A survey of grief counseling of clinicians from coronavirus disease 2019 designated hospitals

Since the outbreak and spread of Corona Virus Disease 2019 epidemic in Wuhan in December 2019, Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital have taken the advantages and rich experiences of intensive care, treatment of organ failure, life support, multidisciplinary team working and disaster relief. During the epidemic, Tongren Hospital of Wuhan University & Wuhan Third Hospital was requisitioned as Corona Virus Disease 2019 fixed-point hospital. As the only remained burns department in Hubei province, Department of Burns, Tongren Hospital of Wuhan University & Wuhan Third Hospital sent a large number of medical staff to fight the Corona Virus Disease 2019, and admitted all the critical patients from other departments of the hospital, who could not be discharged. In the successful completion of the epidemic fighting and burns care work, there was no coronavirus infection among burn patients, accompanying family members and medical staff, and the burns department have played a good role of national key burn specialties in combating the Corona Virus Disease 2019. Key words: Burns; Infection; Corona Virus Disease 2019; Epidemic prevention and control

Dealing with grief and bereavement in the emergency department.

The novel coronavirus has been spreading since December 2019. It was initially reported in Wuhan, Hubei province of China. Coronavirus disease 2019 (COVID-19) has currently become a pandemic affecting over seven million people worldwide, and the number is still rising. Wenzhou, as the first hit city out of Hubei Province, achieved a remarkable success in effectively containing the disease. A great record was also observed in Wenzhou for the clinical management of COVID-19 patients, leading to one of the lowest death rates in China. Researchers and clinical specialists proposed and formulated combined approaches such as computerized tomography (CT)- scans and molecular assays, as well as using both allopathic and traditional medications to mitigate its effects. Iranian and Chinese specialists and scientists had a communication in clinical, molecular and pharmaceutical aspects of COVID-19. A proper guideline was prepared according to the experiences of Chinese clinicians in managing the full spectrum of COVID-19 patients, from relatively mild to highly complex cases. The purpose of this guideline is to serve a reference in the hospital for specialists so that they may better diagnose cases and provide effective therapies and proposed antiviral and anti-inflammatory drugs for patients.

Objective To study the effect of the grief counseling on the anxiety level of fetal loss maternity patients.Methods Totals of 322 cases with fetal loss were recruited and randomly divided into control group (n =161) and experimental group (n =161).The control group received the nursing care according to the responsibility system mode,while the experimental group received the one-on-one grief sorrow tutoring on the basis of maternity care according to responsibility system mode.Two groups were investigated with self-rating anxiety scale in the admission and before discharge.Results After the intervention,anxiety score of experimental group was significantly lower than that of control group (49.2 ± 10.2 vs 42.6 ± 9.1 ; t =2.283,P ＜ 0.05).Before and after the intervention,significant difference was found in the anxiety score (51.2 ± 10.1vs 42.6 ±9.1 ;t =2.415,P ＜0.05).Before and after the grief counseling in the experimental group,significant difference was found in anxiety level as follows:the number of no anxiety (0 vs 98),mild (57 vs 62),moderate (102 vs 1),severe(2 vs 0) patients (U =13.29,P ＜ 0.05).Conclusions Fetal loss maternal receiving the intervention of grief counseling can improve their anxiety level,relieve pain,and promote them go out of the psychological shadows. Key words: Anxiety; Maternity patient; Fetus abortion; Grief counseling

