Risultati per: Anticoagulazione nei pazienti con COVID-19

Objectives
The purpose of this study is to describe and evaluate, in a real-life context, the support and communicate with families (SCF) team’s contribution to maintaining communication and supporting relatives when patients are at the end of their lives by mobilising the points of view of SCF team members, healthcare professionals, managers and the relatives themselves.

Design
An in-depth mixed-method case study (quantitative and qualitative). Individual interviews were conducted with members of the SCF team to assess the activities and areas for improvement and with co-managers of active COVID-19 units. Healthcare professionals and managers completed a questionnaire to assess the contribution made by the SCF team. Hospitalised patients’ relatives completed a questionnaire on their experience with the SCF team.

Setting
The study was conducted in a university teaching hospital in the province of Québec, Canada.

Participants
Members of the SCF team, healthcare professionals, managers and relatives of hospitalised patients.

Results
Between April and July 2020, 131 telephone communications with families and healthcare professionals, 43 support sessions for relatives of end-of-life patients and 35 therapeutic humanitarian visits were carried out by members of the SCF team. Team members felt that they had played an active role in humanising care. Fully 83.1% of the healthcare professionals and managers reported that the SCF team’s work had met the relatives’ needs, while 15.1% believed that the SCF team should be maintained after the pandemic. Fully 95% of the relatives appreciated receiving the telephone calls and visits, while 82% felt that the visits had positive effects on hospitalised patients.

Conclusion
The COVID-19 pandemic forced the introduction of a social innovation involving support for and communication with families. The intention of this innovation was to support the complexity of highly emotional situations experienced by families during the COVID-19 pandemic.

Takenobu K, Yoshida S, Katanoda K, et al. Impact of workplace smoke-free policy on secondhand smoke exposure from cigarettes and exposure to secondhand heated tobacco product aerosol during COVID-19 pandemic in Japan: the JACSIS 2020 study. BMJ Open 2022;12:e056891. doi: 10.1136/bmjopen-2021-056891
This article was previously published with an error.
The authors have informed the journal that two of the authors have received payment from the tobacco industry on projects unrelated to the one described in the article. This was not in breach of the journal’s policy at the time of publication, which stated that we will not ‘consider for publication any study that is partly or wholly funded by the tobacco industry’.1 However, to make these personal funds transparent, we have corrected the competing interests statement of the article.

Affette 1,5 milioni di persone e numero è destinato ad aumentare

Objectives
During the COVID-19 epidemic, due to the high risk associated with travel and group gatherings, the Ministry of Public Health in Qatar introduced home delivery of pharmaceutical services. This study aims to investigate the satisfaction and preferences of patients who used the new home delivery services provided by health centres (HCs).

Study design
A cross-sectional study was conducted using an exploratory questionnaire to assess patients’ preferences for pharmaceutical delivery services.

Settings
Primary care.

Participants
A convenient sample of 604 adults who used the pharmaceutical delivery services was recruited. The study tool measured satisfaction with a set of 11 service evaluation criteria on a Likert scale of 5 grades. The score ranged between 1 for highly dissatisfied and 5 for highly satisfied. A quantitative summary satisfaction score was calculated by summing the satisfaction rating for home delivery on the 11 service evaluation criteria. The final score was adjusted to a maximum of 100 for ease of understanding.

Results
Results showed that 45.5% of participants were highly satisfied with the overall quality of the home delivery service. Furthermore, 58.9% were willing to recommend the service to others, while only 30.9% considered the delivery cost to be reasonable. Among the factors associated with satisfaction was nationality, where Qatari nationals had a significantly higher mean satisfaction score (89%) compared with expatriates (79.5%).

Outcome
The satisfaction score exhibited a significant positive trend with age and educational level. Factors such as gender, the time required to access the HCs, frequency of requesting pharmacy service and income categories did not show a significant difference in the satisfaction score.

Conclusion
The home delivery service is a promising addition to primary care. It may play a crucial role in enhancing accessibility for the beneficiaries reducing unnecessary visits to HCs in the future.

