ObjectiveTo explore the innovative application and effect of lead-type close medical consortium under the epidemic situation of coronavirus disease 2019 (COVID-19).MethodsDuring the epidemic of COVID-19, Jintang First People’s Hospital implemented a series of innovative countermeasures under the guidance of West China Hospital of Sichuan University, the leading hospital of a lead-type close medical consortium. To verify the implementation effect of the countermeasures, the patient satisfaction questionnaire and medical personnel satisfaction questionnaire were administered in confirmed or suspected COVID-19 patients and anti-epidemic healthcare workers. The relevant health economic indicators were extracted through the hospital information system for descriptive analysis.ResultsA total of 16 patients were included, including 10 confirmed patients and 6 suspected patients. The median score of patient satisfaction was 66. All patients were cured and discharged. A total of 56 healthcare workers were included, including 18 doctors and 38 nurses, with a median satisfaction score of 81. The average length of hospital stay of patients was 11.00 d, the average hospitalization cost was 5 117.35 yuan; the average drug cost was 1 099.95 yuan, accounted for 21.49%; the average material cost was 38.63 yuan, accounted for 0.75%.ConclusionsThe innovative application of the lead-type close medical consortium in the treatment of patients with COVID-19 plays an important role in the prevention and control of epidemic, and has achieved remarkable results in patients treatment, patients satisfaction, and hospital management. It is worthy of being widely popularized.
Objective To investigate the problems and needs of teachers and international bachelor of medicine and bachelor of surgery (MBBS) students in the online clerkship since the outbreak of coronavirus disease 2019. Methods In May 2020, questionnaires, telephone communication and face-to-face interviews were conducted among 85 international MBBS students and clinical teachers of 10 related departments in West China Hospital, Sichuan University. Teachers and students perceptions towards online clerkship were collected from five aspects including department orientation, attendance, teaching plan, assignment & assessment, and overall evaluation. Results Four departments and 43 students (50.6%) thought that online clerkship increased time input, while 3 departments thought that students’ enthusiasm decreased significantly compared to ordinary clerkship. Six departments reported that students’ compliance was poor; 58 students (68.2%) reported that they could not experience the real clinical environment. All departments reported difficulties in completing procedures and skills, and believed the teaching objectives were only partially achieved; 78 students (91.8%) thought that the effect of online clerkship met with their expectations; 16 students (18.8%) were very satisfied, and 59 students (69.4%) were satisfied. The majority of students believed that the advantages of online clerkship were that they had more time to prepare for their licensing examination [66 students (77.6%)] and could ask questions online at any time [48 students (56.5%)]. Conclusions There are both pros and cons in the online clerkship. It has put forward higher requirements for the efficiency and accuracy of English communication between teachers and students, and for the self-restraint and discipline of students. Under the current global epidemic situation, we should make full use of the information technology to constantly strengthen the practical education.
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 outbreak of the coronavirus disease 2019, the incidence and mortality of cardiac arrest have increased significantly worldwide, and the management of cardiac arrest is facing new challenges. The European Resuscitation Council issued the 2021 European Resuscitation Council Guidelines in March 2021 to update the important parts of cardiopulmonary resuscitation and added recommendations for the management of cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic. This article will compare the difference between this guideline and the 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care and integrate some key points, review literature and then summarize the latest research progress in cardiopulmonary resuscitation since the outbreak of the coronavirus disease 2019 epidemic. The content mainly involves cardiopulmonary resuscitation during the coronavirus disease 2019 epidemic, early prevention, early recognition, application of new technologies, airway management, extracorporeal cardiopulmonary resuscitation and post-resuscitation treatment.
Since the outbreak of coronavirus disease 2019, hospital laboratories have become an important place for testing all kinds of specimens of patients with suspected or confirmed coronavirus disease 2019. There may be a high load of severe acute respiratory syndrome coronavirus 2 in clinical specimens of confirmed patients, and the biosafety risk is high, so it poses a challenge to the hospital laboratory testing process. This paper compares the microbial pre-processing, culture, identification and drug sensitivity analysis of the traditional clinical microbial detection process and the fully automated microbial pipeline, expounds the biosafety risks of the traditional manual detection process of pathogenic microorganisms in the epidemic situation, and discusses the role and dilemma of the fully automated microbial pipeline in the biosafety assurance of the epidemic situation. The purpose is to provide a basis for the promotion of fully automated microbial pipeline in the future.
