Verpleegkundig leiderschap in de praktijk

Voor behoud van verpleegkundigen en verzorgenden zijn een betere positionering, meer handen aan het bed en waardering voor de beroepsgroep nodig. Verpleegkundig leiderschap is daarbij een belangrijk instrument om zowel goede zorg als meer zeggenschap te realiseren.

Vasopressin, Cortisol, and Osmotic Regulation in Non‐hospitalized SARS‐CoV‐2 Infected Patients

Vasopressin (AVP) has been implicated in the inflammatory response to SARS‐CoV‐2 infection as increased disease severity has been reported to be associated with elevated levels of copeptin. Elevated AVP and cortisol levels seen in systemic inflammatory responses may be associated with severe pulmonary edema and dilutional hyponatremia caused be dysregulation of neurohormonal control of fluid and electrolyte balance. Early and effective regulation of fluid balance before acute respiratory failure spirals into hypoxemia‐induced septic shock and multisystem organ failure, may be needed to prevent progression to severe disease. We hypothesized that control of osmotic homeostasis in non‐severe cases of COVID‐19 is an outcome of cortisol and AVP stimulation arising from an appropriate stress response. In an observational study of asymptomatic to moderately symptomatic non‐hospitalized individuals (n = 45;14 to 71 years of age) positive for SARS‐CoV‐2 (confirmed by PCR test), we assessed osmotic regulation by measuring circulating AVP (by radioimmunoassay), cortisol (by enzyme linked immunoassay), plasma osmolality (pOsm), plasma sodium (pNa) and plasma potassium (pK). Two plasma specimens from each person were collected between 2 and 32 days from onset of symptoms or confirmed positive test. Inflammatory stimulation of the immune response was verified by quantitative measurement of IgG targeted to the SARS‐Cov‐2 spike protein (Epitope Diagnostics, Dynex Agility). Plasma osmolality (293+1 mOsm/L) remained stable even at the peak of IgG immune response. Multiple regression analyses showed pOsm was directly related to AVP and inversely related to cortisol (p<0.001). Examination of electrolyte levels over time from positive SARS‐CoV‐2 test week 1 vs week 3 (7+1 vs 18+1 days) revealed a slight decrease in pNa (139.7+0.8 to 136.9+0.5 mEq/l p<0.05, but there was no evidence of hyponatremia or inappropriate levels of AVP (SIADH) which was 1.9+0.2 uU/ml at week 1 and 2.2+0.3 uU/ml at week 3. Vasopressin regulation was appropriately positively correlated with pOsm and cortisol and negatively related to pK (p<0.001). Cortisol levels increased from week 1 to 3 (14.7+1.2 to 22.2+2.2 ug/dL), and positively correlated with AVP and negatively correlated with pNa. Results demonstrated that the stimulated immune response to SARS‐CoV‐2 infection in mild to moderate cases of COVID‐19 does not disrupt osmotic regulation by AVP. Thus, reports of dysregulation of osmotic homeostasis and SIADH observed in severe pneumonia and coronavirus sepsis in hospitalized patients is likely due to the dominating non‐osmotic stimulation of AVP to pathophysiological levels needed to maintain blood pressure and renal perfusion. In mild to moderate COVID‐19 cases, control of fluid and electrolyte balance at physiological levels of AVP appears to be maintained.

Early detection and treatment of attention deficits in preterm and at term infants with risk factors for brain damage.