Introduction
Mental health concerns are prevalent among adult patients with long COVID (LC), but the current state of knowledge regarding mental health in the context of LC is not fully understood. The objective of this scoping review is to map and summarise the existing research on mental health conditions among LC patients and highlight the knowledge gaps. This review aims to provide a comprehensive overview of the evolving landscape of research in the area.

Methods and analysis
The concept of interest is mental health in adult LC patients. This scoping review will be guided by the Joanna Briggs Institute Manual for Evidence Synthesis and reported according to the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review guidelines. Using predefined search parameters, a comprehensive search of two electronic databases (Medline and APA PsycINFO) and grey literature sources identified 3104 potentially eligible articles published from 1 January 2020 to 4 April 2024. Following the removal of duplicates, 2767 articles were imported for screening in Covidence. The study selection process involves screening titles, abstracts and full text of potentially relevant articles, which will then be analysed using thematic analysis. Data will be extracted using a predefined extraction form.

Ethics and dissemination
Ethical approval is not required because this study does not involve human participants or primary data collection. The findings from this review will be disseminated through a peer-reviewed publication, conference presentations and professional networks. In addition, a summary of the results will be shared with patient partners and other relevant stakeholders.

Public health implications
The findings from this scoping review will contribute to a better understanding of mental health issues arising in LC patients and inform future research directions and public health interventions in this area.

Introduction
Migration of the health workforce from low- and middle-income countries (LMCIs) is increasingly becoming a phenomenon of interest within migration governance systems. The COVID-19 pandemic aggravated health workforce shortages that have created job opportunities in high-income countries such as the USA, UK, Canada and Germany among others. Conditions of service in LMCIs are unattractive, leading to the search for better opportunities. The digital environment is becoming one of the facilitators of migration intentions due to the activities of recruitment agencies and the search for job opportunities on the World Wide Web. The digital environment creates opportunities for migration but also poses a security threat, economic loss and a brain drain to departure countries. However, there is a paucity of evidence on how the proliferation of advertisements on health workforce recruitment within social media, unsolicited emails and activities of recruitment agencies in the digital environment influence the migration of the health workforce and the implications of migration governance.

Method and analysis
This scoping review protocol describes a comprehensive systematic extraction and examination of existing literature to map key concepts and identify previous literature, noting the gaps in how social media and the digital environment are influencing the migration of the health workforce. We lean on Arksey and O’Malley’s scoping framework in developing this protocol. This involves the following: identifying research questions, searching for the literature, selecting articles or studies, charting the data and organising and reporting the outcome of the review. The review question is informed by the population, concept and context framework, which details the population as the health workforce (doctors, nurses, midwives and pharmacists), the key concepts as migration, social media and digital environment, and the context as LMICs. The search strategy was developed with the assistance of an experienced librarian who will work with the team to conduct a Peer Review of Electronic Search Strategies to evaluate titles, abstracts and full-text articles for inclusion from databases such as Scopus, PubMed, MEDLINE and Google Scholar. Additionally, we will search grey literature sources including online news media, social media platforms (Facebook, Instagram and Twitter), web pages of WHO, UN and migration-related agencies, and interfaces like EBSCO host. Two members of the team will screen titles and abstracts, and all team members will screen full text for data extraction. Data from grey sources will be converted to transcripts, coded and grouped into themes and subthemes consistent with thematic analysis strategies. All authors will be involved in the synthesis of the data. We intend to follow Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines in reporting the outcome of peer-review sources.

Ethics and dissemination
This is a scoping review protocol that addresses a subject of interest that poses no risk to individuals or groups. All the information will be retrieved from open sources only. The protocol was registered with the Open Science Framework registry (osf.oi/zan3q) to serve as an audit trail. Reports from the review will be published in peer-reviewed journals and presented at conferences.

Objectives
Antihypertensives reduce the risk of myocardial infarction and stroke. Restrictions during the COVID-19 pandemic limited access to healthcare, which may have had a negative impact on drug prescribing. This study aimed to assess the effect of the COVID-19 pandemic on the initiation of antihypertensive drugs.

