Bed Availability Research Articles

COVID-19 impact on the emergency and hospitalization of a tertiary hospital. Management lessons learned

IntroductionThe objective is to analyze the impact of the COVID-19 pandemic on the pediatric emergencies and hospital admissions. MethodsRetrospective cohort study of patients treated in a tertiary hospital, from March 14 to April 26, 2020, compared to the same period of the previous 3 years. ResultsA notable overall reduction in emergency room visits and admissions is observed in all pediatric areas, maintaining care in neonatology and scheduled admissions in oncology. DiscussionThe reduction in global activity in pediatric emergencies is not only explained by the decrease in contagious diseases. The decrease in inadequate demand and inappropriate income may have contributed. The availability of pediatric beds would make the reduction of programmed surgical activity unnecessary and would allow the redistribution of resources to areas with greater healthcare pressure.

CHANGING MORTALITY WITH ECLS IN COVID-19: ONE TERTIARY CENTER'S LONGITUDINAL EXPERIENCE

TYPE: Abstract TOPIC: Critical Care PURPOSE: The use of ECMO as a rescue therapy in patients with COVID-related severe respiratory and/or cardiac dysfunction has become accepted care in many centers. We reviewed our outcomes in COVID ECMO patients over time. METHODS: IRB-approved database review and analysis of 65 patients in our center who had undergone ECLS related to COVID 19 beginning March 2020 through September 2021. RESULTS: Quarterly data is shown. Survival rates improved from 64% in 2020 to 68% in 2021. Length of ECLS therapy for survivors was shorter with mean duration of support of 11.8 days (range: 3 – 36 days, 2020 mean: 11.3 days, 2021 mean: 13.4 days) compared to the mean duration of support in those who died of 40 days (range: 1 – 164 days, 2020 mean: 36.4 days, 2021 mean: 52.8 days). Median age increased from 46.6 to 49 years between 2020 and 2021. The longest run of 164 days was in a patient who was transitioned to ECCO2R after 120 days. CONCLUSIONS: We found improved survival at our center, as compared to 50% survival reported to the ELSO registry for COVID-19 ECLS. The decrease in COVID-19 ECLS use over time may reflect improved therapies or management, less severe illness or a lack of ECMO availability in 2021 due to the return of hospital care to pre-pandemic levels. Many patients referred to our site were unable to receive ECMO in 2021 due to lack of nursing staffing or bed availability. CLINICAL IMPLICATIONS: Optimal use of ECMO and triage of patients require ongoing study and discussion. DISCLOSURE: Nothing to declare. KEYWORD: ECMO

Mitigation Strategies for COVID-19: Lessons from the K-SEIR Model Calibrated to the Observable Data

This article develops a detailed epidemiological multi-factor model, the K-susceptible–exposed–infected–removed (K-SEIR) model, and several simpler sub-models as its building blocks. The general model enables us to account for all the relevant COVID-19 features, its disparate impact on different population groups, and interactions within and between the groups. It also includes the availability (or lack thereof) of spare hospital beds and intensive care units (ICU) to accommodate the pent-up demand due to the pandemic. We use the most recent hospitalization and mortality data to calibrate the model. Since our model is multi-factor, we can use it to simulate and analyze the consequences of the sheltering-in-place for each specific group and compare the lives saved and lost due to this measure. We show that in countries with well-developed healthcare systems and a population willing to abide by suitable containment and mitigation procedures, the sheltering in place of the entire community is excessive and harmful when considered holistically. At the same time, sealing nursing homes as thoroughly as possible to avoid high infection and mortality rates is an absolute necessity.

