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This research aims to grasp the evolution of consumer demand and improve the resilience of the hotel industry under the public health crisis (COVID-19). Online reviews of 7,679 hotels in 10 cities were collected from Ctrip, China's major online hotel platform. Then, we applied opinion mining and time evolution to mine the change in consumer demand before, during, and after the COVID-19 pandemic. Findings show that some consumer demands (e.g. epidemic safety) will change during the outbreak period. However, during the nonoutbreak period, users were more concerned about their own check-in experience (e.g. hotel facilities, front desk services). This article provides new ideas for identifying the dynamic value of online reviews. We suggest that businesses focus on ensuring hotel safety during the crisis period. The results contribute essential theoretical and practical significance to the hotel industry's crisis management during public health crises.
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Broiler chicken eggs are one of the main and strategic foods for the people of Indonesia and contribute to regional and national inflation. Broiler egg production in Indonesia differs between regions. Areas with a surplus of eggs tend to have lower prices than areas with a deficit. This research is to measure the transmission of broiler egg prices between markets in surplus and deficit areas, using weekly price time series data for the period January 2018-December 2021. Areas of surplus broiler eggs, East Java Province (the highest broiler egg production in Indonesia) which become one of the main suppliers to the Province of East Nusa Tenggara as a deficit area. Using the Johannsen cointegration test it is found that there is no cointegration or there is no relationship between the surplus and deficit regions in the long term but not in the short term. Factors of marketing infrastructure, market information systems, and geographical conditions can be obstacles to the absence of cointegration. The VAR (Vector Auto-Regressive) Vector Error Correction model (VECM) test, found that price transmission occurred between surplus and deficit areas, meaning that between the two regions, there was market integration prior to Covid. The transmission has weakened, and due to the Covid situation, there have been restrictions on the movement of people and goods. The government and other market players need to study the response of the broiler egg market, in the short and long term so that market players can make the right policies.
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Documentation can support design work and create opportunities for learning and reflection. We explore how a novel documentation tool for a remote interaction design course provides insight into design process and integrates strategies from expert practice to support studio-style collaboration and reflection. Using Research through Design, we develop and deploy Kaleidoscope, an online tool for documenting design process, in an upper-level HCI class during the COVID-19 pandemic, iteratively developing it in response to student feedback and needs. We discuss key themes from the real-world deployment of Kaleidoscope, including: tensions between documentation and creation;effects of centralizing discussion;privacy and visibility in shared spaces;balancing evidence of achievement with feelings of overwhelm;and the effects of initial perceptions and incentives on tool usage. These successes and challenges provide insights to guide future tools for design documentation and HCI education that scaffold learning process as an equal partner to execution. © 2023 Owner/Author.
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Digital nomads live a new way of life that creates an ideal balance of work and leisure. Research on the phenomenon of digital nomads is still in its early stages and is not fully framed as a proper research category. Therefore, the present research aims to explore research on digital nomadism by study leading countries, authors and themes that can become a foundation for future research. This study is exploratory and interpretive - using bibliometrics, we systematically searched all articles indexed in the Web of Science database. The study presents the evolution of scholarly production, and identifies key authors and countries that have the potential to become pioneers in digital nomad research. We identified 17 core concepts of digital nomad research as well as concepts that have not yet received much attention from scientists. Additionally, our study provides a framework for research on digital nomadism and presents topics for future research: we determine how the 17 core concepts identified in this study affect the lives of digital nomads, research into legislation that directly affects digital nomads, study how COVID-19 has changed working styles, and offer a bibliometric analysis of data on digital nomads from other databases.
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The popularity of Petra, Jordan, as a tourist destination has surged among international visitors since the 1980s. This has led to the tourism sector's emergence as a major source of income for indigenous communities living adjacent to the ancient city's ruins. Rapidly expanding visitor numbers and business activity-both licensed and unlicensed-exposed the need for government to play an active role in organizing Petra's tourism industry. Drawing upon a thematic analysis of interviews I conducted in three tourism-reliant, tribal communities in Petra's vicinity in 2022, this case study examines relations between the Petra Development and Tourism Region Authority (PDTRA) and indigenous stakeholders in the local economy. Focusing on the period extending from 2019-just before the COVID-19 pandemic's onset-to 2022, I explore local perspectives towards PDTRA policies impacting indigenous work in the tourism sector. I find that legality, size, and internal organization of stakeholder groups affect their capacity to influence political decisions that impact their lives and livelihoods.
