An immune-protein score combining TRAIL, IP-10 and CRP for predicting severe COVID-19 disease.

COVID-19 patients are oftentimes over- or under-treated due to a deficit in predictive management tools. This study reports derivation of an algorithm that integrates the host levels of TRAIL, IP-10, and CRP into a single numeric score that is an early indicator of severe outcome for COVID-19 patients and can identify patients at-risk to deteriorate. 394 COVID-19 patients were eligible; 29% meeting a severe outcome (intensive care unit admission/non-invasive or invasive ventilation/death). The score's area under the receiver operating characteristic curve (AUC) was 0.86, superior to IL-6 (AUC 0.77; p = 0.033) and CRP (AUC 0.78; p < 0.001). Likelihood of severe outcome increased significantly (p < 0.001) with higher scores. The score differentiated severe patients who further deteriorated from those who improved (p = 0.004) and projected 14-day survival probabilities (p < 0.001). The score accurately predicted COVID-19 patients at-risk for severe outcome, and therefore has potential to facilitate timely care escalation and de-escalation and appropriate resource allocation.

Public views on healthcare workers' burnout before and during COVID-19: A comparative study.

INTRODUCTION: Understanding burnout among nurses and physicians may mobilize public support for increasing budgets, personnel, and trust in both routine and pandemic times. The study aimed to examine public views of nurse and physician burnout both before and 1 year after the COVID-19 outbreak. DESIGN: This study was conducted in two phases in a pre-post design. METHODS: The general public (a random sample) responded to a structured questionnaire with 1-2 open-ended questions: (a) before the COVID-19 pandemic, in 2019 during routine life (n = 504) and (b) 1 year after the COVID-19 outbreak, in 2021 (n = 500). Quantitative and qualitative data on public perceptions of nurse and physician burnout, its sources and consequences, were collected. RESULTS: The public view was that hospital physicians and even more so hospital nurses suffer from higher burnout than those working in the community, and that this worsened during the pandemic. Three themes related to caregiver burnout were identified: (a) work overload, (b) lack of sensitivity, empathy, and motivation, and (c) impaired ability to provide quality care. CONCLUSIONS: The public is aware of the experiences of caregivers both in times of routine and in emergency. Healthcare management must influence public opinion in order to receive support for organizational steps. CLINICAL RELEVANCE: Healthcare leaders should leverage public support in order to receive backing for organizational moves aimed at improving work conditions and, in turn, the quality of care and patient outcomes.

Self-efficacy, uncertainty and anxiety among nursing graduates in response to licensing test postponement due to the COVID-19 pandemic: A mixed-methods study.

AIM: To examine the relationships between self-efficacy, uncertainty and anxiety among nursing graduates waiting for a mandatory nursing licensing test that was postponed due to the COVID-19 pandemic. METHODS: A total of 352 graduates of nursing education programs participated in this mixed-methods study. The data were collected using an online questionnaire in June 2020. RESULTS: The participants demonstrated high uncertainty and anxiety and low self-efficacy towards the ability to succeed in the licensing exam. Graduates, who started working, reported lower uncertainty. Self-efficacy, uncertainty, gender and family status contributed significantly to the explanation of 24% of the variance of the anxiety. The qualitative analysis revealed three themes: (a) emotional distress, cognitive challenge and social implications, (b) consequences for significant others and (c) strengthening of professional values and norms. CONCLUSIONS: A significant crisis like a pandemic is accompanied by acute cognitive burden and stressful emotional experiences and creates an unconventional situation that requires unusual solutions. Granting a temporary permit for employment as a nurse following the postponement of a licensing test contributed to the ability of nursing graduates to cope with the situation. Policies to deal with similar situations in the future emergencies should be developed and implemented.

Israeli parents` views on coronavirus (COVID-19) vaccinations for children: A cross-sectional study.

