Risultati per: Long COVID: principali risultati, meccanismi e raccomandazioni

Sono stati 2,8 milioni gli screening oncologici saltati nei primi 17 mesi di pandemia. Manca un programma di recupero delle cure saltate e il Piano oncologico

Stroke, Ahead of Print. The main burden of SARS-CoV-2 falls on the lungs but neurological manifestations, the most disabling of which are strokes and which correlate with disease severity, are common. We proffer a novel mechanism for acute COVID-19 stroke whereby pulmonary vein clots developing within the characteristic pulmonary intravascular thrombotic lesions can embolize to the brain. Appreciation of this mechanism requires an understanding of the tricompartmental model of lung parenchyma oxygenation (the alveolus, the bronchial artery, and the pulmonary artery), all of which are compromised in COVID-19. Of these 3 sources, the bronchial artery plays a crucial role in COVID-19 stroke because the unique collaterals from bronchial artery to pulmonary vein which exist under normal physiological conditions (and which maintain venous patency when the pulmonary artery is blocked by embolus) are occluded, thus leading to venular thrombosis in the presence of hypercoagulability. Dislodgement of clots from this source translocates the pathology to the brain and is a disease mechanism, formerly rare, which may account for many cases of large vessel occlusion stroke in COVID-19. This mechanism extends the concept of cardioembolic stroke from endocardium retrogradely into the pulmonary circulation with which the left cardiac chambers lie in direct continuity, and which is an accepted stroke mechanism under other circumstances such as lung lobectomy, where surgical ligation of the pulmonary vein creates a blind sac from which thrombi can embolize. The proposed model is supported by postmortem studies which have demonstrated venular thrombosis and by case reports of pulmonary vein thrombosis in COVID-19. This concept provides a more plausible cause for COVID-19 associated large vessel occlusion stroke than other putative mechanisms, such as cerebral endotheliitis, cytokine storm, and hypercoagulopathy, although it is acknowledged that the latter mechanism contributes to the genesis of pulmonary vein clots. Recognizing that extrapulmonary manifestations including stroke arise within thrombosed pulmonary veins is key to understanding of neurological manifestations of SARS-CoV-2 infection.

BackgroundThe purpose of this study was to evaluate the health-related Quality of Life (HRQoL) of OHCA survivors in Singapore using EQ-5D-3L and to assess the factors affecting survey response.MethodAdult OHCA patients aged >/= 18 years between April 2014 to December 2017 who survived to hospital discharge or 30 days were included in a retrospective follow-up study using data obtained from a national registry. EMS-witnessed arrests, those of a drowning or traumatic aetiology, or immediately pronounced dead at scene were excluded. Uncontactable and deceased patients at time of survey were deemed ineligible. The remaining were administered the EQ-5D-3L questionnaire via telephone follow-up at different time points.ResultsOf 2727 patients with ROSC, 368 (25%) survived to discharge or were alive at 30 days. At point of survey, 77 (20.9%) had passed away and 38 (10.3%) were uncontactable. Of the remaining 253, 121 (47.8%) refused and interviews were conducted with 132 (52.2% ) patients or proxies. The median follow-up time was 24.5 months (19.2, 33.3)The mean EQ5D index score was 0.77 (SD 0.44), 86 (65.7%) patients had a full score of 1. The mean EQ5D VAS score was 76.3 (SD17.6). Non-responders tended to be older (60.8 vs 54.9, p

BackgroundThe COVID-19 Ambulance Response Assessment (CARA) study was a prospective, longitudinal survey of UK ambulance staff providing both direct and remote patient care during the first wave of the COVID-19 pandemic. CARA aimed to evaluate perceptions of preparedness and wellbeing, and to collect staff suggestions to benefit working practices and conditions.MethodThree online questionnaires were presented, coinciding with the acceleration, peak and deceleration phases of the first COVID-19 wave. Inductive thematic analysis was employed to represent 14,237 free text responses from 3,717 participants to 18 free-text questions overall.ResultsA thematic framework was constructed from across the variety of questions that demonstrated participants’ objectives to minimise infection risks, maintain service delivery and support their own wellbeing. Additionally, the following requirements of national and organisational leadership were identified as enablers to achieving those objectives.Evidence-based policies, that are consistently applied, clearly communicated and accompanied by adequate training improve confidence and allay anxiety. Demonstrating learning, planning, and astute use of resources will further benefit trust in leadership and to support staff wellbeing there must also be meaningful dialogue and demonstrable empathy with further appropriate preventative and therapeutic interventions enabled.ConclusionInclusive, compassionate leadership will support both ambulance staff wellbeing and service delivery whilst working within pandemic conditions. New working practices should be introduced with transparency and staff experiences of implementing changes should be heeded by leadership to enable further policy development.Conflict of interestNone.FundingCollege of Paramedics.

