The impact of COVID-19 pandemic on medical students: A cross-sectional study

Background: The coronavirus disease (COVID-19) pandemic has affected the medical education throughout the world. A study was done to assess the effect of education and psychological behavior on medical students. Aims and Objectives: The objective of the study is to evaluate the effect of COVID-19 on medical graduates in various aspects such as education, effect on clinical rotations, impact on the technology used for online classes, effect on quality of life, loneliness, sleep, and depressive symptoms. Material(s) and Method(s): A set of questions were distributed to Government Medical college, Suryapet students during November 2021-January 2022. Questionnaire aimed to study students' viewpoint of COVID-19's impact on their education, mental health, and willingness to participate clinically. Result(s): One hundred medical students from Government Medical College, Suryapet participated in this study. Most students (88%) agreed that pandemic had disrupted their medical education. About 64% agreed to attend clinical rotations and 68% of students accepting the risk of contracting COVID-19 in clinical rotations. COVID-19 had an impact on technology tools used for medical education. Students reported that COVID-19 had moderate impact on quality of life, sleep quality, anxiety, and depressive symptoms. Conclusion(s): The COVID-19 had an overall significant negative impact on undergraduate medical education. It is recommended that measures need to be taken to relieve students' stress.Copyright © 2023, Mr Bhawani Singh. All rights reserved.

Findings from a regional survey of critical care nursing staff focusing on retention and factors that influence wellbeing

Introduction: The Covid-19 pandemic has put unprecedented pressures on the National Health Service (NHS) with adult critical care being one of the key specialties that has been affected. NHS staff have been working relentlessly throughout the pandemic and adult critical care teams were at the forefront of that. Thames Valley & Wessex and Kent, Surrey & Sussex Adult Critical Care Operational Delivery Networks had heard from our unit matrons and clinical leads around their concerns for the wellbeing of their staff. We had also heard of the number of critical care nurses who have either left their roles or are planning to leave. Objective(s): As Networks our main objective was to gain a better understanding on some of the factors that locally might be influencing the wellbeing of our staff and any intentions to leave, and to see if this aligns with the published research. The Networks also planned to develop a series of recommendations based on the results from the data. Method(s): A survey was developed as a method of gathering both qualitative and quantitative self-reported data from nurses currently working on adult critical care units. All survey data collected was anonymous. This was circulated, via the unit Matrons and Nurse Leads, to nursing staff within their critical care department. Result(s): The survey produced a large amount of data, with 427 responses (approximately 15% of nurses) from 33 units across 24 questions. The data found that 51% of nurses report that Covid-19 has made them less likely to stay in their current roles. 7 in 10 reported high levels of stress because of their work with the most common cause of stress being "staff shortages" and "being asked to work on other wards". The results also showed within the next 3 years, 50% of nurses are planning on leaving their current roles in their adult critical care unit with 47% of nurses feeling they do not get adequate salary. On a positive note, 87% of nurses feel they are having a positive impact on patient care with 74% reporting that they would recommend adult critical care nursing to other nurses. Following this analysis of the data, the networks developed six recommendations that looked at repeating and sharing the report, wellbeing, salary, contributing factors for stress and dedicated time for education and development. Alongside a formal report, individual units with more than five participants were provided with an infographic, personalised to them with their results. Conclusion(s): The data showed points of significant interest for the networks and units and has generated interest from the wider critical care community, with the desire to replicate this survey Nationally. It is clear that despite 87% of nurses feeling they have a positive impact on patient care and 74% recommending critical care nursing to others, 50% of nurses are looking to leave. We need to understand this aspect in more detail along with the two key reasons for stress, moving to the wards and staff shortages.