Objective To study the manifestations of digestive system of hospitalized patients with coronavirus disease 2019 (COVID-19) in Wuhan, China, and to provide a reference for disease control and treatment. Methods The data of hospitalized patients with COVID-19 in the Sino-French Branch of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 27 to February 14, 2020 were retrospectively analyzed, which included general information, positive rate of nucleic acid test, severity of disease, incubation period, initial symptoms and manifestations of digestive system. The general information, positive rate of nucleic acid detection, and manifestations of digestive system were compared between critical patients who required non-invasive or invasive assisted ventilation (critical group) and non-critical patients without assisted ventilation (non-critical group). Continuous corrected Chi-square test and independent sample median Chi-square test were used for statistical analysis. Results Among the 305 patients, there were 146 males (47.9%) and 159 females (52.1%), and the median age was 57 years old. Nucleic acid assay of nasopharyngeal swabs or pharyngeal swabs were positive in 84.1% (228/271) patients including 46 patients (15.1%) of critical group and 259 patients (84.9%) of non-critical group. The incubation period was one to fifteen days, and the median period was six days. The initial symptoms were mainly fever (81.1%, 163/201), cough (39.3%, 79/201), fatigue (54.7%, 110/201), and loss of appetite (50.2%, 101/201). In one to ten days after the disease onset, 79.1% (159/201) of patients developed gastrointestinal symptoms including nausea (29.4%, 59/201), vomiting (15.9%, 32/201), or abdominal pain (6.0%, 12/201). 49.5% (146/295) of patients had diarrhea, with a median time of 3.3 days, (3.3±1.6) times per day, and a duration of (4.1±2.5) days. After excluding possible drug-related diarrhea, the incidence of diarrhea was still 22.2%. Only 6.9% (4/58) of patients had positive fecal leukocytes or fecal occult blood test. Alanine aminotrans ferase (ALT), aspartate aminotransferase (AST), or total bilirubin (TBil) increased in 39.1% (119/304) of patients on admission. Patients with ALT or AST ≥ 80 U/L only accounted for 7.9% (24/304) and 6.3% (19/304), respectively. About 2.0% (6/304) of patients also had increased TBil level, and the average level was (37.4±21.1) μmol/L. The median age of critical group was older than that of non-critical group (65 years vs. 56 years), the proportion of patients with abnormal liver function and slightly increased AST (40- 0.05). Conclusions The manifestation of digestive system of hospitalized COVID-19 patients in Wuhan is significant, the proportion of patients with diarrhea and abnormal aminotransferase level is high. And on admission the proportion of patients with abnormal liver function of critical group is higher than that of non-critical group, which will provide reference for the prevention and treatment of COVID-19. Key words: 2019-nCoV; COVID-19; Diarrhea; Liver function; Gastrointestinal tract

Objective To explore the relationships between medical coping modes of patients with COVID-2019 and general information and social supports. Methods From January to February 2020, a total of 128 patients in a designated hospital in Wuhan with novel coronavirus pneumonia were investigated using the General Information Questionnaire and the Chinese version of the Medical Coping Modes Questionnaire(MCMQ) by convenient sampling. Pearson univariate analysis and multiple linear regression were used to analyze the relationship between the basic situation of patients with novel coronavirus pneumonia and coping modes. Results The scores of the face dimension and yield dimension of patients with COVID-2019 were lower than the norm model, while the avoidance dimension was higher than the norm model, and the differences were statistically significant (P<0.05). Support utilization and complexity were influencing factors of the face dimension (P<0.05). Support utilization and age were influencing factors of the yielding dimension (P<0.01). Subjective support, the complexity dimension of disease uncertainty and the number of confirmed patients in the family were influencing factors of the avoidance dimension (P<0.01). Conclusions Patients with COVID-2019 have poor medical coping modes, and they are prone to face the disease with a negative attitude. Patients are unwilling to face the disease and the tendency to yield to the disease is greater. And the older the patients, the less likely they are to succumb to the disease. The more patients diagnosed in the family, the less likely they are to avoid the disease. Patients with higher social supports and utilization have a more reasonable medical coping mode. This reminds medical staff to pay more attention to the psychological problems of patients in coping with COVID-2019 and improve their coping modes and methods. Key words: Corona virus disease 2019; Pneumonia; Medical coping modes; Disease uncertainty

Grief nursing can help bereaved people go through the sad period, reduce the occurrence of pathologic grief, which has a positive significance to the bereaved. In this paper, a summary of grief nursing status in China is performed, which based on the analysis of grief nursing problems and influencing factors. Then, finally put forward the development strategies of the grief nursing in China, in order to attract the attention of scholars and hospital management. All of these can better help the bereaved people smoothly go through the grieving period. Key words: Grief nursing; Grief counseling; Bereavement; Grief