Cognitive deficits in infants born preterm and infants at term with risk factors for brain damage are a common outcome. Attention deficits in preterm infants are related to the development of attention-deficit/hyperactivity disorder (ADHD), and therefore, there is a need for earlier evaluations and treatment procedures that are implemented before the presence of signs of ADHD. METHODS: We studied preterm (74%) and term infants with the Infant Scale of Selective Attention (ISSA, Escala de Evaluación de la Atención Selectiva (EEAS), in Spanish). This scale evaluates both visual- and auditory-orienting attention. Two groups participated, one with attention deficits (n = 26) and another with regular performance (n = 36). An early attention-stimulation program (EASP) was implemented in the infant group with attention deficits from three to eight months of age. All infants underwent magnetic resonance imaging (MRI), and visual and auditory evoked responses were assessed. RESULTS: All infants had prenatal and perinatal risk factors for brain damage and abnormal MRI findings, and the majority had abnormalities compatible with white matter injury. However, there were four infants with porencephalic cysts; 3 of them were in the treated group. At the beginning of the treatment, ISSA values showed differences between groups. These differences persisted for five months in the visual test and up to the sixth month in the auditory evaluation. Afterward, there were no significant differences, indicating that infants with attention deficits had satisfactorily responded to the treatment. CONCLUSIONS: The ISSA is helpful for the early evaluation of visual and auditory attention. Infants with attention deficits react well enough after six months of EASP.

Recalibrating the notion of modelling for policymaking during pandemics.

COVID-19 disease models have aided policymakers in low-and middle-income countries (LMICs) with many critical decisions. Many challenges remain surrounding their use, from inappropriate model selection and adoption, inadequate and untimely reporting of evidence, to the lack of iterative stakeholder engagement in policy formulation and deliberation. These issues can contribute to the misuse of models and hinder effective policy implementation. Without guidance on how to address such challenges, the true potential of such models may not be realised. The COVID-19 Multi-Model Comparison Collaboration (CMCC) was formed to address this gap. CMCC is a global collaboration between decision-makers from LMICs, modellers and researchers, and development partners. To understand the limitations of existing COVID-19 disease models (primarily from high income countries) and how they could be adequately support decision-making in LMICs, a desk review of modelling experience during the COVID-19 and past disease outbreaks, two online surveys, and regular online consultations were held among the collaborators. Three key recommendations from CMCC include: A 'fitness-for-purpose' flowchart, a tool that concurrently walks policymakers (or their advisors) and modellers through a model selection and development process. The flowchart is organised around the following: policy aims, modelling feasibility, model implementation, model reporting commitment. Holmdahl and Buckee (2020) A 'reporting standards trajectory', which includes three gradually increasing standard of reports, 'minimum', 'acceptable', and 'ideal', and seeks collaboration from funders, modellers, and decision-makers to enhance the quality of reports over time and accountability of researchers. Malla et al. (2018) A framework for "collaborative modelling for effective policy implementation and evaluation" which extends the definition of stakeholders to funders, ground-level implementers, public, and other researchers, and outlines how each can contribute to modelling. We advocate for standardisation of modelling processes and adoption of country-owned model through iterative stakeholder participation and discuss how they can enhance trust, accountability, and public ownership to decisions.

Seroprevalence of SARS-CoV-2 antibodies among physicians from a children's hospital

