Trauma and Distress on a Cruise during the COVID-19 Pandemic: A Qualitative Study with Italian and French Tourists

The COVID-19 pandemic has drastically changed our daily lives. One of the sectors most affected was tourism and travel – and, more specifically, cruises, given the prolonged time passengers spend with others within the small spaces of the cruise ship. While finding well-organised entertainment opportunities on cruises is possible, emergency conditions may cause panic. On such occasions, reactions can be highly stressful or even traumatic. This research explores the events and emotions experienced by passengers during a cruise ship quarantined for COVID-19. The empirical materials consist of interviews with 15 passengers. The analyses show four thematic areas: fear of contagion, feelings of discrimination, cooperation between passengers and relationship with the crew. The problems during a cruise ship quarantine presented by the passengers in this study reveal the need for psychological preparation for the crew and security personnel. Finally, we suggest that telemedicine and telepsychology are key elements to improve the efficiency of behavioral control on cruise ships and to mitigate the COVID-19 effects on tourists' well-being during a quarantine. © 2023 by the author.

Finding Strength in Times of Crisis? Post-Traumatic Growth During the Covid-19 Pandemic: A Saudi Arabian Perspective

This paper contributes to the Covid-19 literature by exploring the concept of post-traumatic growth (PTG) utilizing a mixed methods approach. The study examines to what extent the participants experienced positive growth and renewal arising from the prolonged period of lockdowns and emergency online learning. Exploring the experiences of 552 female undergraduate students in a private Saudi Arabian university, an online survey was utilized to gather the data. All the students had experienced online education as a result of the pandemic. The findings indicate the participants underwent a diversity of personal growth experiences. In addition, they also developed different coping mechanisms. The study provides insights into the responses of the students to the issues they were facing during the pandemic. It identifies ways in which participants experienced personal growth as well as a shift in perspective about their lives. There are implications for educators, counselors and policymakers emerging from this study. AD -, Kingdom of Saudi Arabia ;, Netherlands ;, Kingdom of Saudi Arabia

Evaluation of Microbiological Culture and Antibiogram of the Patient with Corneal Ulcer due to Exposure Keratitis in the Intensive Care Unit in Sina Farshchian Hospital (2019-2020)

Background: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.

Professional Experience in Times of COVID-19

This study examined the preparedness and capabilities of pre-service teachers in the midst of the COVID-19 pandemic when many schools were teaching online. The university curriculum was adapted to enable pre-service teachers to explore suitable pedagogies to not only teach remotely but to engage their students using contemporary technology-based learning materials. The school in this study was in a low socio-economic area with diverse students, many with a language back-ground other than English. This study was thus positioned at the intersection of what is known as trauma-informed education, professional learning and the resilience of both practising and pre-service teachers. The study used a case-study method-ology with data collected from online surveys and group interviews on Zoom. The participants were pre-service teachers from the university and staff, including super-vising teachers, from the school. The data from both the surveys and the group inter-views were analysed thematically, guided by a theoretical framework addressing the intersection of resilience, trauma-informed education, and professional learning. Resilience in coping with the unusual classroom context was enhanced by the smaller number of students in class;the greater range of life experiences of the more mature pre-service teachers;and the skills and experience of the school's teachers to support and mentor the pre-service teachers. The guidance provided by the university in conjunction with the experience of the school's teachers enhanced the pre-service teachers' ability to manage trauma-affected students. The greatest source of trauma was when students who were learning remotely returned to school as they struggled to catch up on work missed and the mental-health issues that resulted. Pre-service teachers stated that as a result of the combination of the adapted university course work and the practical learning during professional experience their preparedness was significantly enhanced. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2023, corrected publication 2023.

Writing and reading fiction behind the lines: Creative learning on the home front

The purpose of this paper is to investigate writing and reading that would engage postsecondary students under crisis conditions in which face-to-face peer and teachers' support might not be available. In this project, I am looking at how students can use writing and reading fiction to understand their own experiences in being locked down during the COVID-19 pandemic. Starting with a one-paragraph short story to a fully developed narrative with plot, characterization, theme, and narrative voice, writing assignments lead to a growing realization of how reflection and writing emerge from the body, the mind, and the imagination. Reading a novel, Deafening (2003), by Frances Itani, shows students how a writer links battle scenes from World War I to the flu epidemic on the home front. © Springer Nature Switzerland AG 2021. All rights reserved.

