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Submission content Introduction: Intensive care medicine has become an admired, loved, hated, and definitely more interesting Specialty due to a special situation (COVID-19) that exposed the training process to numerous criticisms, positives, and negatives, and this is how I believe we could improve our beloved world. Proposal: 1. Ideal training program from medical school to Certificate of Completion of Training (CCT): * Medical school: In their last year they should do more than 1 week in the Intensive Care Unit (ICU) * Stage 1: there should be a core surgical training of at least 6 months * Stage 2: there should be a rotation on Psychiatry of at least 4 weeks with on calls in ICU and 2 weeks in Palliative Care * Stage 3: acting as a consultant for the last six months on ST7 with backup from a formal consultant, and * Surgical training should be included in the possible dual or triple CCT 2. How would we be assessed? I agree with the Faculty of Intensive Care Medicine (FICM) staging program assessment, with some modifications: * As ST7 the trainee should act as a consultant with back support at least 50% of the stage and need to be evaluated by a Multi-Source Feedback (MSF). * Clinical Fellows should have a consultant as a Certificate of Eligibility for Specialist Registration (CESR) guide who establishes the equivalent stage of training supporting them and assessing them under the same model. * Changing the way, the General Medical Council (GMC) conducts the CESR application and making it really equivalent to the ICM training with the FFICM curriculum. 3. What do we need to be taught? * Hot topics for ICU (academic), * Overseas talks to share experiences, * Ultrasound (FUSIC), * Wellbeing strategies, * Leadership training * Psychiatric and physiological effects post ICU for patients and staff, * The administrative and political model of the National Health Service (NHS), and * Communication skills to establish excellent relationships with the other specialties. 4. What would our working life look like? * Normal day: 8 am to 3 pm * Midday shift: 1 pm to 8:30 pm * Night shift: 8 pm to 8:30 am * A rolling rota of 12 weeks with 2 weekends during this time 5. How would you produce Intensive Care Medicine (ICM) Consultants of the future who both love their job and their life: * Starting with less intense shifts, * More cordial relationships between the teams, * Supporting ICM trainees and Fellows going through their CESR pathway, * Making the training more attractive to either male-female doctors getting them involved in as many different specialties as ICM can cover, Conclusion(s): Having full-time ICM Consultants should be welcome in all ICUs in the country, which is not at the moment. This will definitely attract a lot of excellent doctors who are 100% focused on ICM.
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Submission content Introduction: At the end of a particularly hectic night shift on the intensive care unit (ICU) I found myself sitting in the relatives' room with the mother and aunt of a young patient, listening to their stories of her hopes and aspirations as she grew up. She had been diagnosed with lymphoma aged 14 and received a bone marrow transplant from her younger sister. Fighting through treatment cycles interposed with school studies, she eventually achieved remission and a portfolio of A-levels. Acceptance into university marked the start of a new era, away from her cancer label, where she studied forensic science and took up netball. Halfway through her first year she relapsed. Main body: When I met this bright, ambitious 20-year-old, none of this history was conveyed. She had been admitted to ICU overnight and rapidly intubated for type-1 respiratory failure. The notes contained a clinical list of her various diagnoses and treatments, with dates but no sense of the context. Rules regarding visitation meant her family were not allowed onto the unit, with next-of-kin updates carried out by designated non-ICU consultants to reduce pressures on ICU staff. No photos or personal items surrounded her bedside, nothing to signify a life outside of hospital. She remained in a medically-induced coma from admission onwards, while various organ systems faltered and failed in turn. Sitting in that relatives' room I had the uncomfortable realisation that I barely saw this girl as a person. Having looked after her for some weeks, I could list the positive microbiology samples and antibiotic choices, the trends in noradrenaline requirements and ventilatory settings. I had recognised the appropriate point in her clinical decline to call the family in before it was too late, without recognising anything about the person they knew and loved. She died hours later, with her mother singing 'Somewhere Over the Rainbow' at her bedside. Poignant as this was, the concept of this patient as more than her unfortunate diagnosis and level of organ failure had not entered my consciousness. Perhaps a coping mechanism, but dehumanisation none-the-less. Conclusion(s): Striking a balance between emotional investment and detachment is of course vital when working in a clinical environment like the ICU, where trauma is commonplace and worst-case-scenarios have a habit of playing out. At the start of my medical career, I assumed I would need to consciously take a step back, that I would struggle to switch off from the emotional aspects of Medicine. However, forgetting the person behind the patient became all too easy during the peaks of Covid-19, where relatives were barred and communication out-sourced. While this level of detachment may be understandable and necessary to an extent, the potential for this attitude to contribute to the already dehumanising experience of ICU patients should not be ignored. I always thought I was more interested in people and their stories than I was in medical science;this experience reminded me of that, and of the richness you lose out on when those stories are forgotten.