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There is evidence that sacred places across the world are launching augmented reality (AR) applications. This application of AR is somehow prompted by the most recent Covid-19 pandemic where in-person experiences are altered by the virtual. AR, as an innovative technology, augments the physical environment with digitally generated imagery that can generate privileges for tourists in sacred places and become the reason to trigger cultural conflicts and religious controversy. This in-depth interview-based research aims to explore the tourists' views and ideas of applying AR in the Mosque City of Bagerhat of Bangladesh, a UNESCO World Heritage Site in terms of possibilities, cultural conflicts, and religious controversy. Findings show that the application of AR in a sacred place can support tourists in many useful ways, can offer them positive experiences, and help in sustainability concerns of the site. However, the application of AR in a sacred place can be an element of conflicting interests between the religious and general tourists. Adequate attention is thus required from the parties involved in terms of applying AR in the Mosque City of Bagerhat of Bangladesh, a sacred religious site.
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The key challenges that are commonly faced by companies undertaking a tech transfer include: * Client expectations and initial project scope definition: the initial assumptions of the drug developer or marketing authorization holder (MHA) based on their initial information relating to the product can be a significant challenge. Typical examples include product stability issues (typically on legacy products) being evidenced due to a change to more compliant analytical methods;change to product brought about by compliance-related requirements on legacy products, such as nitrosamines, and elemental impurities guidelines, etc.;and regulatory requirements being misjudged at the onset of the project, among other factors. * Product knowledge management: particularly when undertaking tech transfers of legacy products or products in the initial discovery phase, there may be a lack of technical knowledge on the product itself to make a comprehensive and robust tech transfer process. All this may contribute to slowing down the transfer of knowledge, with implications for tech transfer timelines. * Standardization at receiving site: another challenge typically faced by receiving sites of CDMOs is a lack of standardization of their internal processes and or documentation brought about by multiple tech transfers with varying types of clients with multiple requirements. The originating site-particularly if it belongs to a small start-up-may not have team members with specialist experience in handling a transfer, so may need additional support in collating the required information to hand over to the receiving site.
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With the changes in consumer profile, especially in tourism activity, facing the issues brought by globalization, greater access to and use of Technologies, and more recently, the restrictions imposed by the protocols to prevent contamination by the Covid-19 virus and its consequences, it has been necessary to change the way of experiencing tourism, leading the market to adapt to the new reality. Thus, the incentive to implement so-called Proximity Tourism has gathered strength, prompting the following research question: how has this type of tourism been addressed and how have the cities of the Brazilian Northeast have been working with this theme to promote their potential on the social network platform Instagram? The main objective of this study was to perform an observational analysis of what is being posted on this social network concerning proximity tourism, by investigating the use of the hashtag #turismodeproximity, and whether the cities of the Northeast of Brazil are using this Instagram tool. As the result of this research, it was found that of the total posts indexed with this hashtag, only a small number are directly related to this region, indicating a lack of dissemination, and consequently, failure to generate greater visibility for this tourism modality.