ECT on a world map - a narrative review of the use of electroconvulsive therapy and its frequency in the world

Abstract Introduction: Since implementation, electroconvulsive therapy has remained very effective treatment in psychiatry. The aim of this study is to present the differences in its use in medical practice around the world. The range of diseases in which ECT is most commonly used and the frequency of its use in different countries were compared with special attention to the differences between highly and poorly developed countries. Material and method: Review of literature by searching PubMed and Google Scholar databases using the keywords: indications of ECT, frequency of ECT use for papers published from 1991 to 2021. Results: Among the diseases for which electroconvulsive therapy is used worldwide, major depression dominates, while in Asia and Africa this therapy is used in schizophrenia. In Latin America it is used primarily for schizophrenia and bipolar disorder. In Poland, it is used for depression, bipolar disorder, and fewer for schizophrenia. The highest rate of people treated with therapy per 100,000 population is found in countries such as the USA (51), Canada (23.2-25.6), Australia (37.85), Sweden (41), Finland (23), Slovakia (29.2), Estonia (27.8) and Belgium (47). Conclusions: There is a relationship between the range of diseases most frequently treated with ECT, the frequency of use and the level of country development. In the high developed countries, ECT is used mainly in major depression, in less developed countries more frequent treatment of schizophrenia may be determined by the high cost of medications and limited availability of hospital beds. The highest rates of use of this therapy are found in more developed countries.

Improving Awareness about Patient Blood Management in Portugal: A Call for Action Arising from a Delphi Panel.

Anaemia and iron deficiency are associated with increased mortality and poor surgical outcomes. Consensus in their definitions is expected to optimize their management, which is encompassed by patient blood management, providing patient-centred care while improving patient safety and clinical outcomes. Patient blood management implementation is even more relevant in contingency times and faces barriers due to lack of standardization, among others. The aim is to establish a consensus on these diagnoses and implement patient blood management principles in clinical practice in Portugal. Eight experts in Transfusion Medicine, Haematology, Anaesthesiology, Internal Medicine, and Obstetrics/Gynaecology were assembled; a focus group was conducted, defining 33 statements. A Delphi panel was conducted, with experts from the clinical specialities named above as well as from General Surgery, Urology, and Orthopaedics. The Delphi panel's rounds had 70 (Round 1) and 46 (Round 2) respondents. Specialists were consensual in only two statements, on the existence of a preoperative patient blood management consultation for candidates to elective surgeries in which the use of blood derivatives is anticipated and, on the importance of the correction of postoperative anaemia and iron deficiency. Of the remaining 31 statements, 27 reached high agreement or disagreement by the respondents. Consensus was reached in only two (6%) of the 33 statements. There was a consensual agreement on the relevance of establishing patient blood management as the standard of care and of valuing preoperative and postoperative patient blood management interventions. Nevertheless, our results point to the lack of awareness regarding patient blood management principles - which could result in better postoperative outcomes, shorter hospitalizations, reduced costs and increased availability of beds. Training and literacy initiatives could help further implement patient blood management standards in Portuguese hospitals.

Clinical and organizational factors associated with mortality during the peak of first COVID-19 wave: the global UNITE-COVID study

PurposeTo accommodate the unprecedented number of critically ill patients with pneumonia caused by coronavirus disease 2019 (COVID-19) expansion of the capacity of intensive care unit (ICU) to clinical areas not previously used for critical care was necessary. We describe the global burden of COVID-19 admissions and the clinical and organizational characteristics associated with outcomes in critically ill COVID-19 patients.MethodsMulticenter, international, point prevalence study, including adult patients with SARS-CoV-2 infection confirmed by polymerase chain reaction (PCR) and a diagnosis of COVID-19 admitted to ICU between February 15th and May 15th, 2020.Results4994 patients from 280 ICUs in 46 countries were included. Included ICUs increased their total capacity from 4931 to 7630 beds, deploying personnel from other areas. Overall, 1986 (39.8%) patients were admitted to surge capacity beds. Invasive ventilation at admission was present in 2325 (46.5%) patients and was required during ICU stay in 85.8% of patients. 60-day mortality was 33.9% (IQR across units: 20%–50%) and ICU mortality 32.7%. Older age, invasive mechanical ventilation, and acute kidney injury (AKI) were associated with increased mortality. These associations were also confirmed specifically in mechanically ventilated patients. Admission to surge capacity beds was not associated with mortality, even after controlling for other factors.ConclusionsICUs responded to the increase in COVID-19 patients by increasing bed availability and staff, admitting up to 40% of patients in surge capacity beds. Although mortality in this population was high, admission to a surge capacity bed was not associated with increased mortality. Older age, invasive mechanical ventilation, and AKI were identified as the strongest predictors of mortality.

