Background The severity of the COVID-19 pandemic has resulted in limited provision of palliative care and hospital teams have had to rise to the challenge of how to deliver care safely to people with palliative needs. Telehealth interventions have been seen as a useful resource with potential to improve clinical effectiveness. Objective To describe the implementation of a spiritual and psychological palliative telehealth system during the pandemic. Methods Pilot study based on the implementation of a telehealth system designed to support hospitalized patients referred to a mobile palliative care team, through synchronic videoconferences, and including patients’ relatives. The implementation included protocol development, physical infrastructure, and training. The intervention consisted of spiritual and psychological telehealth sessions performed remotely by the chaplain and psychologist of a palliative care team. Results During the study period 59 patients were recruited, median age of 70 years, 57.6% females. The primary diagnosis was severe COVID-19 (50.8%), advanced cancer (32.2%) and advanced chronic illness (16.9%). A total of 211 telehealth sessions were carried out, 82% psychological and 18% spiritual. The main criteria for psychological sessions were being related to seriously ill patients with withdrawal or withholding of life-support treatment (60.1%). The main criteria for spiritual sessions were being a patient with spiritual suffering or requesting spiritual assistance (73.6%). An electronic user satisfaction survey indicated high satisfaction rates. Conclusion This report demonstrates that it is possible to provide spiritual and psychological palliative care to hospitalized patients and families during pandemic restrictions through interdisciplinary telehealth delivery.

Aims of this study To describe the Latin American population affected by COVID‐19, and to determine relevant risk factors for in‐hospital mortality. Methods We prospectively registered relevant clinical, laboratory, and radiological data of adult patients with COVID‐19, admitted within the first 100 days of the pandemic from a single teaching hospital in Santiago, Chile. The primary outcome was in‐hospital mortality. Secondary outcomes included the need for respiratory support and pharmacological treatment, among others. We combined the chronic disease burden and the severity of illness at admission with predefined clinically relevant risk factors. Cox regression models were used to identify risk factors for in‐hospital mortality. Results We enrolled 395 adult patients, their median age was 61 years; 62.8% of patients were male and 40.1% had a Modified Charlson Comorbidity Index (MCCI) ≥5. Their median Sequential Organ Failure Assessment (SOFA) score was 3; 34.9% used a high‐flow nasal cannula and 17.5% required invasive mechanical ventilation. The in‐hospital mortality rate was 14.7%. In the multivariate analysis, were significant risk factors for in‐hospital mortality: MCCI ≥5 (HR 4.39, P < .001), PaO 2 /FiO 2 ratio ≤200 (HR 1.92, P = .037), and advanced chronic respiratory disease ( HR 3.24, P = .001); pre‐specified combinations of these risk factors in four categories was associated with the outcome in a graded manner. Conclusions and clinical implications The relationship between multiple prognostic factors has been scarcely reported in Latin American patients with COVID‐19. By combining different clinically relevant risk factors, we can identify COVID‐19 patients with high‐, medium‐ and low‐risk of in‐hospital mortality.

Hospital palliative medicine. Revision of a care model implemented at a university hospitalBackground: Palliative Medicine (PM) is a specialty whose objective is to prevent and alleviate suffering associated with advanced diseases. Hospital palliative medicine has benefits in symptom control, quality of life and cost containment. Hospital PM support teams that serve as referral specialists are in charge of a PM care model. Aim: To describe the clinical experience of a PM support team in a tertiary hospital in Chile. Material and Methods: Review of clinical records of patients referred to a hospital PM support team between March 2015 and July 2018. Administrative data of referrals, sociodemographic and clinical characteristics of patients, their investigated problems and the interventions proposed by the PM team were described. Results: During the study period, 790 referrals were registered, most of them from the internal medicine department (31%) or critical care (24%). During the study period, the number of annual referrals increased from 177 to 237 and the time lapse after hospital admission decreased from five to three days. The mean age of patients was 65.8 years and their main diagnosis was an oncological disease in 81%. The most frequently identified symptoms were fatigue in 71% of patients, depression in 68% and pain in 60%. The main interventions proposed by the PM team were communication support in 64% of patients, analgesia in 62% and education for family caregivers in 49%. Conclusions: The hospital PM team proposes a care model that allows the evaluation and a therapeutic approach for patients suffering from advanced diseases, using a multidimensional perspective including their families.

COVID-19 infection presenting as a myocardial infarction. Report of one caseIsolated cardiac involvement of COVID-19 is an infrequent presentation, and myocardial infarction is even less common. We report a 30-year-old man presenting with retrosternal pain of insidious onset whose intensity increases suddenly. On admission, the patient had tachycardia and an EKG showed a 1 mm ST-elevation and diffuse PQ segment depression. Troponin was 26.9 ng/ml (normal value [NV] < 0.03), inflammatory parameters were elevated, and SARS-CoV 2 PCR was positive. He was hospitalized with the diagnosis of myopericarditis secondary to SARS-CoV 2. He progressed favorably without pain during the hospital stay and with decreasing troponin values. A Cardiac Magnetic Resonance Imaging (MRI) was compatible with an infero-lateral transmural infarction. A coronary angiography showed a distal occlusion of the circumflex artery. Consequently, anticoagulation and double platelet anti-aggregation were started. The patient evolved favorably, with a decreasing troponin curve (last at discharge 0.49 ng/ml