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Introduction: Inter-facility critical care transfers are a high-risk activity, with a significant reported critical incident rate.1 The 2019 ICS Transfer of the Critically Ill Adult Patient guideline2 recommends a consultant-led risk assessment is performed in order to provide a rationale for the make-up of the transfer team. Prior to our project, there was no formalised risk assessment process at our unit. Objective(s): We wished to assess whether any 'informal' risk assessment process was already being performed prior to transfers. We then aimed to implement a clear assessment process, initially for our unit but ultimately for our critical care network. Method(s): We performed a baseline audit of adult inter-facility critical care transfers undertaken by a team from our unit between 1st December 2019 and 28th February 2020. Notes were analysed for evidence of any risk assessment performed in discussion with the responsible consultant We then locally piloted a new risk assessment tool for our Critical Care Network's transfer documentation. It included the required elements from ICS guidance, and followed a systems-based approach to facilitate completion in time-critical situations. Colour coding enabled easy identification of potential high-risk transfers and guided team formation. Initial re-audit of the new tool was performed between 16th September and 16th October 2020, after which it was implemented across the network. A further re-audit was performed between 1st October and 31st December 2021. Result(s): Fifteen transfers occurred during the initial audit period. All were clinical. No risk assessments were documented (0% compliance), although all were accompanied by a transfer-trained, airway competent doctor and all but one by an ODP. Our second audit cycle identified 10 transfers, of which 4 had risk assessments completed (40% compliance). All transfers had been undertaken with a dual doctor/ODP team. We identified that there was limited knowledge of the risk assessment process among clinicians, so introduced the topic into our unit's transfer training programme. Assessment completion was made a key performance indicator, fed back to team members following each transfer. Our final cycle covered 14 clinical transfers. Eight had a fully completed risk assessment (57% compliance), 2 had partially completed risk assessments (14% partial compliance), 4 had no risk assessment and 2 cases were excluded due to incomplete data. Conclusion(s): Our tool is now used for all inter-hospital transfers across the Midlands Critical Care Network. It enabled risk assessments to be performed appropriately for transfers originating from our unit. Introduction was initially hampered by limited training for clinicians during the first wave of the Covid pandemic, and compliance improved once this was implemented. The recent introduction of a regional critical care transfer service means that the majority of transfers undertaken by our unit's staff are now time-critical clinical transfers. This may contribute to the failure to complete risk assessments in some cases, however these assessments are likely to be of higher importance since such transfers may be higher risk. We now aim to collect feedback from transferring staff to identify any barriers to correct completion.
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BackgroundBefore the COVID-19 pandemic it was estimated that nearly 70% of the population is deficient in vitamin D - 25(OH)D <20ng/ml in Poland [1]. The percentage was expected to increase due to indoor isolation during the COVID-19 pandemic. Vitamin D has a positive effect on the condition of the bones, affects the course of autoimmune diseases, the course of neurological diseases, in type 2 diabetes, vitamin D supplementation improves glucose tolerance and reduces insulin resistance [2,3,4].ObjectivesThe aim of the retrospective study was to determine what percentage of rheumatology clinic patients suffer from vitamin D deficiency and whether this condition is effectively treated.MethodsIn January 2023, a retrospective analysis of the documentation of 172 patients treated at the Rheumatology Outpatient Clinic in Bełżyce (Poland) in 2022 was conducted.ResultsResults: The mean age of the 172 patients whose documentation was analyzed was 60.43 years (min 19, max 88). There were 132 women (76.8%) and 40 men (23.2%) in this group. The mean concentration of vitamin D was 25.57ng/ml±SD11.9 (min 5.7, max 75, Me 22.8). Vitamin D deficiency was found in 44% (serum concentration <20mg/ml), suboptimal concentration (20-30ng/ml) in 31%, optimal concentration (30-50ng/ml) in 21%, and high concentration (>50ng/ml) ml) in 4%. All those with a deficit or deficiency (75 people) were prescribed cholecalciferol in a dose of 20,000 units orally, 1 capsule twice a week after breakfast for 2 months [5]. Patients with optimal vitamin D levels were advised to take a dose of 2,000 units per day. Among