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Background: Nurses and other first responders are at high risk of exposure to the SARS-CoV2 virus, and many have developed severe COVID-19 infection. A better understanding of the factors that increase the risk of infection after exposure to the virus could help to address this. Although several risk factors such as obesity, diabetes, and hypertension have been associated with an increased risk of infection, many first responders develop severe COVID-19 without established risk factors. As inflammation and cytokine storm are the primary mechanisms in severe COVID-19, other factors that promote an inflammatory state could increase the risk of COVID-19 in exposed individuals. Alcohol misuse and shift work with subsequent misaligned circadian rhythms are known to promote a pro-inflammatory state and thus could increase susceptibility to COVID-19. To test this hypothesis, we conducted a prospective, cross-sectional observational survey-based study in nurses using the American Nursing Association network. Method(s): We used validated structured questionnaires to assess alcohol consumption (the Alcohol Use Disorders Identification Test) and circadian typology or chronotype (the Munich Chronotype Questionnaire Shift -MCTQ-Shift). Result(s): By latent class analysis (LCA), high-risk features of alcohol misuse were associated with a later chronotype, and binge drinking was greater in night shift workers. The night shift was associated with more than double the odds of COVID-19 infection of the standard shift (OR 2.67, 95% CI: 1.18 to 6.07). Binge drinkers had twice the odds of COVID-19 infection of those with low-risk features by LCA (OR: 2.08, 95% CI: 0.75 to 5.79). Conclusion(s): Working night shifts or binge drinking may be risk factors for COVID-19 infection among nurses. Understanding the mechanisms underlying these risk factors could help to mitigate the impact of COVID-19 on our at-risk healthcare workforce.Copyright © 2023 The Authors. Alcohol: Clinical and Experimental Research published by Wiley Periodicals LLC on behalf of Research Society on Alcohol.
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Objectives: Uncommon presentations of common diseases present a challenge in recognizing the correct diagnosis. Beside uncommon symptoms, uncommon age of onset challenges the pattern recognition abilities of clinicians. Method(s): Here we present a 6 week old boy with acute haemorrhagic edema of infancy in association with COVID-19. The otherwise healthy term born infant presented in our clinic with fever, mild respiratory symptoms and a rash. After establishing a sufficient saturation of oxygen, also during sleep, the infant was discharged. Result(s): Complete resolution of the rash was within days after. On admittance 60 mg prednisolone rectal was applied by the emergency night shift staff also to stabilize a slight wheeze due to COVID-19 but other than that no therapy was needed. Discussion(s): Reviewing the literature the benign nature of this leucocytoclastic vasculitis was commonly reported as well as the common onset during late infancy (about 8 to 23 months). Very few reports target the age group outside this age brackets. Nonetheless it is important to think outside the box when examining a patient in emergency paediatric derm.atology.
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BACKGROUND: The COVID-19 pandemic has exhausted the employees of hospital center and had a negative impact on medical students. AIM: The aims are to show the efforts of Occupational Medicine to provide support for healthcare workers and to increase student's interest in O.M. MATERIALS AND METHODS: Out of the total number of employees of the Clinical Hospital Center Rijeka, which is 3500, 275 of them claim for recognition of COVID-19 occupational diseases in 2022. The 6th-year medical students of the Rijeka Faculty of Medicine, 130 in total and 22 sanitary engineers were surveyed by the quality service regarding their satisfaction with the Occupational Medicine classes. Statsoft Statistica 10 was used to calculate the results. RESULT(S): All HCW are recognized as having COVID-19 as a professional disease. Older age correlated with greater absenteeism. Hospital employees are dissatisfied, tired, they demand work benefits, contraindications for shift work, night work, work in COVID centers, and requesting maternity leave. Many also quit their jobs the hospital management is looking for and hiring new employees, who quickly leave due to difficult working conditions and low incomes. Occupational medicine also has a problem with students. During the pandemic, classes were held online. Interest in classes declined, a small number of students joined the lectures, but all responded to the survey. The answers showed a lack of interest in the Occupational Medicine course. With subsiding of the pandemic, it would be obligatory to continue "live" classes, take students on a tour of industrial facilities, and cancel the failed evaluation of teachers. CONCLUSION(S): Easing of working conditions for HCW and changes in teaching is necessary.Copyright © 2023, Scientific Foundation SPIROSKI. All rights reserved.