Design
Interrupted time series study using a segmented linear regression model.

Setting
Swedish population assessed through linked national healthcare registers.

Participants
720 300 new users of antihypertensives.

Intervention
March 2020, COVID-19 pandemic onset.

Main outcomes measures
The change in the initiation of antihypertensives expressed as monthly cumulative incidence, stratified by age and sex. Data on dispensed prescriptions of diuretics, beta-blockers, calcium channel blockers, ACE inhibitors (ACEi) and angiotensin receptor blockers were extracted from the Swedish Prescribed Drug Register, from March 2018 to November 2021. Initiation (new use) was defined as having no previous dispensations before March 2019. Monthly cumulative incidence in March 2019–November 2021 was calculated as the number of patients initiating each drug class in each month divided by the population.

Results
The start of the pandemic was associated with an immediate drop in the initiation of any antihypertensive, but no sustained effects were observed, as the incidence continued to increase in the postinterruption period by +0.02% each month in both sexes. The immediate drop was statistically significant for ACEi in both sexes and all antihypertensive classes except diuretics in patients >65 years. A significant postintervention trend change was observed for initiation of diuretics (+0.013% overall), driven mainly by a significant increase in patients >65 years. Similar findings were also observed for diuretics in females (+0.02%) and ACEi (+0.03%) in patients >65 years.

Conclusions
The pandemic had an immediate negative short-term effect, but we found no major long-term negative influence of the COVID-19 pandemic on initiation of any type of antihypertensive drugs.

Objectives
To examine the impact of the COVID-19 pandemic on deprivation-related inequalities in hospitalisations for cardiovascular disease (CVD) conditions in Denmark and England between March 2018 and December 2021.

Design
Time-series studies in England and Denmark.

Setting
With the approval of National Health Service England, we used English primary care electronic health records, linked to secondary care and death registry data through the OpenSAFELY platform and nationwide Danish health registry data.

Participants
We included adults aged 18 and over without missing age, sex or deprivation information. On 1 March 2020, 16 234 700 people in England and 4 491 336 people in Denmark met the inclusion criteria.

Primary outcome measures
Hospital admissions with the primary reason for myocardial infarction (MI), ischaemic or haemorrhagic stroke, heart failure and venous thromboembolism (VTE).

Results
We saw deprivation gradients in monthly CVD hospitalisations in both countries, with differences more pronounced in Denmark. Based on pre-pandemic trends, in England, there were an estimated 2608 fewer admissions than expected for heart failure in the most deprived quintile during the pandemic compared with an estimated 979 fewer admissions in the least deprived quintile. For all other outcomes, there was little variation by deprivation quintile. In Denmark, there were an estimated 1013 fewer admissions than expected over the pandemic for MI in the most deprived quintile compared with 619 in the least deprived quintile. Similar trends were seen for stroke and VTE, though absolute numbers were smaller. Heart failure admissions were similar to pre-pandemic levels with little variation by deprivation quintile.

Conclusions
Overall, we did not find that the pandemic substantially worsened pre-existing deprivation-related differences in CVD hospitalisations, though there were exceptions in both countries.

Senza servizi territoriali e aiuto a casa impossibile dimetterli

Objective
This study aimed to evaluate the impact of the COVID-19 pandemic on the management of acute coronary syndrome (ACS) in Yogyakarta, Indonesia with respect to time to treatment, treatment pattern and treatment outcome.

Design
This is a retrospective cohort study in which medical records of hospitalised patients with ACS were reviewed.

Setting
Three hospitals in Yogyakarta, Indonesia.

Participants
Patients hospitalised with ACS during two pandemic periods (first pandemic period: March–August 2020; second pandemic period: March–August 2021) and prepandemic period (March–August 2019).

Outcome measures
Time to treatment, treatment pattern and treatment outcome.

