CHANSE BOEHRINGER
RE: Discussion – Week 1
COLLAPSE
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Covid-19 has affected many parts of the World at this time. Informatics will play a pivotal part in helping to diagnose and treat covid. Most facilities now have an electronic medical record. This medical record can be utilized to collect most of the information we would need to diagnose and potentially treat covid. As the current director of our covid unit I use much of the information I will identify. However, I currently do not have a program designed for this. I am having to research each patients chart to find this information. Once the nurse leader collects this data, we can then evaluate the information for trends and identify weaknesses. According to Brown (2018), clinical leaders use this data to evaluate a patient’s case: observe, collect, process, decide, plan, act, evaluate, and reflect. These are the same processes we do to start a new policy. According to Rotmensch (2017), graphs of disease-symptom relationships can be elicited from the learned parameters and the constructed knowledge graphs can be evaluated and validated, against the manually constructed knowledge graph and against expert physician opinions. utilizing this information could help us go through thousands of cases quickly to identify common traits among covid patients. Due to the lack of research we currently are not able to tell with certainty if the treatments are working or if the test are even accurate at identifying covid patients. According to Miri (2020), for Covid data to work we would need: standard testing criteria, mandatory lab and case reporting, define clear minimum content, and build data submission endpoints. At this time, I can almost identify the result of the Covid test with some of the basic information we have easily available. The biggest issue that will have with this is that x-rays do not have the ability to be read by a computer and rely on human judgement. I have noticed that many radiologists are including that they cannot rule out Covid to the summary. This may be due to risk of legal ramifications if they do not include this. However, I have seen many cases recently that were clearly fluid overload or pneumonia get tagged with this phase. Currently the data needed includes highest temperature, WBC, Ferritin, lactate, CRP, x-ray, and d-dimer. by trending these labs, we can identify who is likely to have Covid. Once Covid is positive we can tell to what severity Covid is affecting them. This data would help determine who is appropriate to screen for Covid.
References
Brown, E. (2018, March 7). Clinical Reasoning: An Important Aspect of Clinical Skills. Retrieved from Clinician Today: https://cliniciantoday.com/clinical-reasoning-an-important-aspect-of-clinical-skills/
Miri, A. (2020, April 14). Accelerating Data Infrastructure For COVID-19 Surveillance And Management. Retrieved from Health Affairs: https://www.healthaffairs.org/do/10.1377/hblog20200413.644614/full/
Rotmensch, M. (2017, July 20). Learning a Health Knowledge Graph from Electronic Medical Records. Retrieved from Scientific Reports: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5519723/
Response
Hi Chanse, the society is grappling with the public health and economic challenges manifesting due to the COVID 19 pandemic. Human to human contacts and respiratory droplets are the main route of transmission of the virus. During the initial stages of infection, patients present with symptoms of acute respiratory distress syndrome. Others present with severe complications, which eventually result in multiple organ failure (Gao et al., 2020). Thus, early identification and treatment of patients presenting with symptoms of the virus are critical in combatting the spread of the disease. Gao et al., (2020) cites that at the moment, the manifestation, development, and the mechanisms of prognosis and the immune status of COVID 19 victims is unclear. However, as healthcare workers, data obtained by analyzing the lab findings of patients will go a long way in developing a clear prognosis for COVID 19. Boulos & Geraghty (2020) also argues that when disease travels fast, data should be captured abundantly to ensure adequate tracking of health threats prevent further spread of coronavirus disease.
References
Boulos, M. N. K., & Geraghty, E. M. (2020). Geographical tracking and mapping of coronavirus disease COVID-19/severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic and associated events around the World: how 21st century GIS technologies are supporting the global fight against outbreaks and epidemics.
Gao, Y., Li, T., Han, M., Li, X., Wu, D., Xu, Y., … & Wang, L. (2020). Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID‐19. Journal of medical virology. https://doi.org/10.1002/jmv.25770
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RE: Discussion – Week 1
COLLAPSE
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I’m currently working in a COVID 19 unit, and access to data is critical. This disease is not fully understood, and basically, the treatments are trial and error. The use and access of data are needed to see if anything, all of these patients have in common such as trending lab results or treatments that are effective. For example, there is talk of a cure with antibody treatment (STI-1499). Data is going to be needed to understand how effective is this treatment, does it work for all patients, are there any side effects, etc. Most hospitals use electronic documentation systems; it can be easier to pull up charts side by side instead of looking through a paper chart. Being able to see such data, we can predict to some degree patients outcomes like things to look for that are signs of patient outcomes are headed in the wrong direction. Somethings, we have already figured out with looking at data of COVID 19 is people with hypertension and diabetes are at higher risk for developing severe life-threatening complications from COVID. We started to see every patient in the ICU with COVID began to have kidney failure. It may be many different reasons why this could be happening. Some ideas are: COVID 19 might target kidney cells and bind to the cells receptors, which could be accurate due to similar receptors found on cells in the heart and lungs, which also has shown injury from coronavirus. The cytokine storm most COVID patients experience can cause severe inflammation and destroy healthy kidney tissue. The kidney injury could be from critically low levels of oxygen in the blood. COVID causes patients to produce small blood clots; these clots can block the small vessels In the kidney leading to AKI. Whatever the case may be, we need data from other patients to determine which is the cause of kidney failure. Then we could get ahead of the game by taking steps to prevent or at least reduce the severity of the injury to the kidneys.
Kramer, J. (2020 May 29). Coronavirus Antibody Therapies Raise Hopes-and-skepticism. Scientific American. Retrieved from https:// www.scientificamerican.com/article/coronavirus-antibodytherapies-raise-hopes-and-skepticism1/
Chen, J., Tangkai, Q., Liu, L., Ling, Y., Qian, Z., & Li, T. (2020 March 19). Clinical progression of patients with covid-19 in Shanghai, China. PMC US Nationa Library of Medicine National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102530/
Zhai, P., Ding, Y., Wu, X., Long, J., Zhong, Y., & Li, Y. (2020 March 28). The epidemiology, diagnosis and treatment of COVID -19. PMC US National Library of Medicine National Institutes of Health. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7138178/
Response
The beginning of 2020 has seen the emergence of COVID 19 pandemic caused by the novel coronavirus. The virus has spread to over 180 countries globally, affecting millions of individuals and causing a substantial number of deaths. There is then, a looming need to understand the virus to stop its spread and perhaps, find a treatment for it. To do so, data is needed to analyze trends in patients who test positive for coronavirus disease. The pandemic has presented a new challenge for health care workers, especially intensivists because during the second week in the course of infection, 15-20% of patients develop severe hypoxemia; thus, they require ventilator support. In addition, patients develop other complications, including shock, gastrointestinal bleeding, acute kidney injury, and rhabdomyolysis (Naicker et al., 2020). So far, no antiviral agent has been proven effective for the management of the virus and healthcare workers only offer supportive management to patients instead of definitive therapies, which lead to the remarkable workload for intensive care health workers (Qiu et al., 2020). So, utilizing data from laboratory findings is essential in identifying an effective treatment for the virus.
References
Naicker, S., Yang, C. W., Hwang, S. J., Liu, B. C., Chen, J. H., & Jha, V. (2020). The Novel Coronavirus 2019 epidemic and kidneys. Kidney International, 97(5), 824-828. https:// DOI: https://doi.org/10.1016/j.kint.2020.03.001
Qiu, H., Tong, Z., Ma, P., Hu, M., Peng, Z., Wu, W., & Du, B. (2020). Intensive care during the coronavirus epidemic. https://doi.org/10.1007/s00134-020-05966-y