the patients with deficit or deficiency, 48 people came for a follow-up visit to check the level of vitamin D (64% of the group with too low vitamin D concentration;28% of the entire group whose documentation was analyzed). In the follow-up examination, the mean concentration of vitamin D was 37.14±9.8ng/ml (min 28, max 84, Me 35.3). Therefore, a statistically significant increase in the concentration of vitamin D in the blood was noted (p<0.05). In the group of people who came for the follow-up examination, there were 35 women, whose mean age was 60.7 years and 13 men (mean age 68.2 years).Conclusion:1. During the COVID-19 pandemic in the group of outpatient rheumatology patients, 75% had a deficiency or suboptimal level of vitamin D.2. Treatment with cholecalciferol in a dose of 20,000 IU twice a week orally for 2 months is effective treatment of vitamin D deficiency.3. Too low percentage of patients diagnosed with vitamin D deficiency come for visits and check-ups.References[1]Hilger J., Friedel A., Herr R.. A systematic review of vitamin D status in populations worldwide. Br J Nutr. 2013;9: 1023.[2]Karczmarewicz E., Czekuć-Kryskiewicz E., Płudowski P. Effect of vitamin D status on pharmacological treatment efficiency-impact on cost- effective management in medicine. Dermatoendocrinology, 2013;5: 299-304.[3]Zhu J., Bing C., Wilding J.P.H. Vitamin d receptor ligands attenuate the inflammatory profile of IL-1β-stimulated human white preadipocytes via modulating the NF-κB and unfolded protein response pathways Biochemical and Biophysical Research Communications 2-18, 503: 1049-1056.[4]Luan W., Hammond L.A. Vuillermot S. Maternal vitamin d prevents abnormal dopaminergic development and function in a mouse model of prenatal immune activation. Scientific Reports 2018;8 (1) article numer 9741.[5]Płudowski P., Karczmarewicz E. i wsp. Witamina D: Rekomendacje dawkowania w populacji osób zdrowych oraz w grupach ryzyka deficytów.Wytyczne dla Europy Środkowej 2013 r. Standardy Medyczne/Pediatria 2013, 10, 573-578 (in Polish).Acknowledgements:NIL.Disclosure of InterestsNone Declared.
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In Japan, workcations have gained attention as a way to offset the economic damage caused to inbound tourism by the COVID-19 pandemic. Considering its aims to contribute to the local community and increase interactions with local residents, the Japanese-style workcation can be positioned as a form of digital nomadism that seeks alternatives to existing work styles. This study is based on fieldwork in Tottori Prefecture in Japan and includes interviews and participant observation. It aims to examine (1) national and local government workcation policies, (2) the development of new services and businesses that facilitate workcation, and (3) the process of introducing hybrid work in companies. Japanese-style workcation as a social design can offer solutions to problems such as the concentration of population in cities, ageing population, and declining tourism industry. The work styles and lifestyles suggested by the Japanese-style workcation should continue to be explored as an area where new tourism, social design, and community design overlap. At the same time, incorporating digital nomadism as individualism into the workcation remains a future issue.
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Objectives: To investigate why a tertiary hospital has a high number of patients with type 2 diabetes presenting with diabetic ketoacidosis. Method(s): An audit was carried out looking at all of the inpatient admissions for diabetic ketoacidosis in patients with type 2 diabetes between 2021 and 2022. Any patient with a coding of diabetic ketoacidosis and type 2 diabetes had their inpatient clinical notes evaluated using the following criteria: 1) Were the criteria for diabetes ketoacidosis met? 2) Patient age. 3) Patient anti-diabetic medications. 4) If relevant, who prescribed a sodium-glucose cotransporter- 2 inhibitor and was sick day rule advice given? 5) Did the patient have a concurrent Covid-19 infection? Results: Almost a quarter of patients (24%) included in this audit did not fulfil the diagnostic criteria for diabetic ketoacidosis. For those that did: -Over a quarter of patients (26%) were on sodium-glucose cotransporter-2 inhibitors with the majority being commenced by GPs (81%). There was no documentation as to whether sick day rule advice had been given. -Only 7% of patients had a concurrent Covid-19 infection. -The majority of patients (68%) were aged less than 75 years. Conclusion(s): Coding on discharge summaries is important and junior doctors may need further guidance with regards to the diagnostic criteria for diabetic ketoacidosis. Sodium-glucose cotransporter-2 inhibitors inhibitors are a significant cause of diabetic ketoacidosis in patients with type 2 diabetes and patient sick day rule advice is needed prior to initiation. Covid-19 infection wasn't found to be a significant causative factor.