Introducción. En pocos meses, la enfermedad por coronavirus 2019 (COVID-19) se transformó en una pandemia, alcanzando millones de casos y centenas de miles de muertos. Por la enorme capacidad de contagio, el personal de salud se encuentra más expuesto a contraerla. Sin embargo, aún hay muy poca información al respecto, particularmente, entre pediatras.Objetivo. Evaluar la seroprevalencia de anticuerpos anti SARS-CoV-2 en médicos de un hospital pediátrico, a 3 meses del primer caso en la Argentina. Explorar si algunas características demográficas, profesionales y epidemiológicas son factores de riesgo para presentar seropositividad para SARS-CoV-2.Métodos. Estudio transversal, con médicos seleccionados aleatoriamente de la nómina de un hospital pediátrico. En todos, se pesquisaron anticuerpos anti SARS-CoV-2por quimioluminiscencia (inmunoglobulinas G/M -IgG/IgM-) y se recogieron antecedentes epidemiológicos (edad, lugar de residencia, categoría profesional, contacto con enfermos), para explorar asociación entre los predictores y seropositividad.Resultados. Se incluyeron 116 médicos, con una edad promedio de 45,6 ± 13,3 años. El 62,9 % eran médicos de planta, y el resto, residentes. El 42,2 % prestaban servicios en áreas dedicadas a la asistencia directa de pacientes con COVID-19.Cuatro (el 3,5 %) refirieron contacto con enfermos sin la debida protección, y 6 (el 5,2 %), viaje previo a zonas de riesgo. Solo se identificaron anticuerpos anti-SARS-CoV-2 (IgG) en un profesional. Debido a ello, no se pudo evaluar asociación entre los potenciales predictores y la presencia de anticuerpos anti-SARS-CoV-2.Conclusión. Se encontró que solo el 0,9 % de los médicos de un hospital pediátrico presentaban anticuerpos anti-SARS-CoV-2. Introduction. In just a few months, coronavirus disease 2019 (COVID-19) has become a pandemic, causing millions of cases and hundreds of thousands of deaths. Due to its high infectiousness, the health care staff is even more exposed. Nevertheless, there is still very limited information about it, especially among pediatricians.Objective. To assess the seroprevalence of SARS-CoV-2 antibodies among physicians from a children's hospital 3 months after the first case in Argentina. To explore if certain demographic, occupational, and epidemiological characteristics are risk factors for SARS-CoV-2 seropositivity.Methods. Cross-sectional study of physicians randomly selected from the list of workers of a children's hospital. All of them were screened for SARS-CoV-2 antibodies by chemiluminescence (immunoglobulins G/M [IgG/IgM]) and their epidemiological history was collected (age, place of residence, professional category, contact with infected people) in order to explore the association between predictors and seropositivity.Results. A total of 116 physicians were included;their average age was 45.6 ± 13.3 years. Of them, 62.9 % were staff physicians, and the rest, residents;42.2 % worked in areas designated for direct care of COVID-19 patients. Four (3.5 %) referred contact with infected people without the appropriate protection, and 6 (5.2 %), having traveled to risk areas. SARS-CoV-2 antibodies (IgG) were only detected in one of the professionals. Because of this, it was impossible to assess the association between potential predictors and the presence of SARS-CoV-2 antibodies.Conclusion. It was observed that only 0.9 % of the physicians from a children's hospital had SARS-CoV-2 antibodies

Seroprevalence of SARS-CoV-2 antibodies among physicians from a children's hospital. / Seroprevalencia de anticuerpos anti SARS-CoV-2 en médicos de un hospital pediátrico.

INTRODUCTION: In just a few months, coronavirus disease 2019 (COVID-19) has become a pandemic, causing millions of cases and hundreds of thousands of deaths. Due to its high infectiousness, the health care staff is even more exposed. Nevertheless, there is still very limited information about it, especially among pediatricians. OBJECTIVE: To assess the seroprevalence of SARSCoV- 2 antibodies among physicians from a children's hospital 3 months after the first case in Argentina. To explore if certain demographic, occupational, and epidemiological characteristics are risk factors for SARS-CoV-2 seropositivity. METHODS: Cross-sectional study of physicians randomly selected from the list of workers of a children's hospital. All of them were screened for SARS-CoV-2 antibodies by chemiluminescence (immunoglobulins G/M [IgG/IgM]) and their epidemiological history was collected (age, place of residence, professional category, contact with infected people) in order to explore the association between predictors and seropositivity. RESULTS: A total of 116 physicians were included; their average age was 45.6 ± 13.3 years. Of them, 62.9 % were staff physicians, and the rest, residents; 42.2 % worked in areas designated for direct care of COVID-19 patients. Four (3.5 %) referred contact with infected people without the appropriate protection, and 6 (5.2 %), having traveled to risk areas. SARS-CoV-2 antibodies (IgG) were only detected in one of the professionals. Because of this, it was impossible to assess the association between potential predictors and the presence of SARS-CoV-2 antibodies. CONCLUSION: It was observed that only 0.9 % of the physicians from a children's hospital had SARS-CoV-2 antibodies.

