Risultati per: Anticoagulazione nei pazienti con COVID-19

Objectives
While older adults showed higher mortality during COVID-19 pandemic, protective behaviours (knowledge regarding coping with COVID-19 symptoms and preventive behaviours) were highlighted to be important to prevent the spread of infection. This study aimed to identify individual and community-level variables influencing deficient knowledge regarding coping with COVID-19 and not-practicing COVID-19 of older adults during the pandemic.

Design
This is a secondary analysis of a cross-sectional study using the 2020 Korea Community Health Survey (KCHS).

Setting
255 community public health centres nationwide, South Korea.

Methods and analysis
Using 2020 KCHS data, multilevel logistic regression analysis was conducted on 55 005 adults aged 65 years or older.

Results
Older adults who reside alone, as opposed to with their spouse and who lack the support of another individual exhibited insufficient COVID-19 coping-related knowledge (OR: 1.142, p

Objectives
This study addressed two research questions: What factors do doctors in training describe as influencing their choices to apply (or not apply) for specialty training during their Foundation Year 2? Which of these factors are specific to the context of the COVID-19 pandemic, and the unique experiences of the cohort of doctors who qualified early during the pandemic?

Design
Sequential explanatory mixed methods study: Quantitative survey. Qualitative semistructured interviews. Quantitative data were analysed with logistic regression. Qualitative data were analysed using reflexive thematic analysis.

Setting
UK-wide.

Participants
Junior doctors who graduated medical school in 2020. Survey: 320 participants (22% of those contacted). 68% (n=219) were female, 60% (n=192) under 25 and 35% (n=112) 25–30. 72% (n=230) were white, 18% (n=58) Asian and 3% (n=10) black. Interviews: 20 participants, 10 had applied for specialty training, 10 had not.

Results
A minority of respondents had applied for specialty training to start in 2022 (114, 36%). While burnout varied, with 15% indicating high burnout, this was not associated with the decision to apply. This decision was predicted by having taken time off due to work-related stress. Those who had not taken time off were 2.4 times more likely to have applied for specialty training (OR=2.43, 95% CI 1.20 to 5.34). Interviews found reasons for not applying included wanting to ‘step off the treadmill’ of training; perceptions of training pathways as inflexible, impacting well-being; and disillusionment with the community and vocation of healthcare, based, in part, on their experiences working through COVID-19.

Conclusions
Participants infrequently cited factors specific to the pandemic had impacted their decision-making but spoke more broadly about challenges associated with increasing pressure on the health service and an eroded sense of vocation and community.

Objective
Liver function test (LFT) abnormalities are higher in patients with severe COVID-19. Most of the studies on this theme were conducted in foreign nations, and the association with LFT abnormalities was not sufficiently addressed in the study areas. Therefore, the current study aimed to investigate the effects of COVID-19 infection on liver function of patients.

Setting
A facility-based comparative cross-sectional study was carried out from 10 April to 15 June 2022, among COVID-19 infected individuals admitted in Eka Kotebe General Hospital and Saint Petrous Specialized Hospitals, Addis Ababa, 2022.

Participants
A total of 284 confirmed COVID-19-positive and COVID-19-negative controls matched by gender and age were included in the present study.

Results
Among SARS-COV-2 positive groups, 63 (44.4%) had one or more LFT abnormalities. The most common elevated level of the LFTs among patients with COVID-19 were gamma-glutamyl transferase (GGT) 50 (35.2%), while the most common lowered level was albumin 58 (40.8%). The mean values of aspartate aminotransferase (AST) (35.4±26.9 vs 22.9±12.6, p

Objectives
To appraise the quality of clinical practice guidelines (CPGs) and expert consensus statements on rehabilitation for patients with COVID-19, summarise recommendations of rehabilitation assessments and interventions and evaluate the heterogeneity of the recommendations.

Design
Systematic review.

Data sources
PubMed and Embase databases and five online guideline repositories: The National Guideline Clearinghouse, Guidelines International Network, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence and WHO were searched from their inception to August 2024. In addition, we reviewed reference lists of eligible citations and searched the grey literature on the relevant websites.