Objective To analyze epidemiological characteristics of coronavirus disease 2019(COVID-19) in Dazhou City, we provide a scientific basis for prevention and control of COVID-19 in Dazhou City. Methods Statistical analysis of 42 cases of COVID-19 reported in Dazhou were conducted from January to February 2020. Results Cases were reported in 7 counties (cities, districts) of Dazhou City. The population was mainly 30–49 years old, and no confirmed cases of minors were reported. The peak incidence was from January 26 to February 5, 2020. Clinical symptoms were mainly fever (59.52%) and cough (64.29%), and the abnormal rate of lung was 90.48% in early CT examination. 18 of the 19 imported cases had a history of residence or staying in Wuhan. The median number of days from onset to hospitalization, confirmed to discharge, and long duration of viral shedding were 5.5, 18.5 and 7.0 days, inter-quartile range of days were 5.5, 8.0 and 6.0 days, respectively. Conclusion In January, the imported epidemic were the main ones in Dazhou, and in February, local cases kept increasing. Later, the epidemic disease was gradually controlled after the strict control measures were implemented. Fever and cough are used as clinical screening indicators for COVID-19, and CT examination can be used as an early screening method; Shortening the time from onset to hospitalization and ensuring the operation of fever clinics can reduce the spread of the disease; The time of hospitalization and the average time of carrying virus of patients are relatively long. Long-term treatment, psychological counseling and improving patient’s coordination should be prepared during treatment. The aggregated epidemic in Dazhou City is serious, and there is a gap in grass-roots work. In the new cycle, various prevention and control work need to be further implemented so as to prevent local cases caused by foreign imports. 摘要：目的 分析达州市新型冠状病毒肺炎 (新冠肺炎) 病例流行病学特征, 为达州市新冠肺炎防控提供科学依 据。 方法 对 2020 年 1—2 月达州市报告的 42 例新冠肺炎病例资料进行统计分析。 结果 达州市 7 个县 (市、区) 均有 病例报告, 人群以 30~<50 岁为主, 无未成年人确诊病例报告; 发病高峰在 2020 年 1 月 26 日—2 月 5 日, 临床症状以发热 (59.52%) 和咳嗽 (64.29%) 为主, 早期 CT 检查肺部异常率 90.48%; 19 例输入性病例中 18 例有武汉旅居史或停留史; 患 者发病到住院、确诊到出院和持续排毒时间中位数分别为 5.5 d、18.5 d 和 7.0 d, 四分位数间距分别为 5.5 d、8.0 d 和 6.0 d。 结论 达州市 1 月份以输入性疫情为主, 2 月份本地病例不断增加, 2 月下旬疫情逐渐控制; 将发热、咳嗽作为新 冠肺炎临床筛查指征, CT 检查可作为早期筛查手段; 患者住院时间和持续排毒时间较长, 应做好长时间治疗准备及治 疗过程中心理疏导, 提高患者配合度; 达州市聚集性疫情程度较重, 基层工作有差距, 新周期需进一步落实各项防控工 作, 严防因境外输入引发本地病例。

Recently, picture story books are published in great quantities, and the topics of the picture story books are discussed from many different perspectives. When a child realizes that the happy ending of traditional fairy tale stories cannot solve the difficulties in their real life, the picture story book becomes a good assistant tool. This paper mainly discusses the children's picture story books related to the topic of death, which have been published in the three years; and the concepts of death and grief counseling in these picture story books are analyized. In addition, these concepts are expected and provided to be as the reference while counseling children. The findings show: (1) Death Concepts: One-third of picture story books include the irreversibility and nocorporeal continuation, but less universality. (2)Grief Counseling: Four phases of adjustment are discussed in most picture story books. (3)Personal Suggestion: When children have questions about the death, adults should discuss the topic with them in a gentle and open minded way. In addition, adults should select appropriate picture story books according to their cognitive stage of the death and their real life experience. Adult's support and company will be the best strength to help children go through the grief period.

