"The Days Are Long But the Nights Are Even Longer": A Mixed-Method Study of Sleep Disturbances Among Patients in an Inpatient Rehabilitation Program.

Objective: To assess sleep quality of patients on a rehabilitation ward and to identify staff practices and beliefs about management of sleep disturbance. Design: Mixed-methods design including patient surveys and staff interviews. Setting: Inpatient rehabilitation ward in a tertiary teaching hospital in Adelaide, Australia. Participants: Of the 345 screened inpatients who had been in a mixed post-acute rehabilitation ward for at least 5 days, 120 (43% women) were included. The mean age was 67.7 years and the main admission reason was functional decline (40%). Patients with stroke or traumatic brain injury were excluded. Eleven (n = 11) staff (a mix of doctors, nurses, and allied health) were interviewed. Main Outcome Measures: The surveys comprised of the Pittsburgh Sleep Quality Index, the Epworth Sleepiness Scale, the Flinders Fatigue Scale, and the Sleep Inertia Questionnaire. The survey results were compared with functional outcomes using the functional independence measure (FIM). Staff interviews delved into barriers to good sleep, ward practices, and knowledge about sleep hygiene. Results: 43% of the surveyed patients reported having healthy amount of sleep. Sleep quality was not significantly correlated with rehabilitation outcomes (assessed using FIM). Staff reported having a good awareness of sleep hygiene; however, acknowledged limitations about the environment and routine which were not conducive to healthy sleep. They identified several actions which could be taken to improve patients' sleep hygiene. Conclusions: Sleep disturbance is common for patients in rehabilitation. Rehabilitation wards should address this often-neglected critical component of rehabilitation to improve patient experience and potential participation in therapy. Introducing a systematic approach for assessing sleep during admission, establishing clear roles regarding sleep assessment and intervention among staff, and ensuring that patients and staff are aware of good sleep hygiene practices may promote better sleep during inpatient rehabilitation.

Is this the solution to wellbeing and burnout management for the critical care workforce? A parallel, interventional, feasibility and realist informed pilot randomized control trial protocol.

Critical care healthcare professionals are at high risk in developing burnout and mental health disorders including depression, anxiety, and post-traumatic stress disorder. High demands and the lack of resources lead to decreased job performance and organizational commitment, low work engagement, and increases emotional exhaustion and feelings of loneliness. Peer support and problem-solving approaches demonstrate promising evidence as it targets workplace loneliness, emotional exhaustion, promotes work engagement, and supports adaptive coping behaviors. Tailoring of interventions have also shown to be effective in influencing attitudes and behavior changes, attending to the individual experience and specific needs of end-users. The purpose of this study is to assess the feasibility and user-perceived acceptability of a combined intervention (Individualized Management Plan (IMP) and Professional Problem-Solving Peer (PPSP) debrief) in critical care healthcare professionals. This protocol was registered in the Australian and New Zealand Clinical Trials Registry (ACTRN12622000749707p). A two-arm randomized controlled trial, with pre-post-follow-up repeated measures intergroup design with 1:1 allocation ratio to either 1) treatment group-IMP and PPSP debrief, or 2) active control group-informal peer debrief. The primary outcomes will be conducted by assessing the recruitment process enrolment, intervention delivery, data collection, completion of assessment measures, user engagement and satisfaction. The secondary outcomes will explore preliminary effectiveness of the intervention using self-reported questionnaire instruments from baseline to 3-months. This study will provide the interventions' feasibility and acceptability data for critical care healthcare professionals and will be used to inform a future, large-scale trial testing efficacy.

What are the essential components to implement individual-focused interventions for well-being and burnout in critical care healthcare professionals? A realist expert opinion.

Background: This study aimed to determine what, how, and under what circumstances individual-focused interventions improve well-being and decrease burnout for critical care healthcare professionals. Method: This realist approach, expert opinion interview, was guided by the Realist And Meta-narrative Evidence Synthesis: Evolving Standards II (RAMESES II) guidelines. Semi-structured interviews with critical care experts were conducted to ascertain current and nuanced information on a set of pre-defined individual interventions summarized from a previous umbrella review. The data were appraised, and relationships between context, mechanisms, and outcomes were extracted, which created theory prepositions that refined the initial program theory. Results: A total of 21 critical care experts were individually interviewed. By understanding the complex interplay between organizational and personal factors that influenced intervention uptake, it was possible to decipher the most likely implementable intervention for critical care healthcare professionals. The expert recommendation suggested that interventions should be evidence-based, accessible, inclusive, and collaborative, and promote knowledge and skill development. Unique mechanisms were also required to achieve the positive effects of the intervention due to the presence of contextual factors within critical care settings. Mechanisms identified in this study included the facilitation of self-awareness, self-regulation, autonomy, collaboration, acceptance, and inclusion (to enable a larger reach to different social groups). Conclusion: This validation of a theoretical understanding of intervention that addressed well-being and burnout in critical care healthcare professionals by expert opinion demonstrated essential mechanisms and contextual factors to consider when designing and implementing interventions. Future research would benefit by piloting individual interventions and integrating these new theoretical findings to understand better their effectiveness for future translation into the "real-world" setting.

