Articles: coronavirus.
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The coronavirus disease-2019 (COVID-19) pandemic remains an extraordinary event that continues to strain healthcare systems worldwide. Unlike the military treatment facilities (MTFs) in the USA, which have ready access to tertiary care facilities, those MTFs in foreign countries confront a host of challenges in meeting mission requirements. ⋯ These factors are further analyzed from a "lessons learned" perspective, and recommendations to shape the future response to a pandemic are provided. This current crisis portends a future where pandemics may remain an omnipresent threat.
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Landstuhl Regional Medical Center's response to the coronavirus disease 2019 pandemic included a plan to provide just-in-time training for nursing staff and paraprofessionals from throughout the organization in the event that it became overwhelmed with more critically ill patients than the facility was staffed to manage. Training conducted was a combination of online learning from the Society of Critical Care Medicine and the Association of Critical Care Nurses as well as a 2-hour block of hands-on skills. ⋯ Quick implementation of the plan led to over 125 nurses and paraprofessionals receiving the education and training in preparation for the pandemic response. The article further discusses training topics covered and the competency expectations for non-critical care nurses trained.
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Case Reports
A Case Report of Air Force Reserve Nurses Deployed to New York City for COVID-19 Support.
Initial DoD support of Federal Emergency Management Agency (FEMA) operations for New York City (NYC) coronavirus disease 2019 (COVID-19) relief included the deployment of military medics to the Javits New York Medical Station and USNS Comfort. When Air Force (AF) Reservists arrived in NYC, 64th Air Expeditionary Group leaders worked with FEMA, Task Force New York/New Jersey, and NYC chains of command to send Airmen to NYC hospitals, including Lincoln Medical Center (LMC). Within 72 hours of arrival, 60 AF Reservists, including 30 registered nurses and 3 medical technicians, integrated into LMC to provide support during April and May 2020. ⋯ In these units, AF nurses provided patient care and worked directly with LMC nurses to provide directed teaching experiences to improve their comfort and competency with caring for acutely ill COVID-19 patients. The deployment of AF Reservists into civilian facilities was a success and bolstered the capability of three facilities struggling to care for SARS-CoV-2 patients. This effort was recognized by military and civilian healthcare leaders and resulted in over 600 military medical personnel being sent to support 11 NYC public hospitals.
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Multicenter Study
Identification of distinct clinical subphenotypes in critically ill patients with COVID-19.
Subphenotypes have been identified in patients with sepsis and ARDS and are associated with different outcomes and responses to therapies. ⋯ We identified four subphenotypes of COVID-19 critical illness with distinct patterns of clinical and laboratory characteristics, comorbidity burden, and mortality.
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Multicenter Study
After the first wave and beyond lockdown: long-lasting changes in emergency department visit number, characteristics, diagnoses, and hospital admissions.
The first wave (FW) of COVID-19 led to a rapid reduction in total emergency department (ED) visits and hospital admissions for other diseases. Whether this represented a transient "lockdown and fear" phenomenon, or a more persisting trend, is unknown. We divided acute from post-wave changes in ED flows, diagnoses, and hospital admissions, in an Italian city experiencing a FW peak followed by nadir. ⋯ Non-COVID-19 hospital admissions were reduced by 12.8% (P = 0.001), 6.3% (P = 0.1) and 12.2% (P = 0.001), respectively. Reductions in ED flows, led by non-critical codes, persisted throughout the summer nadir of COVID-19. Hospital admissions for non-COVID-19 diseases had transient changes.