Background: In India, most tissues are received from voluntary donors. There is a huge potential of harvesting surgically competent tissues by the Hospital Cornea Retrieval Program which involves counselors trained in grief counseling and tissue retrieval, posted at hospitals. They approach families of all the deceased in the hospital motivate them to pledge the eyes of the deceased: Advantage being that no potential donor is missed, easy availability of medical history, and reduced time interval between death and corneal excision. Aims: The aim of this study is to examine the utilization of corneas procured and determine how maximum tissue procurement and utilization can be ensured. Setting and Design: Tissue utilization analyzed at a tertiary care eye bank (EB) postapplication of revised guidelines of standards of eye banking of India, 2009. Materials and Methods: Data between January 2010 and December 2012 were reviewed. Reasons for rejection of corneas for transplantation were noted. Statistical Analysis: Retrospective analysis. Results: Of 1908 corneas accepted at our EBs in that duration, 1239 (65%) were received from voluntary donors at their residence and from other associated EBs; 599 corneas (31%) from hospitals and 70 (4%) came from mortuary. Six hundred and twenty-three corneas (33%) were transplanted, 1007 (53%) were directed toward research or training and 91 (5%) tissues had to be incinerated. Seven hundred and thirty-four (38%) were excluded from transplantation due to a contraindication in the donor's medical history. Conclusion: Majority tissues are received from voluntary eye donation with most tissues excluded due to contraindication in donor's medical history. Ensuring thoroughly trained, well-equipped enucleation teams reaching out to all suitable donors from hospitals and voluntary donors can hugely increase the numbers of surgically competent tissues.

Objective To understand the clinical characteristics of patients with Corona Virus Disease 2019 (COVID-19) so as to further provide practical instructions for clinical practice through collecting and analyzing the clinical data of COVID-19 patients admitted to Beijing YuoAnHospital. Methods The clinical data were summarized and analyzed for COVID-19 classified as severe patients and critically ill patients between January 28, 2020 and February 12, 2020 in Beijing You An Hospital,including their age, gender, course of disease, epidemiological history, previous history, clinical symptoms, laboratory tests, CT findings of lungs, treatment and clinical outcomes. Statistical processing was performed using SPSS software (version 22.0). Results 19 patients were included in this study and divided into two groups by investigators, i.e. The percentage of patients was 10 for the severe type and 9 for the critically ill type. The average age of the patients was 75 years (range from 58 to 94 years), including 10 males and 9 females. Their course of diseases varied from 1 days to 14 days with a median of 5 days. Among these patients, 4 patients did used to reside in Wuhan, 13 patients had been in close contact with confirmed patients (including family gatherings, meals, living in the same room, etc.), and 2 patients had no relevant epidemiological history. 14 patients suffered from underlying chronic diseases (including 11 cases of hypertension, 4 cases of coronary heart disease, 4 cases of cardiac insufficiency, 3 cases of chronic obstructive pulmonary disease, 2 cases of previous anterior myocardial infarction, 3 cases of arrhythmia, 1 case of heart valve disorders, 2 cases of diabetes mellitus, 2 cases of chronic renal disease, etc.), and 4 patients were accompanied with 3 or more underlying diseases at the same time. The first symptoms at onset of illness were fever in 18 cases, cough in 13 cases, and dyspnea in 8 cases. 17 patients were accompanied with absolute lymphocyte count (ALC) lower than the normal range. 11 patients experience different degrees of hepatic injury, 10 patients had renal injury, 7 patients had abnormal myocardial enzymes in a varying degree. C-reactive protein was increased in 18 patients.12 patients received hormone therapy, 4 patients were treated with gamma globulin, 3 patients used non-invasive ventilator mechanical ventilation, and 7 patients used an invasive ventilator to assist ventilation. Moreover, 1 patients received continuous renal replacement therapy (CRRT), and 1 patient was treated with extracorporeal membrane oxygenation (ECMO). As of February 17, 2020, 10 patients had recovered or been discharged upon treatment, 4 patients were still in the intensive care unit (ICU), and 5 patients had died. Conclusions The elderly and individuals accompanied with underlying diseases were considered as independent predictors for developing severe and critically ill population, and were faced with increased mortality. The decrease of ALC and the increase of C-reactive protein levels in the patients, and the abnormality of liver function, renal function and myocardial enzyme spectrum in different degrees suggests the correlation with severe cases. Hormone and ventilator are effective in the treatment of severe cases. Key words: 2019-nCoV; clinical features; COVID-19; Critically ill diseases