Digital follow-up in obstetric anaesthesia

Introduction: Throughout the COVID-19 pandemic and in order to maintain essential operations in a socially distanced environment, many services in healthcare have undergone significant change, moving towards telemedicine solutions. This has ranged from virtual GP consultations to virtual examinations for post-graduate students. Telemedicine solutions are unlikely to provide a wholesale replacement for face-to-face patient interaction without significant deficiencies, however, they do herald new hybrid ways of working, allowing service providers to reach clients where they are. Anaesthetic followup for Obstetric clients who have undergone an anaesthetic intervention is a national recommendation by RCOA [1] and AAGBI/OAA [2]. The aim of this QI project was to launch a digital follow-up survey for Obstetric clients who underwent an anaesthetic intervention which could be utilised in a busy unit where staff shortage or high clinical workload often preclude daily face-to-face follow up. Method(s): We created a digital clients survey which is accessed by scanning a QR code. With the support of senior midwifery coordinators, large posters advertising the survey and QR code were put up in each client bay on the post-natal ward and flyers with QR codes were given to clients. Midwives reminded post-natal clients to complete the survey. We included a flyer with the QR code in discharge paperwork. The survey included an option to request a face-to face anaesthetic review. Result(s): During the trial period of three weeks, 87 inpatient and discharged post-natal clients responded via the digital follow-up tool. Discussion(s): Digital follow-up can provide an invaluable supplemental source of follow-up, supporting conventional follow-up methods and facilitating safe fast-track discharge. [Figure presented]Copyright © 2023 Elsevier Ltd

Out-Patient Antimicrobial Therapy Unit in Universiti Malaya: The Experience of a Single Tertiary Centre in the Klang Valley

Intro: The Out-Patient Parenteral Antimicrobial Therapy (OPAT) is a form of Antimicrobial Stewardship that is now widely-practise throughout the world. However, in Malaysia, this has just only begun to take root and the OPAT in Universiti Malaya (UM) has only just begin operating on 2 August, 2018. The OPAT in Universiti Malaya has been operating for 4 years and is a collaboration between the General Medical Unit and the Infectious Control Unit. Method(s): This was a longitudinal study of all the patients that has been admitted to the OPAT since the start of the service. For each patient the starting and ending date in OPAT, anitbiotic used, the diagnosis, the referring unit, and any problems were recorded. Finding(s): The total patient-days of antibiotics served in the OPAT was 4978, with a mean duration of 66.37 days per patient and a median of 31 days. The majority of cases was referred from the medical department with 41 cases (54.67%) followed by Surgery with 22 cases (29.33%). Ertapenem was the most common antimicrobial served with 39 patients on it (52%) and ceftriaxone was second with 8 patients served (10.67%). All antibiotics have been agreed upon by the Infectious Disease Unit. In our study, 2 patients in OPAT has died but the rest none of them were admitted for hospital associated infection. Discussion(s): We found that OPAT on average save at least ten beds per day in the hospital. The patients are happy because they do not need to be warded in hospital to receive their antimicrobials. However, we faced limitations in recruitment of patients to the OPAT during the COVID-19 pandemic, staff shortages, the lack of infusion pumps for serving multidose antimicrobials, and bureacratic red-tape. Conclusion(s): OPAT was useful in reducing bed occupancy rate and hospital associated infection. Patients also are happy with the service.Copyright © 2023

Health Service Quality and its Relationship to Team Collaboration and Communication during the COVID-19 Pandemic

BACKGROUND: In the search for innovative methods to improve the quality and efficiency of health services, integrated clinical pathways (ICPs) have been introduced. AIM: As there is a gap in research on ICP efficiency, the aim of the study was to investigate the role and impact of collaboration and communication among three interprofessional ICP teams on the self-assessment of efficiency of ICPs. METHOD(S): A cross-sectional study was conducted using a descriptive quantitative with a survey (n = 152) and qualitative methods with a focus group (n = 27) and in-depth interviews (n = 22) in a typical general hospital in Slovenia. RESULT(S): The results showed that health-care professionals found patient health care and the work of healthcare professionals' better quality with ICP than without ICP. The ICPs team members assessed communication, cooperation, and effectiveness in the ICP team as relatively good but identified the lack of staff as the main reason for their limitations. The impact of ICP team collaboration and communication on ICP safety exists but it does not explain a sufficient proportion of the variance and the corelation is medium strong. The result also revealed that the COVID-19 pandemic did not primarily affect ICP team members' fear of possible infection, as studies have shown in the first wave of the COVID-19 pandemic, but rather staff shortages leading to increased fear of errors and possible complaints and lawsuits from patients and relatives. CONCLUSION(S): Measures are needed for the additional employment of team members and the retention of current staff through financial compensation and the promotion of supportive workplace characteristics.Copyright © 2023 Mateja Simec, Sabina Krsnik, Karmen Erjavec.

