Respiratory Therapists' Mental Health and Experiences during Covid-19

Respiratory therapists (RTs) are enduring novel COVID-19-related challenges, compacting upon existing stressors in the profession, including a lack of adequate personal protective equipment and increased exposure to death and dying. Here, RTs are at an increased risk for a host of negative psychological impacts, such as anxiety, depression, PTSD or moral injury. Critically, little is known about the mental health and experiences of RTs during the COVID-19 pandemic. With the mental health of this vital workforce at stake, it is essential to understand the impact that serving on the frontlines of the COVID-19 pandemic has had on Canadian RTs. RTs from across Canada were invited to complete an online survey and virtual interview about their experiences during the second wave of the COVID-19 pandemic. The survey included basic demographic information (e.g., sex, age, marital status) and questionnaires about mental health and functioning. The virtual interview allowed RTs to share and discuss challenges and associated impacts experienced during the pandemic as well as their opinions on relevant supports. Two-hundred and forty-two (N = 242) RTs from across Canada participated in this study. While data analysis remains ongoing, preliminary analyses reveal that RTs are suffering from the provision of perceived futile care and standing in for family at the bedside of dying COVID-19 patients. Symptoms of anxiety, depression, PTSD, moral distress and moral injury are relevant concerns among RTs. COVID-19 restrictions have prevented RTs from engaging in usual coping strategies (e.g., going to the gym, going out with friends and family). Furthermore, a quarter of our sample reported that they were considering leaving their position due to moral distress, with these individuals endorsing greater symptoms of all negative psychological outcomes included in this study than their counterparts who did not report considering leaving their position. Providing care during the second wave of the COVID-19 pandemic has negatively impacted Canadian RTs' mental health. Adequate resources and interventions are essential to support RTs during and beyond the pandemic and to ensure the continuity of our healthcare system.

A Bayesian adaptive algorithm (QUEST) to estimate olfactory threshold in hyposmic patients

Objectives The sense of smell is important as a warning system, in social communication and in guiding food intake. Impairment is common, and cases are increasing following COVID-19. Olfactory dysfunction may lead to decreased quality of life. There are several established ways to assess olfaction including the "Sniffin' Sticks" which are a validated test for healthy and diseased populations. Methods The odor threshold is traditionally determined using a single staircase procedure, with narrow or wide step. We investigated a Bayesian adaptive algorithm (QUEST) to estimate olfactory threshold in a hyposmic population compared with a healthy control group. Thresholds were measured using the three procedures in two sessions (Test and Retest). Results All the tested methods showed considerable overlap in both groups: there was a positive correlation between the QUEST procedure and classic staircase method (r = 0.88), and high test-retest reliability for all three methods used (Sniffin' Sticks narrow: r = 0.81;Sniffin' Sticks wide: r = 0.95;QUEST: r = 0.80). Conclusions Results from these approaches exhibit considerable overlap with all of them being suitable for clinical use. An advantage of the QUEST method can be the defined number of trials needed to determine an odor threshold.

High prevalence of long-term olfactory, gustatory, and chemesthesis dysfunction in post-COVID-19 patients: a matched case-control study with one-year follow-up using a comprehensive psychophysical evaluation.

BACKGROUND: Using an age and gender matched-pair case-control study, we aimed to estimate the long-term prevalence of psychophysical olfactory, gustatory , and chemesthesis impairment at least one year after SARS-CoV-2 infection considering the background of chemosensory dysfunction in non-COVID-19 population. METHODOLOGY: This case-controlled study included 100 patients who were home-isolated for mildly symptomatic COVID-19 between March and April 2020. One control regularly tested for SARS-CoV-2 infection and always tested negative was matched to each case according to gender and age. Chemosensory function was investigated by a comprehensive psychophysical evaluation including ortho- and retronasal olfaction and an extensive assessment of gustatory function. Differences in chemosensory parameters were evaluated through either Fisher’s exact test or Kruskal-Wallis test. RESULTS: The psychophysical assessment of chemosensory function took place after a median of 401 days from the first SARS-CoV-2 positive swab. The evaluation of orthonasal smell identified 46% and 10% of cases and controls, respectively, having olfactory dysfunction, with 7% of COVID-19 cases being functionally anosmic. Testing of gustatory function revealed a 27% of cases versus 10% of controls showing a gustatory impairment. Nasal trigeminal sensitivity was significantly lower in cases compared to controls. Persistent chemosensory impairment was associated with emotional distress and depression. CONCLUSION: More than one year after the onset of COVID-19, cases exhibited an excess of olfactory, gustatory , and chemesthesis disturbances compared to matched-pair controls with these symptoms being associated to emotional distress and depression.

Gastrointestinal symptoms and digestive comorbidities in an Italian cohort of patients with COVID-19.

OBJECTIVE: The Coronavirus Disease 2019 (COVID-19) pandemic mainly involves respiratory symptoms, though gastrointestinal (GI) symptoms are increasingly being recognized. In this context, the presence of comorbidities appears to be associated with adverse outcomes. However, the role of digestive manifestations is not yet well defined. The primary aim of this study was to assess the prevalence of GI symptoms and digestive comorbidities in a cohort of patients with COVID-19 compared to controls. The secondary aim was to determine the association of GI-symptoms and digestive comorbidities with clinical outcomes. PATIENTS AND METHODS: Inpatients with COVID-19 and controls with similar symptoms and/or radiological findings were enrolled. Symptoms at admission and throughout hospitalization were collected as they were comorbidities. The measured clinical outcomes were mortality, intensive care unit admission and cumulative endpoint. RESULTS: A total of 105 patients were included: 34 with COVID-19 and 71 controls. At admission, the prevalence of GI symptoms among COVID-19 patients was 8.8%. During hospitalization, the frequency of GI symptoms was higher in patients with COVID-19 than in controls (p=0.004). Among patients with COVID-19, the mortality and a cumulative endpoint rates of those with GI symptoms were both lower than for those without GI symptoms (p=0.016 and p=0.000, respectively). Finally, we found digestive comorbidities to be associated with a milder course of COVID-19 (p=0.039 for cumulative endpoint). CONCLUSIONS: Our results highlighted the non-negligible frequency of GI symptoms in patients with COVID-19, partly attributable to the therapies implemented. In addition, the presence of GI symptoms and digestive comorbidities is associated with better outcomes. Most likely, digestive comorbidities do not hinder the host's immune response against SARS-COV-2, and the occurrence of GI symptoms might be linked to a faster reduction of the viral load via the faecal route.