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Shift workers are known to have poorer metabolic health outcomes compared to day workers,(1) whilst those who work in rotating shift work roles have the highest risk.(2) To date, overall energy intake in shift workers has been found to be similar to day workers,(3) but it is unknown whether energy intake in workers on rotating shift schedules may be a contributing factor to the observed higher chronic disease risk. A systematic review and meta-analysis were conducted to explore how rotating shift work schedules impact total energy intake compared to fixed day/morning work schedules. Intra-person differences in energy intake amongst rotating shift workers on day/morning versus night shifts was also examined. Searches were conducted on CINAHL, Cochrane, Embase, MEDLINE PsycINFO and Scopus databases to identify articles reporting energy intake for rotating shift workers and fixed day workers. Articles were screened in duplicate against inclusion criteria using Covidence software. Data were extracted by one reviewer and checked independently by one of three reviewers. Quality assessment of included studies was assessed in duplicate using the American Dietetic Association (ADA) Quality Criteria Checklist for Primary Research. Meta-analyses were performed in RevMan using a random effects model, to compare mean difference in 24-hour energy intake with 95% confidence intervals. Heterogeneity was assessed with the I-squared test (I2). Thirty-one studies (n = 18196 participants) met the inclusion criteria and were included in the review with data for the two meta-analyses comprising 18 studies and seven studies, respectively. Overall, rotating shift workers had significantly higher average 24-hour energy intake compared to fixed day or morning work schedules (weighted mean difference [WMD] = 264 kJ;95% CI [70, 458], p < 0.008;I2 = 63%). Within rotating shift workers, the mean difference in 24-hour energy intake across morning/day shifts compared to night shifts was not statistically significant (WMD = 101 kJ;95% CI [-651, 852];p = 0.79;I2 = 77%). Results indicate workers on rotating shift schedules had a higher average 24-hour energy intake compared to their fixed day schedule counterparts. However, energy intake across shift schedules did not differ for individuals working this pattern. A higher 24-hour energy intake in rotating shift workers can contribute to gradual weight gain and higher metabolic risk in rotating shift work populations.
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Introduction: Nursing officers are one of the susceptible groups prone to have sleep disturbances, which may not only influence their own health but also affect the nursing quality and treatment process. During COVID Pandemic, because of high work demand, nurses were made to run more shifts than regular days which can be quite stressful for them. Our study was conducted to assess the sleep quality and sleep hygiene among Nursing officers during COVID pandemic andto determine the factors influencing the Sleep quality and Sleep Hygiene Methods: A cross sectional study was conducted from September 2021-October 2021 among nursing officers of Kodagu district hospital attached to Kodagu Institute of Medical sciences. Pittsburgh Sleep Quality Index questionnaire was used to assess the sleep quality, Epworth Sleepiness Scale was used to determine the presence of tendency of daytime sleepiness and Sleep hygiene index was used to assess the sleep hygiene among the respondents. Result(s): Poor sleep quality was high(70.4%) among nursing officers. A significant association (p<0.05) of poor sleep quality was found with 31-40 years age group, nuclear family, less than 10 years of work experience and >15 nights shifts per month when logistic regression was applied. Poor sleep quality was high among the nursing officers who were practicing poor sleep hygiene (79.16 %).The assessment of daytime sleepiness showed that majority of the nursing officers (94%) were unlikely to be abnormally sleepy. Conclusion(s): The prevalence of poor sleep quality was high among nurses which was done during COVID pandemic. Poor sleep quality was associated age, type of family, years of work experience and nights shifts. Recruitment of adequate number of nursing staff and scrupulously planned night shifts are needed to improve the sleep health and well being of nurses which sequentially will result in better and efficient patient care.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
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Introduction: Medical professionals are known to experience high levels of stress because of their work since the current pandemic but they are rarely recognized as vulnerable and little attention is paid to their mental health. Objective : To detect burn out syndrome (BOS) among health workers in COVID19 centers and to summarise its potential risc factors. Method(s): we conducted a prospective and descriptive study, referring to Maslash Burnout Inventory, among a sample of medical professionals in COVID departments in Sfax from January to March 2020 by emailing a survey to 114 eligible participants. Result(s): Public COVID hospitals were the most frequent workplaces. Sixty three percent of people had high level of emotional exhaustion (EE), 57% had high level of depersonnalisation(DP) and 73% had low personal accomplishement(AP). These three components of MBI were correlated to female gender (P=0.001), single status (P=0.001), and the fear of contaminating siblings (P=0.001). Daily direct exposure to positive patient was noted in 79% of cases, and 42% of them had night shifts. High level of (DP) and low (AP) were correlated with night shifts at hospital (P=0.001). BOS was related to the non payment of the shifts (P<0.001), and the lack of free time (P=0.004). High levels of pressure from superiors is also correlated to low (AP) (P<0.001), while high level of (DP) was correlated to lack of appreciation from superiors (P<0.001) Conclusion(s): This study shows a high self-reported burnout level among medical professionals. It highlights the need for effective interventions to reduce BOS since the pandemic is still going on to this day.