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Following the rapid scientific and technological development in this new era of global industrial transformation, the tourism industry has overcome the severe challenges of the COVID-19 pandemic by taking advantage of new development opportunities. Digital technologies, such as big data, cloud computing, artificial intelligence, and fifth-generation mobile communications have released the huge potential for promoting the development of the high-quality cultural tourism integration. Scholars have explored the benefits of developing and improving the quality of cultural tourism integration in addition to how the digital economy can promote the development of cultural tourism integration. Most existing research has regarded the digital economy as a means to promote the development of cultural tourism integration;however, there is relatively little systematic research on the logical mechanism, transmission channels, and practical paths that enable the high-quality development of cultural tourism integration. Therefore, this paper systematically explores the logical mechanism, direct effects, and transmission mechanisms in the digital economy that promote the development of high-quality cultural tourism integration. The study findings open up the "black box"of developing high-quality cultural tourism integration and help to establish its scientific basis in the digital economy. Based on a systematic explanation of how the digital economy enables the high-quality development and transmission of cultural tourism integration through organizational, technological, and product innovation channels, this paper conducts empirical testing using 2011-2020 panel data from 30 Chinese provinces (excluding Tibet, Hong Kong, Macao, and Taiwan of Chian) and obtains three main findings. First, the digital economy has a positive enabling effect on the development of high-quality cultural tourism integration, which has been verified in benchmark regression, instrumental variable regression, and robustness testing. Second, this enabling effect shows regional differences. For example, East China benefits from its relatively well-developed digital economy and can enjoy the dividends from its high-quality cultural tourism destinations. However, although West China has seen rapid growth in its digital economy, the region also shows a trend of increasing marginal effects from its enabling effect, while the digital economy's enabling trend in Central China still needs to be strengthened. Third, by constructing a transmission channel, that is, "digital economy-organization-technology-product innovation-developmental quality of cultural tourism integration", we find that the digital economy can positively promote the development of high-quality cultural tourism integration by regulating transmission channels for innovation, such as organizational, technological, and product innovation. According to the research conclusions, measures to promote the development of high-quality cultural tourism integration in the digital economy should be taken in the following four areas. First, local governments and cultural tourism departments should deepen their development strategies to integrate the digital economy with the real economy and systematically cultivate new drivers for the development of high-quality cultural tourism integration. Second, a digital cultural tourism platform should be built to optimize the value creation mechanism for the development of high-quality cultural tourism integration. Third, regional heterogeneity characteristics should be combined with the digital economy's enabling effect to implement a differentiated digital cultural tourism development strategy. Fourth, organizational, technological, and product innovation advantages should be cultivated to expand the transmission channels for the development of high-quality cultural tourism integration within the digital economy.
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Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic. Countries introduced public health measures to contain and reduce its spread. The effect of mandated societal lockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is not known. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai. As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge to manage these mass casualty patients who require intensive care as well as Medicolegal documentation, record keeping, Consent for life saving procedures in absence of Relatives. Material(s) and Method(s): We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai from January 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock down and 1st July as the first day of re-opening. Result(s): We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries during lockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medical resources, manpower as most of manpower and resources were being utilized for covid patients. Conclusion(s): Road traffic accidents are a prominent contributor to hospitalization and may negatively impact the existing hospital resources directed towards COVID-19.Copyright © 2023, World Informations Syndicate. All rights reserved.
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The immunity (or vaccine) passport of the coronavirus pandemic, as a concept and object, is not unprecedented. This health and identity document features a history spanning over half-a-millennium and appearing across diverse geopolitical and sociocultural contexts. This article presents a documentary history of the immunity passport and its heterogeneous material instantiations, uses and effects across divergent historical settings. It illuminates how the immunity passport has helped shaped identities and public health, as well as impacted individual and institutional agency, during health crises. Four historical cases are explored, including the plagues ravaging the Renaissance Mediterranean region, the 1665 Great Plague of London, the yellow fever outbreaks in the antebellum slave-era southern USA and the chronic cholera conditions confronting colonial-era British India. Although disparate, these historical cases share the immunity passport as a non-pharmaceutical intervention into their respective health crises that played important roles in people's lives during these troubled times.