THE EFFECT OF COVID-19 PANDEMIC ON THE FREQUENCY OF SPINAL TRAUMA: AN EPIDEMIOLOGICAL STUDY

Objective: This study aims at comparing the patients with spinal trauma in the Coronavirus disease-2019 pandemic era and pre-pandemic era. Materials and Methods: Patient records for a 9-month period of pandemic (April 1, 2020 - December 31, 2020) and the same period of the previous year (April 1, 2019 - December 31, 2019) were retrospectively collected. These 2 periods were compared in terms of the total number of patients with spinal trauma, the type of injuries, the level of injuries in the spine, the treatment methods applied, and whether there was a neurological deficit. The first group was called as pandemic group (PG) and the latter as control group (CG). The differences between them were statistically examined. Results: The study sampled 278 patients (CG: 203 patients, PG: 75 patients). It was detected that the number of patients with spinal trauma in the PG dropped by 60% compared to the CG. The most frequent cause of spinal trauma for both groups was traffic accidents. No statistically significant difference was detected in terms of the type, level and severity of injuries, neurological examination findings and method of treatment (p>0.05). However, the rate of indoor or outdoor falls were significantly different between the two groups (p=0.002). Conclusion: It has been determined that the pandemic-induced social isolation and lockdown process is an important factor in the primordial prevention of spinal trauma. With the result obtained, we think that if adequate and correct measures are taken, the number of spinal traumas will continue to remain low in the post-pandemic period as well. © Copyright 2022 by the Turkish Spine Society/The Journal of Turkish Spinal Surgery published by Galenos Publishing House.

The danger of inappropriate use of personal protective equipment

The coronavirus pandemic is a global health emergency which has had widespread unforeseen mental health consequences. Those with borderline personality disorder are predisposed to poor coping strategies to manage such stress and require intense psychological input which was not widely available during the peak of the pandemic. It is likely that the coronavirus outbreak has had a significant impact on the mental stability of such patients aggravating deliberate self-harm behaviours. A 20-year old psychiatric in-patient with borderline personality disorder, held under Section III of the mental health act, presented to the adult plastic surgery team in Bristol with localised infection of her right forearm. Foreign bodies were easily palpable and imaging revealed linear metal objects. The patient reported that she had removed metal strips from her collection of face masks and inserted them into her forearm as an act of deliberate self-harm. The patient was taken to operating theatre for removal of these foreign bodies under general anaesthetic. After twenty-four hours of antibiotics she was discharged safely back to the psychiatric ward. Despite the epilogue of the COVID-19 pandemic facemasks are still mandatory within the hospital setting. Clinicians need to be aware of these unusual circumstances where a form of protective equipment was deconstructed to cause actual bodily harm. The purpose of this report is to promote awareness of this type of injury especially in those suffering from mental illness. The authors would suggest an alternative mask without any form of metal.

COVID-19 and dermatology

The aim of this manuscript is to investigate skin diseases associated with COVID-19 under three main headings: skin problems related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections, and skin findings due to COVID-19 treatment agents. In PubMed and Google Scholar databases, publications on skin lesions related to personal protective equipment and personal hygiene measures, skin findings observed in SARS-CoV-2 virus infections and skin findings due to COVID-19 treatment agents subjects were searched in detail. Pressure injury, contact dermatitis, pruritus, pressure urticaria, exacerbation of preexisting skin diseases, and new skin lesion occurrence/new skin disease occurrence may be due to personal protective equipment. The incidence of skin lesions due to COVID-19 was reported to be between 0.2% and 29%. Many skin lesions including maculopapular, urticarial, vesicular, chilblain-like, thrombotic/ischemic, etc., are observed in COVID-19 patients. Some authors have stated that there is an absence of SARS-CoV-2 virus infection-specific skin rashes. Many skin lesions may appear as a result of COVID-19. Even in the absence of a COVID-19 diagnosis, skin findings should be evaluated carefully in the pandemic period.

A Case Report on Heart Rate Variability Biofeedback and Postconcussion Syndrome: Healing the Autonomic Nervous System

Postconcussion syndrome is a devastating condition of the mind, body, and even personality. Mounting research demonstrates that heart rate variability biofeedback can help the concussed individual in three critical ways: (a) eliciting high amplitude oscillations in cardiovascular functions and thereby strengthening self-regulatory control mechanisms;(b) restoring autonomic balance;and (c) increasing the afferent impulse stream from the baroreceptors to restore balance between inhibitory and excitatory processes in the brain.

