. Most of the patients (80 [85.1%]) had COVID-19 symptoms at the time of stroke with a median interval of 10 days to stroke from the diagnosis of COVID-19. Three-fourths (86 [74.8%]) of the patients were critically ill which frequently delayed the diagnosis of stroke. High levels of D-dimer, and ferritin were observed in these patients. Patients with COVID-19 and stroke had a high mortality (47.9%). Factors associated with mortality were intensive care unit admission, having two or more vascular risk factors, particularly smoking and high levels of D-dimer, C-reactive protein, and lactate dehydrogenase.ConclusionsThe association between stroke and COVID-19 is probably multifactorial including an amalgamation of traditional vascular risk factors, proinflammatory and a prothrombotic state. Prospectively collected data is required in the future to confirm this hypothesis.
| S-EPMC7568983 | biostudies-literature
Project description:BackgroundWhen a sudden outbreak of an infectious disease occurs, emergency medical services (EMS) response could be negatively affected. The poor prognosis of acute stroke may be largely attributed to delays in treatment. This study aimed to identify the impact of the sudden outbreak of coronavirus disease 2019 (COVID-19) on EMS response for patients with acute stroke.MethodsThis comparative cross-sectional study was conducted in 25 safety centers in Seoul, Korea. We enrolled patients with acute stroke who were transferred to the emergency department by EMS. The study period was from February-April 2020 and the same period in 2019. Patients were divided into two groups, pre-COVID-19 period and early-COVID-19 period, and previously collected patient data were analyzed. We performed comparative analyses of EMS response and clinical outcomes between the groups.ResultsOf 465 patients, 231 (49.7%) had an acute stroke during the study period. There was no significant difference between clinical characteristics of patients with acute stroke before and after the COVID-19 outbreak. EMS response times increased significantly during the early COVID-19 outbreak. The intensive care unit admission rate and mortality rate increased during the early COVID-19 outbreak.ConclusionIn the initial phase after the sudden COVID-19 outbreak, EMS response times for acute stroke were delayed and the clinical outcomes of patients with acute stroke deteriorated.
| S-EPMC8845098 | biostudies-literature