Salt steps and sugar checks - Making arterial line use safer in our trust

Introduction: Arterial lines are used within our intensive care unit to allow invasive blood pressure monitoring and regular blood gas analysis. Inadvertent use of dextrose containing fluids in the flush have been associated with falsely high glucose readings. When these are acted on with insulin, it can cause devastating hypoglycaemic brain injury. There have been a number of deaths and other incidents relating to the wrong fluid being used in arterial line set up reported within the UK in recent years. In 2014 the AAGBI released a safety guideline on the use of arterial lines specifically to reduce to the risk of hypoglycaemic brain injury. Objective(s): Our objective was to ensure that 100% of arterial lines in use within Royal Victoria Hospital's intensive care unit were compliant with our trust policy on the management of arterial lines. Method(s): We audited our intensive care unit's compliance with our trust policy and found that we were 80% compliant. We formed a multi-disciplinary arterial line working group in order to tackle the problem. Our quality improvement project consisted of two main approaches: 1. To educate staff on how to manage arterial lines correctly. We divided the management of arterial lines into S.A.L.T steps (a 7 step bundle on "Setting up an Arterial Line Transducer") and SUGAR checks ( a series of red flag moments to prompt staff to review the patient prior to starting or increasing insulin administration).We developed educational posters for key areas in ICU and presented our findings at departmental meetings. 2. To change the system, in order to make it easier to do the right thing. We developed a Universal Adult Arterial Pack (UAAP) containing key components in the setup of an arterial line. This also included aide memoires for the S.A.L.T steps and SUGAR checks. In order to measure the effect of these changes, we: 1. Audited compliance on a regular basis. 2. Monitored serious bundle breaches ( for example no label, wrong fluid used) 3. Assessed usage of the UAAP. Result(s): 1. Bundle compliance improved during the first half of 2021, however then reduced in the second half with the number of serious bundle breaches increasing. This coincided with COVID surge 4 - associated with reduced nursing ratios and staff redeployment. 2. UAAP usage increased throughout the project, from an average of 6 to 9 per day. 86% of staff found the packs useful and 85% thought that they reduced the potential for error. Conclusion(s): The presence of a policy does not ensure that staff will know about it or adhere to it. Although we have not yet achieved our target of 100% compliance, we have seen evidence of how our project has the potential to do so in the near future. We aim to roll out our new e-learning module for staff education, manufacture our UAAP on a bigger scale, and disseminate the project to other departments within the trust.

Preliminary Findings on Long-Term Impacts of the COVID-19 Pandemic on Social Work Students

Impacts of the COVID-19 pandemic upon social work programs have been profound and institutions have struggled to identify appropriate policies and interventions to address students' educational, health, and safety needs. This manuscript reports the results of a survey administered to BSW and MSW students at three different timepoints during the pandemic: March 2020 (N = 157), November 2020 (N = 87), and March 2021 (N = 45). The survey explored students' experiences of online learning, pandemic-related stressors, mental health symptoms, and the department and institution's responses to the pandemic. Although initial comfort with online classroom learning was low, comfort levels increased significantly as the pandemic continued. Students in the MSW online program were the most comfortable with online learning and BSW students the least. Students reported high levels of pandemic-related stressors and behavioral health symptoms throughout the pandemic and approximately half the sample reported concerns about program continuance. Although students felt supported by the social work program, they felt institutional policies to address COVID-19 were inadequate. Useful interventions identified included access to mental health, financial supports, flexibility and support from faculty, clear and consistent communication, and a decrease in field hours during the pandemic. © 2023 Taylor & Francis.

Patient and provider experiences with virtual care during the COVID-19 pandemic: A mixed methods study

The COVID-19 pandemic prompted the rapid uptake of Virtual Care (VC). Positive patient outcomes with VC are previously reported but little is known about the experiences of patients and providers using VC during the pandemic. We aimed to describe patient and primary care provider experiences, satisfaction, perceptions, and attitudes to VC during the COVID-19 pandemic that might explain adoption of VC across the continuum of care and inform sustained uptake. We conducted a sequential explanatory mixed methods study using online surveys and virtual interviews with a convenience sample of primary care providers and patients in a Canadian province (July – December 2020). Eligible participants included patients and primary care providers using VC during the COVID-19 pandemic. Survey responses and interviews were analyzed using descriptive statistics and thematic analysis, respectively. Overall satisfaction was compared using the Mann-Whitney U test. Eighty-five patients and 94 primary care providers responded to the surveys. Patients reported higher overall satisfaction with VC than primary care providers (median [interquartile range]: 4.4 [4.0-4.7] and 3.7 [3.4-3.9] p < 0.001). Ten patients and 11 primary care providers were interviewed. Both groups strongly appreciated VC’s increased access and convenience, identified the lack of compensation as a pre-pandemic barrier to providing VC, and reported willingness to continue VC post-COVID-19 pandemic. The COVID-19 pandemic provided an opportunity for patients and primary care providers to rapidly adopt VC with high satisfaction. Patients and primary care providers viewed VC positively due to its convenience and accessibility;both intend to continue using VC post-pandemic. © The Author(s), 2022.

The trajectory of psychological distress and problematic Internet gaming among primary school boys: a longitudinal study across different periods of COVID-19 in China

Background: Children are a vulnerable population in terms of the impact of COVID-19 on their psychological well-being. When restricted to their homes, children are susceptible to problematic Internet gaming (PG). Primary school boys are particularly at risk of PG, which may lead to negative psychological effects, such as distress. Emerging research has identified perceived weight stigma (PWS) as a variable closely associated with both PG and psychological distress, particularly during the COVID-19 pandemic. The purpose of this study was to evaluate the trajectory of psychological distress among this vulnerable population from a longitudinal perspective, evaluating the role of PG and PWS. Methods: Self-report measures were used to assess psychological distress, PG, and PWS among primary school boys (grades 4 to grade 6; N = 283). Data were collected across three waves: before the pandemic, during school closure, and following the lifting of restrictions. Results: The trajectory of psychological distress among primary school boys was concave, indicating their mental health was negatively impacted during home restriction but recovered after the lockdown ended (linear change = 0.98, p < 0.01; quadratic change = -0.19, p < 0.01). PG was a significant covariate in terms of the trajectory of psychological distress (b = 0.02, p < 0.01). Moreover, baseline values for PWS were shown to have a negative direct effect on mental health before the pandemic (b = 0.05, p < 0.01), and moderated the time factor for boys' psychological distress over time (b of PWS × linear change = 0.04, p = 0.006; b of PWS × Quadratic change was negative at -0.01, p = 0.002). Conclusions: Although mental health gradually improved as home restrictions subsided, future studies are required to address changes in mental health upon return to school for students reporting higher levels of weight stigma.

Animal and translational models of SARS-CoV-2 infection and COVID-19.

COVID-19 is causing a major once-in-a-century global pandemic. The scientific and clinical community is in a race to define and develop effective preventions and treatments. The major features of disease are described but clinical trials have been hampered by competing interests, small scale, lack of defined patient cohorts and defined readouts. What is needed now is head-to-head comparison of existing drugs, testing of safety including in the background of predisposing chronic diseases, and the development of new and targeted preventions and treatments. This is most efficiently achieved using representative animal models of primary infection including in the background of chronic disease with validation of findings in primary human cells and tissues. We explore and discuss the diverse animal, cell and tissue models that are being used and developed and collectively recapitulate many critical aspects of disease manifestation in humans to develop and test new preventions and treatments.