BackgroundTRIM is an evaluation of the triage models used by emergency ambulance services caring for patients with suspected COVID-19 during the pandemic’s first wave in 2020. We aimed to understand experiences and concerns of staff about implementation of triage protocols.MethodResearch paramedics interviewed stakeholders from four ambulance services (call handlers, clinical advisors, paramedics, managers) and ED clinical staff from receiving hospitals. Interviews (n=23) were conducted remotely using MS Teams, recorded, and transcribed in full. Analysis generated themes from implicit and explicit ideas within participants’ accounts (Braun and Clarke 2021), conducted by researchers and PPI partners working together.ResultsWe identified the following themes:Constantly changing guidelines – at some points, updated several times a day.The ambulance service as part of the wider healthcare system – changes elsewhere in the system left ambulance services as the default.Peaks and troughs of demand – fluctuating greatly over time, and varying across the staff groups.A stretched system – resources were overextended by staff sickness and isolation, longer job times, and increased handover delays at ED.Emotional load of responding to the pandemic – including call centre staff. Doing the best they can in the face of uncertainty – a rapidly evolving situation unlike any which ambulance services had faced before.ConclusionImplementing triage protocols in response to the COVID-19 pandemic was complex and had to be actively managed by a range of frontline staff, dealing with external pressures and a heavy emotional load.Conflict of interestNone.FundingUKRI-DHSC Covid-19 Rapid Response Funding.

BackgroundThe COVID-19 Ambulance Response Assessment (CARA) study was a prospective, longitudinal survey of UK ambulance staff during the first wave of the COVID-19 pandemic. CARA aimed to evaluate perceptions of preparedness and wellbeing, and to collect staff suggestions to benefit working practices and conditions.MethodThree online questionnaires were presented, coinciding with the acceleration, peak and deceleration phases of the first COVID-19 wave in 2020. Inductive thematic analysis was employed to represent 14,237 free text responses from 3,717 participants to 18 free-text questions overall. This report focuses on experiences of IPC practices.ResultsMany participants lacked confidence in using PPE because of low familiarity, an inadequate evidence-base and changing policy. Some experienced insufficient supply, items of poor quality and suboptimal fit-testing procedure. PPE use was further influenced by discomfort, urgency, and perceptions of risk. Various suggestions were made to improve IPC practices, including decontamination personnel, staff ‘bubbles’ and limiting exposure through public education and remote triage improvements.ConclusionRepeated poor experiences of implementing IPC practices1 2 demand that lessons are learnt from this pandemic. PPE developed with specific regard for ambulance staff’s unique working environment and for them to receive regular familiarization training in its use would likely benefit performance and confidence. Overall, ambulance staff emphasised the need for IPC policies to be pragmatic, evidence-based and communicated with clarity.ReferencesBillings J, Ching B C F, Gkofa V, Greene T, & Bloomfield M. (2020). Healthcare workers experiences of working on the frontline and views about support during COVID-19 and comparable pandemics: A rapid review and meta-synthesis. MedRxiv. https://www.medrxiv.org/content/10.1101/2020.06.21.20136705v1.full-textHoughton C, Meskell P, Delaney H, Smalle M, Glenton C, Booth A, Chan XHS, Devane D. & Biesty L M. (2020). Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases: a rapid qualitative evidence synthesis. Cochrane Database of Systematic Reviews, (4).Conflict of interestNone.FundingCollege of Paramedics.

