Hospital incident command system is a series of management systems for emergencies response of hospitals from the United States. Some hospitals in many countries have applied this system, but it has not yet been applied in China. In the process of responding to the coronavirus disease 2019 epidemic, West China Hospital of Sichuan University managed coronavirus disease 2019 patients through a standardized and programmatic model using the concept and framework of hospital incident command system, which included organizing hospital incident management team, carrying out incident action plan, space management, personnel management, material management and information management, in order to carry out standardized and procedural crisis response. This article introduces these management measures of West China Hospital of Sichuan University, aiming to provide a reference for establishing a more complete hospital emergency management system in line with China’s system in the future.
Previous studies have shown that rehabilitation can relieve clinical symptoms, prevent complications, and improve physical function and quality of life in patients with pneumonia. This consensus summarizes the rehabilitation assessment, self-protection, rehabilitation goals, rehabilitation programs, indications for termination of treatment, nutrition support and psychological rehabilitation for patients with mild, moderate, severe and critical types of coronavirus disease 2019 based on the relevant literature and previous practice of coronavirus disease 2019. We hope this consensus can provide a reference for rehabilitation of coronavirus disease 2019.
Since December 2019, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has gradually spread all over the world. With the implementation of class B infectious disease management policy for coronavirus disease 2019 (COVID-19), China has experienced a pandemic. For patients receiving a time-sensitive or emergency surgery, SARS-CoV-2 infection may increase the risk of postoperative pulmonary complications. An appropriate perioperative mechanical ventilation strategy, such as lung protective ventilation strategy, is particularly important for preventing postoperative pulmonary complications in patients undergoing general anesthesia. In addition, how to protect medical personnel from being infected is also the focus we need to pay attention to. This article will discuss the perioperative mechanical ventilation strategy for COVID-19 patients and the protection of medical personnel, in order to provide reference for the development of guidelines.
Maintenance hemodialysis patients face great risk and challenges in the current coronavirus disease 2019 (COVID-19) epidemic, and adequate and reasonable nutrition is an important weapon in the prevention and treatment of COVID-19. Therefore, the Chinese Society of Parenteral and Enteral Nutrition proposed Dietary Expert Advice on Prevention and Treatment of COVID-19 in Hemodialysis Patients for hemodialysis patients. In this paper, the nine pieces of advice on hemodialysis patients’ staple food, intake of high-quality protein, vegetables and fruits, food types and combinations, prevention of virus transmission, fluid intake, nutritional supplements, regular rest and adequate sleep, as well as supplement of anti-inflammatory and antioxidant preparations are interpreted in detail.
ObjectiveTo investigate the epidemiological characteristics of the first cluster of patients with coronavirus diseases 2019 (COVID-19) in Gansu.MethodsAll 6 COVID-19 patients from a non-familial cluster in Gansu, were extracted from Gansu Provincial Health Information System until Feb 20, 2020. The patients were confirmed by nucleic acid detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The analyses were included via retrospective method: patient clinical characteristics, the summary of epidemiology, and CT image characteristics.ResultsThis clustered outbreak was the first non-family clustered outbreak in Gansu after traveled to Thailand. All 6 COVID-19 confirmed patients were a kindergarten staff in Gansu, aged from 26 to 51 years, and were female. They traveled to Thailand in the same period, and had the same epidemiological exposure history. They were diagnosed as COVID-19 by transnasopharyngeal swab real-time fluorescent reverse transcription-PCR for SARS-CoV-2 nucleic acid examination at different time points after return to Gansu. The first patient was ill on January 21, 2020, with fever as first symptom. She was diagnosed at the Xigu District People’s Hospital in Lanzhou and was transferred to Lanzhou Pulmonary Hospital after being diagnosed. She was cured with one week’s antiviral treatment. The remaining 5 patients were treated in Longxi People’s Hospital. The common clinical symptoms were fever, throat discomfort, headache, and fatigue. Through 7 to 10 days’ antiviral treatment, they all were cured. All patients belonged to common type and had good prognosis.ConclusionThe COVID-19 patients in a non-familial cluster have the same epidemiological history. Early medical observation, SARS-CoV-2 nucleic acid examination and comprehensive chest CT should be arranged promptly to make diagnosis and give responsive treatment, so that the prognosis is often good.
Objective To conduct a systematic and comprehensive bibliometric analysis related to medical imaging in coronavirus disease 2019 (COVID-19) published by Chinese authors, and indicate the current status and guidance for coping with the challenges brought by long COVID. Methods Literature records pertaining to COVID-19 imaging were retrieved from the Web of Science (WOS) and Chinese Science Citation Database (CSCD) with a date range of January 1st, 2020 to December 31st, 2022. CiteSpace was used to analyze the popular topics and generate a visual map to further refine research trends. Results The search enrolled 2229 publications (1771 publications from WOS and 458 from CSCD). The monthly volume of publications showed a significant increase followed by a gradual decline, and then maintained a stable level. Clustering analysis of keywords and co-citations revealed that the research hotspots in COVID-19 imaging were clinical features, imaging differential diagnosis, and the application of artificial intelligence. Keyword burst analysis showed that “deep learning” was the most intensive keyword, while “attention mechanism” had the longest burst duration. Conclusions In recent years, the research in the field of COVID-19 imaging has made steady progress. Artificial intelligence has received the most attention. Clinical features, imaging features and artificial intelligence assisted diagnosis are the top of most concerns. The future focus of COVID-19 imaging research may be on improving algorithm models to expand the application of artificial intelligence in disease diagnosis, treatment, and management.