Comparison of urgent and early endoscopy for acute non-variceal upper gastrointestinal bleeding in high-risk patients

ObjectiveData regarding early (within 24h) and urgent endoscopy (within 12h) in non-variceal upper gastrointestinal bleeding (NV-UGIB) revealed conflicting results. This study aimed to investigate the impact of endoscopy timing on the outcomes of high-risk patients with NV-UGIB. Patients and methodsFrom February 2020 to February 2021, consecutive high-risk (Glasgow–Blatchford score ≥12) adults admitted to the emergency department with NV-UGIB were analyzed retrospectively. The primary composite outcome was 30-day mortality from any cause, inpatient rebleeding, need for endoscopic re-intervention, need for surgery or angiographic embolization. Results240 patients were enrolled: 152 (63%) patients underwent urgent endoscopy (<12h) and 88 (37%) patients underwent early endoscopy (12–24h). One or more components of the composite outcome were observed in 53 (22.1%) patients: 30 (12.5%) had 30-day mortality, rebleeding occurred in 27 (11.3%), 7 (2.9%) underwent endoscopic re-intervention, and 5 (2.1%) required surgery or angiographic embolization. The composite outcome was similar between the groups. Multivariate analysis showed only hemodynamic instability on admission (OR: 3.05, p=0.006), and the previous history of cancer (OR: 2.42, p=0.029) were significant in predicting composite outcome. In terms of secondary outcomes, the endoscopic intervention was higher in the urgent endoscopy group (p=0.006), whereas the number of transfused erythrocyte suspensions and the length of hospital stay was higher in the early endoscopy group (p=0.002 and p=0.040, respectively). ConclusionsUrgent endoscopy leads to a significant reduction in the length of hospitalization and the number of transfused erythrocyte suspensions in NV-UGIB, which can contribute to patient satisfaction, reduce healthcare expenditure, and improve hospital bed availability. The composite outcome and its sub-outcomes were the same among both groups.

P351 “HOLDING AREA AND SHORT STAY HOSPITAL: A NEW MODEL OF ORGANIZATION

Abstract In A.O. San Camillo–Forlanini, dedicated “Holding Areas” (HA) are active. They enable a rapid allocation of patients (pts), avoiding their long stay in the Emergency Department (ER) and therefore reducing the overcrowding. Moreover they allow the optimization of diagnosis and care, thanks to the direct management of specialists and reduce improper hospitalizations. Our HA is committed to receive (except on weekends) 3 pts/day destined to hospitalization in Cardiology. Here the patients are re–examined and quickly undergo to further specific tests, aiming at identifying those who can be addressed to alternative paths (Day Hospital/Day Service) and those who need to be hospitalized. For the latter, the HA allows to select the most appropriate diagnostic/therapeutic path according to the model of the intensity of care: critical area (ICU); ordinary hospitalization; short stay (SHS). In 2020 (with a total of 206 of Cardiology HA opening days, net of the lockdown and summer closure periods) 402 patients from the ER were admitted to cardiology HA. Among those, 20% (81 pts) was assigned to the SHS (availability of 2 beds/day, except for weekends) while another 4.3% (17 pts) was allocated to outpatient care. 52% of SHS pts had ischemic pathology (NSTE–ACS at low risk, CCS – Chronic Coronary Syndrome – with positive stress test, doubtful chest pain with multiple risk factors), 33% arrhythmic pathology (66% tachyarrhythmias, 34% bradyarrhythmias) and 12.6% heart failure (Killip class I–III). The HA reduced the average hospital stay (AHS): for SCA–NSTE, for example, from 5.1 days to 3.6 and the waiting time for diagnostic procedures (for example, for coronary angiography from 1.8 to 0.3 days). The opening of the SHS has further reduced the duration of the AHS: 1.5 nights for the CCS (the need for revascularization was not indicated in 68% of cases); 1 night for tachyarrhythmias (electrical cardioversion in 89% of cases); 3.75 nights for bradyarrhythmias (PMK implantation in 55% of patients). The overall average stay in SHS was very brief (2.5 nights) allowing a rapid turnover even with more difficult procedures. While criticalities persist (limited availability of SHS beds, “short” week opening), the results obtained confirm the need for dedicated and specialized HA in order to reduce improper hospitalizations, trim hospitalization times and broaden the appropriateness of care.