Efficacy of Early Treatment With Favipiravir on Disease Progression Among High-Risk Patients With Coronavirus Disease 2019 (COVID-19): A Randomized, Open-Label Clinical Trial.

BACKGROUND: The role of favipiravir in preventing disease progression in coronavirus disease 2019 (COVID-19) remains uncertain. We aimed to determine its effect in preventing disease progression from nonhypoxia to hypoxia among high-risk COVID-19 patients. METHODS: This was an open-label, randomized clinical trial conducted at 14 public hospitals across Malaysia (February-July 2021) among 500 symptomatic, RT-PCR-confirmed COVID-19 patients, aged ≥50 years with ≥1 comorbidity, and hospitalized within first 7 days of illness. Patients were randomized 1:1 to favipiravir plus standard care or standard care alone. Favipiravir was administered at 1800 mg 2×/day on day 1 followed by 800 mg 2×/day until day 5. The primary endpoint was rate of clinical progression from nonhypoxia to hypoxia. Secondary outcomes included rates of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. RESULTS: Of 500 patients randomized (mean [SD] age, 62.5 [8.0] years; 258 women [51.6%]; 251 [50.2%] had COVID-19 pneumonia), 487 (97.4%) patients completed the trial. Clinical progression to hypoxia occurred in 46 (18.4%) patients on favipiravir plus standard care and 37 (14.8%) on standard care alone (OR, 1.30; 95% CI: .81-2.09; P = .28). All 3 prespecified secondary endpoints were similar between both groups. Mechanical ventilation occurred in 6 (2.4%) vs 5 (2.0%) (OR, 1.20; 95% CI: .36-4.23; P = .76), ICU admission in 13 (5.2%) vs 12 (4.8%) (OR, 1.09; 95% CI: .48-2.47; P = .84), and in-hospital mortality in 5 (2.0%) vs 0 (OR, 12.54; 95% CI: .76-207.84; P = .08) patients. CONCLUSIONS: Among COVID-19 patients at high risk of disease progression, early treatment with oral favipiravir did not prevent their disease progression from nonhypoxia to hypoxia. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov (NCT04818320).

What are the solutions for well-being and burn-out for healthcare professionals? An umbrella realist review of learnings of individual-focused interventions for critical care.

OBJECTIVE: To determine what, how, for whom and under what conditions individual-focused interventions are effective to improve well-being and decrease burn-out among critical care healthcare professionals. DESIGN: This study is an umbrella review that used the realist approach, using Realist and Meta-narrative Evidence Synthesis: Evolving Standards guidelines. PsycINFO, Web of Science, CINAHL, MEDLINE, Scopus, ClinicalTrials.gov and ISRCTN databases were searched for published and unpublished systematic reviews and meta-analyses literature between 2016 and 2020. The team appraised and extracted data and identified relationships between content, mechanism and outcomes (CMOs). Theory prepositions were developed using CMOs and were used to refine the existing programme. RESULTS: A total of 81 interventions from 17 reviews were mapped, including mindfulness interventions, cognitive-behavioural therapy, self-care and coping strategies. The revised programme theory determined that contextual factors such as ethnicity, workload, and work schedules play a crucial role in determining the effectiveness of interventions. Mechanisms including the interventions' interests, acceptance, and receptivity are also influential in determining engagement and adherence to the intervention. Findings suggest that the solution for burn-out is complex. However, it offers an optimistic view of tailoring and customising one or a combination of interventions, integrating structured education and components of emotional intelligence. Self-care, social support, awareness or mindfulness and self-efficacy are prime components to improve emotional intelligence and resilience for critical care healthcare professionals to improve well-being and decrease burn-out experience. CONCLUSIONS: These findings provide realistic and reliable reporting of outcomes to better support implementation within the 'real world'. Future research such as seeking validation using expert opinions can provide further in depth understanding of hidden contextual factors, mechanisms and their interactions to provide a greater depth of knowledge ready for application with the critical care population.

