The experiences of pediatric nurses deployed to adult COVID-19 wards

Background The coronavirus pandemic created an unprecedented deployment of health professionals. The objective of this study was to describe the experiences of pediatric nurses transferred to adult COVID-19 wards during the first wave of the pandemic. Methods We performed a qualitative study using a phenomenological approach. Nurses were recruited on a voluntary basis. All participants moved from a pediatric ward and were redeployed to an adult COVID-19 ward in another hospital. Interviews were carried out face to face in line with social-distancing guidelines. We used a script of open-end questions. The interviews were recorded and transcribed in full and qualitative data were analyzed using NVivo software. Results and Conclusions In total, 23 nurses were interviewed. Our analysis revealed positive and negative experiences given the different types of support the nurses received, individual attitudes that promoted resilience in a crisis situation, ethical conflicts linked to end-of-life care, and their perspectives on the next wave of the pandemic. The main difficulties encountered by the transferred nurses were related to their working conditions and safety, communication about working practices, and end-of-life patient care. In most cases, the individual resilience strategies put in place and the different forms of social support enabled them to cope with stress and maintain their commitment. However, some interviewees would have benefited from improved managerial support. For all participants, their perception of this support and the benefits of their experience influenced their willingness to be transferred to an adult ward again during a future wave of the pandemic.

The experiences of pediatric nurses deployed to adult COVID-19 wards.

BACKGROUND: The coronavirus pandemic created an unprecedented deployment of health professionals. The objective of this study was to describe the experiences of pediatric nurses transferred to adult COVID-19 wards during the first wave of the pandemic. METHODS: We performed a qualitative study using a phenomenological approach. Nurses were recruited on a voluntary basis. All participants moved from a pediatric ward and were redeployed to an adult COVID-19 ward in another hospital. Interviews were carried out face to face in line with social-distancing guidelines. We used a script of open-end questions. The interviews were recorded and transcribed in full and qualitative data were analyzed using NVivo software. RESULTS AND CONCLUSIONS: In total, 23 nurses were interviewed. Our analysis revealed positive and negative experiences given the different types of support the nurses received, individual attitudes that promoted resilience in a crisis situation, ethical conflicts linked to end-of-life care, and their perspectives on the next wave of the pandemic. The main difficulties encountered by the transferred nurses were related to their working conditions and safety, communication about working practices, and end-of-life patient care. In most cases, the individual resilience strategies put in place and the different forms of social support enabled them to cope with stress and maintain their commitment. However, some interviewees would have benefited from improved managerial support. For all participants, their perception of this support and the benefits of their experience influenced their willingness to be transferred to an adult ward again during a future wave of the pandemic.

Future Uses of Telesimulation: National Survey of Emergency Medicine Residency Simulation Directors

Study Objective: The COVID-19 pandemic accelerated the need for virtual learning opportunities including telesimulation. Many Emergency medicine (EM) simulation directors were forced to halt their in-person simulation curriculum and adapt to telesimulation, but specifics on their utilization practices and plans for future use is unknown. We sought to describe the patterns of telesimulation usage in recent times and its anticipated utility in medical education moving forward. Method(s): We developed a confidential, Web-based survey after literature review, using survey research best practices. The survey consisted of multiple choice and free response items pertaining to use of telesimulation before, during, and after in-person learning restrictions due to COVID-19. The survey was piloted prior to use and disseminated to emergency medicine simulation directors in January-February 2022. Programs were identified via the EMRA Match Web site and simulation director's contact information was obtained via the residency program's Web site if available. When not available on the Web site, contact information was obtained by emailing the program coordinator and/or program director. Result(s): Contact information was obtained for 139 residency simulation directors. Survey response rate was 68% (94/139), with 3 participants opting out of the survey, leaving 91 responses. Seventy percent of respondents were from PGY 1-3 programs and 30% from PGY 1-4 programs. During in-person learning restrictions, 62% (56/91) of programs used some form of telesimulation. Assuming all in-person education restrictions lifted, 38% (34/90) of respondents plan to use telesimulation in some capacity in their curricula, compared to 9% (8/91) who reported they were using telesimulation prior to the pandemic. Most who plan to use telesimulation in the future plan to integrate it with their in-person simulation curricula, using telesimulation for 25% of the time of less (30/34), with only few planning to use telesimulation for more than 25% of their simulation curriculum (4/34). While many different types of simulation cases and activities were trialed using telesimulation, the majority of survey respondents that plan to continue using telesimulation plan to use it for medical knowledge (76%, 26/34) and communication/teamwork focused cases (68%, 23/34), rather than for procedure focused cases (21%, 7/34) or dedicated procedure training (15%, 5/34). Conclusion(s): Despite relatively low use of telesimulation in emergency medicine residencies prior to the COVID-19 pandemic, experience using telesimulation during the pandemic has led to an increased number of residency programs who plan to incorporate it into their simulation curricula. This plan for continued use opens opportunities for further innovation and scholarship within this area of simulation education. [Formula presented] No, authors do not have interests to disclose Copyright © 2022