Inequity in inequity: Disproportional mortality risk in patients with cancer with COVID-19 in Brazil - a call to action

Inequity in inequity: Disproportional mortality risk in patients with cancer with COVID-19 in Brazil - a call to action

Ethical Management of COVID-19 Pandemic at a Neurological Hospital: The Ethicovid Report.

During the first wave of the coronavirus disease-2019 (COVID-19) pandemic, it was necessary to prepare for the possibility of triaging patients who could benefit from access to an intensive care unit (ICU). In our neuroscience institution, the challenge was to continue to manage usual neurological emergencies as well as the influx of COVID-19 patients. We report the experience of an ethical consulting unit to support care clinical decisions during the first wave of the pandemic (March 16 to April 30, 2020). Three objective evaluation criteria were defined: 2 of these criteria, patient's factors and general disease severity (Simplified Acute Physiology Score II), were common to all patients, and the third was the specific severity of the disease (neurological for brain injury, respiratory for COVID-19). Given our scarce resources, we used a high probability of a 3-month modified Rankin Scale ≤3 as the criterion for further resuscitation and management. A total of 295 patients were admitted during the first pandemic wave; 111 with COVID-19 and 184 with neurological emergencies. The ethical unit's expertise was sought for 75 clinical situations in 56 patients (35 COVID-19 and 21 neurological). Decisions were as follows: 11% no limitation on care, 5% expectant care with reassessment (maximum therapy to assess possible progress pending decision), 67% partial limitation (no intensification of care or no transfer to ICU), and 17% limitation of curative care. At no time did a lack of availability of ICU beds require the ethical unit to advise against admission to the ICU. Our ethical consulting unit allowed for collegial ethical decision-making in line with international recommendations. This model could be easily transferred to other triage situations, provided it is adapted to the local context.

No increase of device associated infections in German intensive care units during the start of the COVID-19 pandemic in 2020

BackgroundThe COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019.MethodsWe utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019–2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days; device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models.ResultsThe number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed.ConclusionsThe lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.

MO350: Transfer Times for Renal Patients to a Tertiary Centre

BACKGROUND AND AIMSThe renal unit at Sunderland Royal Hospital (SRH) provides tertiary services to an area of North East England covering South Tyneside, Sunderland and County Durham. An AKI service was commenced in September 2020 at University Hospital North Durham (UHND), which is part of the County Durham and Darlington NHS Foundation Trust (CDDFT) with aims to improve recognition and treatment, support early discharge planning, and prevent severe injury for patients with AKI and renal conditions. The service comprises two specialist nurses and a team of consultant renal physicians providing in-reach at UHND across Monday–Friday 52 weeks/year, with over 700 patients seen within the first 12 months of operation.With the introduction of this service, we carried out a review of transfer times for patients requiring transfer from UHND to SRH for inpatient renal management. Delays in patient transfer between hospitals can result in deferred treatment and poor patient outcomes, hence the importance of analysing the benchmarking the first year's performance to inform future service development both regionally and nationally. With the use of this data, we hope to share our model with other teams and trusts with the goal of enhancing and streamlining the referral methods to renal services.METHODWe examined transfer data for 36 patients from CDDFT to the renal unit at SRH over a 12-month period from August 2020 to July 2021. This information looked at transfers from the time of consultant acceptance to the time of arrival on the ward and was compiled in conjunction with the AKI specialist nurses at CDDFT. Using the computer system and phone records, we were able to accurately document time of acceptance to time of arrival. Data was split into categories to enable further comparison; pre-June 2021 (when haematology patients were excluded from the inpatient ward at SRH due to protective isolation during COVID-19) increasing the availability of acute renal beds and June 2021 onwards. Additionally, we analysed patients with acute kidney injury versus those that were known to us with chronic kidney disease, and times by week days and where emergency cover is usual.RESULTSThe data showed a median time between acceptance and arrival for patients accepted pre-June 2021 of 8 h 7 min compared with 6 h 18 min from June 2021 onwards. Median time between acceptance and arrival of acute patients was 8 h 7 min compared with 6 h 35 min for chronic kidney disease patients. Acceptance and arrival times varied also depending on time of transfer; 6 h 29 min during working hours on a weekday, 9 h 23 min out-of-hours on a weekday and 8 h 48 min on a weekend. The overall median transfer time from acceptance to arrival across all categories was 7 h 38 min.CONCLUSIONCurrently, no standard national target exists for the transfer of patients to tertiary renal services, however there are ongoing discussions surrounding this and how it could be implemented. There are difficulties in compiling data to effect change in referral methods, in part due to the inter-trust movement of patients and challenges in coding; however, our initial findings support the positive impact of the AKI service at CDDFT and highlight the scope for further service development across the region. For example, in commissioning at software to streamline, process audit data using a web-based portal, accessible to all parties and extending nurse presence across 7 days due to the delayed times for weekend and evening transfers. Additionally, we were encouraged that our prevalent patients, usually dialysis recipients, experienced the shortest wait.FIGURE 1:Median Time Between Acceptance and Arrival Based on Time of Patient Transfer.

