Factors affecting resilience of nursing staff involved in clinical care of Covid-19 patients

The aim of this study was to discover factors enhancing the psychological resilience of nursing staff involved in the frontline of clinical care of Coronavirus Disease Patients. The research method is exploratory mixed method (qualitative - quantitative). In qualitative stage, Systematic and in-depth review of qualitative studies related to the subject and in quantitative stage, a questionnaire has been used to collect data. Based on the results of the study, three categories including mobilize public support for mental health care of nursing staff, fostering key resilience competencies and working life of nursing staff were identified and extracted as key categories affecting psychological resilience of nursing staff involved in the front line of crisis. In the quantitative stage, the validity and reliability of the structure for all components except public emotional support were confirmed. Also, in ranking the importance of the approved components, the competence of the head nurses in leading the nursing teams was in the first place. According to the changes of the nature of diseases and public health challenges, it is necessary to address problems such as psychological trauma of nursing staff that have a profound and lasting impact on their performance and quality of clinical care of patients, and to define and apply new standards in clinical care management appropriate to the nature and characteristics of future viral diseases Predicted by Scientists and International experts. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Clinical Oncology Nursing: Will You Leave or Stay?

Anyone who works in clinical oncology care sees it, experiences it, or feels it on a daily basis: a real or perceived shortage of nurses and, specifically, experienced clinical oncology nurses.

eHealth, mHealth, and Telemedicine for COVID-19 Pandemic

eHealth, mHealth, and Telemedicine refer to the application of communication technology and information entrenched in software programs with high-speed telecommunications systems for monitoring, delivery, and management of healthcare services. The utilization of telemedicine has been recognized as a sustainable technology that could help in protection of patients, medical practitioners as well as reduction of social mobility of patients, thereby decreasing the spread of virus. Therefore, this chapter intends to provide a detailed information on the application of eHealth, mHealth, and telemedicine as a preemptive measure to increase clinical care. Detailed information on the practical application of eHealth, mHealth, and telemedicine that has been adopted for the management of COVID-19 during the pandemic period was highlighted. Moreover, detailed information on future recommendation and the role of relevant stakeholders, policy makers, and healthcare providers in obtaining relevant appreciated awareness in the regional dissemination of infection load and healthcare consumption that could enhanced the management of COVID-19 are discussed. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Redesigning Chronic Care delivery using Mobile Health Technology

Typical management of chronic conditions is through sporadic office visits. But health indicators (such as blood pressure) can fluctuate significantly within a day. The infrequent office visits, however, offer the provider little information about the medical history of the patient between office visits resulting in delayed and sometimes inappropriate interventions. Use of mobile health (mHealth) technology in clinical care can help make appropriate interventions at the patient's location before the worsening condition leads to costlier consequences. mHealth enables patients to remotely upload measurements and providers to continuously monitor these measurements and intervene if necessary. mHealth, therefore, results in bidirectional information flow between providers and patients, thereby reducing information asymmetry. Our study examines redesigning of chronic care delivery using mHealth. It is important to make sure the redesigned delivery process is both efficient (reduces cost) and effective (improves patient health). In this paper, we first present a big picture of the redesigned care delivery process. We then show how this delivery process can improve patient health by analyzing a panel dataset of 1627 patients. We examine the relationship between use of mobile health applications and quality of care delivery for hypertensive patients. We observe the blood pressure readings to decrease with frequency of app usage and time since adoption. With the use of mHealth apps increasing in the post COVID-19 era, our analysis indicates an efficient use of physician's time and an increased role for support-staff under the supervision of the physician. The chronic care delivery process can therefore be redesigned with the help of mHealth, improving patient health and reducing cost for both patients and providers. © 2023 IEEE Computer Society. All rights reserved.