Patient-Centered Surveillance of Drug-Resistant Infections

Drug resistance or multidrug resistance is multidimensional and complex. Over the past decade and especially during the covid-19 pandemic, the incidence of drug resistant infections increased despite the implementation of infection control precautions. This was most commonly seen in low- and middle-income countries, due to the higher burden of infectious diseases, lack of proper infrastructure, unregulated antimicrobial prescriptions over the counter, limited surveillance of antimicrobial use and resistance patterns. This was further compounded by the dearth of healthcare personnel trained in appropriate infectious disease management. Strategies in high income countries to prevent and manage drug resistant infections are unfortunately, not implementable in LMICs due to differences in antimicrobial resistance (AMR) burden, access to newer antibiotics, limited infrastructure and human resources with requisite expertise with lack of economic investment by regulatory authorities to tackle AMR. During the covid-19 pandemic, the lack of therapeutic options and the similar clinical picture initially led to rampant antimicrobial use which in turn contributed to rise in multi-drug resistant infections (MDR). Along with inappropriate antimicrobial use, redistribution of staff assigned to enforce infection control practices, shortage of personnel protective equipment, overcrowded healthcare settings, use of prolonged broad-spectrum antimicrobials in patients requiring during intensive care and mechanical ventilation contributed to the rise in hospital transmission of multidrug resistant infections during the pandemic. To mitigate the effects of drug resistance, healthcare systems must ensure effective implementation of surveillance of antimicrobials, AMR patterns especially in MDR HAIs and antimicrobial stewardship interventions to promote optimal antimicrobial use. National level investment to improve diagnostics must be given priority as it can limit drug resistance and promote the role of biomarkers in streamlining antimicrobial use. These need to be planned to facilitate future integration with any future pandemic surveillance.Copyright © 2023

A historical review of pandemics with a dermatological perspective

We present a literature review of dermatology features in historical pandemics. A pandemic is an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and affecting a large number of people. Smallpox was the first documented pandemic, around 10 000 BC, spread by the inhalation of airborne droplets. A few days after an initial high fever, headache and fatigue, a mucocutaneous maculopapular eruption appeared, which then developed pustules and erosions. The last outbreak occurred in the USA in 1949. Smallpox was eradicated in 1980, following a vaccination programme. Mycobacterium tuberculosis is the causative agent of tuberculosis (TB), an ongoing global pandemic. The earliest documentations were 3300 years ago. In 2020, the World Health Organization (WHO) provisionally estimated 1.5 million deaths globally. Most commonly affecting the lungs, cutaneous TB may present with inflammatory papules, plaques, suppurative nodules and chronic ulcers. Requiring long, complex antibiotic regimens, multidrug resistant TB is an increasing problem. Now extremely rare, yet still with recent outbreaks in 2021 in Madagascar, bubonic plague arrived in Europe in 1346 causing 75-200 million deaths. It is caused by the bacterium Yersinia pestis, transmitted through fleas that have fed on infected rodents. Clinical features include papules, pustules, ulcers and eschars, tender lymphadenopathy and systemic symptoms, and it responds to antibiotics. Syphilis, caused by the bacterium Treponema pallidum, is sexually transmitted. The first known outbreak was during warfare in 1494-5 in Naples, Italy. In 2020, the WHO estimated that, globally, seven million people had new infections. Primary syphilis typically produces a painless, genital ulcer (or chancre). Secondary syphilis presents with a nonitchy, maculopapular erythema over the trunk, palms and soles. Early recognition and antibiotic treatment usually lead to good outcomes. Estimated by the WHO to affect 37.7 million people in 2020, HIV is thought to have mutated from simian immunodeficiency virus by the 1960s in sub-Saharan Africa, spreading to the Caribbean and USA by the late 1960s. Initial symptoms include a fever, headache and lymphadenopathy. Dermatological features are common, including opportunistic cutaneous infections, nonspecific exanthemas, seborrhoeic dermatitis and Kaposi sarcoma. Advances in antiretroviral therapies mean people with HIV can have an excellent prognosis, although the WHO estimated in 2020 that more than 200 000 people with HIV died from concomitant TB. Since 2019, COVID-19 has had a considerable global impact on healthcare. With more than 300 million cases and 5.5 million deaths to date, some services have been overwhelmed owing to large case numbers, variable vaccine uptake, workplace changes to reduce transmission and staff shortages. Cutaneous features include perniosis, urticarial, purpuric, vesicular or maculopapular eruptions. Pandemics throughout history have been repeatedly shown to present with an element of skin involvement. We can utilize this to promote education and early recognition of these features, to facilitate diagnosis and raise awareness of the potential complications of serious diseases.