Eligibility criteria for selecting studies
We included CPGs and expert consensus statements which provided information about rehabilitation of patients with COVID-19. To be eligible, the CPGs and expert consensus statements were issued in English by a nationally or internationally recognised government authority, medical/academic society or organisation. If there were multiple versions of the guidelines, we included the latest one. The translations, interpretations and abstracts of guidelines were excluded.

Data extraction and synthesis
All recommendations on rehabilitation assessments and interventions for COVID-19 were extracted and summarised. Two reviewers independently evaluated the methodological quality with the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument, and two other reviewers assessed the reporting quality using the Reporting Items for Practice Guidelines in Healthcare (RIGHT) statement of included CPGs and expert consensus statements. We used the Measurement Scale of Rate of Agreement to evaluate the heterogeneity of the recommendations in different CPGs and expert consensus statements.

Results
A total of 31 CPGs and expert consensus statements were included. 14 guidelines provided recommendations for rehabilitation assessments. At the early, development, critical and recovery stages of COVID-19, the most frequently recommended were exercise therapy (25.8%, 35.5%, 25.8% and 58.1%, respectively). According to AGREE II, 17 included guidelines were assessed as low methodological quality (35%–56%), 10 guidelines were rated as moderate quality (46%– 62%) and four had high quality (69%–79%). Among 31 eligible guidelines, the reporting rate of 22 items in the RIGHT checklist ranged from 10% to 100%. The included guidelines were consistent with the reference guidelines (80%–100%). Only one guideline existed minor (60%–80%) disagreements in respiratory muscle training relative to the reference guideline.

Conclusions
Rehabilitation assessments and interventions should be implemented consistently throughout the entire process of COVID-19. The recommendations should be tailored to each stage of COVID-19. The methodological and reporting qualities of several guidelines remain suboptimal. Therefore, developers should adhere strictly to the AGREE II standard and RIGHT checklist to formulate and publish CPGs and expert consensus statements with high quality.

PROSPERO registration number
CRD42020190761.

4,2 anni in più per le femmine, 1,4 per i maschi

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

While the incidence of persistent and recurring symptoms of SARS-CoV-2, also known as post–COVID-19 condition or long COVID, decreased over the course of the COVID-19 pandemic, the risk remained even among those who were vaccinated, according to a new study published in the New England Journal of Medicine.

Scendono i decessi. La Lombardia è la regione con più contagi

Per l’amaurosi congenita di Leber risultati duraturi e notevoli

Objectives
To ensure sufficient resources to care for patients with COVID-19, healthcare systems delayed non-urgent surgeries to free capacity. This study explores the consequences of delaying non-urgent surgery on surgical care and healthcare resource use.

Design
This is a population-based retrospective cohort study.

Setting
This study took place in Alberta, Canada, from December 2018 to December 2021.

Participants
Adult patients scheduled for surgery in Alberta during the study period were included.

Primary and secondary outcomes measures
The proportion of surgeries completed and surgery wait time were the primary outcomes. The secondary outcomes were healthcare resource use (hospital length of stay, emergency room visits and physician visits). The association between the primary outcomes and patient and surgery-related variables was explored using regression.

Results
There were 202 470 unique patients with 259 677 scheduled surgeries included. Fewer surgeries were completed throughout the pandemic compared with before; in the fourth wave, there was a decrease from 79% pre-COVID-19 to 67%. There was a decrease in wait time for those who had surgery completed during COVID-19 (from 105 to 69 days). Having surgery completed and the wait for surgery were associated with the geographical zone, COVID-19 wave, and the surgery type and priority. There was a decrease in all measures of healthcare resource use and an increase in hospital and all-cause mortality during COVID-19 compared with before COVID-19.

Conclusions
The change in the proportion of scheduled surgeries completed and the wait time for completed surgery was modest and associated with COVID-19 wave and surgery-related variables, which was aligned with policies enacted during COVID-19 for surgery. The decrease in healthcare resource use suggests the effects of the COVID-19 pandemic may be delayed and may result in many patients presenting with advanced disease requiring surgical care.