Impacto en la incidencia de perforación gastrointestinal durante la pandemia de COVID-19 en el área sanitaria Costa del Sol

Introduction and aimsGastrointestinal perforation is a surgical emergency that is associated with a high mortality rate and requires special care. During the pandemic, there has been competition with COVID-19 patients for health resources, especially ICU bed availability. The primary aim of our study was to compare the incidence of gastrointestinal perforation during the COVID-19 pandemic, with cases registered before the pandemic. Materials and methodsA retrospective, observational, single center, cohort study was conducted that included patients that underwent emergency surgery for gastrointestinal perforation in the periods during the pandemic (6 months) and before the pandemic (12 months). Sociodemographic characteristics, comorbidities, duration of hospital and ICU stay, status at discharge, and perforation site were compared. ResultsThe study included 67 subjects (33 in the pre-pandemic period and 34 in the pandemic period). There were no significant differences regarding sex, age, or comorbidity. The perforation rate per emergency intervention was 4-times higher during the pandemic. There was an increase in the number of patients that were foreigners (4 [11%]) and nonresidents (6 [17%]). ICU admissions decreased (6 [19%]) but ICU stay increased to 137h. Hospital stay increased by 5 days and delay in care increased 4.5h. The number of deaths was higher (from 5 [15.2%] to 10 [29.4%]). Four patients with perforations were positive for COVID-19, were admitted to the ICU, and died. ConclusionsDuring the COVID-19 pandemic there was an increase in the incidence of gastrointestinal perforations at our healthcare system area; symptoms were more advanced, and mortality was higher.

ICU Clinician Perceptions of COVID-19 ICU Readiness: Results of a Thematic Analysis of National U.S. Survey Data

The COVID-19 pandemic has greatly impacted intensive care unit (ICU) clinicians worldwide. Case number surges resulted in high or even above-capacity ICU patient census, limited bed availability, clinical staffing strains, and concerns about maintaining adequate medication, personal protective equipment (PPE), and equipment supplies to ensure optimal patient care. In the United States, a series of rapid cycle COVID-19 surveys were disseminated to ICU clinicians to assess ICU readiness and ongoing challenges posed by the pandemic. This article reports on a qualitative thematic analysis of the descriptive data for general themes provided by over 800 ICU nurses, advanced practice providers, physicians, pharmacists and respiratory therapists, reflecting upon their perceptions from the early to mid-pandemic timeline.

Outcomes and success of new tiered perinatal transfer policy within a tertiary level obstetric unit in Australia.