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The aim of the present study was to analyze any relations existed between sampling characteristics and the onset of the severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection, also by considering the number of times that it occurred in a cohort of Italian nurses interviewed. Additionally, by considering the nutritional supplemental taking, this research wanted to assess any differences both in the onset and in the number of times in which the infection occurred among participants. An observational cohort study was carried out thorough all Italian nurses by advertising the questionnaire through some professional Internet pages. Work typology (P=0.021), coronavirus disease 2019 (COVID-19) ward (P=0.002) and regular meal assumption (P=0.019) significantly associated to the onset of the SARS-CoV-2 infection. Most of nurses who contracted the SARS-CoV-2 infection worked during the night shift (53.7%), 44.3% worked in a no-COVID-19 ward and 53% declared to have a regular meals' assumption. Ward typology significantly associated to the times of the SARSCoV-2 onset (P=0.003), as most of nurses who contracted almost one time the SARS-CoV-2 infection were employed in a no-COVID-19 ward (55.5%) and 54.1% of them declared to have a regular meals' assumption. The onset of the SARS-CoV-2 infection seemed to be more present in the most part of the sample collects. The present study could be considered as pilot in this sense and also more studies will be performed in order to better relate the function of supplemental food intakes with a better functioning of the immune system.Copyright © the Author(s), 2022 Licensee PAGEPress, Italy.
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Globalization and the expansion of essential services over continuous 24 h cycles have necessitated the adaptation of the human workforce to shift-based schedules. Night shift work (NSW) causes a state of desynchrony between the internal circadian machinery and external environmental cues, which can impact inflammatory and metabolic pathways. The discovery of clock genes in the lung has shed light on potential mechanisms of circadian misalignment in chronic pulmonary disease. Here, the current knowledge of circadian clock disruption caused by NSW and its impact on lung inflammation and associated pathophysiology in chronic lung diseases, such as asthma, chronic obstructive pulmonary disease, pulmonary fibrosis, and COVID-19, is reviewed. Furthermore, the limitations of the current understanding of circadian disruption and potential future chronotherapeutic advances are discussed.