Objective
To identify the associations of in-hospital cardiovascular events and mortality with pre-existing comorbidities and cardiovascular disease (CVD) risk factors among COVID-19 patients in Bangladesh without vaccine availability.

Design
A secondary analysis of a prospective multicountry study.

Setting
Three COVID-19-designated hospitals in Bangladesh.

Participants
Adult patients aged ≥18 years with PCR-positive COVID-19 admitted between 10 October 2020 and 31 July 2021 at participating hospitals.

Outcome measures
In-hospital cardiovascular events and mortality.

Main exposures
Pre-existing comorbidities and cardiovascular risk factors.

Results
In 897 COVID-19 patients, 18.7% developed cardiovascular events and 12.6% died. After adjusting for clinical information and treatment, patients with two comorbidities (excluding CVD risk factors) were significantly associated with cardiovascular events (adjusted (adj.) OR 2.47, 95% CI 1.24 to 4.90). Patients with a higher heart rate at admission (adj. OR 1.03, 95% CI 1.01 to 1.04) and those who were receiving intravenous fluids (adj. OR 2.13, 95% CI 1.23 to 3.70) or antibiotics (adj. OR 4.54, 95% CI 1.47 to 14.01) had significantly higher odds of cardiovascular events. The odds of cardiovascular events were lower in those receiving antiviral medications (adj. OR 0.31, 95% CI 0.18 to 0.53). There were no interactions between comorbidities and other covariates in the models. Comorbidities and cardiovascular risk factors were not significantly associated with 30-day mortality in the Cox regression models after adjusting with clinical information and treatment. The mortality within 30 days of admission was significantly higher in patients receiving corticosteroids (adj. HR 2.82, 95% CI 1.48 to 5.38) and lower in those receiving antiviral treatment (adj. HR 0.53, 95% CI 0.34 to 0.81). Those having cardiovascular events significantly increased mortality hazard.

Conclusions
Clinical factors and treatment affected in-hospital cardiovascular events, which subsequently increased the risk of mortality within 30 days for COVID-19 patients. COVID-19 patients regardless of CVD risk factors and comorbidities require close monitoring for cardiovascular events.

Impiegati a San Marino. Anelli, ‘sentenza dopo quella Consulta’

Crescono i decessi: sono stati 135, quasi la metà in Lombardia

Introduction
Post- or long-COVID-19 conditions manifest with a spectrum of symptoms reminiscent of pulmonary, musculoskeletal, psychological and neurological disorders. Individuals with post- or long-COVID-19 syndrome often present with myalgia, pulmonary problems and fatigue, which significantly impact their daily functioning. Physiotherapy interventions are an accepted medical remedy for these symptoms. This scoping review aims to outline the evidence of physiotherapy interventions documented in the scientific literature, specifically focusing on hands-on therapy.

Methods and analysis
This scoping review conforms to the methodological framework established by the Joanna Briggs Institute (JBI). The procedure for drafting a scoping review involves several steps, starting with defining the research question and the inclusion and exclusion criteria. Eligible studies are those analysing physiotherapy treatment parameters for direct patient interaction in post- and long-COVID-19 patients. Telemedicine and entirely home-based workouts will be excluded aligning with the context of outpatient physiotherapy in Germany. The literature search will be conducted in PubMed, EBSCO research, Scopus, Web of Science, Embase, PEDRO, Cochrane and WISO databases by two independent researchers. Screening, data extraction and a critical appraisal will be performed by these researchers using assessment tools provided by the JBI. Extracted data will encompass demographic characteristics, definitions of post- or long-COVID-19 conditions, descriptions of interventions, their treatment parameters and treatment outcome. Subsequently, findings will be disseminated through a scoping review article or conference presentation.

Ethics and dissemination
Given that this review does not involve human participants, ethical committee approval is deemed unnecessary. The results will be published in peer-reviewed journals and presented at academic and physiotherapeutic conferences.