Electrical and optical enhancement of ITO/Mo bilayer thin films via laser annealing.

ITO/Mo bilayer thin films were sputtered on n-type silicon and glass substrates and annealed with a Nd:YAG pulsed laser. The structural results show that both the as-deposited and the annealed ITO/Mo thin films have a polycrystalline structure, and that the annealing treatment enhanced the crystallinity of samples. Moreover, the XRD patterns exhibited a cubic structure preferentially oriented along the (222) and (400) planes. The AFM analysis shows that grain size and RMS roughness increased from 16.02 to 36.19 nm and 0.4 to 2.6 nm, respectively, when the laser energy was increased to 120 mJ. The as-deposited sample has an optical transmittance of nearly 80% in the 300-800 nm range. The laser annealing yielded a higher transmittance of 94% and increased the bandgap energy from 2.76 to 2.88 eV at 120 mJ. The annealing treatment decreased the resistivity from 15.63 × 10-4 to 1.73 × 10-4 Ω/cm-1. Additionally, the figure of merit of the ITO/Mo structure improved significantly from 6.63 × 10-4 Ω-1 of the as-deposited sample to 17.6 × 10-3 Ω-1 of the the annealed structure. The results indicate that the laser annealing could improve the efficiency of the transparent conductive layer, which can be potentially applied in optoelectronic devices.

Clinical Profile of Uterine Prolapse Cases in South India.

BACKGROUND: Uterine prolapse is a common problem among women in developing countries. It is known to cause physical and psychosocial problems affecting the quality of life of patients. This study was done to determine the risk factors, clinical features, and management practices in uterine prolapse (UP). METHODS: A review of 350 case records of UP cases admitted between 2009 and 2014 was done in tertiary care hospitals. RESULTS: Mean age at presentation of UP was 52.8 ± 13.2 years. Majority of cases were manual laborers [232 (78.6 %)]. Obstetric factors like parity ≥5 times [78 (22.3 %)], age at last pregnancy between 30 and 39 years (57.2 %), inadequate birth spacing (57.8 %), home deliveries [162 (58.3 %)], deliveries conducted by untrained personnel (25.3 %), vaginal deliveries (89.7 %), prolonged duration of labor (21.6 %), and heavy work in post natal period (29.8 %) were observed among cases. Correlation between age of presentation of prolapse with age at first and last pregnancy was significant. Most common associated complaint among UP cases was pain abdomen [55 (15.7 %)] and difficulty in micturition [51 (14.6 %)]. Majority were cases of third-degree prolapse [269 (76.8 %)]. Most common associated organ prolapse was cystocele [261 (74.6 %)]. The most common operative procedure done was vaginal hysterectomy, and conservative procedure was ring pessary application. CONCLUSION: Public awareness on reduction in family size, support for institutional-based delivery by trained personnel, and adequate rest and exercises in early post natal period is required to minimize the occurrence of UP.

Physico-chemical removal of iron from semi-aerobic landfill leachate by limestone filter.

Limestone has been proven effective in removing metals from water and wastewater. A literature review indicated that limestone is capable of removing heavy metals such as Cu, Zn, Cd, Pb, Ni, Cr, Fe and Mn are through a batch process or by filtration technique. The removal capability is reported at up to 90%. However, to date most of the studies have been focused on synthetic wastewater. The present study attempts to investigate the suitability of limestone to attenuate total iron (Fe) from semi aerobic leachate at Pulau Burung Landfill Site in Penang, Malaysia. Iron was found in significant quantities at the landfill site. The study also aims to establish the Fe isotherm and breakthrough time of the proposed limestone filter for post-treatment to the migrating landfill leachate before its release to the environment. The Fe isotherms were established using a batch equilibrium test, while the breakthrough characteristics were determined using continuous flow permeating through a limestone column. The latter was used in order to simulate the continuous flow of leachate that would occur in the proposed limestone filter. The limestone media used in the experiment contain more than 90% CaCO3 with particle sizes ranging from 2 to 4 mm. Four filter columns (each 150 mm in diameter and 1000 mm depth) were installed at the landfill site. Metal loadings were kept below 0.5 kg /m3 day and the experiment was run continuously for 30 days. Initial results indicated that 90% of Fe can be removed from the leachate based on retention time of 57.8 min and surface loading of 12.2 m3/m2 day. For the batch study on the Fe isotherm, the results indicated that limestone is potentially useful as an alternative leachate treatment system at a relatively low cost.