Providing Comprehensive Services to Treat Patients and the Inpatient Psychiatric Bed Crisis

Objectives: A growing mental health crisis and a shortage of inpatient psychiatric beds have resulted in a surge of patients' boarded' in emergency departments awaiting acute inpatient psychiatric placement. This delays care and causes a further burden on already stressed emergency services. In June 2020, the Centers for Disease Control and Prevention (CDC) reported an increased incidence of anxiety and depressive disorders since March of 2020, in comparison to pre-pandemic data. This has further exacerbated the shortage of psychiatric beds nationwide. In addition, staff shortages at state psychiatric hospitals in the Commonwealth of Virginia led to temporary closures to admissions. State facilities in VA provide care for our most vulnerable population, including (involuntary) patients on a temporary detention order (TDO). Carilion Clinic implemented the Comprehensive Psychiatric Emergency Program (CPEP) in August 2020 with the goal of early identification and robust treatment of psychiatric patients while in the ED. Since implementation of the CPEP, providers have been able to redirect patients away from burdened state psychiatric facilities by rapid stabilization of patients in the ED. Patients were able to step down to a less restrictive environment, often no longer meeting criteria for TDO. This study aims to assess the rate of TDO releases pre- and postimplementation of the CPEP at Carilion Clinic. Method(s): A pilot program was launched in August 2020 at Carilion Roanoke Memorial Hospital through a collaboration of the Departments of Emergency Medicine and Psychiatry. The staff was comprised of a psychiatrist, a psychiatric nurse practitioner, and a social worker. Data was collected from May 2020 to June 2021 from the Epic electronic medical record and included all patients in the ED on a TDO, ages six and above. Patients who no longer met criteria for a TDO were released from involuntary status and either redirected as a voluntary patient to an inpatient psychiatric unit or discharged to the community. The rate of TDO releases three months prior to CPEP implementation was assessed and compared to the TDO release rate post-CPEP implementation. Result(s): Prior to CPEP implementation, the TDO release rate was 7%, amounting to four patients released from a TDO per month. After implementation of CPEP, the TDO release rate increased to 19%, equating to thirteen patients released from a TDO per month during the pilot period. This led to a decrease in the number of patients that would have previously been admitted to a state psychiatric facility. Patients who benefitted from implementation of the CPEP were those with conditions in the following categories: chronic mental illness (32%), individual/family crisis (24%), neurocognitive disorders (20%), substance use disorder (18%), autism spectrum disorders and intellectual/developmental disabilities (6%). Conclusion/Implications: Implementation of the Comprehensive Psychiatric Emergency Program (CPEP) in Carilion Clinic' Emergency Department was successful in reducing the number of state psychiatric admissions by redirecting 11% more involuntary patients to voluntary status. The results of this study highlight the benefits of having in-house psychiatry teams dedicated to early triage, rapid treatment, and comprehensive case management for psychiatric patients in the emergency department. References- CDC, National Center for Health Statistics. Indicators of anxiety or depression based on reported frequency of symptoms during the last 7 days. Household Pulse Survey. Atlanta, GA: US Department of Health and Human Services, CDC, National Center for Health Statistics;2020. https:// www.cdc.gov/nchs/covid19/pulse/mental-health.htm.