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Objectives: The critical shortage of health care providers has been accelerated by the COVID-19 pandemic into a staffing crisis. In this setting, it became infeasible for our large tertiary academic hospital to consistently staff our emergency department observation unit with on-site providers. Telemedicine has been utilized and studied as a solution to this shortage in part because it enhances access to a larger staffing pool and allows for increased flexibility without geographic constraints. While telemedicine is well vetted across the continuum of health care, there is a paucity of data regarding the use of telemedicine in the observation medicine setting. This study aimed to primarily evaluate the safety and quality of care and secondarily the satisfaction of staff and patients when using a virtual provider in an emergency department observation unit. Design/Methods: This prospective observational quality improvement study occurred over a three month period where a virtual provider was piloted in an emergency department observation unit on dedicated night shifts at a tertiary care, academic hospital. Utilizing structured survey instruments and post shift interviews, nursing and provider perceptions of care were assessed across multiple domains of both health care quality, safety, and workflow efficiency. Secondary objectives evaluated include: patient and staff satisfaction, overall observation unit census and number of patients upgraded to a higher level of care. Patient satisfaction was assessed through surveys with questions based on Emergency Department Consumer Assessment of Healthcare Providers and Systems (ED-CAHPS) questionnaires. These were compared to the unit's ED- CAHPS results in the three month time frame prior to the pilot. Results/Findings: 89% of nurses rated the virtual provider as equal, or better than an in-person provider when addressing clinical concerns. 96% of nurses similarly reported that the virtual provider was more or equally accessible. Moreover, 89% highlighted that the telemedicine workflow resulted in minimal or no increase to their work burden. Of the 16 virtual providers, 14 reported that they were "extremely" or "very" able to deliver appropriate care and engage with patients;the other 2 providers reported they were "somewhat able." 97% of patients reported satisfaction regarding their telemedicine experience. 3% of patients reported a neutral experience and none endorsed being dissatisfied. For ED-CAHP scores in the following categories: "treated with courtesy and respect," "listened carefully," "explained in a way you understand," virtual providers scored "always," the highest mark possible, greater than 93% of the time. Comparatively, in-person providers scored, "always", 63-73% of the time in the above categories during the three month period prior to this pilot. There was only one patient upgraded to a higher level of care, which compared favorably to baseline. Conclusion(s): After implementation of a virtual provider in an emergency department observation unit, clinical staff and patients perceived virtual care to be either similar or improved as compared to an in-person provider. A virtual provider may be an efficient and safe staffing solution in an emergency department observation unit. This may be particularly relevant in the context of an ongoing nationwide staffing crisis. No, authors do not have interests to disclose Copyright © 2022
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Introduction: The COVID-19 infection rapidly became a worldwide pandemic and a public health emergency that seriously burdened healthcare systems. Health care professionals (HCPs) were faced with a new difficult and demanding challenge which frequently meant working long h shifts with low staffing members under high pressure environments. This may have had an important impact on sleep quality of HCPs. Aim(s): To evaluate the quality of sleep of HCPs after 3 waves of the COVID-19 pandemic. Method(s): A sleep questionnaire developed by the authors was sent to all HCPs of a tertiary hospital after the first 3 waves of the COVID-19 pandemic. Result(s): We had a total of 651 participants, mostly female (81.3%). Most participants were nurses (38.1%) and doctors (19.1%), with ages between 30 and 50 years. Other HCPs included were technicians, assistants, pharmaceuticals, among others. The majority dealt directly with COVID-19 patients (73.7%). Concerning quality of sleep, a significant proportion of HCPs referred a bad or very bad quality of sleep (41.5%) and only 16.1% stated a good or very good quality of sleep, of the last, 57% did not work night shifts. The majority suffered from night awakenings (88.6%), with 38.2% referring more than 2 awakenings per night;of these, 65% stated difficulty falling back to sleep. Furthermore, 46.2% HCPs referred initial insomnia and 59.9% referred terminal insomnia. Regarding quantity of sleep 16.9% slept less than 5 h, 47.3% slept approximately 6 h and only 7% slept 8 or more hours. Approximately 33% of HCPs resorted to sleeping medication, most frequently anxiolytics. In reference to daily symptoms, 71.3% of HCPs stated daytime sleepiness, most frequently after lunch (50.5%). Nonetheless, a significant proportion mentioned sleepiness during work (24%), and while driving (14.3%). Finally, 50.4% of the HCPs considered that the 3 waves of the COVID-19 pandemic worsened their sleep quality. Conclusion(s): This analysis demonstrates concerning results regarding the quality of sleep of HCPs after the first 3 waves of the COVID-19 pandemic with important daytime repercussions. This may reflect a consequence of the COVID-19 pandemic, as half of the HCPs considered that that the pandemic worsened their sleep quality.
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Introduction/Objectives: Evidence suggests that night work, short sleep duration and sleep problems are associated with poor long-term health outcomes, including increased risk of infections. In this symposium, epidemiological data from recent studies among (a) patients in general practice in Norway and (b) day and shift/night workers participating in a large international study (ICOSS-2) on COVID-19 and longcovid, will be presented. Method(s): The study in general practice included a total of 1848 unselective patients visiting their general practitioner. The patients completed a one-page questionnaire while waiting for the consultation. The international study included a total of 7182 day and shift workers from 15 different countries around the world. These participants completed an online survey covering several aspects of sleep. Result(s): The study from general practice showed that patients reporting a sleep duration of less than 6 h had significantly higher risk of infection (any type) compared to patients reporting 7-8 h of sleep (Relative Risk (RR) 1.27, confidence interval (CI) 1.11-1.46). Furthermore, the risk of infection was significantly higher in patients with chronic insomnia compared to patients without insomnia (RR 1.15, CI 1.05-1.27). Preliminary data from the ICOSS-2 show that the prevalence of COVID-19 was significantly higher among participants involved in irregular day work (20.7%) and shift/night work (25.3%) compared with participants involved in regular day work (18.9%). Furthermore, the prevalence of long-covid (according to WHO criteria) was significantly higher among irregular day workers (11.4%) and shift/night workers (13.6%) compared with regular day workers (8.4%). Conclusion(s): These data indicate that shift/night work, short sleep duration and sleep problems are associated with an increased risk of infections, including COVID-19. Furthermore, preliminary data suggest that shift/night work also is associated with increased risk of developing long-covid. The possible mechanisms involved will be discussed.