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The COVID-19 pandemic has influenced various aspects of people's lives;for instance, restrictions during the pandemic have forced people to think about sports participation and physical activity in new ways. There has been growing interest in technological interventions to support exercise-related behavioural changes in daily life;in particular, exergames designed to induce full-body movement offer alternatives to physical activity. Since Taiwan has a high rate of ownership of exergame-related equipment, it is worth examining players' perceptions of using exergames for exercise. This study utilised a Means-End Chain analysis with in-depth laddering interviews to investigate Taiwanese perceptions of certain attributes of exergames as most likely to produce desired consequences in accordance with their values. The findings provide researchers and practitioners interested in the use of technology for exercise with valuable implications of Means-End Chain theory and structuration theory and suggestions for exergame design and promotion.
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Opportunities to participate in physical activities (PA) and fitness exercises in public and private facilities have been reduced or banned due to social distancing regulations during the height of the global pandemic. Though Korea has not experienced lockdown, several venues have been restricted to prevent the spread of Covid-19. Despite the limitations of PA engagement, people have found alternative activities by using online platforms to keep active and fit. Thus, this study focuses on analyzing fitness-related video titles from YouTube. By collecting data through text mining and conducting network analysis, it provides basic knowledge of the fitness trends from pre- and post-Covid-19. As a result, 'exercise' was found to have the highest tendency and had strong connections to keywords that indicated specific methods of working out to become fit, but it also had connections to trendy keywords such as 'hip-up' and 'body-profile' which reflect the fitness culture in Korea.
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Background: The recent pandemic prompted a number of clinical trials to assess the efficacy and safety of medication use for the treatment for COVID-19. As pregnant women are excluded or vastly underrepresented in clinical research, there is a paucity of data on how pregnancy and perinatal outcomes are impacted by such medications. Considering that pregnant women are at increased risk for COVID-19 infection and that pregnancy is also associated with an increased risk of developing severe COVID-19, it is of utmost importance to assess the effect of gestational medications use for COVID-19 on pregnancy outcomes. Objective(s): The aims of this systematic review were to (1) determine and quantify COVID-19-specific and repurposed medication use during pregnancy, and (2) provide an overview of the pregnancy and neonatal outcomes that have occurred in COVID-19-positive pregnant women exposed to COVID-19-specific or repurposed medications compared to use in pregnant women without COVID-19;neonatal outcomes compared between COVID-19 positive pregnant women treated and untreated with these medications. Method(s): A systematic literature search was conducted in Ovid and executed in the following databases: MEDLINE, Embase, and Global Health. Search strategies applied combined database-specific subject headings and keywords relevant to the topic. Some subject headings used in databases were pregnancy outcome, COVID-19, SARS-CoV-2, pharmaceutical preparations, drugs, and prescription. Some keywords used for the searches were pregnancy outcome, neonatal outcome, coronavirus disease 2019, drug, medication, and treatment. For each database, keywords were searched within the , keyword heading word or heading words, and title fields. Restrictions were applied regarding the date of publication and searches were limited to English publications. Study selection was accomplished by two independent investigators (NSK, NAB). Only original research articles were considered for inclusion. Included studies investigated pregnancy or neonatal outcomes in women with COVID-19 receiving medication to treat COVID-19. A standardized extraction form was used to independently extract relevant information. Result(s): The literature search yielded a total of 344 records. After deduplication, 69 records were removed. The title and of 275 publications were screened.