Prevalence of Musculoskeletal Disorders among Nursing Personnel

Background: Health sectors can be listed under the high-risk work areas. As we all know, in this COVID 19 pandemic, doctors, nurses, health workers are the front line warriors. If we consider only the nursing personnel here, their tasks alone are prone to occupational hazards. Musculoskeletal disorders (MSDs) are most common among the self-reported occupational diseases. In previous studies, a significantly large number of participants reported musculoskeletal symptoms faced at least once. Insufficiency of ergonomic expertise is one of the most important recognizable risk factors as well as the shortage of staff in hospitals. MSDs are caused due to stressful physical work, static work postures, frequent bending, and twisting, lifting, pushing, and pulling of heavy objects, vibrations, localized mechanical pressure, etc. Various studies have shown that the daily chores of nursing personnel put them at high risk of MSDs. Methods : The study areas were different hospitals and nursing homes in West Bengal. Only the female, registered nurses working in different wards are chosen for this study. The study's inclusion criteria were only the female, registered nurses and the absence of any chronic disease in them. The exclusion criteria were the nursing students, nurses having histories of recent or previous major accidents/injuries or chronic diseases. The study population was interviewed on a one-to-one basis by means of a questionnaire based on Modified Nordic Musculoskeletal Questionnaire. Result(s): Among the total study population, 67.5% of subjects reported low back pain (LBP). 22.5% reported upper back, knee, and ankle discomfort. 27.5%, 15%, and 12.5% reported neck, shoulder, and wrist/hand discomfort, respectively. Conclusion(s): The results of this study have revealed that MSDs are a common phenomenon among nursing personnel. LBP is the most familiar among them, 67.5% of subjects have reported the presence of discomfort. Not only LBP, subjects reported neck, shoulder, knee, and upper back discomfort along with ankle and wrist symptoms. In this COVID-19 scenario, their jobs have become more strenuous than usual. It is found that tasks requiring continuous long hours to perform are causing symptoms to appear. Shift rotations, splitting of shifts, using more ergonomically designed tools, knowledge of ergonomic skills are required in this situation to avoid the aggravation of symptoms.

Challenges Faced by Hilly Hospitals during Covid-19 Second Wave Disaster: Quantitative Study in Garhwal Region, Uttarakhand

Covid -19 second wave was considered a disaster in India as it was more havoc than the first one. Shortness of breath in patients leads to more demand for oxygen and hospitalization. So, there was a challenge for the hospitals to combat this disease. In the covid second wave, moderate to severe cases were treated at three hospital levels (CHC, Sub-district, and District hospital). This disease was not limited to bigger cities but spread to rural and hilly areas. We conducted quantitative research among government hospitals in five hilly districts of Uttarakhand at three levels of hospitals. Data were collected from a close-ended questionnaire using a judgmental sampling technique and analysed with the help of tables and bar charts. Questions were set based on the pilot study. The challenges explored through this study were divided into five main headings and eleven sub-headings. The main headings were Manpower, Surge capacity, logistics, coordination, and management of non-covid patients. Sub-headings were a shortage of medical staff, shortage of paramedical staff, shortage of sweepers, shortage of ambulance drivers, shortage of ICU beds, shortage of oxygen beds, shortage of covid drugs (Remdesivir and Steroids), oxygen cylinders, PPE kits, difficulty in coordination with staff and difficulty in managing non- covid patients.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Human Resources for Pediatric Health Care of Ukraine.

Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

Human Resources for Pediatric Health Care of Ukraine.

