Background
Since the COVID-19 pandemic began, there have been concerns related to the preparedness of healthcare workers (HCWs). This study aimed to describe the level of awareness and preparedness of hospital HCWs at the time of the first wave.
Methods
This multinational, multicenter, cross-sectional survey was conducted among hospital HCWs from February to May 2020. We used a hierarchical logistic regression multivariate analysis to adjust the influence of variables based on awareness and preparedness. We then used association rule mining to identify relationships between HCW confidence in handling suspected COVID-19 patients and prior COVID-19 case-management training.
Results
We surveyed 24,653 HCWs from 371 hospitals across 57 countries and received 17,302 responses from 70.2% HCWs overall. The median COVID-19 preparedness score was 11.0 (interquartile range [IQR] = 6.0–14.0) and the median awareness score was 29.6 (IQR = 26.6–32.6). HCWs at COVID-19 designated facilities with previous outbreak experience, or HCWs who were trained for dealing with the SARS-CoV-2 outbreak, had significantly higher levels of preparedness and awareness (p<0.001). Association rule mining suggests that nurses and doctors who had a ’great-extent-of-confidence’ in handling suspected COVID-19 patients had participated in COVID-19 training courses. Male participants (mean difference = 0.34; 95% CI = 0.22, 0.46; p<0.001) and nurses (mean difference = 0.67; 95% CI = 0.53, 0.81; p<0.001) had higher preparedness scores compared to women participants and doctors.
Interpretation
There was an unsurprising high level of awareness and preparedness among HCWs who participated in COVID-19 training courses. However, disparity existed along the lines of gender and type of HCW. It is unknown whether the difference in COVID-19 preparedness that we detected early in the pandemic may have translated into disproportionate SARS-CoV-2 burden of disease by gender or HCW type.
Predicting left atrial appendage thrombus (LAAT) in chronic nonvalvular atrial fibrillation remains challenging despite the fact that several predictive models have been proposed to date. In this study, we sought to develop new and simpler models for LAAT prediction in chronic nonvalvular atrial fibrillation. The study enrolled 144 patients with chronic nonvalvular atrial fibrillation who underwent transesophageal echocardiography for LAAT detection. We examined the association of LAAT incidence with the CHA2DS2-VASc score and echocardiographic parameters pertaining to the left atrium (LA), including diameter, volume index, strain, and strain rate measured on speckle tracking echocardiography. LAAT was found in 24.3% of patients (39/144). The following parameters had good diagnostic performance for LAAT: LA volume index >57 mL (area under the curve (AUC), 0.72; sensitivity, 77.1%; specificity, 64.2%), LA positive strain ≤6.7% in the four-chamber view (AUC, 0.84; sensitivity, 77.1%; specificity, 77.1%), and LA negative strain rate >−0.73 s−1 in the four-chamber view (AUC, 0.83; sensitivity, 85.7%; specificity, 70.6%). The CHA2DS2-VASc score alone had a low predictive value for LAAT in this population (χ2 = 3.53), whereas the combination of CHA2DS2-VASc score with LA volume index had significant association and better predictive value (χ2 = 12.03), and the combination of CHA2DS2-VASc score with LA volume index and LA positive strain or negative strain rate in the four-chamber view had the best predictive ability for LAAT (χ2: 33.47 and 33.48, respectively). We propose two novel and simple models for noninvasive LAAT prediction in patients with chronic nonvalvular atrial fibrillation. These models combine the CHA2DS2-VASc score with LA volume index and LA longitudinal strain parameters measured on speckle tracking echocardiography in the four-chamber view. We hope these simple models can help with decision-making in managing the antithrombotic treatment of such patients, whose risk of stroke cannot be determined solely based on the CHA2DS2-VASc score.
Mục tiêu: Đánh giá vai trò của cắt lớp vi tính đa dãy hệ tĩnh mạch cửa trong lựa chọn và lập kế hoạch can thiệp TIPS ở bệnh nhân xơ gan. Đối tượng và phương pháp: 71 bệnh nhân được chẩn đoán xơ gan có chỉ định can thiệp TIPS được chụp cắt lớp vi tính đa dãy, điều trị tại Bệnh viện Trung ương Quân đội 108 và Bệnh viện Đa khoa tỉnh Phú Thọ từ tháng 10/2013 đến tháng 07/2020. Kết quả: Tỷ lệ bệnh nhân được can thiệp TIPS sau khi chụp cắt lớp vi tính là 70,4%. Nguyên nhân không can thiệp chủ yếu là do bất thường hình thái gan và tĩnh mạch cửa chiếm 38,1% (8/21). Kế hoạch can thiệp từ tĩnh mạch gan phải - nhánh phải tĩnh mạch cửa chiếm 92%, trên thực tế là 70%. Số lần chọc kim vào tĩnh mạch cửa trung bình là 2,0 ± 0,9 lần, chọc kim 2 lần chiếm tỷ lệ cao nhất là 45,8%. Tai biến tụ máu dưới bao gan chiếm tỷ lệ cao nhất là 22,9%. Kết luận: Cắt lớp vi tính có vai trò trong lựa chọn và lập kế hoạch can thiệp TIPS ở bệnh nhân xơ gan
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