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The objective of this article is to summarise the course of illness and treatment for patients with COVID-19 admitted to Bærum Hospital since the start of the pandemic.We present data from a prospective observational study with the aim of systematising knowledge about patients admitted because of COVID-19. All patients admitted to Bærum Hospital up to and including 28 June 2021 were included. The results are presented for three waves of admissions: 9 March-23 June 2020, 21 September 2020-28 February 2021 and 1 March-28 June 2021.A total of 300 patients, divided into 77, 101 and 122 in the three waves respectively, were admitted because of COVID-19. The number of hospital deaths during the three waves was 14 (18 %), 11 (11 %) and 5 (4 %) respectively. The average age of the patients was 67.6 years in the first wave and 53.3 years in the third wave. Altogether 204 patients (68 %) received medical oxygen or ventilation support, and 31 of these (10 % of all the patients) received invasive ventilation support. Non-invasive ventilation support was used as the highest level of treatment in 4 (8 %), 9 (13 %) and 17 (20 %) patients with respiratory failure in the three waves respectively. In the second and third wave, 125 out of 152 patients with respiratory failure (82 %) were treated with dexamethasone.Differences in patient characteristics and changes to treatment methods, such as the use of dexamethasone and non-invasive ventilation support, may have contributed to the apparent fall in mortality from the first to the third wave. Conditions that are not registered in the study, such as vaccination status, may also have impacted on mortality.

BAKGRUNN Formålet med artikkelen er å oppsummere sykdomsforløp og behandling for pasienter med covid-19 innlagt på Bærum sykehus siden starten av pandemien. MATERIALE OG METODE Vi presenterer data fra en prospektiv observasjonsstudie med mål om å systematisere kunnskap om pasienter innlagt på grunn av covid-19. Alle pasienter innlagt på Bærum sykehus til og med 28.6.2021 ble inkludert. Resultatene presenteres for tre bølger av sykehusinnleggelser: 9.3.–23.6.2020, 21.9.2020–28.2.2021 og 1.3.–28.6.2021. RESULTATER I alt 300 pasienter, fordelt på hhv. 77, 101 og 122 i de tre bølgene, var innlagt på grunn av covid-19. Antallet som døde under sykehusoppholdet i de tre bølgene, var hhv. 14 (18 %), 11 (11 %) og 5 (4 %). Gjennomsnittsalderen for innlagte var 67,6 år i første bølge og 53,3 år i tredje bølge. Totalt 204 pasienter (68 %) fikk oksygenbehandling eller ventilasjonsstøtte, og 31 av disse (10 % av alle pasientene) fikk invasiv ventilasjonsstøtte. Ikke-invasiv ventilasjonsstøtte ble brukt som høyeste nivå av behandling hos hhv. 4 (8 %), 9 (13 %) og 17 (20 %) pasienter med respirasjonssvikt i de tre bølgene. I andre og tredje bølge fikk 125 av 152 pasienter med respirasjonssvikt (82 %) behandling med deksametason. FORTOLKNING Forskjeller i pasientkarakteristika og endringer i behandling, som i bruk av deksametason og ikke-invasiv ventilasjonsstøtte, kan ha bidratt til at dødeligheten tilsynelatende sank fra første til tredje bølge. Forhold som ikke er registrert i studien, slik som vaksinasjonsstatus, kan også ha påvirket dødeligheten.

Purpose We aimed to study the use of The 4 ‘A’s test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p p Conclusion Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis. Graphic abstract

BACKGROUND: Syncope is usually a benign event that affects up to 50% of people over a lifetime, needing no extensive examination. The challenge is to diagnose the few with underlying life-threatening disease in need of immediate medical attention. Guidelines are clear, but unfortunately, clinical practice does not always follow recommendations, as illustrated by this case report. CASE PRESENTATION: A diabetic, hypertensive male in his eighties had a myocardial infarction in his medical history. He presented to his GP with recurrent syncopal episodes that had occurred while erect and in motion. Physical examination was found to be normal for his age, and he was referred to a cardiologist and seen three months later. An ECG showed sinus rhythm and a previous inferior wall myocardial infarction. A 24-hour ECG recorder was fitted, and a consultation was scheduled for the next day. At home the patient died. The ECG recording revealed sinus rhythm with increasing depression of the ST segment, followed by rapidly conducted atrial fibrillation, and then rapid ventricular tachycardia followed by terminal ventricular fibrillation. INTERPRETATION: A patient with a history where there is suspicion of cardiac syncope should be immediately and intensively examined when presenting to the healthcare services.