Due to the coronavirus disease 2019 pandemic, the traditional outpatient and medical center pulmonary rehabilitation models for chronic obstructive pulmonary disease have been limited, while pulmonary rehabilitation technology has always been the focus of clinical and scientific research in rehabilitation. This article reviews the application status of remote pulmonary rehabilitation for chronic obstructive pulmonary disease under the coronavirus disease 2019 epidemic in recent years. From the selection and method of remote pulmonary rehabilitation equipment before the epidemic, to the development of rehabilitation forms and equipment innovation after the epidemic, the current status and problems of remote pulmonary rehabilitation are clarified. Establishing a remote pulmonary rehabilitation model in line with China’s national conditions is the direction and goal of future development.
In addition to the typical respiratory symptoms, COVID-19 patients present with clinical manifestations of cardiovascular system damage, and they are at higher risk of intensive care or mortality. The mechanism of COVID-19's impact on the cardiovascular system is still unclear, therefore we need to pay close attention to it. Based on the existing research, this paper focused on the concurrent characteristics of the cardiovascular system diseases, summarized the possible mechanisms of cardiovascular system damage, including the coronavirus invaders directly into cardiomyocytes and its conduction system, with complications or accompanying conditions such as cytokine storm, imbalance of oxygen supply and demand, drug influence, stress and other damage to cardiovascular system. Meanwhile, current clinical manifestations and treatment methods of COVID-19 were summarized.
ObjectiveTo analyze the clinical characteristics of coronavirus disease 2019 (COVID-19), identify the high-risk factors which promoted the disease progression into severe or critical cases, and provide clinical guidance.MethodsNinety-six cases of clinically diagnosed coronavirus disease 2019 were collected and analyzed from General Hospital of the Yangtse River Shipping from January 20 to February 14, 2020. According to clinical classification, those cases were divided into two groups: mild group, including common and mild cases, and severe group including severe and critical cases.ResultsThere were more than half of patients ages>60 years old and severe or critical illness (61.5%, 56.3%), and obese patients accounts for 45.8%, the complication of hypertension accounts for 52.1%. The average time from onset to hospitalization was (6.1±2.6) days, and the average hospitalization days were (15.7±6.3) days. Compared with the mild group, the number of male patients in the severe group was more (57.4% vs. 35.7%, P<0.05), the numbers of elderly patients were larger (77.8% vs. 40.5%, P<0.01), and more obese peoples (55.6% vs. 33.3%, P<0.05). Cough symptom was more common in clinical presentation in the severe group (81.5% vs. 61.9%, P< 0.05). Patients with the complication of hypertension or diabetes occupied a higher proportion in the severe group, which were 64.8% vs. 35.7% and 35.2% vs. 14.3% (P< 0.05), respectively. And the rate of hypoxemia in admission of the severe group was significantly higher (79.6% vs. 9.5%, P< 0.01).ConclusionsThe cases of ages>60 years old and severe or critical illness in coronavirus disease 2019 occupy a higher proportion, and the complication of hypertension accounts for high proportion. Men, ages>60 years old, obese, coughing symptoms, with hypertension and / or diabetes, hypoxemia upon admission are high risk factors for progression into severe and critical cases.
At present, coronavirus disease 2019 has become the most serious public health emergency in the world. The disease is still spreading around the world. The disease progresses rapidly and is highly contagious, causing great harm to the public health security of the world. Based on the research evidence published at home and abroad, this article systematically summarizes the biological structure of severe acute respiratory syndrome coronavirus 2, and the pathogenesis, transmission routes and susceptible populations, clinical features and treatment methods of coronavirus disease 2019. It aims to help medical workers understand coronavirus disease 2019 in order to better diagnose and treat the disease, and provide references for future research.