Objective stress values during radiation emergency medicine for future human resources: Findings from a survey of nurses.

INTRODUCTION: Shortages of human resources in radiation emergency medicine (REM) caused by the anxiety and stress of due to working in REM, are a major concern. The present study aimed to quantify stress and identify which tasks involved in REM response are most stressful to help educate (human resource development) and effectively reduce stress in workers. Furthermore, the final goal was to reduce the anxiety and stress of medical personnel in the future, which will lead to sufficient human resources in the field of REM. METHODS: In total, 74 nurses who attended an REM seminar were asked to answer a questionnaire (subjective) survey and wear a shirt-type electrocardiogram (objective survey). Then, informed consent was obtained from 39 patients included in the analysis. In the objective survey, average stress values of participants for each activity during the seminar were calculated based on heart rate variability (HRV). The average stress value was output as stress on a relative scale of 0-100, based on the model which is the percentile of the low-frequency/high-frequency ratio derived from HRV at any point in time obtained over time. RESULTS: A total of 35 (89.7%) participants answered that they had little or no knowledge of nuclear disaster and 33 (84.6%) had more than moderate anxiety. Stress values observed during the decontamination process were significantly higher than those observed when wearing and removing protective gear and during the general medical treatment process (P = 0.001, 0.004, and 0.023, respectively). Stress values did not increase during general medical treatment performed in protective clothing, but increased during the decontamination process, which is the task characteristic of REM. DISCUSSION: Stress felt by medical personnel throughout the entire REM response may be effectively reduced by providing careful education/training to reduce stress during the decontamination process. Reducing stress during REM response effectively could contribute to resolving the shortage of human resources in this field.

Maternal thrombocytopenia precedes fetal death associated with COVID-19.

Acute coagulopathy, specific placental pathology, and an increased risk of fetal death have been reported in pregnant women with COVID-19; however, the association between coagulopathy and fetal death remains unknown. We report two pregnant women with COVID-19 who showed acute coagulopathy prior to fetal death. Both pregnant women presented with thrombocytopenia after testing positive for SARS-CoV-2 (days 5 and 7). They had mild symptoms, but coagulopathy progressed, and their fetuses died on day 9 at 27 and 22 weeks of pregnancy. Their coagulability improved after delivery. Placental histology in both cases showed intervillous infiltration of histiocytes, necrosis of trophoblasts, and intervillous fibrin deposition, which were consistent with previously reported pathological findings related to SARS-CoV-2. In the management of pregnant women with COVID-19, thrombocytopenia may be a predictive marker of fetal death following coagulopathy and placental inflammatory changes due to SARS-CoV-2 infection.