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SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: INTRODUCTION: Oxygen is life saving if administered properly. Low and middle income countries recently faced a acute oxygen shortage during covid surge. We aim to study the oxygen requirement and its administration in patients with acute respiratory failure requiring oxygen therapy. AIMS AND OBJECTIVES: 1. To study the oxygen requirement and its utilization in patients with acute respiratory failure 2. To study the effectiveness of oxygen saving protocols and its impact on healthcare delivery METHODS: Sample size: 50 patients with acute respiratory failure INCLUSION CRITERIA: 1. Patients aged 20 years and above 2. Patients with acute respiratory failure 3. Patients requiring oxygen EXCLUSION CRITERIA: 1.Patients unable to consent 2.Patients requiring NIV 3.Patients with poisoning METHODOLOGY: We developed a protocol according to which ROX index of each patient was calculated and suitable interface like nasal prongs, face mask, NRB mask etc were used. Oxygenation was delivered with the target oxygen saturation of 92% and above. Also the oxygen delivery system was checked for potential leakage. RESULTS: 1. 80% of the oxygen delivery lines had a minute leakage and were a source of oxygen wastage 2. 92% patients just removed the oxygen mask for drinking water, eating, etc without turning off the valve 3. Night nursing staff was a bit careless and never cared to check for oxygen leakage from mask in night shifts. It accounted for approximately 24% of total leakage per patient 4. 56% of patients were not aware of proper usage of nasal prongs 5. Unavailability of liquid oxygen storage facilities in hospitals was a cause of delayed supply of oxygen during the crises CONCLUSIONS: Liquid medical oxygen is a life saving in patients of acute respiratory failure. However proper supply, storage facilities and usage protocols have to be followed rigorously to avoid acute shortages. CLINICAL IMPLICATIONS: Oxygen if used properly is a live saving measure in patients of respiratory failure. DISCLOSURES: No relevant relationships by Sarang Patil
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Background: Exclusive breastfeeding is recognized as the ideal feeding method for infants. Newborns receiving formula inhospital are at higher risk for early breastfeeding cessation. Among infants born in 2017, CDC Breastfeeding Report Card, 2020, reported the rate of breastfed infants receiving formula before two days of age as 15% in West Virginia (WV). We aimed to determine factors associated with in-hospital formula supplementation of breastfed newborns at a large community hospital in Southern WV. We hypothesized that disparities exist in supporting women to exclusively breastfeed. Methods: We retrospectively reviewed 500 randomly selected charts of infants born 09/01/2019-09/1/2020. Full-term infants with a recorded maternal decision to exclusively breastfeed were included. Exclusion criteria were prematurity, NICU admission, maternal diabetes, and infant hypoglycemia. Factors associated with formula supplementation were compared between mothers exclusively breastfeeding and those who were not at the time of discharge. Results: Of the reviewed charts, 70% of birth mothers desired to exclusively breastfeed. 211 infants met all inclusion criteria. 70% were delivered via vaginal delivery;52% were induced. Of the included newborns, 41% were supplemented with formula. 32% of mothers met with lactation consultants prior to formula supplementation. Top reasons for formula supplementation were mother request (45%) and newborn difficulty latching (22%). Median time of first supplementation was 20.0 hours (range:0.5-54). 12% of the supplementation occurred within 6 hours and 96.5% within 2 days of age. Rates of formula supplementation did not increase during the nurses' night shift or at nurses' shift change. Exclusive breastfeeding at discharge was associated with higher education level (p=0.002), tobacco abstinence (p=0.03), prior births (p=0.04), and increased maternal age (p=0.02);with every 1 year increase in maternal age, there was 7% decrease in supplementation. No statistically significant associations were present between exclusive breastfeeding at discharge meeting with a hospital lactation consultant, maternal race, marital status, induction need, or neonatal characteristics (p>0.05). When controlling for confounders of maternal age, marital status, tobacco use, and lactation consultation, Cesarean delivery (odd ratio: 2.0,1.03-4.2, 95% confidence interval), primiparity (2.6, 1.4-4.8), and not completing high school (12.5, 1.6-96.5) predicted formula supplementation. Exclusive breastfeeding discharge rates remained relatively steady over the 12 month study period, including during the COVID-19 pandemic. Conclusion: At our center, formula supplementation rate of 41% in the first two days of age appears higher than the state's rate using the CDC report card. Mother request and newborn difficulty latching are the top reasons for formula supplementation. Median age of supplementation was 20 hours. Lactation consultations were not universal and disparities existed for breastfeeding mothers supplementing with formula. Addressing maternal disparities is essential to enhance newborn health equity. Our study's findings will be used to develop prenatal and postnatal interventions to maximize hospital breastfeeding support and minimize formula supplementation.
