Objective To evaluate the coronavirus disease 2019 (COVID-19) impact on diagnosis related groups (DRGs) in a general hospital based on the front page of the medical record. Methods The first page data of discharge medical records of Nanjing First Hospital from February to March 2019 (before the epidemic) and from February to March 2020 (during the epidemic) were selected. Five indexes including total weight, number of DRGs, case mixed index index, time consumption index and cost consumption index were calculated. The rank of DRGs indexes of departments was compared by rank-sum ratio (RSR) method. The departments were sorted by frequency distribution and linear regression equation. Meanwhile, the COVID-19 impact on DRGs index of surgical departments and non operative departments was observed. Results Twenty-eight departments were included from February to March 2019, and 25 departments were included from February to March 2020. After the outbreak of COVID-19, the total DRGs index rank (RSR) decreased from 12.982 to 11.710. Ophthalmology, burn and plastic surgery, orthopedics, otorhinolaryngology, stomatology and pain department were the departments with lower ranking; the departments of gynecology, oncology, immunology and neurology were ranked higher. After the outbreak of COVID-19, the DRGs related indexes of surgical departments and non-surgical departments decreased significantly in terms of total weight and the number of DRGs (P<0.05). Conclusions COVID-19 affects the overall quality of hospital difficulty, and the surgical departments are significantly involved. The RSR level of several departments is reduced. In the face of the epidemic situation, hospitals should offset or weaken the uncertainty brought by the epidemic situation to the hospital disease treatment and ensure the high-quality hospital treatment by improving the “technical source”, ensuring the “disease source pool”, optimizing the “process chain” and strengthening the “new media”.
Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic at the end of December 2019, more than 85% of the population in China has been infected. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mainly affects the respiratory system, especially the lungs. The mortality rate of patients with severe infection is high. A percentage of 6% to 10% of patients will eventually develop into COVID-related acute respiratory distress syndrome (CARDS), which requires mechanical ventilation and extracorporeal membrane oxygenation (ECMO) support. Some patients who survive acute lung injury will subsequently develop post COVID-19 pulmonary fibrosis (PCPF). Both fully treated CARDS and severe PCPF are suitable candidates for lung transplantation. Due to the special course, evaluation strategies are different from those used in patients with common end-stage lung disease. After lung transplantation in COVID-19 patients, special treatment is required, including standardized nucleic acid testing for the novel coronavirus, adjustment strategy of immunosuppressive drugs, and rational use of antiviral drugs, which is a big challenge for the postoperative management of lung transplantation. This consensus was evidence-based written and was reached by experts after multiple rounds of discussions, providing reference for assessment and postoperative management of patients with interstitial pneumonia after COVID-19 infection.
Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
ObjectiveTo investigate the psychological status and its influencing factors of hospital staff during the outbreak of coronavirus disease 2019 (COVID-19), and provide a reference for psychological intervention strategies for hospital staff in public health emergencies.MethodsIn this cross-sectional study, we investigated the staff of Mianzhu People’s Hospital through an anonymous questionnaire survey sent through WeChat group from February 13th to 18th, 2020, to analyze the psychological situation and influencing factors of the on-the-job staff. SPSS 22.0 software was used for statistical analysis.ResultsAmong the 1 115 staff members who met the inclusion criteria, 951 completed the questionnaire, with a response rate of 85.3%. There were 945 valid questionnaires, with an effective response rate of 84.8%. A total of 224 staff members (23.7%) had mental health problems. Multivariate logistic regression analysis showed that the total scores of social support [odds ratio (OR)=0.869, 95% confidence interval (CI) (0.805, 0.938), P<0.001] and the total scores of stress coping strategies [OR=0.685, 95%CI (0.607, 0.772), P<0.001] were protective factors of psychological status, while having kids [OR=1.607, 95%CI (1.084, 2.382), P=0.018] and the position being logistic worker [OR=2.229, 95%CI (1.326, 3.746), P=0.002] were risk factors of psychological status.ConclusionsDuring the outbreak of COVID-19, mental health problems emerged among the staff of designated medical treatment hospital. When a public health emergency occurs, hospitals and relevant departments should take psychological intervention measures as soon as possible to ensure the work of epidemic prevention and control.
Objective To study the epidemic and clinical characteristics of three clusters of early cases of severe acute respiratery syndrome (SARS) in Shenzhen. Methods To retrospectively investigate three clusters of patients. To extract data on clinical presentation and laboratory studies. Results In the first cluster, one patient with SARS in Shenzhen had visited Hong Kong twice in one week. He had felt initial cold and fever in Hong Kong on January 14, while the second case had been onset of SARS when he had been back from Hong Kong. There were 5 people infected in the second cluster at the same time 1 week after they visited their father in a hospital in GuangZhou. Among the three clusters, two clusters had not been infected in ShenZhen, they are inputted, and another cluster is not clear, but it maybe inputted. Three clusters are distributed, they all had high fever. Among them, five had total body muscular soreness and unproductive cough, four with headache, three chill, and two dizziness and pharyngalgia. Three cases had asthma and diarrhea 1 week after the onset of SARS, and progressed to ARDS. The six patients with SARS in Shenzhen People’s Hospital tested positive for coronavirus-related anti-body (IgG) in their plasma 10-15 d after the onset. This IgG titres in one patient remained high (1∶640) 120 days after the onset. Neutrophilia and lymphopenia occurred in patients who died. The more severe the patients’condition was, the higher was the level of LDH increased. Conclusion In three clusters, most patients had not infected in Shenzhen, they are inputted and distributed. That patients with SARS tested positive for coronavirus-related IgG in their plasma.