Results
A total of 598 patients with ST-elevation myocardial infarction (STEMI) and 615 with non-ST-elevation ACS were identified. Of these, 313, 484 and 416 were identified during the prepandemic period, first pandemic period and second pandemic period, respectively. For STEMI, the proportion of patients with a delay from symptom onset to first medical contact (FMC) was significantly higher during the second pandemic period as compared with the prepandemic period (47.7% vs 32.0%, OR=1.84, 95% CI 1.18, 2.85). The proportion of patients with STEMI with delayed door-to-balloon (D2B) time was significantly higher during the second pandemic period as compared with the prepandemic period (99.4% vs 92.9%, OR=13.08, 95% CI 1.57, 108.73). Significantly longer mean total ischaemic time (45.85 hours vs 30.29 hours, mean difference=14.56, 95% CI 1.85, 27.28) was observed among patients with STEMI during the second year of the pandemic as compared with the prepandemic period. No significant differences between the prepandemic period and the first pandemic period were found in terms of proportion of patients with STEMI with a delay in time from symptom onset to FMC, delayed D2B time and total ischaemic time. Only Global Registry of Acute Coronary Events risk score (OR=1.04, 95% CI 1.03, 1.05) was a significant predictor of in-hospital mortality in the multivariate analysis.

Conclusions
This study suggests a significant impact of the COVID-19 pandemic on time to treatment among patients with ACS. Health systems need to be well prepared to support effective and timely treatment of patients with ACS during future crisis.

Purpose
VAccine Study COVID-19 (VASCO) is a cohort study with a 5-year follow-up that was initiated when COVID-19 vaccination was introduced in the Netherlands. The primary objective is to estimate real-world vaccine effectiveness (VE) of COVID-19 vaccines against SARS-CoV-2 infection in the Netherlands, overall and in four subpopulations defined by age and medical risk.

Participants
The cohort consists of 45 547 community-dwelling participants aged 18–85 years who were included irrespective of their COVID-19 vaccination status or intention to get vaccinated. A medical risk condition is present in 4289 (19.8%) of 21 679 individuals aged 18–59 years, and in 9135 (38.3%) of 23 821 individuals aged 60–85 years. After 1 year of follow-up, 5502 participants had dropped out of the study. At inclusion and several times after inclusion, participants are asked to take a self-collected fingerprick blood sample in which nucleoprotein and spike protein receptor binding domain-specific antibody concentrations are assessed. Participants are also asked to complete monthly digital questionnaires in the first year, and 3 monthly in years 2–5, including questions on sociodemographic factors, health status, COVID-19 vaccination, SARS-CoV-2-related symptoms and testing results, and behavioural responses to COVID-19 measures.

Findings to date
VASCO data have been used to describe VE against SARS-CoV-2 infection of primary vaccination, first and second booster and bivalent boosters, the impact of hybrid immunity on SARS-CoV-2 infection and VE against infectiousness. Furthermore, data were used to describe antibody response following vaccination and breakthrough infections and to investigate the relation between antibody response and reactogenicity.

Future plans
VASCO will be able to contribute to policy decision-making regarding future COVID-19 vaccination. Furthermore, VASCO provides an infrastructure to conduct further studies and to respond to changes in vaccination campaigns and testing policy, and new virus variants.

Trial registration number
NL9279.

To more closely target SARS-CoV-2 variants currently circulating in the US, the US Food and Drug Administration (FDA) authorized an updated formula of the messenger RNA (mRNA) COVID-19 vaccine, the agency announced in mid-August.

Circulation, Ahead of Print. Cardiac arrhythmias are commonly noted in patients during infections with and recovery from COVID-19. Arrhythmic manifestations span the spectrum of innocuous and benign to life-threatening and deadly. Various pathophysiological mechanisms have been proposed. Debate continues on the impact of incident and exacerbated arrhythmias on the acute and chronic (recovery) phase of the illness. COVID-19 and COVID-19 vaccine–associated myocardial inflammation and autonomic disruption remain concerns. As the pandemic has transformed to an endemic, with discovery of new SARS-CoV-2 variants, updated vaccines, and potent antiviral drugs, vigilance for COVID-19–associated arrhythmic and dysautonomic manifestations remains. The objective of this American Heart Association scientific statement is to review the available evidence on the epidemiology, pathophysiology, clinical presentation, and management of cardiac arrhythmias and autonomic dysfunction in patients infected with and recovering from COVID-19 and to provide evidence-based guidance. The writing committee’s consensus on implications for clinical practice, gaps in knowledge, and directions for future research are highlighted.