Analysis of the Use of Robots for the Second Year of the COVID-19 Pandemic

This article examines 152 reports the use of robots explicitly due to the COVID-19 pandemic reported in the science, trade, and press from 24 Jan 2021 to 23 Jan 2022 (Year 2) and compares with the previously published uses from 24 Jan 2020 to 23 Jan 2021 (Year 1). Of these 152 reports, 80 were new unique instances documented in 25 countries, bringing the total to 420 instances in 52 countries since 2020. The instances did not add new work domains or use cases, though they changed the relative ranking of three use cases. The most notable trend in Year was the shift from a) government or institutional use of robots to protect healthcare workers and the Public to b) personal and business use to enable the continuity of work and education. In Year 1, Public Safety, Clinical Care, and Continuity of Work and Education were the three highest work domains but in Year 2, Continuity of Work and Education had the highest number of instances. © 2022 IEEE.

COVID-19 Invades Several Important Organs other than the Lungs: Organs Crosstalk

In December 2019, a new severe acute respiratory coronavirus (SARS-COV-2) had caused outbreaks of pneumonia in Wuhan city, China. It was known as coronavirus infected dis-ease-2019 (COVID-19). COVID-19 patients typically have a fever and respiratory syndrome, where the lung is the main target organ affected by this virus. The objective of this review is to monitor and evaluate injuries caused by the SARS-COV-2 virus on multiple organs other than the lung as the gastrointestinal tract, liver, kidney, heart, ovary, ocular, olfactory, gonad, skin, central nervous system, and sense organs. As SARS-COV-2 virus enters host cells via cell receptor an-giotensin circulating enzyme-2 (ACE2), so it is important to identify the main target cells attacked by SARS-COV-2 virus by comparing the ACE2 expression and viral upload in different organs. In conclusion, the definite role of body organs is explored in the manifestation of COVID-19 infection and crosstalk between other organs are useful tools to find any correlation between disease severity and organs dysfunction, exact prognosis, disease prevention measures, clinical care, and treatment strategies.Copyright © 2021 Bentham Science Publishers.

Exploring staff perspectives on caring for isolated hospitalised patients during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Strict isolation of COVID-19 patients to prevent cross infection may inadvertently cause serious adverse outcomes including psychological harm, limitations to care, increased incidence of delirium, deconditioning and reduced quality of life. Previous research exploring the staff perspective of the effect of isolation on patients is limited. The aim of this study is to understand staff perceptions and interpretations of their experiences of the care and treatment of isolated patients and the impact of isolation on patients, families, and staff. METHOD: This qualitative, exploratory study is set in a major metropolitan, quaternary hospital in Melbourne, Australia. Data was collected in focus groups with clinical and non-clinical staff and analysed using content analysis. The hospital ethics committee granted approval. Each participant gave informed verbal consent. RESULTS: Participants included 58 nursing, medical, allied health, and non-clinical staff. Six main themes were identified: 1) Communication challenges during COVID-19; 2) Impact of isolation on family; 3) Challenges to patients' health and safety; 4) Impact on staff; 5) Challenging standards of care; 6) Contextual influences: policy, decision-makers and the environment. CONCLUSION: Isolating patients and restricting visitors resulted in good pandemic management, but staff perceived it came at considerable cost to staff and consumers. Innovative communication technology may facilitate improved connection between all parties. Mental health support is needed for patients, families, and staff. Further research using a co-design model with input from patients, families and staff is recommended to determine appropriate interventions to improve care. Preventing the spread of infection is essential for good pandemic management, but the cost to consumers and staff must be mitigated. Preparation for future pandemics must consider workforce preparedness, adapted models of care and workflow.

A scoping review to assess the effects of virtual reality in medical education and clinical care.

Due to the challenges and restrictions posed by COVID-19 pandemic, technology and digital solutions played an important role in the rendering of necessary healthcare services, notably in medical education and clinical care. The aim of this scoping review was to analyze and sum up the most recent developments in Virtual Reality (VR) use for therapeutic care and medical education, with a focus on training medical students and patients. We identified 3743 studies, of which 28 were ultimately selected for the review. The search strategy followed the most recent Preferred Reporting Items for Systematic Reviews and Meta-Analysis for scoping review (PRISMA-ScR) guidelines. 11 studies (39.3%) in the field of medical education assessed different domains, such as knowledge, skills, attitudes, confidence, self-efficacy, and empathy. 17 studies (60.7%) focused on clinical care, particularly in the areas of mental health, and rehabilitation. Among these, 13 studies also investigated user experiences and feasibility in addition to clinical outcomes. Overall, the findings of our review reported considerable improvements in terms of medical education and clinical care. VR systems were also found to be safe, engaging, and beneficial by the studies' participants. There were huge variations in studies with respect to the study designs, VR contents, devices, evaluation methods, and treatment periods. In the future, studies may focus on creating definitive guidelines that can help in improving patient care further. Hence, there is an urgent need for researchers to collaborate with the VR industry and healthcare professionals to foster a better understanding of contents and simulation development.