ObjectiveTo systematically review the efficacy of convalescent plasma (CP) in the treatment of coronavirus disease 2019 (COVID-19). MethodsPubMed, EMbase, The Cochrane Library, VIP, WanFang Data and CNKI databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy of CP in the treatment of COVID-19 from inception to September 15th, 2021. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies; then, meta-analysis was performed using RevMan 5.4.1 software. ResultsA total of 16 RCTs involving 15 301 patients were included. The results of meta-analysis showed that CP treatment did not reduce mortality compared with no-placebo (RR=0.99, 95%CI 0.93 to 1.05, P=0.63) or normal saline (RR=1.06, 95%CI 0.60 to 1.86, P=0.84). However, compared with standard plasma, the mortality of CP group was lower (RR=0.59, 95%CI 0.37 to 0.95, P=0.03). In addition, compared with no-placebo or normal saline, CP treatment could not improve the clinical condition at 28-30 days, reduce mortality at early treatment and in patients without invasive mechanical ventilation when randomized. ConclusionCurrent evidence shows that compared with no-placebo or normal saline, CP does not reduce mortality in patients with COVID-19. However, when the disease progresses to the point where standard plasma is required, CP may reduce mortality. In addition, use of CP in patients with early or non-critical COVID-19 failed to reduce mortality. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify the above conclusion.
Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has gradually spread all over the world. With the implementation of class B infectious disease management policy for coronavirus disease 2019 (COVID-19), China has experienced a pandemic. For patients receiving a time-sensitive or emergency surgery, SARS-CoV-2 infection may increase the risk of postoperative pulmonary complications. An appropriate perioperative mechanical ventilation strategy, such as lung protective ventilation strategy, is particularly important for preventing postoperative pulmonary complications in patients undergoing general anesthesia. In addition, how to protect medical personnel from being infected is also the focus we need to pay attention to. This article will discuss the perioperative mechanical ventilation strategy for COVID-19 patients and the protection of medical personnel, in order to provide reference for the development of guidelines.
Maintenance hemodialysis patients face great risk and challenges in the current coronavirus disease 2019 (COVID-19) epidemic, and adequate and reasonable nutrition is an important weapon in the prevention and treatment of COVID-19. Therefore, the Chinese Society of Parenteral and Enteral Nutrition proposed Dietary Expert Advice on Prevention and Treatment of COVID-19 in Hemodialysis Patients for hemodialysis patients. In this paper, the nine pieces of advice on hemodialysis patients’ staple food, intake of high-quality protein, vegetables and fruits, food types and combinations, prevention of virus transmission, fluid intake, nutritional supplements, regular rest and adequate sleep, as well as supplement of anti-inflammatory and antioxidant preparations are interpreted in detail.
According to the requirements for the “three districts and two channels” in the sanitary industry standard Technique Standard for Isolation in Hospitals, combining with the spirit of current documents related to the prevention and control of coronavirus disease 2019, in order to guide medical institutions at all levels to conduct standardized design of fever clinics in accordance with the principle of “combining normal time and epidemic period”, this article explains the design points of the fever clinics for the prevention and control of coronavirus disease 2019, introduces the specific methods for the fever clinics to achieve “three districts and two channels”, draws a schematic diagram of the fever clinics in general hospitals, and explains the functional layout and medical procedures of the clean area, potential contaminated area, and contaminated area in detail; at the same time, a schematic diagram of the change of fever clinics from “normal” to “during the epidemic” is drawn, and the ideas for the conversion and the process after the conversion are introduced. It proposes design ideas and drawing references for the construction, transformation, and expansion of fever clinics.
ObjectiveTo investigate a more convenient and safe sampling method for viral nucleic acid detection of coronavirus disease 2019.MethodsAn oropharyngeal swab and nasopharyngeal swab were simultaneously taken from 100 patients with coronavirus disease 2019 in a hospital in Wuhan. Then the efficacies of two sampling methods were compared on the positive rates of viral nucleic acid detection.ResultsThe positive rate for SARS-CoV-2 was 54% in oropharyngeal swabs, while 89% positive in nasopharyngeal swabs. There was a significant difference in the detection rate between oropharyngeal swab and nasopharyngeal swab (χ2=3.850 4, P=0.049 7).ConclusionsThe positive rate for nucleic acid testing from nasopharyngeal swabs are significantly better than that from oropharyngeal swabs. Therefore, sampling by nasopharyngeal swabs, rather than oropharyngeal swabs, should be chosen as the preferred virological screening method for patients with coronavirus disease 2019.