[Current and future therapeutic options for COVID-19]

The anti-inflammatory agents dexamethasone (corticosteroid), and tocilizumab and sarilumab (IL6-inhibitors) are effective in the treatment of late COVID-19. Other anti-inflammatory agents, like anakinra (IL1-inhibitor), baricitinib and tofacitinib (JAK-inhibitors) and lenzilumab (GM-CSF-inhibitor) have also shown positive results in late COVID-19. For the treatment of early COVID-19, the inhalation corticosteroid budesonide is regarded as an off-label treatment option. Virus-inhibitors, like remdesivir, molnupiravir and nirmatrelvir/ritonavir decrease the risk of hospitalization and the development of severe COVID-19 by patients with early symptoms. Monoclonal antibodies have shown limited or no efficacy against the omicron-variant of SARS-CoV-2. Fluvoxamine, l-arginine, AT-527 and ensovibep are considered as potential promising new therapies for the treatment of early COVID-19.

Devenir des patients hospitalisés en soins critiques pour infection à SARS-COV2 : évaluation standardisée des séquelles à 6–9 mois

Identifié en Chine en décembre 2019, le Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV2) s'est rapidement propagé au niveau mondial. Si les études se sont initialement concentrées sur la prise en charge de la phase aiguë de la COrona VIrus Disease (COVID), l'objectif de ce travail est de s'intéresser aux conséquences à distance d'une hospitalisation pour COVID sévère. Nous avons réalisé une étude prospective, monocentrique, incluant des patients 6 à 9 mois après leur hospitalisation en soins critiques (soins intensifs ou réanimation) pour une infection confirmée à SARS-COV2. Les patients étaient évalués au cours d'une hospitalisation de jour en médecine interne. L'entretien débutait par un recueil des antécédents du patient, des évènements et des symptômes post-COVID. L'examinateur procédait ensuite à un examen clinique détaillé et un test de marche des 6 minutes (TM6). Les patients réalisaient de manière systématique des explorations fonctionnelles respiratoires (EFR), une tomodensitométrie (TDM) thoracique non injectée, une échographie cardiaque trans-thoracique (ETT), et un bilan biologique complet. Une batterie de tests était réalisée, explorant la qualité de vie et les séquelles psychologiques. Quatre-vingt-six patients, dont 71 (82,6 %) hommes, d'âge médian 65,8 ans (56,7;72,4), ont été évalués dans un délai moyen de 7 mois (min 3,4;max 14,9). L'hypertension artérielle (46,5 %), le diabète (34,9 %) et la dyslipidémie (39,5 %) étaient les antécédents médicaux les plus représentés. Douze (14,0 %) patients avaient une pathologie pulmonaire sous-jacente, principalement une broncho-pneumopathie chronique obstructive (BPCO). L'indice de comorbidités de Charlson médian était de 1 (0,0;2,0). La durée médiane du séjour en soins critiques était de 10,0 (6,0;17,0) jours. Cinquante-quatre (62,8 %) patients ont eu une ventilation invasive et 67 (77,9 %) patients ont reçu un traitement par corticothérapie. Cinquante-sept (71,3 %) patients ont présenté une asthénie post-COVID, 39 (48,1 %) une faiblesse musculaire, 30 (36,6 %) des arthralgies. Quinze patients ont développé un déséquilibre du diabète et 9 un déséquilibre de la pression artérielle. Dix-sept (21,3 %) patients avaient une distance au TM6 < 80 % de la théorique. Quarante-six patients53,5 %) avaient un score de dyspnée Medical Reaserch Council (MRC) de 0 et 24 (27,9 %) avaient un score MRC de 1. Treize (15,5 %) patients avaient une auscultation anormale à type de crépitants secs des bases. Cinquante-deux (64,2 %) patients ont présenté un déficit de la diffusion du CO défini par une DLCO < 80 % et 16 (19,8 %) avaient une DLCO < 60 %. Le scanner thoracique montrait chez 35 (40,7 %) patients des lésions de verre dépoli et 18 (21,7 %) de la fibrose. Trente-deux patients (37,6 %) avaient un score PHQ-9 significatif pour une dépression, 20 (23,5 %) un score GAD-7 significatif pour un trouble anxieux et 8 (9,4 %) patients avaient un score PCL5 supérieur au seuil évoquant un état de stress post-traumatique. Le niveau de qualité de vie à distance de l'épisode aigu était satisfaisant avec une médiane de l'EQ-5D-3L à 0,89 (0,64;1,00). En analyse univariée, la fibrose sur le scanner de réévaluation et une DLCO < 60 % étaient associées à la durée du séjour en soins critiques et au niveau maximal de CRP pendant l'épisode aigu. En analyse multivariée, la fibrose et la DLCO étaient associées à la durée de séjour. En analyse uni et multivariée, le PHQ-9 et le GAD-7 étaient associés au sexe féminin. À ce jour, rares sont les études qui ont étudié de manière systématisée les séquelles somatiques et psychologiques à long terme de la COVID chez les patients qui ont été pris en charge en soins critiques. Conformément à la littérature, la diminution de la DLCO est l'anomalie la plus fréquemment retrouvée aux EFR, les plages de verre dépoli persistent sur le scanner et des lésions fibrotiques sont retrouvées chez plus d'un patient sur 5 [1 2]. Ces anomalies contrastent avec une plainte respiratoire modérée et un examen clinique rassurant. Les symptômes généraux (asthénie, faiblesse musculaire et arthralgies) sont au cœur de la plainte fonctionnelle. Les déséquilibres de la tension artérielle et du diabète observés justifient un suivi accru des pathologies chroniques au décours de l'épisode aigu. Enfin, nous avons noté une prévalence plus importante des troubles psychologiques que celles relevées rétrospectivement (dossier informatisé) dans une autre étude [3] , renforçant, selon nous, la nécessité d'un dépistage systématique des troubles psychiatriques. De nombreux patients présentent des séquelles à distance d'une COVID sévère nous incitant à un dépistage systématique afin de proposer une prise en charge adaptée. (French) [ FROM AUTHOR] Copyright of Revue de Médecine Interne is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

