ObjectiveTo investigate the current situation of stress load and professional benefit of hemodialysis nurses during the outbreak period and the remission period of coronavirus disease 2019 (COVID-19) epidemic, and discuss the differences in stress load and professional benefit of hemodialysis nurses between the two periods.MethodsIn February 2020, 119 hemodialysis nurses from three hemodialysis centers in Sichuan Province were selected as the respondents. Using the Stress Overload Scale and the Questionnaire of Nurses’ Perceived Professional Benefits, questionnaire survey was conducted in February 2020 and April 2020, respectively. Paired-sample t test was used for analysis.ResultsA total of 109 valid questionnaires were collected. The scores of stress load of hemodialysis nurses in outbreak period and remission stage were 3.00±1.26 and 2.17±1.16, respectively, of which the scores of event load dimension were 3.49±1.15 and 2.31±1.27, respectively, and the scores of individual vulnerability dimension were 2.59±1.19 and 2.05±1.06, respectively; the professional benefit scores of hemodialysis nurses in outbreak and remission were 4.19±0.83 and 4.21±0.78, respectively. The difference in stress load of the same group of hemodialysis nurses between different time periods was statistically significant (P<0.05), while there was no significant difference in professional benefit (P>0.05).ConclusionsDuring the outbreak of COVID-19 epidemic, the stress load of hemodialysis nurses was ata medium level, and that in the remission stage of COVID-19 epidemic was at a low level; the professional benefit of nurses in the outbreak and remission period was at a high level. The stress load status of hemodialysis nurses was different between different periods of the epidemic. We should take incentive mechanism or targeted psychological intervention measures to improve the professional benefit level of nurses.
ObjectiveTo investigate the clinical characteristics and contribution factors in severe coronavirus disease 2019 (COVID-19).MethodsThe clinical symptoms, laboratory findings, radiologic data, treatment strategies, and outcomes of 110 COVID-19 patients were retrospectively analyzed in these hospitals from Jan 20, 2020 to Feb 28, 2020. All patients were confirmed by fluorescence reverse transcription polymerase chain reaction. They were classified into a non-severe group and a severe group based on their symptoms, laboratory and radiologic findings. All patients were given antivirus, oxygen therapy, and support treatments. The severe patients received high-flow oxygen therapy, non-invasive mechanical ventilation, invasive mechanical ventilation or extracorporeal membrane oxygenation. The outcomes of patients were followed up until March 15, 2020. Contribution factors of severe patients were summarized from these clinical data.ResultsThe median age was 50 years old, including 66 males (60.0%) and 44 females (40.0%). Among them, 45 cases (40.9%) had underlying diseases, and 108 cases (98.2%) had different degrees of fever. The common clinical manifestations were cough (80.0%, 88/110), expectoration (33.6%, 37/110), fatigue (50.0%, 55/110), and chest tightness (41.8%, 46/110). Based on classification criteria, 78 (70.9%) non-severe patients and 32 (29.1%) severe patients were identified. Significant difference of the following parameters was found between two groups (P<0.05): age was 47 (45, 50) years vs. 55 (50, 59) years (Z=–2.493); proportion of patients with underlying diseases was 27 (34.6%) vs. 18 (56.3%) (χ2=4.393); lymphocyte count was 1.2 (0.9, 1.5)×109/L vs. 0.6 (0.4, 0.7)×109/L (Z=–7.26); C reactive protein (CRP) was 16.2 (6.5, 24.0) mg/L vs. 45.3 (21.8, 69.4) mg/L (Z=–4.894); prothrombin time (PT) was 15 (12, 19) seconds vs. 18 (17, 19) seconds (Z=–2.532); D-dimer was 0.67 (0.51, 0.82) mg/L vs. 0.98 (0.80, 1.57) mg/L (Z=–5.06); erythrocyte sedimentation rate (ESR) was 38.0 (20.8, 59.3) mm/1 h vs. 75.5 (39.8, 96.8) mm/1 h (Z=–3.851); lactate dehydrogenase (LDH) was 218.0 (175.0, 252.3) U/L vs. 325.0 (276.5, 413.5) U/L (Z=–5.539); neutrophil count was 3.1 (2.1, 4.5)×109/L vs. 5.5 (3.7, 9.1)×109/L (Z=–4.077). Multivariable logistic analysis showed that there was positive correlation in elevated LDH, CRP, PT, and neutrophil count with the severity of the disease. Currently, 107 patients were discharged and 3 patients died. Total mortality was 2.7%.ConclusionsOld age, underlying diseases, low lymphocyte count, elevated CPR, high D-dimer and ESR are relevant to the severity of COVID-19. LDH, CPR, PT and neutrophil count are independent risk factors for the prognosis of COVID-19.