BackgroundThe COVID-19 pandemic has created challenges and led to the massive closure of in-person CPR trainings globally. We developed a mobile application-based real-time CPR training solution named HEROS-Remote, which combines instructors, learners, training contents, and CPR feedback in just one app. In this study, we investigated the usability, acceptability, and feasibility of the HEROS-Remote CPR training solution among community lay people.MethodFrom August to November 2021, HEROS Remote pilot study was conducted in Seoul, Korea. During the study period, 164 learners participated in 22 HEROS-Remote sessions. Before the training, CPR training material, including Little Anne QCPR manikin, was delivered to the individual learner. After one-hour chest compression-only HEROS Remote online training, the learners participated in-depth survey on their experiences of HEROS Remote online training.ResultsA total 152 learners (92.7%) responded to the survey. Overall, 88.1% of the learners were satisfied with the HEROS Remote training and 85.5% responded that they would recommend online training to others. Majority of the learners (37.3% strongly agree; 41.3% agree) also agreed with the easiness of using the HEROS Remote app. Manikin delivery service was highly satisfactory (97%). However, major challenge for this online solution was that the quality of the training highly depended on internet connectivity.ConclusionThis study provides evidence of the feasibility and acceptability of a novel online, real-time CPR training solution. Further research is needed to investigate the effectiveness of online CPR training versus face-to-face training.Conflict of interestSYJK, HM, TSB are employees of Laerdal Medical.FundingSeoul Metropolitan Government.

L’aumento delle infezioni sembra essere guidato dalle sottovarianti Omicron BA.4 – appena isolata anche in Italia – e BA.5, più trasmissibili rispetto alla precedente BA.2

Era il 31 gennaio quando secondo la flash survey dell’Iss questa variante registrava una prevalenza stimata al 99%.

In Africa siamo solo al 15%. Le case farmaceutiche sottolineano: il problema non è nella disponibilità, ma nella logistica della somministrazione

Stroke, Ahead of Print. BACKGROUND:Data on long-term outcomes following an acute stroke are sparse. We assessed survival, risk of recurrent stroke and loss in life expectancy following an acute stroke using population-wide data from Australia and New Zealand.METHODS:We included all adults with the first stroke hospitalization during 2008 and 2017 at all public and most private hospitals. Patients were followed up to 10 years after the stroke by linkage to each region’s Registry of Deaths and subsequent hospitalizations. Flexible parametric survival modeling was used to estimate all-cause mortality, stroke recurrence, and loss in life expectancy. Competing risk model was used when estimating the risk of stroke recurrence.RESULTS:Three hundred thirteen thousand one hundred sixty-two patients were included (mean age 73.0±14.6 y, 52.0% males) with ischemic stroke (175 547, 56.1%) being the most common, followed by hemorrhagic stroke (77 940, 24.9%) and unspecified stroke (59 675, 19.1%). The overall survival probability was 79.4% at 3 months, 73.0% at 1 year, 52.8% at 5 years, and 36.4% at 10 years. Cumulative incidence of stroke recurrence was 7.8% at 3 months, 11.0% at 1 year, 19.8% at 5 years, and 26.8% at 10 years. Hemorrhagic stroke was associated with greater mortality (hazard ratio, 2.02 [95% CI, 1.99–2.04]) and recurrent stroke (hazard ratio, 1.63 [95% CI, 1.59–1.67]) compared with ischemic stroke. Female sex (hazard ratio, 1.10 [95% CI, 1.09–1.11]) and increasing age (≥85 years versus 18–54 years: hazard ratio, 7.36 [95% CI, 7.15–7.57]) were also associated with increased mortality. Several risk factors including atherosclerotic coronary and noncoronary vascular disease, cardiac arrhythmia, and diabetes were associated with increased risk of mortality and recurrent stroke. Compared with the general population, an acute stroke was associated with a loss of 5.5 years of life expectancy, or 32.7% of the predicted life expectancy, and was pronounced in patients with a hemorrhagic stroke (7.4 years and 38.5% of predicted life expectancy lost).CONCLUSIONS:In this population-wide study, death and recurrence of stroke were common after an acute stroke and an acute stroke was associated with considerable loss in life expectancy. Further improvements in treatment and secondary prevention of stroke are needed to reduce these risks.

L’Agenzia del farmaco dovrebbe dare il via libera alla semplificazione per l’impiego degli antivirali nei pazienti che rischiano il Covid severo

Le prime evidenze scientifiche mostrano che per questa categoria di fragili c’è bisogno di una nuova protezione con la vaccinazione