Introduction. The quality and availability of medical care for children of country depends on the quantity of pediatricians and the quality of their training. This is especially important in the context of the COVID-19 pandemic. Purpose. To assess the state of staffing and training of pediatricians in healthcare institutions of Ukraine in comparison with same world and European indicators and determine the necessary measures for improvement. Materials and methods. For this research we have used methods of the system approach and epidemiological analysis of data from GU "Center of medical statistics of the Ministry of Health of Ukraine" for eleven years (2009-2020). Results. According to the level of training of doctors, including pediatricians, Ukraine has reached total rank of 38th in the European region. Such dynamics of changes in the availability of human resources for healthcare is accompanied by reductions in the volume of training of pediatricians since 2017. According to the Center for Medical Statistics from 31.12.2020 the Ministry of Health of Ukraine provided medical care in pediatric health care institutions of all forms of ownership with the help of 8812 pediatricians, of whom 7925 (90%) were worked in primary health care centers, clinics and hospitals of the Ministry of Health of Ukraine. This numbers are significantly lower than in 2009, when there were 12 450 practicing pediatricians. As we see, the number of pediatricians has decreased by 15.4% for the last 7 years. Conclusion. Importance of the problems with personnel in pediatric healthcare had shown us a necessity of radical government management decisions for improvement of the situation with the training of pediatricians and preventing of risks of limitations of access to pediatric medical assistance and deterioration of quality of medical care for children in the country. This might be possible with rational planning of the state necessity in the training of pediatricians and significant improvement of their social protection and working conditions. Possible steps should include increasing pediatrics necessity state order up to 1000 pediatricians in state medical universities annually by targeted regional medical personnel necessity order, taking into account the needs of the regions and reviewing their training programs in accordance with the modern requirements.Copyright © 2022, Professionalnye Izdaniya. All rights reserved.

The Relationship between Burnout Syndrome and Working Alliance in Psichiatric Residential Facilities: A Focus on Schizofrenia Spectrum Disorder