New South Wales Health introduced the new Tiered Networking Arrangements for Perinatal Care in New South Wales policy directive (TPN Policy), which defined key performance and quality indicators after implementation. This study aims to assess the success of the TPN Policy implementation in the Western Sydney TPN in accordance with key performance indicators. This is a retrospective cohort study of acute perinatal transfers within the Western Sydney TPN between 1 December 2019 to 31 December 2020. The primary outcome is compliance with objectives of the TPN Policy, as measured as an Aggregate Compliance Score comprising the five measures. Secondary outcomes include clinical, neonatal and logistics outcomes. There were 181 acute perinatal transfers within, into or out of the Western Sydney TPN between 1 December 2019 to 31 December 2020. There were 122 transfers within the network, 40 into the TPN and 19 were out of the TPN. All groups were at least partially compliant with the TPN Policy. No transfers in any of groups scored below three ('partially compliant'). A quarter of transfers gave birth within 24h of transfer. Over half of those who were transferred and admitted went on to give birth prior to discharge or transfer. Overall, the TPN Policy met its objectives after implementation in the Western Sydney TPN, while maintaining appropriate neonatal outcomes. All women arrived at an appropriate facility prior to giving birth, although the majority did not give birth within 24h. Neonatal intensive care unit bed availability is a key limitation to future improvement.

Developing a Web App to Track Hospital ICU Bed Availability using ReactJS

COVID-19 has caused a dramatic shortage of hospital ICU beds. We have thus developed a Web app to track the availability of hospital ICU beds using React.js and other modern Web development technologies. Web development nowadays is increasingly moving towards leveraging JavaScript frameworks and libraries rather than using basic Web technologies such as HTML, CSS, and vanilla JavaScript to facilitate the implementation of dynamic features and functionalities of modern Rich Internet Applications. React or ReactJS has cemented itself as the frontrunner in a sea of competing JavaScript frameworks. In this presentation, we give an overview of the functionalities that make ReactJS a stand-out option, present the foundational features that create deep flexibility while also maintaining robust functionality, outline the flattened learning curve that makes React an attractive choice for new and seasoned developers, and describe the implementation and features of our Web App.

Assessment of COVID-19 data reporting in 100+ websites and apps in India.

India is among the top three countries in the world both in COVID-19 case and death counts. With the pandemic far from over, timely, transparent, and accessible reporting of COVID-19 data continues to be critical for India's pandemic efforts. We systematically analyze the quality of reporting of COVID-19 data in over one hundred government platforms (web and mobile) from India. Our analyses reveal a lack of granular data in the reporting of COVID-19 surveillance, vaccination, and vacant bed availability. As of 5 June 2021, age and gender distribution are available for less than 22% of cases and deaths, and comorbidity distribution is available for less than 30% of deaths. Amid rising concerns of undercounting cases and deaths in India, our results highlight a patchy reporting of granular data even among the reported cases and deaths. Furthermore, total vaccination stratified by healthcare workers, frontline workers, and age brackets is reported by only 14 out of India's 36 subnationals (states and union territories). There is no reporting of adverse events following immunization by vaccine and event type. By showing what, where, and how much data is missing, we highlight the need for a more responsible and transparent reporting of granular COVID-19 data in India.

A study to assess the risk factors contributing to psychological stress, anxiety and depression in mothers of Covid-19 positive hospitalized children in a Tertiary care hospital

Parents of the COVID -19 positive hospitalized children are facing different psychological stresses which are affecting child’s care and well-being. To determine the psychological stress, anxiety and depression and to identify the associated influencing factors in mothers of hospitalized COVID-19 infected children In this cross-sectional observational study, 150 mothers of COVID-19 positive hospitalized children in a paediatric tertiary care hospital were randomly selected and studied. Data collection tool was a two part questionnaire; the first part was based on ‘Perceived stress scale-10’ and ‘Hospital anxiety and depression scale’ and the second part included stressors related to COVID-19 pandemic selected based on previous researches. The incidence of these stressors and their significance in causing stress, anxiety and depression was assessed using standard statistical methods.83.4% had moderate psychological stress, 35% had significant anxiety and 38% had significant depression. Worry about hospital bed availability and treatment cost (Odd’s ratio&amp;#62;9) and worry about getting infection (Odd’s ratio&amp;#62;8) as main stressors for stress, concern about family members and worry about getting infection (Odd’s ratio&amp;#62;9 for both) as main factors for anxiety and concern about family members (Odd’s ratio&amp;#62;22) as main factor for depression was found in study population. This pandemic has imposed grave psychological impact on mothers of hospitalized COVID infected children and various influencing social factors have been identified through our study. Holistic approach including socio-economic, administrative and political measures should be taken and adequate psychological support should be provided to address maternal mental health related issues.