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Purpose/Objectives: The creation of a biocontainment unit (BCU) team was established for the preparation of care for patients with highly infectious diseases in 2014. When the COVID-19 pandemic surfaced, the nursing and physician leadership from the BCU and the MICU designed simulations around the safe provision of care during aerosol generating procedures (AGPs) in emergent situations. These low fidelity simulation sessions helped to prepare clinicians based on real life scenarios when intubating and coding a patient with COVID-19. The purpose of this was to successfully prepare PICU staff to safely care for patients receiving AGPs during an emergency through quick 30- minute simulations in situ. The goal of these simulations was to practice limiting the number of people in the patient room to minimize exposure risk to staff, while still maintaining highquality communication among all team members during emergency situations. Design/Methods: The simulation sessions occurred on the PICU in an empty bed space with ICU team members during their shift. Simulation offerings occurred during the day and night shifts. For each simulation session, feedback from the multidisciplinary team allowed for iterative changes to be made to the procedural checklist used in everyday practice for intubation. These sessions also identified multiple communication barriers from occurring both inside and outside of the patient room. These communication issues were addressed through real time debriefing and by trialing creative, thoughtful solutions during subsequent simulation sessions such as using wireless headsets and scannable QR codes to zoom calls. A survey sent by the Survey Monkey™ software was given to all participants to determine the effectiveness of these simulations and changes that needed to take place in the future. Results: Survey responses were received from 21 of 42 clinicians who attended the simulations. 90% of clinicians indicated they felt comfortable with the intubation checklist modifications with regard to intubation being considered an AGP. The clinicians all indicated they were comfortable with the new techniques being taught to them in the scenarios. 90% of clinicians understood their roles in the emergency situation and felt they were more prepared for critical care situations involving patients on or receiving AGPs. Conclusion/Discussion: In the event, that the PICU is faced with the inability to utilize simulation spaces in the future, there is an ability now to offer simulation in situ on the PICU itself. The use of Zoom calls to an iPad into the room of a critically ill patient on airborne precautions has been extremely useful in maintaining communication with the rest of the PICU team outside of the room, while minimizing the clinicians required in the room.
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Introduction: To verify the association among the mood state variables (total mood, depression, tension, and anger domains), sleep quality and the sleepiness of the university students during the COVID-19 Pandemic. Objective: To estimate whether mood is associated with the sleep quality and sleepiness in the university student during the COVID-19 Pandemic. Methods: Two hundred and four university students of both sexes, with a mean age of 23.72±5.95 years, registered from the 2nd to the 7th period of both shifts (day and night classes) in three health courses of Brazilian private universities were participated of this study. Sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI), sleepiness by Epworth Sleepiness Scale (ESS) and mood state was measured by Brazil Mood Scale (BRAMS) before classes (day = 7h00 and night = 19h00). The Kolmogorov- Smirnov test was applied to verify the normality of the data. Spearman correlation coefficient was used to calculate the correlation between the following variables. The α-level for all analysis was set at 0.05. Results: The results showed there was a significant positive association among poor sleep quality (PSQI>5) and the total mood state (r=0.53;p<0.01), depression mood domain (r=0.42;p<0.01), tension mood domain (r=0.38;p<0.001), and anger mood domain (r=0.28;p=0.02). In addition, there was a significant association among sleepiness (ESS>9) and the total mood state (r=0.59;p<0.01), depression mood domain (r=0.40;p<0.01), and the anger mood domain (r=0.25;p=0.05). Depressed, high levels of tension and anger mood were associated with poor sleep quality (PSQI>5) and increased sleepiness (ESS>9). Conclusion: Therefore, university students were poor sleep quality, high levels of sleepiness, depression, tension, and anger mood before classes in the day-night shifts. The sleep quality and the sleepiness presented positive moderate correlation with the total mood state. In addition, the sleep quality and sleepiness presented positive weak correlation with depressed, stress and anger mood domains. In this context, it is important to highlight that it is necessary to improve the quality of sleep, alertness, and mood state of the university students during the COVID-19 pandemic to increase their academic performance and positive mood.