Early Career Occupational Therapists' Experiences during the COVID-19 Pandemic.

Occupational therapists entering the clinical workforce during the COVID-19 pandemic experienced levels of uncertainty and stress. This study's aim was to explore the clinical experiences and concerns of early-career occupational therapists entering the workforce during the COVID-19 pandemic (n = 27). We administered an open-ended online survey and analyzed the data using inductive thematic analysis. Resulting themes included: safety, exposure, and transmission; implementation and enforcement of safety protocols; quality of care; and impact of the pandemic on overall health highlighting the issues that need to be addressed to be more prepared for future practice in an evolving environment.

Ethical Challenges Experienced by Clinical Ethicists during COVID-19.

BACKGROUND: The COVID-19 pandemic continues to disrupt every society as SARs-CoV-2 variants surge among the populations. Health care providers are exhausted, becoming ill themselves, and in some instances have died. Indeed, hospitals are struggling to find staff to care for critically ill patients most in need. Previous work has reported on the unending work-related conditions that hospital staff are laboring under and their subsequent mental and physical health strains. Health care providers need support, but it is not clear where that support is to come from. While much research has reported on the COVID-19-related fears of nurses and physicians, fewer studies have focused on supportive features of the hospital work environment and how it may provide relief to front-line health care providers. PURPOSE: This purpose of this study was to explore an often-overlooked resource within hospital systems across the United States-clinical ethicists-and examine their many roles during COVID-19 and the types of ethical issues they addressed with nurses, physicians, administrators, and others. METHODS: This was a primary analysis of semi-structured, qualitative interviews with 23 clinical ethicists across the United States. The interviews were conducted from November 2020-April 2021 and were audiotaped, transcribed verbatim, and de-identified; both inductive and deductive analyses were used to identify qualitative themes. RESULTS: Five major themes were identified: ethical issues that were increasingly more complex, moral distress that was "endemic," shifting ethical paradigms from the focus on the individual to the population, fostering a supportive environment, and organizational ethics: variation in the value, roles, and policy input of clinical ethicists. CONCLUSIONS: Our findings report on the integral and expanded role of clinical ethicists at an unprecedented time in our nation, and how they stepped forward to support front-line clinicians in hospitals across the country.

The primary care COVID-19 integrated pathway: a rapid response to health and social impacts of COVID-19.

BACKGROUND: The first wave of COVID-19 in Calgary, Alberta accelerated the integration of primary care with the province's centrally managed health system. This integration aimed to deliver wraparound in-community patient care through two interventions that combined to create the COVID-19 Integrated Pathway (CIP). The CIP's interventions were: 1) a data sharing platform that ensured COVID-19 test results were directly available to family physicians (FPs), and 2) a clinical algorithm that supported FPs in delivering in-community follow up to improve patient outcomes. We describe the CIP function and its capacity to facilitate FP follow-up with COVID-19 patients and evaluate its impact on Emergency Department (ED) visits and hospitalization. METHOD: We generated descriptive statistics by analyzing data from a Calgary Zone hub clinic called the Calgary COVID-19 Care Clinic (C4), provincially maintained records of hospitalization, ED visits, and physician claims. RESULTS: Between Apr. 16 and Sep. 27, 2020, 7289 patients were referred by the Calgary Public Health team to the C4 clinic. Of those, 48.6% were female, the median age was 37.4 y. 97% of patients had at least one visit with a healthcare professional, where follow-up was conducted using the CIP's algorithm. 5.1% of patients visited an ED and 1.9% were hospitalized within 30 days of diagnosis. 75% of patients had a median of 4 visits with their FP. DISCUSSION: Our data suggest that information exchange between Primary Care (PC) and central systems facilitates primary care-based management of patients with COVID-19 in the community and has potential to reduce acute care visits.

mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App.