Referrals for inpatient rehabilitation and the patient selection processes: Pre-pandemic challenges as a guide towards reforms moving forward

Purpose: To analyse data related to the referral, selection and admission processes for inpatient rehabilitation at Karin Grech Hospital, Malta. Examining pre-pandemic challenges faced can guide reform towards a more sustainable use of inpatient rehabilitation services. Methods: Referrals and outcomes of all patients referred for inpatient rehabilitation between April and August, 2018 were analysed. Results: 47% of patients referred for inpatient rehabilitation were accepted, with an average time to transfer of 4.84 days. Of the 53% deemed unsuitable, the commonest reasons were: excessively high level of independence (22%), non-weight-bearing restriction (12%) and patient refusal (12%). 90% of inpatients in rehabilitation were discharged home, 7% were transferred back due to acute complications and 1 patient was transferred to a residential home. Out of all referrals, 14 passed away within 1 year, two of these within 8 days of referral. Conclusions: Identifying unsuitable referrals for inpatient rehabilitation can avoid inappropriate admissions that would otherwise decrease bed availability and increase waiting times. Basing patient selection on key principles can thence ensure efficient and sustainable rehabilitation services moving forward.

Skor risiko kejadian kardiovaskular mayor di rumah sakit pada sindroma koroner akut dengan elevasi segmen ST yang menjalani intervensi koroner perkutan primer

Background&#x0D; Reduction of major cardiovascular events (MACE) in ST elevation acute coronary syndrome (STE-ACS) patients has been achieved by primary percutaneous coronary intervention (PCI) strategy and intensive care management. However, the intensive care unit bed availability and cost remain a problem for those patients, and thus risk stratification using an objective risk score instrument is required.&#x0D; Aim&#x0D; To develop a risk score of in-hospital MACE for patients with STE-ACS underwent primary PCI.&#x0D; Methods&#x0D; A cohort study of 208 patients with STE-ACS undergoing primary PCI at the Dr. Kariadi General Hospital Semarang. Predictor analysis was carried out using bivariate Chi-Square test and multivariate logistic regression. The obtained independent predictors were then used as risk score variables. The quality of the risk score was tested by the Hosmer and Lemeshow calibration test and AUC ROC analysis for discrimination test.&#x0D; Results&#x0D; Seven out of 13 independent predictors, i.e. Killip class (OR 20,04, p=0,0001), age (OR 3,02, p=0,04), renal insufficiency (OR 9,48, p=0,007), infark related artery final TIMI flow (OR 11,57, p=0,001), admission systolic blood pressure (OR 3,04, p=0,025), duration of total ischaemic time (OR 3,14,p=0,032) and increase of blood glucose levels (OR 3,04, p=0,029) were fulfilled the criteria for risk scores of in-hospital MACE. The risk scores had a good quality with the Hosmer and Lemeshow calibration test&gt; 0,05 and ROC AUC 0,886 (95% CI, 0,827-0,944, p &lt;0,005).&#x0D; Conclusions&#x0D; A risk scoring modele consisting of 7 independent predictor variables i.e. Killip class, age, renal insufficiency, infark related artery final TIMI flow, admission systolic blood pressure, duration of total ischaemic time, and increase of blood glucose levels (KARIADI) has a good calibration and discrimination in predicting the risk of in-hospital MACE in patients with STE-ACS underwent primary PCI.&#x0D; Keywords&#x0D; Predictors of in-hospital MACE, primary PCI, ST-segment elevation acute coronary syndromes, risk score.