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Introduction: Families of patients admitted to the Intensive Care Unit (ICU) experience significant emotional distress.1 Visiting restrictions mandated during the COVID-19 pandemic presented new barriers to family communication, including a shift from regular bedside nursing updates and in-person family meetings to scheduled, clinician-led telephone calls and video calls.2 This resulted in loss of non-verbal clues and feedback during family discussions, difficulties establishing rapport with families and risked inconsistent messages and moral injury to staff.3 Objectives: We aimed to design a system where all ICU family discussions were documented in one place in a standardised format, thereby clarifying information given to families to date and helping staff give families a consistent message. In addition, we aimed to provide practical advice for the staff making family update telephone calls and strategies for managing difficult telephone conversations. Method(s): We designed and implemented an ICU family communication booklet: this was colour-coded blue;separate to other ICU documentation within the patient notes;and included communication aids and schematics to help staff optimise and structure a telephone update. Using Quality Improvement methodology, we completed four Plan-Do-Study-Act (PDSA) cycles and gathered qualitative and quantitative feedback: this occurred prior to the project and at one,12,18 and 21 months post introduction. We implemented suggested changes at each stage. We designed staff surveys with questions in a 5-point Likert scale format plus opportunity for free comments. Twenty-one months post implementation, we designed and delivered an MDT awareness campaign using the 'tea-trolley training' method,4 departmental induction sessions for new ICU doctors and nurses and a 'Message of the Week' initiative. An updated version of the booklet was introduced in February 2022 (Figure 1). Result(s): Staff survey results are shown in Table 1. Forty-six staff participated in tea trolley training, feedback form return rate 100%. Following feedback, the family communication booklet was updated to include the following: a prompt to set up a password;a new communication checklist at the front, including documentation of next of kin contact details, a prompt to confirm details for video calls, confirm primary contact and whether the next of kin would like updates during the night;consent (if the patient is awake) for video calls while sedated;information regarding patient property;prompt to give families our designated ICU email address to allow relatives to send in photographs to display next to patients' beds;prompts to encourage MDT documentation and patient diary entry. Conclusion(s): During unprecedented visiting restrictions in the COVID-19 pandemic, we implemented an ICU family communication booklet which has been so successful that we plan to use it indefinitely. We plan to further develop this tool by encouraging MDT involvement, seek further staff feedback in six months' time, incorporate this structure into our electronic patient information system when introduced and collect feedback from patients and their next of kin at our ICU follow up clinic. This communication booklet would potentially be reproducible and transferable to other ICUs and could be used as part of a national ICU family communication initiative.
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Introduction: Critically-ill obstetric patients admitted to general intensive care units (ICU) are a rare and unique population for whom excellent care is essential to prevent devastating physical and psychological morbidity. Admissions are often unanticipated and can present challenges to obstetric and intensive care MDTs. 2018 Enhanced Maternal Care (EMC) Guidelines provide standards for caring for these women, and the 2022 Ockenden review exposed the association of peripartum ICU admission with undertreated psychological trauma and a desire for individualised debriefing [1,2]. We audited the care of obstetric admissions to general ICUs in our quaternary centre. We sought evidence of psychological morbidity to improve follow-up pathways in line with 2022 Ockenden actions. Method(s): Retrospective online case note review of maternity admissions to general ICUs between 1/1/2021-1/1/2022 compared to EMC audit standards. Exclusion criteria: <22/40 gestation, >6/52 postpartum and admissions to our level 2 labour ward high dependency unit. Result(s): 25 patients were admitted to general ICUs over 12 months. Median age was 35-39 years, mean parity was 1. The commonest indication was obstetric haemorrhage (n = 10). 15 of 25 patients required level 3 care, median length of stay was 1.5 days. Documentation of daily obstetric MDT ward round was variable, as was mother-baby contact. 0 of 25 women were seen in obstetric anaesthesia clinic after discharge, only 1 received outpatient ICU follow-up. 50% of postnatal admissions (n = 14) had documentation of significant psychological distress. In response a local checklist was developed with key colleagues to support collaborative working and standardise quality care. It includes automatic referral into obstetric anaesthesia clinic and access to a novel perinatal mental health service. Discussion(s): A peripartum admission to ICU is highly likely to be experienced as traumatic [2]. The incidence of obstetric ICU admissions may increase in the context of greater clinical complexity of the UK pregnant population and COVID-19, whilst the non-anaesthetic ICU workforce may have little obstetric training. Obstetric anaesthetists are therefore uniquely skilled to facilitate quality resuscitation and referral to ICU, but gold-standard holistic care extends beyond admission. We believe regular audit and dedicated local care pathways which incorporate proactive debriefing and psychological health can improve the care of this important group of women.Copyright © 2023 Elsevier Ltd