BACKGROUND: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. OBJECTIVE: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. METHODS: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. RESULTS: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients' vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed-days saved. CONCLUSIONS: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges.

Measurement of Blood Oxygen based on Remote-Photoplethysmography

SpO2, also known as blood oxygen saturation, is a vital physiological indicator in clinical care. Since the outbreak of COVID-19, silent hypoxia has been one of the most serious symptoms. This symptom makes the patient's SpO2 drop to an extremely low level without discomfort and causes medical care delay for many patients. Therefore, regularly checking our SpO2 has become a very important matter. Recent work has been looking for convenient and contact-free ways to measure SpO2 with cameras. However, most previous studies were not robust enough and didn't evaluate their algorithms on the data with a wide SpO2 range. In this paper, we proposed a novel non-contact method to measure SpO2 by using the weighted K-nearest neighbors (KNN) algorithm. Five features extracted from the RGB traces, POS, and CHROM signals were used in the KNN model. Two datasets using different ways to lower the SpO2 were constructed for evaluating the performance. The first one was collected through the breath-holding experiment, which induces more motion noise and confuses the actual blood oxygen features. The second dataset was collected at Song Syue Lodge, which locates at an elevation of 3150 meters and has lower oxygen concentration in the atmosphere making the SpO2 drop between the range of 80% to 90% without the need of holding breath. The proposed method outperforms the benchmark algorithms on the leave-one-subject-out and cross-dataset validation. © 2022 IEEE.

Influence of the COVID-19 Pandemic on Clinical Oncology Nursing Care.

Exactly where are we in the practice of clinical oncology nursing, now indelibly altered by the COVID-19 pandemic? Depending on the day or hour, experts in clinical oncology care claim that clinical oncology practice has stab.

Audit of Clinical Care Received by COVID-19 Patients Treated at a Tertiary Care Hospital of Nepal in 2021.

Like the world over, Nepal was also hard hit by the second wave of COVID-19. We audited the clinical care provided to COVID-19 patients admitted from April to June 2021 in a tertiary care hospital of Nepal. This was a cohort study using routinely collected hospital data. There were 620 patients, and most (458, 74%) had severe illness. The majority (600, 97%) of the patients were eligible for admission as per national guidelines. Laboratory tests helping to predict the outcome of COVID-19, such as D-dimer and C-reactive protein, were missing in about 25% of patients. Nearly all (>95%) patients with severe disease received corticosteroids, anticoagulants and oxygen. The use of remdesivir was low (22%). About 70% of the patients received antibiotics. Hospital exit outcomes of most (>95%) patients with mild and moderate illness were favorable (alive and discharged). Among patients with severe illness, about 25% died and 4% were critically ill, needing further referral. This is the first study from Nepal to audit and document COVID-19 clinical care provision in a tertiary care hospital, thus filling the evidence gap in this area from resource-limited settings. Adherence to admission guidelines was excellent. Laboratory testing, access to essential drugs and data management needs to be improved.

The design and evaluation of a wearable-based system for targeted tremor assessment in Parkinson's disease

Wearable sensors are worn by subjects to allow for continuous physiological monitoring. The use of wearable sensors for the quantification of movement within research communities has increased in recent years, with the purpose of objectively assessing and diagnosing the progression of Parkinson's Disease (PD). Most studies taking this approach for PD have stated that there is a need for a long-term solution, due to individuals having varying symptoms at different stages of the disease. Furthermore, a preference for home-based care has increased in recent times due to COVID-19, with clinical care being highly effected due to cancellations, delayed appointments, or a reduction of time spent with patients. The necessity for a system for patients with Parkinson's is extremely significant. There is no clinically available long-term assessment for tremors, and how these systems can be used to assess and aid in a clinical environment is still underdeveloped. The proposed system which includes wireless sensors, and results based off the clinical scale used currently for tremor assessment, may allow for constant, real-time, and accurate monitoring of a subject with tremors. This will provide more detailed medical data to enable long-term assessment, diagnosis, as well as person-centered physical therapy. © 2022 ACM.