Introduction: Literature, especially following the COVID-19 pandemic, has given considerable attention to burnout experienced by mental health professionals. Burnout is a multidimensional syndrome that has three indicators (1): emotional exhaustion (EE, fatigue that can be related to devoting excessive time and effort to a task that is not perceived to be beneficial), depersonalization (DP, distant or indifferent attitude towards work, and negative interactions with colleagues and patients), and reduced personal accomplishment (PA, negative evaluation of the worth of one's work and generalized poor professional self-esteem) for the worker. Burnout does not solely impact the wellbeing and quality of life of health professionals but also induces a decline in the quality of care provided to clients. Studies of mental health professionals have shown that this condition could be triggered by associated working stressors including overload, time pressure, understaffing, negative social climate in the workplace, conflicts with patients, job insecurity, and organizational changes. As burnout has important implications for the quality of care, it is essential that the factors which influence burnout and its implications are explored in different contexts, such as in the context of residential facilities (RFs). Workers in the field of mental health are more vulnerable to burnout, as compared with other health professionals (2) because of stigma of the profession, threats of violence from patients and patient suicide and highly demanding therapeutic relationships (3). In a systematic review and meta-analysis, O'Connor and colleagues (4) investigated the prevalence and determinants of burnout in mental health professionals highlighting that staff working in community mental health teams may be more vulnerable to burnout than those working in some other specialist community teams. The key issue that is often left out in literature is the measure of the quality of the health professionals' relationship with patients. Since both the health professional's burnout and the working alliance between them and patients are predictors of therapy outcomes, understanding how burnout affects health professionals' relationship with patients is crucial. Working Alliance (WA) is a well-established index of this relationship as it represents the degree to which a treatment dyad is engaged in collaborative work (5). This construct has an enormous literature in the field of psychotherapy, but it has not been studied in the common treatment of individuals diagnosed with severe mental illness in terms of its relationship with burnout. To our knowledge, this is the first study to investigate the link between burnout among health professionals working in psychiatric RF and WA between individuals with SSD and staff in RF. Method(s): This study is part of a large multicentric observational study conducted in Italy: the DiAPAson study. The final sample of this study includes 303 patients living in RFs (69.3% males;41.0+/-9.8 years) and 164 health workers (27.4% males;41.2+/-9.9 years) of the 99 participating RFs. After collecting sociodemographic data, standardized assessment tools including clinician-administered tools (e.g., psychiatric history, illness duration, lifetime hospitalization stay, total number of psychiatric hospitalizations in the last year, time in the RF, antipsychotic therapy, Brief Psychiatric Rating Scale - BPRS, and Specific Levels of Functioning Scale - SLOF) for patients and self-administered scales (the Italian version of the Working Alliance Inventory short form for Patients, WAI-P;the Italian version of the Working Alliance Inventory short form for Staff, WAI-S;and the Maslach Burnout Inventory, MBI for Staff) were collected. We investigated the relationship between sociodemographic and clinical variables, staff's burnout and working alliance. After rejecting the hypothesis of normality of the variables (by Kolmogorov Smirnov test), we computed correlation matrices calculating Spearman's correlation coefficients. We perfor ed all the analysis with SAS Studio, R and SPSS, considering a p<0.05 value as statistically significant. Result(s): The staff sample presented high mean DP (13.8+/-9.6) while no high mean EE (3+/-3.5) neither low mean PA (38.4+/-5.7) were found according to O'Connor and colleagues' indications (4). Data show significative correlations between: MBI EE and BPRS (beta=0.17;p=0.005), SLOF (beta=-0.12;p=0.048) and WAI-S (beta=-0.17;p=0.003);MBI DP and BPRS (beta=0.22;p<0.001), SLOF (beta=-0.18;p=0.003), WAI-S (beta=-0.19;p=0.001), and WAI-P (beta=-0.13;p=0.028);MBI PA and patients' education years (beta=-0.146;p=0.014) and WAI-S (beta=0.26;p<0.001). Conclusion(s): The result of our large multicentric observational study suggested that health professionals working with SSD patients reported high scores on MBI for the DP domain. This datum is particularly worrying considering the theoretical framework that in 1978 brought to the reform of the Italian Health System that abolished the Psychiatric Hospitals in favor of a community-based treatment approach where the RF where conceived as a temporal intensive approach for the treatment of the most severe conditions, specifically thought to avoid long term seclusion, institutionalization, and patients' depersonalization. In our sample the burnout, specifically higher EE and DP was associated with more severe symptomatology (as measure with BPRS) and poor socio-occupational functioning. These associations are consistent with previous reports. Lower sense of PA was instead reported in working with patients with higher education grade. This effect could be partially associated with the WA. In fact, our data reported greater sense of PA with higher scores of WA as perceived by the staff, again associated with working with patients with lower education grade. WA as perceived by the staff significantly associate with other burnout domains, being inversely correlated with EE and DP. On the other hand, WA rated by the patients was also inversely associated with DP burnout domain. Even though no causal relationship could be assumed from our data, the clear association between burnout and WA, specifically regarding the DP domain, strongly reinforce the need to further investigate the WA between health professionals and RF patients suffering from SSD. Intervention directed toward the improvement of WA could be a complementary way to improve the quality of care provided to severe SSD patients and a way to reduce burnout.

Worker Shortage, Pandemic Make Drug Diversion Easier

The article offers information on how problem of drug diversion among healthcare workers is exacerbated by lax reporting systems and hospital disincentives to alert patients and raise liability issues. Topics include how diverters can move to other facilities and avoid oversight by medical and nursing boards;how covid-19 pandemic has made drug diversion investigations harder to fund;and how longstanding problem often results in a multivictim crime after an outbreak.