Transformation of an independent sector treatment centre to a regional trauma centre during COVID pandemic

ContextOn the 11th March 2020, the WHO declared SARS-CoV-2 (COVID) outbreak a global pandemic. Healthcare facilities in the UK faced an unprecedented challenge of managing the outbreak, whilst maintaining basic healthcare services such as cancer and trauma. The NHS and independent sector partnership allowed a safe work stream, a relationship that continues now to support the elective recovery coming out of the pandemic.Issue/ChallengeReorganisation of healthcare provision led to the transformation of Practice Plus Group (PPG) hospital, Ilford to a green site for Barking Havering and Redbridge NHS University Trust (BHRUT) trauma service from 30/03/2020 to 10/06/2020. PPG Hospital had to rise to the challenge mobilising quickly from an elective service to a trauma unit serving a local population of over 1 million. The hospital transformed over one weekend, mobilising staff and equipment to deliver a trauma service. Their service went on to exemplify gold standard treatment of the very sick. The unit responded, adapted and developed outpatient clinics, plaster room, trauma ward and theatres to manage COVID-negative trauma cases that BHRUT received.Assessment of issue and analysis of its causesClinical staff had to upskill to take on the very sick (ASA 4) who may require end organ support, to carry out trauma surgery and procedures that were never performed before at the unit. Surgeons and surgical trainees from the trust became part of the multidisciplinary collaboration whilst the senior leaders developed a strong relationship to ensure good governance throughout the period. All of PPG staff had to get involved in ward care. Staff were trained with regards to personal protective equipment (PPE), Aerosol generating procedures (AGPs), pressure area care and applying traction to realign bones as some of the examples. The staff involved came from the following groups: theatre staff, outpatient staff, the anaesthetic consultants, ward staff, endoscopy, pharmacy, physio, housekeeping, infection control and portering.ImpactConsultant anaesthetists had a steep learning curve to both update their trauma knowledge and sharpen their skills. The guidelines of fracture hips were reviewed. The weekly teaching meetings’ topics were all about anaesthesia for emergency surgery, trauma and COVID. Anaesthetic work rota modified to provide a suitable recovery time following long days in theatres. The necessity of rest periods improves immunity.InterventionThere were some logistic hurdles, including the lack of availability of a suitable meeting facility that can accommodate a large number of attendees. There was a need to have a combined meeting with the BHRUT team in the red zone. On the first day, the meeting was carried out on the ‘ZOOM’ platform on smart phones. Within a couple of days. The trauma meeting was held in the capacious theatre reception, using a wall-mounted big screen for audio-visual display. This allowed better communication with all clinical teams including orthopaedic surgery, anaesthesia, nursing and coordinators.Involvement of stakeholders, such as patients, carers or family members:The PPG team implemented the pillars of clinical governance to improve the quality of care. The virtual monthly morbidity meeting included clinicians from all disciplines. A brief update of previous monthly data was reviewed. An initial internal audit showed that the average anaesthetic start time was 09:39. 19 lists (out of 23, 83%) started even after 09:15. The identified causes for this delay included late sending time, and the patient not being ready at the ward due to longer pre-operative checks and staff shortage. A ‘Golden Patient' was not always identified. A collaborative multi-disciplinary approach aimed to streamline the admission processes to ensure availability of both the surgical team and the patient to ensure a prompt theatre start. A repeat audit confirmed that the average anaesthetic start time has become 09:03. Only four out of 24 lists had an anaesthetic start time of 09:15 or later (17%). Th t is an Improvement of 69%.Key MessagesAs COVID created so much pressure on BHRUT, we quickly formed a positive can do working relationship both clinically and managerially to set up the Trauma service in just a few days. The 30 day mortality rate of patients with fracture neck of femur was less than the national average. This positive approach has enabled us to continue working together to help ease pressure off the lengthy patient waiting lists in Orthopaedics and General Surgery.Lessons learntPPG was proud to receive many compliments from patients and BHR staff. A patient wrote ‘I am so humbled and impressed by the amazing team-work and skill of the staff here that I want to congratulate you on what is an outstanding success amongst all the many stories coming out of the corona pandemic. Watching the way in which staff from so many different departments and skills bases are coming to this ward and learning nursing techniques with humility and patience as well as bonding in an upbeat, joyful team is something I will always remember. A surgical trainee mentioned The Independent Sector Treatment Centre (ISTC) team has been absolutely excellent so far. They have made us feel welcome and have worked hard to optimize the service'. This COVID cooperation paved the way for the ongoing cooperation between BHR and PPG, Ilford.Measurement of improvementThe outcome data shows that the service was able to successfully manage fractured neck of femur with better outcomes against national KPI. During the period from 30/03/20 to 10/06/2020, 85 patients had surgery for an emergency fracture neck of femur (Table 1). At PPG, the 30 days mortality rate was 3.5%. The national mortality rate for patients with fracture neck of Femur was 6.1%.75 patients with fracture neck of femur had surgical fixation within 36 hours.Strategy for improvementCollaborative cooperation between NHS and PPG led to set up of new pathways, governance and processes that enable patients to be transferred directly to us as well as creating capacity for BHRUT surgeons to operate in our hospital, supported by our theatre and ward teams.