The COVID-19 Global Pandemic: A Neurosurgical Treatment Algorithm

INTRODUCTION: The recent outbreak of a novel coronavirus illness (COVID-19) has grown into a global pandemic. As a response, there have been several treatment recommendations published by international, federal, state, and local governing bodies. METHODS: We performed a comprehensive review of COVID-19 policies and aggregated multi-disciplinary expertise at our quaternary care academic facility to formulate objective criteria for scheduling surgery, providing neurosurgical coverage, and engaging in neurosurgical research during the COVID-19 outbreak. Recommendations from the CDC, WHO, California State Department of Public Health (CDPH), San Francisco Department of Public Health (SFDPH), and the UCSF School of Medicine were collected and reviewed by the expert panel. Treatment algorithms regarding the following issues were drafted: (1) neurosurgical case scheduling, (2) neurosurgical clinic scheduling, (3) contingency plans for neurosurgical staffing and ICU utilization, and (4) staffing neurosurgical research directives. RESULTS: Here, we present a neurosurgical treatment algorithm for varying levels of COVID-19 community infection. This algorithm (with an accompanying checklist) is centered around a three-tiered system of viral 'surge' quantification, which we use to triage case scheduling, and a paired coverage model for inpatient services. CONCLUSION: COVID-19 represents a challenge to ongoing practice, however with clear algorithms, checklists, and contingency planning, it is possible to provide focused neurosurgical care during this pandemic.