Objective To investigate the status of frailty in patients with coronavirus disease 2019 (COVID-19), and to analyze the influence of COVID-19 disease on the prevalence of frailty. Methods This study was conducted using a cross-sectional survey method. COVID-19 patients admitted to a centralized isolation point in Guangzhou were selected for an questionnaire survey by “questionnaire star”, between November and December 2022. The questionnaire included the general information questionnaire, Tilburg Frailty Indicator (TFI), the COVID-19 symptom scale and Mental Resilience Scale (RS-11). Multi-model logistic regression analysis was used to explore the influence of COVID-19 on the occurrence of debilitation. Results A total of 667 questionnaires were distributed, of which 594 were valid, with an effective rate of 89.1%. There were 150 patients (25.3%) were frail, 444 patients (74.7%) were non-frail, and 51 patients (8.6%) were newly frail after infected COVID-19. The median TFI score before COVID-19 was 3 (2, 4) points, 16.7% (99/594) were in a weak state. The median TFI score after COVID-19 was 3 (2, 5) points, 25.3% (150/594) were in a weak state. There were statistically significant differences in TFI scores (Z=?6.596, P＜0.001) and the incidence of debilitation (χ2=351.648, P＜0.001) before and after COVID-19. The results of multivariate logistic regression analysis showed that after controlling disease factors, demographic factors and psychosocial factors, the score of the COVID-19 symptom score was always the influencing factor of COVID-19 patients. The overall change trend of COVID-19 symptom score was statistically significant (P<0.001). Conclusions The COVID-19 symptom score is an important risk factor or predictor of frailty in patients with COVID-19. As the level of COVID-19 symptom score increases, the risk of frailty in COVID-19 patients increases.
Most patients with coronavirus disease 2019 (COVID-19) have a good prognosis, but a certain proportion of the elderly and people with underlying diseases are still prone to develop into severe and critical COVID-19. Kidney is one of the common target organs of COVID-19. Acute kidney injury (AKI) is a common complication of severe COVID-19 patients, especially critical COVID-19 patients admitted to intensive care units. AKI associated with COVID-19 is also an independent risk factor for poor prognosis in patients. This article mainly focuses on the epidemiological data, possible pathogenesis, diagnostic criteria, and prevention and treatment based on the 5R principle of AKI associated with COVID-19. It summarizes the existing evidence to explore standardized management strategies for AKI associated with COVID-19.
Medical records play an important role in medical treatment, prevention, teaching, scientific research and hospital management. The epidemic situation of coronavirus disease 2019 is very serious. How to complete the writing of medical records with high quality and high efficiency under the high-intensity, high-pressure environment of the prevention, diagnosis, and treatment of coronavirus disease 2019 is an important issue for medical quality control management departments. West China Hospital of Sichuan University has adopted various measures to continuously improve the quality management of medical records, including optimizing the medical records of fever clinics and isolation wards, and using various methods of medical record quality management under the support of electronic medical record information systems, so as to improve the writing quality and efficiency of medical records during the diagnosis and treatment of coronavirus disease 2019.
ObjectiveTo investigate the high-resolution computed tomography (HRCT) signs of patients diagnosed with the coronavirus disease 2019 (COVID-19) and explore its evolution features during hospitalization.MethodsFrom January 17, 2020 to February 26, 2020, HRCT images from 15 COVID-19 patients were analyzed. All the patients had positive nucleic acid test results of SARS-CoV-2. The imaging features of initial and follow-up of each patient were reviewed and graded based on the severity of lung lesions.ResultsAmong the 15 COVID-19 patients, ground-glass opacity (GGO) was found in 14 cases. Six patients presented with consolidation and 3 with fibrosis. Five patients had multi-lobe involvement. Subpleural distribution pattern was present in 12 patients (80.0%) and peribronchovascular distribution pattern was present in 2 patients (13.3%). The severity score on HRCT images at the follow-up was significantly higher than that at the initial (4.6±3.4 vs. 3.5±2.5, P=0.018 2). Increase of random distribution pattern (5 cases) were also noted at the follow-up.ConclusionsChest HRCT of COVID-19 patients is characterized with GGO mainly distributed in subpleural areas and a rapid progression within a short time interval. HRCT could provide a sensitive monitor to observe disease progression for COVID-19 patients.