The Impact of COVID-19 on Surgical Disease

The impact of COVID-19 on surgical disease has been transformative. The complete extent of its impact is unlikely to be fully understood for decades to come. New surgical disease processes, many still being elucidated, have emerged as both a direct result of COVID-19, as well as sequelae from the pathophysiologic response to the disease. The most notable consequences include hypercoagulability due to COVID-19 as well as a predilection for gastrointestinal tract pathology. The perioperative sequelae of the novel COVID-19 virus on surgical disease remain unknown, but evidence suggests this disease increases perioperative risk. Perhaps just as concerning, are the economic impacts and paradigm altering consequences that have been felt. Elective surgeries ground to a halt, trauma activations experienced sharp upswings and downswings, and visits to doctors in general have taken a sharp downturn. This has led to delays in diagnosis and treatment, increases in morbidity and mortality, and dramatic changes in how surgical services around the world are run. This global pandemic will forever change how surgery is practiced and shape our profession for decades to come. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

The creative container: Supervision and schools in a time of trauma

This article explores creative supervision with Headteachers and Senior Leaders following the Covid-19 pandemic. It examines the effects of a global trauma on schools and the need for effective supervision to provide a safe container for school staff. Different forms of creative supervision are considered, including the use of symbol and metaphor as well as working outdoors, in nature. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Nobody's child: Managing mental trauma of children with mental health issues

The world has not yet seen the end of COVID-19 or SARS-CoV-2. However, as the spate of infection, hospitalization, and death abates, we are limping back to what we used to know as being normal. A new world is emerging, and more of this newness is yet waiting to be discovered. Children are developing differently, parents are unable to provide the necessary psychological and social support, there is hardly any peer interaction yet, and adults in their lives are too preoccupied with their own distresses to give the kind of support a growing child needs. In many situations, children are being allowed to almost fend for themselves in social and familial areas and in the area of cognitive development and these will surely show their true colors in the years to come. On a positive note, the nearly-post-COVID-19 world has witnessed children displaying an array of coping mechanisms leading to post-traumatic growth (PTG). It is heartening to note that the human psyche has the ability to overcome distress and disaster and forge ahead in a positive manner. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The Whole Story: A Black Principal's Experience with Race, Racism, and Racial Trauma

Principal Harris, a new Black male principal at Merion High School, has found himself under fire for allegedly promoting critical race theory (CRT). He has received several forms of pushback as he navigates district and state mandates, racial trauma, invisible taxes, and microaggressions. Unfortunately, his best intentions are not good enough. This case is designed to display the various factors Black principals face in schools and districts amid ongoing public health crises (e.g., COVID-19 and racism). I describe the layered role of race, racism, and racial trauma on Principal Harris through his reflections and responses to stakeholders.

Isolated Hyoid Fracture Associated with Blunt Trauma

Trauma-related hyoid fractures are rare entities. These fractures represent only 0.002% of head and neck region fractures. Victims of hanging and strangling constitute the great majority of cases. Fractures associated with trauma are extremely rare. These fractures are difficult to diagnose and can easily be overlooked during physical examination. However, they are also important traumas since airway safety is endangered in these rare cases. We describe a case of a young male presenting with isolated neck injury associated with hitting an electric cable while riding a motorbike. Tenderness was present in the anterior neck region at physical examination, but movement was not restricted and no respiratory difficulty was determined. Isolated hyoid fracture was detected at tomography of the neck performed in the emergency department. Hyoid bone fractures should not be forgotten in patients with pain and tenderness in the anterior neck region following blunt trauma to the neck.©Copyright 2020 by Emergency Physicians Association of Turkey - Available online at www.jemcr.com.

Everybody hurts - What can physical health professionals learn about how mental health professionals support their own emotional resilience and mental health?