Impact of the Coronavirus (COVID-19) Pandemic on Public and Private Elementary and Secondary Education in the United States: Results from the 2020-21 National Teacher and Principal Survey. NCES 2022-019

The 2020-21 National Teacher and Principal Survey (NTPS)1 is a national survey of public and private K-12 schools, principals, and teachers. Data were collected in the 50 states and the District of Columbia. NTPS collects data on core topics, including teacher and principal training, classes taught, school characteristics, and backgrounds of teachers and principals. In addition to these core topics, the 2020-21 NTPS collected data on the impact of the COVID-19 pandemic on education during the 2019-20 school year. NTPS collects data to provide a detailed picture of U.S. elementary and secondary schools and their staff. These data are collected through school, principal, and teacher surveys. Data can be linked through all three surveys. This report provides basic findings from the COVID-19 questions asked as part of the NTPS public and private school, principal, and teacher surveys. The full 2020-21 data files will be released in summer 2022. The released data will be imputed before undergoing perturbation and will include final weights. Findings are based on preliminary data in order to provide critical and timely data on the impact of COVID-19 on schools, principals, and teachers in the spring of 2020.

The Covid-19 patients’ characteristics upon admission to intensive care and response to nutrition differ from other patients - Preliminary data

Rationale: The COVID pandemic has resulted in a high number of intensive care (ICU) admissions, generally for respiratory distress. While research has focused on respiratory and infectious characteristics, little is known about their metabolic and nutritional status compared to other categories of patients. The aim was to compare COVID patients’ characteristics and metabolic response to long-stayer patients (LSP) Methods: Prospective observational study in two consecutive cohorts admitted to the ICU: Only ventilated LSP and COVID-19 patients were included. Variables: demographic data, severity score (SAPS2), NRS score, C-reactive protein (CRP), prealbumin values on admission (adm) and D6-9 (delta calculated), nutritional management, length of stay and outcome. Nutritional recommendations were for both groups: energy goal 20 kcal/kg first week (then adapted following indirect calorimetry for LSP, no calorimetry for COVID), protein 1.2 g/kg, enteral nutrition privileged. The confined dieticians worked on computer basis. Statistics: median (interquartiles), percentage Results: Altogether 52 of 55 LST and 74 of 104 COVID were mechanically ventilated. Characteristics in Table. Gender was evenly distributed (75% men). COVID patients were significantly older and heavier. Median NRS was 5 in both groups, 1-3 points coming from reduced eating in COVID. Mortality was higher in COVID. Admission prealbumin was significantly lower in COVID vs LST, unrelated to NRS score, and negatively correlated to CRP (r2=0.082). Prealbumin increased significantly more in COVID, but also in survivors of both groups where difference over time was 0.03 (0;0.09) g/l (p<0.0001). Enteral nutrition initiated earlier in COVID. Energy & substrate data not yet available [Formula presented] Conclusion: Mechanically ventilated COVID patients were older and heavier. Prealbumin values on admission were lower and reverted faster to normal values, which might be due to a more rapid clearance of inflammation and catabolism Disclosure of Interest: None declared

Impaired cytotoxic cd8⁺ T cell response in elderly COVID-19 patients

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces a T cell response that most likely contributes to virus control in COVID-19 patients but may also induce immunopathology. Until now, the cytotoxic T cell response has not been very well characterized in COVID-19 patients. Here, we analyzed the differentiation and cytotoxic profile of T cells in 30 cases of mild COVID-19 during acute infection. SARS-CoV-2 infection induced a cytotoxic response of CD8⁺ T cells, but not CD4⁺ T cells, characterized by the simultaneous production of granzyme A and B as well as perforin within different effector CD8⁺ T cell subsets. PD-1- expressing CD8⁺ T cells also produced cytotoxic molecules during acute infection, indicating that they were not functionally exhausted. However, in COVID-19 patients over the age of 80 years, the cytotoxic T cell potential was diminished, especially in effector memory and terminally differentiated effector CD8⁺ cells, showing that elderly patients have impaired cellular immunity against SARS-CoV-2. Our data provide valuable information about T cell responses in COVID-19 patients that may also have important implications for vaccine development. IMPORTANCE Cytotoxic T cells are responsible for the elimination of infected cells and are key players in the control of viruses. CD8⁺ T cells with an effector phenotype express cytotoxic molecules and are able to perform target cell killing. COVID-19 patients with a mild disease course were analyzed for the differentiation status and cytotoxic profile of CD8⁺ T cells. SARS-CoV-2 infection induced a vigorous cytotoxic CD8⁺ T cell response. However, this cytotoxic profile of T cells was not detected in COVID-19 patients over the age of 80 years. Thus, the absence of a cytotoxic response in elderly patients might be a possible reason for the more frequent severity of COVID-19 in this age group than in younger patients.