Federfarma, Si potrà fare anche vaccinazione per l’herpes zoster

Objectives
With the emergence of new COVID-19 variants (Omicron BA.5.2.48 and B.7.14), predicting the mortality of infected patients has become increasingly challenging due to the continuous mutation of the virus. Existing models have shown poor performance and limited clinical utility. This study aims to identify the independent risk factors and develop practical predictive models for mortality among patients infected with new COVID-19 variants.

Design
A retrospective study.

Setting and participants
We extracted data from 1029 COVID-19 patients in the respiratory disease wards of a general hospital in China between 22 December 2022 and 15 February 2023.

Outcome measures
Mortality within 15 days after hospital discharge.

Results
A total of 987 cases with new COVID-19 variants (Omicron BA.5.2.48 and B.7.14) were eventually included, among them, 153 (15.5%) died. Non-invasive ventilation, intubation, myoglobin, international normalised ratio, age, number of diagnoses, respiratory rate, pulse, neutrophil count and albumin were the most important predictors of mortality among new COVID-19 variants. The area under the curve of logistic regression (LR), decision tree (DT) and Extreme Gradient Boosting (XGBoost) models were 0.959, 0.883 and 0.993, respectively. The diagnostic accuracy was 0.926 for LR, 0.918 for DT and 0.977 for XGBoost. XGBoost model had the highest sensitivity (0.908) and specificity (0.989).

Conclusion
Our study developed and validated three practical models for predicting mortality in patients with new COVID-19 variants. All models performed well, and XGBoost was the best-performing model.

Objective
Pregnant women with COVID-19 are at elevated risk for severe outcomes, but clinical data on management of these patients are limited. Monoclonal antibodies, such as casirivimab plus imdevimab (CAS+IMD), have proven effective in treating non-pregnant adults with COVID-19, prompting further evaluation in pregnant women.

Methods
A phase 3 portion of an adaptive, multicentre, randomised, double-blind, placebo-controlled trial evaluated the safety, clinical outcomes, pharmacokinetics and immunogenicity of CAS+IMD (1200 mg or 2400 mg) in the treatment of pregnant outpatients with COVID-19 (NCT04425629). Participants were enrolled between December 2020 and November 2021, prior to the emergence of Omicron-lineage variants against which CAS+IMD is not active. Safety was evaluated in randomised participants who received study drug (n=80); clinical outcomes were evaluated in all randomised participants (n=82). Only two pregnant participants received placebo, limiting conclusions regarding treatment effect. Infants born to pregnant participants were followed for developmental outcomes ≤1 year of age.

Results
In pregnant participants, CAS+IMD was well tolerated, with no grade ≥2 hypersensitivity or infusion-related reactions reported. There were no participant deaths, and only one COVID-19–related medically attended visit. Although two pregnancies (3%) reported issues in the fetus/neonate, they were confounded by maternal history or considered to be due to an alternate aetiology. No adverse developmental outcomes in infants ≤1 year of age were considered related to in utero exposure to the study drug. CAS+IMD 1200 mg and 2400 mg rapidly and similarly reduced viral loads, with a dose-proportional increase in concentrations of CAS+IMD in serum. Pharmacokinetics were consistent with that reported in the general population. Immunogenicity incidence was low.

Conclusion
CAS+IMD treatment of pregnant outpatients with COVID-19 showed similar safety, clinical outcomes and pharmacokinetic profiles to that observed in non-pregnant adults. There was no evidence of an impact on developmental outcomes in infants ≤1 year of age.

Trial registration number
NCT04425629.