[Implementation of Clinical Practice in Adult Nursing (Chronic Care) During the COVID-19 Pandemic: Report on the Development and Implementation of a Training Program for Clinical Shadowing].

Before the outbreak of COVID-19, "Clinical Practice in Adult Nursing (Chronic Care)", a professional course to acquire basic nursing practice skills for the care of adult patients with chronic diseases, was conducted on site in the wards of internal medicine, outpatient departments, and the admissions support office for a total of three weeks. Due to the spread of the COVID-19 epidemic, however, clinical practice was carried out online from May 2020, and was resumed on site at our university hospital in October 2020. A restriction was placed on the length of time spent at the hospital for on-site training, referring to the training standards based on our university's new coronavirus response manual, and a training program was developed for hospital ward training, consisting mainly of shadowing practice performed without speaking or coming into contact with patients. In principle, two students were assigned to one patient: one in the morning and the other in the afternoon. In addition, for practicing the acquisition of patient information through conversation and the provision of nursing assistance, the perspectives used in the process of shadowing were clearly defined so that students could maintain active attitudes in clinical practice, and support was provided so that students could have the experience of engaging with patients, using nurses as mediators. In the results, the students evaluated the contents of the prepared assistance based on their own nursing plan in reference to the practice of the nurse as a mediator, and compared that with the assistance practiced by the nurse based on clinical judgment, which contributed to acquiring practical learning supported by the grounds for clinical judgment. However, the students could not experience the process of building supportive relationships and the implementation of nursing skills, which remained an issue.

Restriction of SARS-CoV-2 replication in the human placenta.

Although SARS-CoV-2 can infect human placental tissue, vertical transmission is rare. Therefore, the placenta may function as a barrier to inhibit viral transmission to the foetus, though the mechanisms remain unclear. In this study, we confirmed the presence of the SARS-CoV-2 genome in human placental tissue by in situ hybridization with antisense probes targeting the spike protein; tissue staining was much lower when using sense probes for the spike protein. To the best of our knowledge, this is the first evidence directly indicating inefficient viral replication in the SARS-CoV-2-infected placenta. Additional studies are required to reveal the detailed mechanisms.

Intrauterine fetal death during COVID-19 pregnancy: Typical fetal heart rate changes, coagulopathy, and placentitis.

Although various perinatal outcomes in coronavirus disease 2019 (COVID-19) pregnancies have been reported, the fetal and neonatal consequences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remain unclear. Several reports of miscarriages and stillbirths have been recorded, but vertical transmission by SARS-CoV-2 is considered very rare, and the cause remains unknown. We report a case of a 22-year-old uncomplicated Japanese woman infected with SARS-CoV-2 during the second trimester, resulting in intrauterine fetal death due to placental insufficiency associated with COVID-19 placentitis. This report emphasizes the importance of longitudinal assessment of fetal well-being by fetal heart rate monitoring and early detection of maternal coagulation dysfunction representing SARS-CoV-2 inflammation to manage COVID-19 in pregnancy.