BACKGROUND: Parents play the decisive role in children's vaccination. Our study aimed as assessing attitudes of parents toward the COVID-19 vaccine for children aged 5-18 and to define sources of influence on these attitudes, the barriers and reasons for hesitation. METHODS: In this cross-sectional study, 138 Israeli parents of 5-18 aged children completed a self-administered structured questionnaire. FINDINGS: More than a quarter of parents reported that they did not intend to vaccinate their children. Independent of other demographic characteristics, parents who do not vaccinate their children accordingly to the routine vaccinations have five-fold significant odds not to vaccinate with COVID-19 vaccine (OR = 4.8, 95% CI: 1.8-12.7). Greater social influence was significantly and negatively associated with intentions not to vaccinate a child. Among parents who do not intend to vaccinate their children, the most frequent reasons were fear of possible side effects (92%), vaccine novelty (92%) and lack of belief in its effectiveness (69%). DISCUSSION: This study found that vaccination in the past as part of routine government immunization programs predict a tendency to vaccinate children during the pandemic. Among the factors associated with the intention not to vaccinate, concerns and uncertainty about the necessity of the vaccine, its side effects and reliability have been emphasized. APPLICATION TO PRACTICE: Cultural-religious adjustments should be applied when implementing interventions aiming to promote vaccination in routines and emergencies. Social influence is important in adopting a positive attitude toward vaccines. Public health professionals should incorporate those parents who have vaccinated their children and have a positive attitude toward vaccination.

Transient diabetes insipidus in critically ill COVID19 patients.

PURPOSE: Vasopressin has become an important vasopressor drug while treating a critically ill patient to maintain adequate mean arterial pressure. Diabetes insipidus (DI) is a rare syndrome characterized by the excretion of a large volume of diluted urine, inappropriate for water homeostasis. We noticed that several COVID19 patients developed excessive polyuria suggestive of DI, with a concomitant plasma sodium-level increase and/or low urine osmolality. We noticed a temporal relationship between vasopressin treatment cessation and polyuria periods. We reviewed those cases to better describe this phenomenon. METHODS: We retrospectively collected COVID19 ECMO patients' (from July 6, 2020, to November 30, 2021) data from the electronic medical records. By examining urine output, urine osmolality (if applicable), plasma sodium level, and plasma osmolality, we set DI diagnosis. We described the clinical course of DI episodes and compared baseline characteristics between patients who developed DI and those who did not. RESULTS: Out of 37 patients, 12 had 18 episodes of DI. These patients were 7 years younger and had lower severity scores (APACHE-II and SOFA). Mortality difference was not seen between groups. 17 episodes occurred after vasopressin discontinuation; 14 episodes were treated with vasopressin reinstitution. DI lasted for a median of 21 h, with a median increase of 14 mEq/L of sodium. CONCLUSIONS: Temporary DI prevalence after vasopressin discontinuation in COVID19 ECMO patients might be higher than previously described for vasopressin-treated patients.

Experiences and psychosocial predictors of professional function among intensive care nurses under the shadow of Covid-19: A mixed-methods study.

BACKGROUND: The outbreak of the Corona virus (COVID-19) pandemic led to a sharp rise in morbidity and hospitalizations, and a significant therapeutic burden fell on intensive care units (ICUs). Intensive care nurses reported physical and emotional stress in response to the extra workload caused by caring for critically ill COVID-19 patients. However, at the time of publication of the study, to the best of our knowledge there have been no studies that examined uncertainty, stress, or hope in the context of functioning among intensive care nurses. AIM: To examine: (a) the challenges of operating and managing intensive care units during the COVID-19 pandemic among nurse managers in intensive care units, and (b) the relationships between uncertainty, stress, burnout, hope, and professional functioning among intensive care nurses during the COVID-19 pandemic. DESIGN: This mixed-methods study was conducted in intensive care units (ICUs) at a large tertiary medical center in Israel, during February-May 2021. METHODS: The data were collected in two phases. In the first phase, qualitative data were collected from focus groups attended by 15 senior managerial nurses. The second phase involved a cross-sectional study among 100 staff nurses working in 5 ICUs. The data were collected using a structured questionnaire. RESULTS: Qualitative data analysis revealed two main themes: (a) challenges of the COVID-19 pandemic and (b) positive aspects of the COVID-19 pandemic. The nurses reported high levels of burnout, emotional stress and uncertainty, but moderate State Hope Scale scores, and moderate levels of professional functioning. There were no statistical differences in study variables by exposure to COVID-19 patients. State Hope Scale levels, uncertainty, and burnout variables contributed significantly and explained 46% of the variance of the professional functioning. CONCLUSIONS: The intensity of the experiences and psych-social phenomena, is not affected by exposure to treatment of COVID-19 patients. The relationships between the study variables emphasize the importance of initiated and ongoing interventions to reduce uncertainty, address burnout, and strengthen hope. Improvement in these indices may lead to better ICU nurses' professional functioning and their work life well-being.

Practices and experiences of European frontline nurses under the shadow of COVID-19.

