A cross-sectional study on bacterial contamination on the touchscreens and posterior surfaces of smartphones of emergency department staff.

RATIONALE, AIMS AND OBJECTIVES: Cleaning smartphones of healthcare workers (HCWs) is generally recommended; however, most previous studies on bacterial contamination of smartphones assessed touchscreens alone. This study compared the prevalence of bacterial contamination on touchscreens and posterior surfaces of smartphones owned by HCWs. METHOD: A cross-sectional study of smartphones used by HCWs working at an emergency department (ED) at a Japanese tertiary care hospital was conducted. Bacteria on each surface of the smartphones were isolated separately. Descriptive statistics were used to describe the prevalence of microbial contamination on each surface of the smartphones and the types of associated bacterial species. Fisher's exact test was used to compare dichotomous outcomes. RESULTS: The smartphones of 40 HCWs working in the ED of a Japanese tertiary care hospital were examined. The touchscreens and posterior surfaces were contaminated in 26 (65.0%) and 36 (90.0%) smartphones, respectively, indicating the posterior surface was more frequently contaminated (p = 0.014). Bacillus species and coagulase-negative staphylococci were most frequently isolated from each surface of the smartphones. CONCLUSIONS: The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen. Both surfaces of smartphones need to be cleaned to prevent bacterial contamination in healthcare environments.

An approach from the neck to drain expanding pneumomediastinum: a case report.

Background: Several methods for draining pneumomediastinum have been advocated, but no consensus has been established. We propose a novel method for draining air from pneumomediastinum. Case Description: We used an approach from the neck to drain pneumomediastinum that had started to compress the heart in a 33-year-old man with coronavirus disease 2019 (COVID-19) on mechanical ventilation. Computed tomography showed extension of pneumomediastinum to the lateral and dorsal aspects of the right sternocleidomastoid muscle, presenting as subcutaneous emphysema at the neck. We made a 4-cm incision lateral to the right sternocleidomastoid muscle. After incising the platysma muscle, the dorsal side of the sternocleidomastoid muscle was easily stripped off due to the presence of air, allowing placement of a 14-Fr Nelaton catheter. Subcutaneous emphysema as well as pneumopericardium on X-rays improved and disappeared by 3 days after starting drainage. Positive end-expiratory pressure (PEEP) was titrated in a stepwise manner from 6 to 10 cmH2O, with no re-appearance of subcutaneous emphysema. The Nelaton catheter at the neck was removed and the skin was sutured using 3-0 Nylon monofilament. Conclusions: We propose this approach from the neck to release air and prevent deterioration of pneumomediastinum communicating with subcutaneous emphysema at the neck.

Providing End-of-Life Care for Patients Dying of COVID-19 and Their Families in Isolated Death During the Pandemic in Japan: The Providing End-of-life Care for COVID-19 Project.

BACKGROUND: Death resulting from COVID-19 in a hospital during the pandemic has meant death in isolation. Although many health-care providers (HCPs) have struggled with end-of-life (EOL) care for these patients, the various strategies across hospitals are not well known. RESEARCH QUESTION: What EOL care did HCPs give patients dying of COVID-19 and their families in hospitals during the COVID-19 pandemic? What were the key themes in care? STUDY DESIGN AND METHODS: This qualitative study used individual, semistructured, internet, and face-to-face interviews. We recruited HCPs who provided EOL care to patients with COVID-19 dying in hospitals and their families. Purposive sampling was used through the academic networks at the School of Public Health, Kyoto University. Anonymized verbatim transcripts were analyzed thematically. RESULTS: Fifteen doctors and 18 nurses from 23 hospitals in 13 regions across Japan participated; 16 participants (48%) were women, with an age range of 20 to 59 years (most were 30-39 years of age ). Participants described 51 strategies, including providing physical and psychological-spiritual care, making connections, providing death care, and arranging care environments and bereavement care for patients and their families. Four themes emerged as prominent efforts in COVID-19 EOL care: maintaining relationships with isolated patients, connecting patients and families, sharing decision-making in isolation, and creating humanistic episodes. INTERPRETATION: Proper application and awareness of the four themes may help HCPs to implement better EOL care. To compensate for limited memories resulting from isolation and rapid progression of the disease, communicating and creating humanistic episodes are emphasized. ICU diaries and the HCPs' arrangements based on cultural funerary procedures could be provided as grief care for the family and to build trust. EOL education and building partnerships among palliative care staff and nonmedical personnel on a regular basis may enhance the capacity to deliver the necessary support for EOL care.