An early return-to-work program for COVID-19 close contacts in healthcare during the Omicron wave in Japan

During the coronavirus disease 2019 (COVID-19) pandemic, maintaining adequate staffing in healthcare facilities is important to provide a safe work environment for healthcare workers (HCWs). Japan's early return-to-work (RTW) program may be a rational strategy at a time when there is an increased demand for the services of HCWs. We assessed whether the early RTW program for HCWs who have been in close contact with a COVID-19 case in our hospital was justified. Close contacts were identified according to the guidance document of the World Health Organization. HCWs who met all of the following conditions were eligible to apply to an early RTW program: (1) difficult to replace with another HCW, (2) received the third dose of a COVID-19 mRNA vaccine, (3) a negative COVID-19 antigen test before each work shift, and (4) consent from relevant HCWs and their managers to participate in the program. Between January and March 2022, 256 HCWs were identified as close contacts (median age, 35 years;192 female). Thirty-seven (14%) secondary attack cases of COVID-19 were detected. Among 141 HCWs (55%) who applied to the early RTW program, nurses and physicians comprised about three-quarters of participants, with a higher participation rate by physicians (78%) than nurses (59%). Eighteen HCWs tested positive for COVID-19 by the sixth day after starting the early RTW program. No COVID-19 infection clusters were reported during the observation period. These findings suggest that the early RTW program for COVID-19 close contacts was a reasonable strategy for HCWs during the Omicron wave. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

States: End HCW COVID-19 Vaccine Mandates

The article discusses that 22 states have joined to petition Centers for Medicare & Medical Services (CMS) to stop mandating Covid-19 vaccines for healthcare workers. It discusses that CMS does not require the new bivalent Covid-19 booster for healthcare workers;and mentions that whether the SARS-CoV-2 bivalent immunization can blunt the threat to healthcare workers and patients, particularly since the viral iterations have shown the ability to escape vaccine immunity.

Nursing staff and the development of nursing services during the COVID-19 pandemic.

The availability of sufficient, efficient nursing staff and the development of nursing services are crucial in the provision of high quality care to healthcare services users. Provision of adequate nursing staff is of vital importance as it affects patient outcomes and safety. Limited nursing staff and a low ratio of nurses per patient are associated with an increased risk of patient death. Understaffing affects the staff members themselves, the patients and the health-care organizations, and, internationally, measures focusing on setting a safe nurse-to-patient ratio have been devel-oped. Factors that increase the need for nursing staff are the increasingly demanding nursing care of patients in hospitals following advances in technology, the ageing of the population, and the increasing numbers of patients and their co-morbidities. The COVID-19 pandemic constitutes a new significant determinant of increase in the need for qualified nursing staff. The COVID-19 pandemic has caused major organizational issues in healthcare systems world-wide, even in the developed countries with their reasonably well-organized primary and secondary healthcare sys-tems. Staffing plans during the COVID-19 pandemic should focus on the care needs of patients with COVID-19, and should include the deployment and allocation of skilled clinical staff. Healthcare systems internationally need to take immediate and effective action regarding the availability of qualified nursing staff, to be better prepared for future public health threats. Copyright © Athens Medical Society.

The Cost of Ignoring Vaccines

This perspectives piece focuses on the detrimental cost of ignoring vaccines and refusing vaccination against COVID-19 in the United States. Much of the existing literature regarding the consequences of the unvaccinated emphasizes the impact to population health;however, few academic articles have explored the burden the unvaccinated pose to various sectors of society. This paper analyzes the impact that the unvaccinated have on healthcare systems, the US economy, and global health. Throughout the COVID-19 pandemic, unvaccinated populations were found to have put significant strain on healthcare systems, depleting medical resources and contributing to high rates of healthcare worker shortages. Furthermore, research suggests that between November and December 2021, over 692,000 preventable hospitalizations occurred in unvaccinated individuals, costing the US economy over $13.8 billion. Lastly, it is proposed that the strong international presence of the US, when coupled with high levels of disease transmissibility in the unvaccinated, provides a significant threat to global health. In conclusion, the unvaccinated have caused impacts far beyond that of population health;they have also posed a burden to healthcare systems, the economy, and global public health. Copyright © 2022, Yale Journal of Biology and Medicine Inc. All rights reserved.