ABSTRACT
BACKGROUND: A large portion of COVID-19 cases and deaths in the United States have occurred in nursing homes; however, current literature including the frontline perspective of staff working in nursing homes is limited. The objective of this qualitative assessment was to better understand what individual and facility level factors may have contributed to the impact of COVID-19 on Certified Nursing Assistants (CNAs) and Environmental Services (EVS) staff working in nursing homes. METHODS: Based on a simple random sample from the National Healthcare Safety Network (NHSN), 7,520 facilities were emailed invitations requesting one CNA and/or one EVS staff member for participation in a voluntary focus group over Zoom. Facility characteristics were obtained via NHSN and publicly available sources; participant demographics were collected via SurveyMonkey during registration and polling during focus groups. Qualitative information was coded using NVIVO and Excel. RESULTS: Throughout April 2021, 23 focus groups including 110 participants from 84 facilities were conducted homogenous by participant role. Staffing problems were a recurring theme reported. Participants often cited the toll the pandemic took on their emotional well-being, describing increased stress, responsibilities, and time needed to complete their jobs. The lack of consistent and systematic guidance resulting in frequently changing infection prevention protocols was also reported across focus groups. CONCLUSIONS: Addressing concerns of low wages and lack of financial incentives may have the potential to attract and retain employees to help alleviate nursing home staff shortages. Additionally, access to mental health resources could help nursing home staff cope with the emotional burden of the COVID-19 pandemic. These frontline staff members provided invaluable insight and should be included in improvement efforts to support nursing homes recovering from the impact of COVID-19 as well as future pandemic planning.
Subject(s)
COVID-19/epidemiology , Caregivers , Nursing Homes , Pandemics , Adult , Female , Health Facilities , Humans , Male , Middle Aged , Nursing Staff , Risk Factors , Young AdultABSTRACT
SIGNIFICANCE: Because patients with HIV have increased life expectancies with the advent of new drug therapies, complications from iatrogenic syndromes such as drug toxicity can occur. Ritonavir-induced retinal toxicity is one such complication but has rarely been reported in the literature. PURPOSE: This case report describes a patient with bilateral maculopathy and bone spicule-like pigmentary changes in the midperipheral retina due to ritonavir use. In addition, novel optical coherence tomography findings are described. CASE REPORT: A 53-year-old man presented with gradual-onset blurry vision and difficulty seeing at night. He had been diagnosed as having HIV infection 19 years prior and had previously taken ritonavir for 7 years as part of highly active antiretroviral therapy. Best-corrected acuities were 20/30 in the right eye and 20/25 in the left eye. Clinical examination revealed a subtle annular pattern of retinal pigment epithelium mottling around the fovea and bone spicule-like pigment changes in the midperiphery of both retinas. Optical coherence tomography imaging revealed abnormal subfoveal hyperreflectivity of the ellipsoid zone with relative attenuation centrally, annular parafoveal ellipsoid zone loss, and punctate hyperreflectivity within the ellipsoid zone more eccentrically. Fundus autofluorescence in both eyes showed annular hyperautofluorescence in the parafoveal region, geographic hyperautofluorescence in the areas underlying the midperipheral pigmentary changes, and discrete patches of hyperautofluorescence along the far inferotemporal arcades in areas that appeared normal with biomicroscopy. A diagnosis of retinal toxicity secondary to ritonavir use was made based on the patient's history and clinical examination. CONCLUSIONS: Ritonavir retinal toxicity seems to be an uncommon adverse event that can cause decreased visual function. This case report provides further evidence of the retinal toxicity and reviews the reported clinical and optical coherence tomography manifestations of the disease.
Subject(s)
HIV Infections/drug therapy , HIV Protease Inhibitors/toxicity , Retina/drug effects , Retinal Diseases/chemically induced , Ritonavir/toxicity , Vision Disorders/chemically induced , Antiretroviral Therapy, Highly Active , Fluorescein Angiography/methods , Fundus Oculi , Humans , Male , Middle Aged , Retina/diagnostic imaging , Retinal Diseases/diagnostic imaging , Tomography, Optical Coherence/methods , Vision Disorders/diagnosis , Visual AcuityABSTRACT
An alarming number of drownings occur in lifeguarded swimming areas, where one might presume swimmers are protected from injury. One reason drownings occur in lifeguarded swimming areas is because lifeguard surveillance is a highly difficult task. Observational research suggests lifeguards are usually alert, but researchers also report egregious examples of inattention. We offer three strategies that have initial empirical support to reduce risk of drowning at lifeguarded swimming areas: (a) regular training to help lifeguards recognize they are vulnerable to drowning events and to raise their confidence; (b) regular practice via simulated emergency responses, and (c) addressing staff schedules so lifeguards can devote full attention to protecting swimmer safety while on duty.