Burnout and Turnover Intention in Critical Care Professionals During the COVID-19 Pandemic in Japan: A Cross-sectional Survey.

RATIONALE: The prevalence of burnout among critical care professionals during the coronavirus disease (COVID-19) pandemic varies in different countries. OBJECTIVES: To investigate the prevalence of burnout and turnover intention in Japanese critical care professionals in March 2021. METHODS: This cross-sectional study used a web-based survey of Japanese critical care professionals working in 15 intensive care units in 15 prefectures. Burnout was measured using the Mini Z 2.0 Survey. Intention to leave (turnover intention) was assessed by survey. Resilience was measured using the Brief Resilience Scale (Japanese version). Demographics and personal and workplace characteristics were also collected. RESULTS: Of 1,205 critical care professionals approached, 936 (77.6%) completed the survey. Among these, 24.3%, 20.6%, and 14.2%, reported symptoms of burnout, depression, and anxiety, respectively. A total of 157 respondents (16.8%) reported turnover intention. On multivariate analysis, higher resilience scores (odds ratio [OR]: 0.90, 95% confidence interval [CI]: 0.84-0.95; and OR: 0.94, 95% CI: 0.91-0.96) and perceived support from the hospital (OR: 0.64, 95% CI: 0.44-0.93; and OR: 0.54, 95% CI: 0.40-0.73) were associated with a lower odds of burnout and turnover intention, respectively. CONCLUSIONS: Approximately 24% and 17% of the Japanese critical care professionals surveyed had symptoms of burnout and turnover intention from critical care, respectively, during the COVID-19 pandemic. Such professionals require organizational level support to cultivate both individual and organizational resilience to reduce burnout and turnover intention.

Work‐related stress and coping methods of internists and primary care physicians during the COVID‐19 pandemic in Japan: A mixed‐method study

Background The COVID‐19 pandemic has affected the mental health of health care workers. This study aimed to investigate the stress factors that cause burnout in Japanese physicians and their coping methods during the COVID‐19 pandemic. Methods We conducted a sequential explanatory mixed‐method study to investigate the psychological responses of physicians in the early stages of the pandemic. A cross‐sectional, web‐based, anonymous survey was conducted among members of the American College of Physicians Japan Chapter to quantitatively investigate the stress factors and prevalence of burnout. An open‐ended questionnaire with questions about stress factors and coping methods was additionally administered. The qualitative data were analyzed using qualitative content analysis. Results Among the 1173 physicians surveyed, 214 (18.2%) responded. Among the participants, 107 (50.0%) responded “yes” to the question “I feel or have felt very stressed at work during the COVID‐19 pandemic,” and 68 (31.8%) reported burnout symptoms. Those who reported feeling stress (117 respondents) were asked to select 12 items of the stress factors related to COVID‐19. The most significant stress factor related to COVID‐19 was “Perceived risk of spreading COVID‐19 to family members” (n = 47). Content analysis identified 12 categories for the stress factors and 7 for stress‐coping methods corresponding to COVID‐19 (Cohen's kappa = 0.84 and 0.95, respectively). Conclusion Several distinct stressors existed during the COVID‐19 pandemic, which might be related to burnout among physicians. Practicing stress‐coping strategies, as identified in the present study, may help reduce work‐related stress and prevent burnout. In the COVID‐19‐related stress factor, a total of 12 categories and 39 subcategories were identified. ‘Material workload’, ‘Workplace relationship’, ‘Organisation’, ‘Achievement’, ‘Emotional workload’, ‘Human resource’, ‘Family’, ‘Infection control and prevention’, ‘Self‐care’, ‘Income’, ‘Infodemic’, and ‘Patient care’.

Addition of Baricitinib to COVID-19 Treatment Does Not Increase Bacterial Infection Compared to Standard Therapy: A Single-center Retrospective Study.