The Association of Medical Preoperative Evaluation Using Clinical Video Telehealth With Hospital Length of Stay: Descriptive Analysis.

BACKGROUND: Preoperative medical evaluation serves to identify risk factors and optimize patients before surgery. Providing a telehealth option in the perioperative setting has played a significant role in reducing barriers to quality perioperative health care. OBJECTIVE: We aimed to evaluate how telemedicine preoperative evaluations using Clinical Video Telehealth (CVT) impact hospital length of stay. METHODS: We performed a retrospective chart review between 2016 and 2017 of adult patients who underwent evaluations in our hospitalist-run preoperative medicine clinic. Patients seen in our preoperative CVT program were compared to patients seen in person to evaluate the association of visit type (preoperative CVT versus in-person evaluation) with hospital length of stay, defined as hospital stay from postoperative day 0 to discharge. There were 62 patients included in this retrospective study. RESULTS: The adjusted incidence rate ratio (IRR) for hospital length of stay was significantly shorter in patients who underwent preoperative CVT compared to an in-person visit (IRR 0.52, 95% CI 0.29-0.92, P=.02). CONCLUSIONS: After adjusting for age and comorbidities, we show that preoperative telemedicine in the perioperative setting is associated with a shorter hospital length of stay compared to in-person visits. This suggests that telemedicine can play a viable role in this clinical setting.

Health-Related Quality of Life Among Members Using an On Demand Behavioral Health Platform: Pilot Observational Study.

BACKGROUND: Despite the well-known adverse health conditions and negative economic outcomes associated with mental health problems, accessing treatment is difficult due to reasons such as availability and cost. As a solution, digital mental health services have flooded the industry, and new studies are quickly emerging that support their potential as an accessible and cost-effective way to improve mental health outcomes. However, many mental health platforms typically use clinical tools such as the Patient Health Questionnaire-9 (PHQ-9) or General Anxiety Disorder-7 (GAD-7). Yet, many individuals that seek out care do not have clinical symptomatology and thus, traditional clinical measures may not adequately capture symptom improvement in general well-being. As an alternative, this study used the health-related quality of life (HRQoL) tool from the Centers for Disease Control and Prevention "Healthy Days" measure. This subjective measure of well-being is an effective way to capture HRQoL and might be better suited as an outcome measure for treatments that include both clinical and subclinical individuals. OBJECTIVE: The purpose of this study was to describe changes in HRQoL in clinical and subclinical members assessing virtual care and to examine the association between text-based behavioral coaching and virtual clinical sessions with changes in HRQoL. METHODS: A total of 288 members completed the 4-item HRQoL measure at baseline and at 1 month following use of the Ginger on demand behavioral health platform. Baseline anxiety and depression levels were collected using the GAD-7 and PHQ-9, respectively. RESULTS: Members completed on average 1.92 (SD 2.16) coaching sessions and 0.91 (SD 1.37) clinical sessions during the assessment month. Paired samples t tests revealed significant reductions in the average number of unhealthy mental health days between baseline (mean 16, SD 8.77 days) and follow-up (mean 13.2, SD 9.02 days; t287=5.73; P<.001), and in the average number of days adversely impacted (meanbaseline 10.9, meanfollow-up 8.19; t287=6.26; P<.001). Both subclinical members (t103=3.04; P=.003) and clinical members (t183=5.5; P<.001) demonstrated significant improvements through reductions in adversely impacted days over a month. Clinical members also demonstrated significant improvements through reductions in unhealthy mental health days (t183=5.82; P<.001). Finally, member engagement with virtual clinical sessions significantly predicted changes in unhealthy mental health days (B=-0.96; P=.04). CONCLUSIONS: To our knowledge, this study is one of the first to use the HRQoL measure as an outcome in an evaluation of a digital behavioral health platform. Using real-world longitudinal data, our preliminary yet promising results show that short-term engagement with virtual care can be an effective means to improve HRQoL for members with subclinical and clinical symptoms. Further follow-up of reported HRQoL over several months is needed.