The physical aspects of ultrasonography, difficult posture with prolonged pressure exertion, have been extensively researched and addressed with advances in machine ergonomics, operator awareness of posture and positioning and workplace tools to identify musculoskeletal problems. The mental stresses are less well recognized and have only recently started getting investigated. Ultrasonography is a mentally challenging activity requiring long periods of intense concentration, empathy and communication of complex and often difficult information to patients and clinicians, all of which carries an emotional toll. Practitioners are also under increasing time and caseload pressures exacerbated by COVID recovery and chronic fatigue from two years of pandemic. A survey of UK obstetric sonographers showed 92.1% and 91.0% met the burnout thresholds for exhaustion and disengagement, respectively).1 While many Trusts provide training to support physical health, few radiology departments educate their staff on emotional resilience or offer regular support to either promote or maintain mental wellbeing. Training, when available, is often focused on the receiver and not on the impact of vicarious traumas experienced as a result of repeatedly discovering/delivering difficult outcomes to patients on a regular and prolonged basis. Few health professionals are face-to-face with their patient at point of significant discovery whether that information is imparted to the patient or not. Mental health professionals have adopted a traumainformed stance into their working practices. This has not only informed the direct clinical work with patients but is also evident in the way the workforce is supported by the trust. Regular supervision, reflective practice and debriefs are required and monitored by the trust, based on research in clinical psychology to inform best practice. Some of these practices could be applied to physical health professionals to address some of the emotional burdens experienced as part of day-to-day delivery of care.

Trauma Informed Educational Practices: An Educational Innovation for Graduate Nursing Students

[...]the most recognized definition, as espoused by the Substance Abuse and Mental Health Services Administration fSAMHSA. 2014). is the response of an individual to an event, series of events, or set of circumstances that is perceived as physically or emotionally harmful or threatening. Examples of circumstances that are potentially traumatic include emotional, physical, or sexual abuse;sudden separation from a loved one;childhood neglect;family members with a mental health condition;poverty;and discrimination (Center for Health Care Strategies. 2017). Findings of the Adverse Childhood Experience (ACE) Study indicated that exposure to trauma increases the likelihood of health-risk behaviors as well as a person's lifetime risk for chronic health conditions such as autoimmune disorders, depression, heart disease, liver disease, lung disease, obesity, sexually transmitted diseases, and substance use disorders. (2022) assert that there is a significant need to incorporate traumainformed practices within graduate nursing curriculum to address mental health concerns that graduate nursing students struggle with during their programs of study.

The effect of coronavirus disease-19 lockdown on the incidence and profile of penetrating ocular injuries

Background: Perforating ocular injuries in particular carry a high risk of visual morbidity in all age groups. Risk factors associated with ocular trauma include gender, age, occupation, and lower socioeconomic status. Eye injuries are causing a major concern to the general ophthalmologists both in the developed and developing countries. Background: The objective of this article is to study the profile of penetrating ocular injuries before and during the period of lockdown. Materials and Methods: A study was done to make a comparative analysis of the penetrating ocular injuries occurring during the period of lockdown of 3 months (April 1, 2020-June 30, 2020) and 3 months (January 1, 2020-March 31, 2020) before lockdown. Results: The study included 33 patients hospitalized before lockdown and 45 hospitalizations during the lockdown in all age groups. Injuries were more common in males. The injuries reported in the age group of 0-15 years before lockdown were 36.36% while during lockdown 60% injuries were observed. Modes of injuries reported before lockdown were indoor injuries (36.36%) and road traffic accidents (36.36%) while during lockdown, the major mode of injuries were indoor injuries (76.6%) whereas the road traffic accidents (10.0%) declined. Conclusion: During the lockdown, indoor injuries were more common in comparison to the outdoor injuries such as road traffic accidents, the latter being more prevalent before lockdown. During lockdown, increase in the indoor leisure activities of children led to a rise in the cases of eye injuries and an increase of almost double the number was observed. In addition to this, immobilization led to a decrease in the injuries due to road traffic accidents. The coronavirus disease-19 lockdown did have an impact on the profile of penetrating ocular injuries.

Impact of COVID-19 Governmental Restrictions on Emergency General Surgery Operative Volume and Severity.

BACKGROUND: To describe the effect of the COVID-19 pandemic on emergency general surgery operative volumes during governmental shutdowns secondary to the pandemic and characterize differences in disease severity, morbidity, and mortality during this time compared to previous years. METHODS: This retrospective cohort study compares patients who underwent emergency general surgery operations at a tertiary hospital from March 1st to May 31st of 2020 to 2019. Average emergent cases per day were analyzed, comparing identical date ranges between 2020 (pandemic group) and 2019 (control group). Secondary analysis was performed analyzing disease severity, morbidity, and mortality. RESULTS: From March 1st to May 31st, 2020, 2.5 emergency general surgery operations were performed on average daily compared to 3.0 operations on average daily in 2019, a significant decrease (P = .03). No significant difference was found in presenting disease severity, morbidity, or mortality between the pandemic and control groups. DISCUSSION: This study demonstrates a decrease of 65% in emergency general surgery operations during governmental restrictions secondary to the COVID-19 pandemic. This decrease in operations was not associated with worse disease severity, morbidity, or mortality.