Objective The coronavirus disease 2019 (COVID-19) pandemic continues to spread across the world, and the utility of many drugs for treatment has been suggested. However, few studies have examined the efficacy and safety of treatment with baricitinib, remdesivir, and dexamethasone. Methods A retrospective, cohort study of patients who were admitted to Kurashiki Central Hospital in Japan between April 6 and June 29, 2021, was conducted. Differences in patients' background characteristics, clinical outcomes, and safety were investigated in the groups with and without baricitinib treatment. The primary outcome was the bacterial infection rate, and the secondary outcome was the 28-day mortality rate. An inverse probability of treatment weighting (IPTW) analysis, including 12 covariates, was used as a propensity score analysis to reduce biases. Results In total, there were 96 patients, including 43 in the baricitinib-containing therapy (BCT) group and 53 in the non-baricitinib-containing therapy (non-BCT) group. In the BCT group, the ordinal scale on admission was 2.3% with 4, 51.1% with 5, 23.3% with 6, and 23.3% with 7. In the non-BCT group, the ordinal scale was 1.9% with 3, 18.9% with 4, 58.5% with 5, 13.2% with 6, and 7.5% with 7. After adjusting by the IPTW analysis, the BCT group did not have an increased bacterial infection rate [odds ratio (OR), 1.1; 95% confidence interval (CI), 0.36-3.38; p=0.87] or 28-day mortality rate (OR, 0.31; 95% CI, 0.07-1.3; p=0.11) compared with the non-BCT group. Conclusion BCT can be administered without increasing the infection risk compared with non-BCT.

Prevalence of Burnout among Internal Medicine and Primary Care Physicians before and during the COVID-19 Pandemic in Japan.

Objective To evaluate the change in the prevalence of burnout during the COVID-19 pandemic among internists and primary care physicians in Japan, and to identify factors associated with the exacerbation of burnout among these populations during this period. Methods This was a cross-sectional study based on two web-based surveys conducted in January 2020 (before the declaration of the COVID-19 pandemic) and June 2020 (during the pandemic). The participants were internists and primary care physicians of the Japanese Chapter of the American College of Physicians. The main outcome was the change in the prevalence of burnout between before and during the "first wave" of the pandemic. We also examined factors associated with the exacerbation of burnout during this period. Results Among the 283 respondents in the first survey and 322 in the second survey, 98 (34.6%) and 111 (34.5%) reported symptoms of burnout, respectively. In June 2020, 82 respondents (25.5%) reported that their level of burnout exacerbated compared to January 2020. Only the experience of self-quarantine was associated with the exacerbation of burnout [odds ratio (OR) 3.12; 95% confidence interval (CI) 1.49-6.50; p=0.002], while being a woman, being a resident physician, and an experience of having worked in a prefecture under a state of emergency were not. Conclusions No marked change in the prevalence of burnout among internists and primary care physicians in Japan was observed during the COVID-19 pandemic as a whole. However, self-quarantine was associated with the exacerbation of the burnout level.

ANXIETY, DEPRESSION, AND BURNOUT IN CRITICAL CARE PROFESSIONALS IN JAPAN IN THE COVID-19 PANDEMIC

B Learning Objectives: b Japan faces the fifth wave of the COVID-19 pandemic as of August 2021, and the number of COVID-19 patients has increased with each wave. B Conclusions: b Critical care professionals in Japan experience psychological burden during the COVID-19 pandemic. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A pandemic recap: lessons we have learned.

On January 2020, the WHO Director General declared that the outbreak constitutes a Public Health Emergency of International Concern. The world has faced a worldwide spread crisis and is still dealing with it. The present paper represents a white paper concerning the tough lessons we have learned from the COVID-19 pandemic. Thus, an international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making. With the present paper, international and heterogenous multidisciplinary panel of very differentiated people would like to share global experiences and lessons with all interested and especially those responsible for future healthcare decision making.

Prevalence of bacterial contamination of touchscreens and posterior surfaces of smartphones owned by healthcare workers: a cross-sectional study.

BACKGROUND: Mobile phones used by healthcare workers (HCWs) are contaminated with bacteria, but the posterior surface of smartphones has rarely been studied. The aim of this study was to compare the prevalence of microbial contamination of touchscreens and posterior surfaces of smartphones owned by HCWs. METHODS: A cross-sectional study of smartphones used by HCWs employed at two intensive care units at a Japanese tertiary care hospital was performed. Bacteria on each surface of the smartphones were isolated separately. The primary outcomes were the prevalence of microbial contamination on each surface of smartphones and associated bacterial species. Fisher's exact test was used to compare dichotomous outcomes. RESULTS: Eighty-four HCWs participated in this study. The touchscreen and posterior surface were contaminated in 27 (32.1%) and 39 (46.4%) smartphones, respectively, indicating that the posterior surface was more frequently contaminated (p = 0.041). Bacillus species and coagulase-negative staphylococci were isolated from each surface of the smartphones. CONCLUSIONS: The posterior surface of a smartphone was more significantly contaminated with bacteria than the touchscreen, regardless of having a cover. Therefore, routine cleaning of the posterior surface of a smartphone is recommended.