The COVID-19 pandemic has caused health professionals to deal with new situations they have not encountered before. Nurses were forced to cope with increased workloads, seriously ill patients, numerous patient deaths, and unresolved ethical dilemmas. This study aimed to examine the lived experiences of nurses across Europe during the first wave of the COVID-19 pandemic. This was a qualitative narrative research study. Eighteen nurses from eight European countries (four each from the UK and Israel, three from Portugal, two each from the Netherlands and Ireland, and one each from Belgium, Italy, and Sweden) submitted narratives about their professional experiences during May-June 2020. The narratives were analyzed using thematic analysis. Seven categories across the narratives were condensed and interpreted into three themes: opportunities and growth, care management, and emotional and ethical challenges. The COVID-19 pandemic has affected nurses emotionally and provided an opportunity to actively develop systems and skills needed to minimize harm and maximize benefits to patients and nurses.

Diabetes nurse practitioners in the shadow of the COVID-19 pandemic: Challenges, insights, and suggestions for improvement.

PURPOSE: The study examined the role of diabetes nurse practitioners (DiNPs) and their contribution to the quality of care of individuals with diabetes during the COVID-19 pandemic. Specifically, we examined the benefits and barriers of using telemedicine for managing diabetes. DESIGN: A descriptive qualitative research using content analysis of interviews. METHODS: Participants were invited through the National DiNPs' Forum. Semi-structured interviews were conducted with 24 licensed DiNPs (age range, 37-58 years) who were involved in the clinical care of individuals with diabetes during the COVID-19 pandemic. The interviews were recorded and transcribed, and content analysis was then used for extracting themes and their related categories. FINDINGS: Content analysis revealed five themes: (a) Benefits and barriers of remote diabetes treatment; (b) Teamwork and its implications to DiNPs; (c) Technological challenges, resourcefulness, and creativity; (d) Changed perception of DiNP roles; and (e) Cultural diversity and improving communication skills. The benefits of telemedicine included improved control, efficiency, convenience and satisfaction, while the disadvantages of this method included the inability to provide optimal practical guidance on technical aspects of physical assessments and care. Sectors with limited digital literacy and language barriers had difficulties using telemedicine. Teamwork was reported as a facilitator to managing treatment. Telemedicine provided an opportunity for DiNPs to become more efficient and focused and to clearly define their role in the organization. CONCLUSIONS: The COVID-19 pandemic has posed new challenges. Along with the need to adapt the therapeutic approach to remote care, DiNPs improved their professional status, acquired new skills, and were satisfied with their personal and professional growth. CLINICAL RELEVANCE: Telemedicine should become an integral part of diabetes management to enable access to populations who cannot come to the clinic. Patients should be guided on using telemedicine platforms.

A Mixed-Methods Study of Nurse Managers' Managerial and Clinical Challenges in Mental Health Centers During the COVID-19 Pandemic.

PURPOSE: The worldwide outbreak of the COVID-19 pandemic has posed challenges for nurses. The aim of this study was to examine the managerial and clinical challenges of nurse managers in mental health centers during the current COVID-19 pandemic. DESIGN: A mixed-methods study based on an analysis of data obtained in focus groups with 25 nurse managers from two mental health centers in Israel. METHODS: The quantitative phase was conducted prior to the group sessions using a structured self-administered questionnaire that examined the nurse managers' (a) background data, (b) communication with the staff nurses, (c) perceptions of nurses' functioning, (d) perceptions of their own functioning, and (e) management as impacted by the pandemic. The qualitative phase included three sessions of focus groups in which the nurse managers discussed both their challenging and positive issues during the pandemic. FINDINGS: The most important challenges were related to the need to protect patients from infection and communicating with families and primary caregivers. Work policies and procedures were less well adapted to pandemic conditions; nevertheless, nurse managers felt a sense of purpose, duty, and pride in their work. Three themes emerged: (a) "management complexity" included the change from a familiar routine to a new reality, working in capsules, protecting against infection, functional confusion, and insights into future epidemics; (b) "challenging communication" included communication with patients through glass walls and communication with staff through screens and (c) "bright spots" referred to staff cohesion and the provision of respectful care. CONCLUSIONS: Mental health nurse managers have experienced during the pandemic a change in their roles from being less managerial to focusing more on clinical work. Communication between nurse managers and staff nurses and between mental health patients and staff were the main challenges. Nurse managers favorably noted the uniformity and humanity of the staff, sense of cohesion, and shared responsibility. CLINICAL RELEVANCE: In the first wave of the pandemic, there was confusion as to the functional role of ward nurse managers, as the focus of their activities became more clinical and less managerial. During and after the pandemic, preventive interventions should be carried out in order to assist patients, staff nurses, and nurse managers in mental health centers.