ObjectiveTo study the clinical characteristics of overseas imported and related local COVID-19 patients in Chengdu.MethodsFifty overseas imported patients who were Chinese and 14 related local patients with COVID-19 who were admitted to Public Health Clinical Center of Chengdu from November to December 2020 were selected. The epidemiological characteristics, clinical manifestations, auxiliary examination, treatment and prognosis were summarized and analyzed.ResultsThe local group were older, and they were mostly elderly and females (P≤0.05). Compared with the imported group, the proportion of the local group was higher in heart disease and tumor. More patients had cough, fever and expectoration symptoms (P≤0.05). C-reactive protein, fasting blood glucose and fibrinogen were higher, and the lymphocyte count, blood platelet count, CD3+ T lymphocyte count, CD4+ T lymphocyte count, CD8+ T lymphocyte count were lower. The positive rate of novel coronavirus total antibody, IgG antibody and IgM antibody in the imported group were higher than those in the local group (P≤0.05). The negative conversion time of the median nucleic acid was shorter than that of local patients (P≤0.05).ConclusionThere are differences in sex ratio, age, complications, clinical manifestations, lymphocyte measurement value, T lymphocyte count and negative conversion time of nucleic acid between overseas imported and local COVID-19 patients in Chengdu. The local patients are mostly elderly and have more complicated conditions, but all of them have good prognosis.
Objective To conduct a systematic and comprehensive bibliometric analysis related to medical imaging in coronavirus disease 2019 (COVID-19) published by Chinese authors, and indicate the current status and guidance for coping with the challenges brought by long COVID. Methods Literature records pertaining to COVID-19 imaging were retrieved from the Web of Science (WOS) and Chinese Science Citation Database (CSCD) with a date range of January 1st, 2020 to December 31st, 2022. CiteSpace was used to analyze the popular topics and generate a visual map to further refine research trends. Results The search enrolled 2229 publications (1771 publications from WOS and 458 from CSCD). The monthly volume of publications showed a significant increase followed by a gradual decline, and then maintained a stable level. Clustering analysis of keywords and co-citations revealed that the research hotspots in COVID-19 imaging were clinical features, imaging differential diagnosis, and the application of artificial intelligence. Keyword burst analysis showed that “deep learning” was the most intensive keyword, while “attention mechanism” had the longest burst duration. Conclusions In recent years, the research in the field of COVID-19 imaging has made steady progress. Artificial intelligence has received the most attention. Clinical features, imaging features and artificial intelligence assisted diagnosis are the top of most concerns. The future focus of COVID-19 imaging research may be on improving algorithm models to expand the application of artificial intelligence in disease diagnosis, treatment, and management.
Objective To investigate the values of cytokines in evaluating the severity and prognosis of patients with coronavirus disease 2019 (COVID-19). Methods A total of 205 COVID-19 patients in Wuhan Leishenshan Hospital were retrospectively analyzed. According to the severity of the disease, patients were divided into common group (n=117), severe group (n=69) and critical group (n=19). The patients’ basic condition and cytokine related parameters were collected, the differences between the three groups were compared and their values in assessing the severity and prognosis of COVID-19 patients were analyzed. Results There were statistically significant differences in the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test results, interleukin (IL)-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α among the three groups of patients (P<0.05). Correlation analysis showed that the age, severe acute respiratory syndrome coronavirus 2 nucleic acid test continued to be positive for 20 days, IL-6 level, IL-10 level, IL-2 receptors level, IL-8 level and tumor necrosis factor-α level were related to the classification of COVID-19. The correlation coefficient rs was 0.354, 0.187, 0.366, 0.327, 0.329, 0.273 and 0.157, respectively (P<0.05). The levels of IL-6, IL-10, IL-2 receptor, IL-8, and tumor necrosis factor-α in dead patients with COVID-19 were higher than those in surviving patients (P<0.05). Multivariate analysis showed that age [odds ratio (OR)=1.034, 95% confidence interval (CI) (1.006, 1.063), P=0.016], IL-6 level [OR=1.030, 95%CI (1.006, 1.055), P=0.015], IL-10 level [OR=1.088, 95%CI (1.003, 1.179), P=0.042] and IL-2 receptor level [OR=1.003, 95%CI (1.001, 1.005), P=0.001] were independent risk factors for common COVID-19 to become severe or critical. Conclusion The levels of cytokines in COVID-19 patients are closely related to the severity and prognosis of the disease.
