Diagnosis (Berlin, Germany)
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Objectives The pandemic COVID-19 currently reached 213 countries worldwide with nearly 9 million infected people and more than 460,000 deaths. Although several Chinese studies, describing the laboratory findings characteristics of this illness have been reported, European data are still scarce. Furthermore, previous studies often analyzed the averaged laboratory findings collected during the entire hospitalization period, whereas monitoring their time-dependent variations should give more reliable prognostic information. ⋯ Among them, earliest indicators were: platelets, lymphocytes, lactate dehydrogenase, creatinine, alanine aminotransferase, C-reactive protein, white blood cells and neutrophils. Conclusions This longitudinal study represents, to the best of our knowledge, the first study describing the laboratory characteristics of Italian COVID-19 patients on a normalized time-scale. The time-dependent prognostic value of the laboratory parameters analyzed in this study can be used by clinicians for the effective treatment of the patients and for the proper management of intensive care beds, which becomes a critical issue during the pandemic peaks.
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Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), shares similarities with the former SARS outbreak, which was caused by SARS-CoV-1. SARS was characterized by severe lung injury due to virus-induced cytopathic effects and dysregulated hyperinflammatory state. ⋯ We highlight that immunomodulatory treatment must be tailored to the underlying immunobiology at different stages of disease. Moreover, by investigating sex-based immunobiological differences, we may enhance our understanding of COVID-19 pathophysiology and facilitate improved immunomodulatory strategies.
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Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV2), is an ongoing pandemic that has already affected millions of patients worldwide, and is associated with significant morbidity and mortality burden. Although the clinical and laboratory characteristics of this illness have been reported in patients from China and Europe, data are scant in the United States. Methods We extracted data regarding all patients hospitalized at our hospital with COVID-19 infection between March 1 and April 4, 2020. ⋯ A total of three patients died; all were aged 70 years or older. Conclusions Laboratory abnormalities and acute renal failure were common in hospitalized patients with SARS-CoV2 infection in our center. Admission to ICU and mechanical ventilation were common.
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Background Front-line clinicians are expected to make accurate and timely diagnostic decisions before transferring patients to the pediatric intensive care unit (PICU) but may not always learn their patients' outcomes. We evaluated the characteristics of post-transfer updates received by referring clinicians regarding PICU patients and determined preferences regarding content, delivery, and timing of such updates. Methods We administered an electronic cross-sectional survey to Iowa clinicians who billed for ≥5 pediatric patients or referred ≥1 patient to the University of Iowa (UI) PICU in the year before survey administration. ⋯ Among clinicians who received updates, 13% received unexpected information; 40% changed their practice as a result. Conclusions Clinicians received updates on less than half of the patients they referred to a PICU, although such updates could potentially influence clinical practice. Study findings will inform the development of a formal feedback system from the PICU to referring clinicians.
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Background Diagnostic error is a major preventable cause of harm to patients. There is currently limited data in the literature on the rates of misdiagnosis of doctors working in an ophthalmic emergency department (ED). Misdiagnosis was defined as a presumed diagnosis being proven incorrect upon further investigation or review. ⋯ Misdiagnosis rates of RVEEH doctors were: emergency registrars (7.1%), RVEEH residents (16.7%), first-year registrars (5.1%), second-year registrars (7.1%), third-year registrars (7.7%), fourth-year registrars (0%), senior registrars (6.9%), fellows (0%) and consultants (8.3%). Conclusions The misdiagnosis rates in our study were comparable to general medical diagnostic error rates of 10-15%. This study acts as a novel pilot; in the future, a larger-scale multi-centre audit of ophthalmic presentations to general emergency departments should be undertaken to further investigate diagnostic error.