Introducción. En pocos meses, la enfermedad por coronavirus 2019 (COVID-19) se transformó en una pandemia, alcanzando millones de casos y centenas de miles de muertos. Por la enorme capacidad de contagio, el personal de salud se encuentra más expuesto a contraerla. Sin embargo, aún hay muy poca información al respecto, particularmente, entre pediatras. Objetivo. Evaluar la seroprevalencia de anticuerpos anti SARS-CoV-2 en médicos de un hospital pediátrico, a 3 meses del primer caso en la Argentina. Explorar si algunas características demográficas, profesionales y epidemiológicas son factores de riesgo para presentar seropositividad para SARS-CoV-2. Métodos. Estudio transversal, con médicos seleccionados aleatoriamente de la nómina de un hospital pediátrico. En todos, se pesquisaron anticuerpos anti SARS-CoV-2 por quimioluminiscencia (inmunoglobulinas G/M -IgG/IgM-) y se recogieron antecedentes epidemiológicos (edad, lugar de residencia, categoría profesional, contacto con enfermos), para explorar asociación entre los predictores y seropositividad. Resultados. Se incluyeron 116 médicos, con una edad promedio de 45,6 ± 13,3 años. El 62,9 % eran médicos de planta, y el resto, residentes. El 42,2 % prestaban servicios en áreas dedicadas a la asistencia directa de pacientes con COVID-19. Cuatro (el 3,5 %) refirieron contacto con enfermos sin la debida protección, y 6 (el 5,2 %), viaje previo a zonas de riesgo. Solo se identificaron anticuerpos anti-SARS-CoV-2 (IgG) en un profesional. Debido a ello, no se pudo evaluar asociación entre los potenciales predictores y la presencia de anticuerpos anti-SARS-CoV-2. Conclusión. Se encontró que solo el 0,9 % de los médicos de un hospital pediátrico presentaban anticuerpos anti-SARS-CoV-2.

Estrés, ansiedad, depresión y apoyo familiar en universitarios mexicanos durante la pandemia, COVID-19

Objetivo: Identificar los niveles de estrés, ansiedad y depresión presentes en los universitarios durante la pandemia en relación con el apoyo que brinda la familia. Materiales y Métodos: Se trata de un estudio de tipo cuantitativo con un diseño descriptivo, correlacional y transversal. La muestra (n=105), fueron estudiantes de la facultad de Enfermería de la Universidad Veracruzana;se obtuvo a través de un muestreo no-probabilístico a conveniencia. Los datos fueron recolectados a través de un instrumento digital (Google Forms). Las variables se midieron utilizando la Escala de Depresión, Ansiedad y Estrés (DASS-21) y el Inventario de Percepción de Apoyo Familiar (IPAF). Los datos fueron analizados mediante estadística descriptiva y la prueba de correlación de Spearman. Resultados: Los resultados evidencian que no existe una asociación entre las variables estudiadas r=-0.192, n=105, p=0.134., pero si existe depresión (85.8%), ansiedad (84%) y estrés (77.4%) en los estudiantes, aunque se presenta de forma leve y un nivel medio bajo de apoyo familiar (afecto 61.3%, adaptabilidad 62.3% y autonomía 40.6%). Conclusión: Los trastornos por ansiedad, estrés y depresión afectan gradualmente diversas esferas de actuación personal de los estudiantes, por lo cual una intervención oportuna y preventiva es relevante.Alternate :Objective: To identify the levels of stress, anxiety, and depression present in university students during the pandemic in relation to the support provided by the family. Materials and Methods: This is a quantitative study with a descriptive, correlational, and cross-sectional design. The sample (n = 105) was composed of students of the Faculty o ursing of the Veracruzana University;it was obtained through convenience non-probabilistic sampling. The data was collected through a digital instrument (Google Forms). Th ariables were measured using the Depression, Anxiety and Stress Scale (DASS-21) and the Inventory of Perception of Family Support (IPAF). The data was analyzed using descriptive statistics and the Spearman correlation test. Results: The results show that there is no association between the studied variables r = -0.192, n = 105, p = 0.134., but if there is depression (85.8%), anxiety (84%), and stress (77.4%) in the students, although in a mild form, and a low medium level of family support (affection 61.3%, adaptability 62.3%, and autonomy 40.6%). Conclusion: Anxiety, stress, and depression disorders gradually affect various spheres of personal performance of students, for which a timely and preventive intervention is relevant.