Objective To analyze the clinical characteristics of adverse drug reaction (ADR) caused by 3 kinds of coronavirus disease 2019 drugs, and provide a reference for clinical safe medication. MethodsA total of 33 patients with coronavirus disease 2019 admitted to Xiangtan Central Hospital from January 20 to March 5, 2020 were selected as the research objects. The clinical data of patients with ADR during the antiviral process were analyzed retrospectively. The patients’ gender, age, type of medication, combination medication, organs or systems involved, and clinical manifestations were summarized and analyzed. Results A total of 33 patients were enrolled. A total of 21 cases of ADR were reported. The incidence of ADR is higher in patients older than 60 years (80.0%). The most common clinical manifestations are digestive tract symptoms (66.7%). The incidence of ADR is highest in the combination of lopinavir/ritonavir+arbidol+ribavirin (100.0%), followed by the combination of lopinavir/ritonavir+arbidol (85.7%). Abidol and ribavirin each caused 1 case of severe ADR. Conclusion For patients with coronavirus disease 2019, the combination of two or more antiviral drugs should be avoided, and pharmaceutical monitoring should be strengthened for elderly, severe/critical and allergic patients.
ObjectiveTo explore the epidemiological characteristics, clinical manifestations, laboratory examination and imaging findings of patients with coronavirus disease 2019 (COVID-19) outside Hubei Province in 2019.MethodsFrom January 21, 2020 to February 18, 2020, 17 patients with COVID-19 diagnosed by SARS-CoV-2 nucleic acid test in Xianyang Central Hospital of Shaanxi Province and 23 patients in Liaocheng Infectious Disease Hospital of Shandong Province were collected. The information of epidemiology, age, time of onset, first symptom, white blood cell, lymphocyte count, procalcitonin (PCT), serum amyloid protein A (SAA), C-reactive protein (CRP) and chest CT were collected and analyzed.Results40.0% of the 40 patients had a clear history of contact with Wuhan or other areas of Hubei, 60.0% had no clear exposure history, 60.0% were aggregative diseases, 40.0% were imported patients; the average visit time was (4.9±3.5) d, 35% of the patients had underlying diseases; 75.0% of the patients had fever, 7.5% of the initial symptoms were cough, 5.0% pharyngitis, 2.5% headache, and 10.0% were asymptomatic. In the laboratory examination, 77.5% of the patients' white blood cells were normal, 45.0% of the patients' lymphocyte count could be decreased, 72.5% and 55.0% of the patients' SAA and CRP increased respectively, 92.5% of the patients' PCT was normal, 92.5% of the patients were positive for the first nucleic acid test, and 72.5% of the patients' chest CT showed multiple ground glass lesions in one or both lungs, and the positive coincidence rate between the initial nucleic acid test and the chest CT test was 92.5%. 90% of the patients in the group were common type, and all patients were treated with aerosol inhalation of α-interferon combined with lopinavir/ritonavir tablets, 62.5% were treated with antibiotics and 15.0% were treated with glucocorticoid. All patients were improved and 14 patients were cured and discharged from hospital.ConclusionsSARS-COV-2 is highly contagious, family aggregation infection and asymptomatic infection may be the main mode of transmission outside Hubei Province, mild and common types are common, there are no specific changes in laboratory examination, and the condition is stable after treatment.
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”.
Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. MethodsThe Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and China Biology Medicine from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the Stata 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.
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.