ABSTRACT
Introduction: The sleep-wake rhythm irregularities can cause poor sleep quality and mood changes, such as increased fatigue and sleepiness in the students in consequence of the academic tasks and social life. Objective: The objective of this study was to verify the sleep quality, sleepiness, alertness state and mood state of the university students prior to the day-night-shift classes (online) during the COVID-19 Pandemic. Methods: One hundred sixty-eight university students of both sexes, with a mean age of 23.8±5.4 years, registered from the 2nd to the 7th period in three courses (Medicine, Nursing and Physiotherapy) of the two Brazilian private university in the day (n=90) and night-shift (n=78) were participated of this study. The measurements of sleep quality (Pittsburgh Sleep Quality Index - PSQI), sleepiness (Epworth Sleepiness Scale), alertness state (Karolinska Sleepiness Scale), mood state (Brazil Mood Scale - BRAMS), fatigue (FB) and vigor BRAMS domains (VB) were performed immediately prior to the classes online (day shift = 7h00;night shift = 19h00). The normality of the data was verified using the Kolmogorov-Smirnov test. The Mann-Whitney U test of independent samples was used to compare the variables between day-shift and night-shift university students. The size of the Cohen effect (ES) was estimated. The α-level for all analysis was set at ≤0.05. Results: The results showed there was a significant difference in sleep quality, fatigue mood domain, and alertness state between university students in the day and night shifts: sleep quality - PSQI (U= 2789.5;p=0.02;ES=0.46), alertness state - KSS (U= 2933.0;p=0.04, ES=0.48) and FB mood domain (U= 2877.0;p=0.05;ES=0.31). However, there was no difference in sleepiness (ESS) and Vigor mood domain (BRAMS) between day-shift and night-shift students. Therefore, the night-shift university students showed a significant worsening of the sleep quality, fatigue mood and alertness state compared to the day-shift students prior the classes. Conclusion: The results indicated that night-shift students were inattentive, fatigue, and sleepy prior to their academic activities (classes), in addition to presenting poor sleep quality (IQSP>5). Thereby, strategies implementation such as naps, restorative sleep, blue light therapy, and sleep hygiene are important to improve the alertness, attention, general health, and academic performance of the university students during the COVID-19 Pandemic.
ABSTRACT
Background: Nurses constitute the majority of healthcare practitioners, have been fighting the COVID-19 outbreak on the front lines. Nurses could face several challenges during delivering care for patients at ICUs especially at the time of pandemic of COVID -19, including workload and shortage, psychological load, availability of resources, responsibilities, and role conflict. Aims of the study: To what extent is there a significant relationship between challenge that facing nursing care at intensive care unit during the pandemic of corona virus ? Methodology: A descriptive study design was conducted on ICU nurses at Baquba teaching hospital for the period October 15th, 2021, to March 25th, 2022. A non-probability (Purposive) sample was selected of 35 nurses who work at Baquba teaching hospital. The data was collected using a previously prepared questionnaire and official agreement to use the study questionnaire was obtained from the original author. Descriptive statistics (frequencies, percentages, mean, and standard deviation) and inferential statistics (person correlation) were used in the data analysis. Results: Results showed that nurses who work at ICU during the pandemic of COVID -19 were faced several challenges to deliver care for patients, including shortage of nurses in the presence of large number of patients, lack of appropriate offices for nurses, stressful work environment, sense responsibilities for some critical cases, and lack of support from superiors. Conclusion: The study concluded that nurses who work at ICU during the pandemic of COVID -19 were faced several challenges to deliver care for patients, including shortage and workload, psychological load, taking responsibilities, and role conflict challenges.