To determine the environmental contamination degree of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in corona virus disease 2019 (COVID-19) wards, to offer gui-dance for the infection control and to improve safety practices for medical staff, by sampling and detecting SARS-CoV-2 nucleic acid from the air of hospital wards, the high-frequency contact surfaces in the contaminated area and the surfaces of medical staff's protective equipment in a COVID-19 designated hospital in Wuhan, China. From March 11 to March 19, 2020, we collected air samples from the clean area, the buffer room and the contaminated area respectively in the COVID-19 wards using a portable bioaerosol concentrator WA-15. And sterile premoistened swabs were used to sample the high-frequency contacted surfaces in the contaminated area and the surfaces of medical staff's protective equipment including outermost gloves, tracheotomy operator's positive pressure respiratory protective hood and isolation clothing. The SARS-CoV-2 nucleic acid of the samples were detected by real-time fluorescence quantitative PCR. During the isolation medical observation period, those medical staff who worked in the COVID-19 wards were detected for SARS-CoV-2 nucleic acid with oropharyngeal swabs, IgM and IgG antibody in the sera, and chest CT scans to confirm the infection status of COVID-19. No SARS-CoV-2 nucleic acid was detected in the tested samples, including the 90 air samples from the COVID-19 wards including clean area, buffer room and contaminated area, the 38 high-frequency contact surfaces samples of the contaminated area and 16 surface samples of medical staff's protective equipment including outermost gloves and isolation clothing. Moreover, detection of SARS-CoV-2 nucleic acid by oropharyngeal swabs and IgM, IgG antibodies in the sera of all the health-care workers who participated in the treatment for COVID-19 were all negative. Besides, no chest CT scan images of medical staff exhibited COVID-19 lung presentations. Good ventilation conditions, strict disinfection of environmental facilities in hospital wards, guidance for correct habits in patients, and strict hand hygiene during medical staff are important to reduce the formation of viral aerosols, cut down the aerosol load, and avoid cross-infection in isolation wards. In the face of infectious diseases that were not fully mastered but ma-naged as class A, it is safe for medical personnel to be equipped at a high level.

Objective: To sum up the experience of healthcare-acquired infection control against coronavirus disease 2019 (COVID-19) in Wuhan by a medical team from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, so as to provide reference for the contain strategy of sudden infectious diseases in China Methods: The whole process of prevention and control of HAI was implemented through methods such as management organization construction, institutional establishment and implementation, personnel training, occupational exposure planning, and introduction of hightech methods Results: There were a total of 136 members in the medical team, including 30 doctors, 100 nurses, and 6 administrative staffs None of them were infected with COVID-19, achieving zero infection among medical staff Conclusion: Although the task of assisting Wuhan was tight in time, and materials and heavy, under the leadership of the team leader and the cooperation of all the staff, all measures were implemented, the training covered all the staff, and high-tech means were introduced to optimize the control strategy, achieving the goals of zero infections among medical staffs and zero cross infections among patients

Objective To investigate the clinical characteristics, diagnosis and treatment of neurological diseases combined with coronavirus disease 2019(COVID-19). Methods The data of five patients of neurological diseases combined with COVID-19 (including two suspected cases) in the Department of Neurology, Renmin Hospital of Wuhan University from January 1, 2020 to February 24, 2020 were retrospectively collected. The epidemiology, clinical manifestations, laboratory and radiologic characteristics, diagnosis, treatment and outcomes of these cases were described and analyzed. Results Among the five patients, three were confirmed cases and two were suspected cases with a history of indirect contact with confirmed cases of COVID-19. The age of these patients was (76.4 ± 9.3) years. Neurological diseases included cerebral infarction in two cases, cerebral hemorrhage, Guillain-Barre syndrome and Alzheimer's disease each in one case. There was one acute case and one chronic case, and three patients were in the sequelae stage of acute diseases. One patient had an open airway as a result of Guillain-Barre syndrome. There were four cases of limb paralysis, half of whom were hemiplegic and quadriplegic respectively. The initial symptom was fever in all cases, and they showed a decrease in lymphocyte count. Four patients with chest computed tomographic scans showed bilateral lung lesions, of whom two cases showed multiple lung patches and ground glass shadows. Tests for 2019 novel coronavirus nucleic acid were positive in three patients and negative in two. The time from onset of COVID-19 to diagnosis was (6.6 ± 5.6) d. As of February 24, two patients died and the remaining were still hospitalized. Conclusions Neurological diseases, especially in elderly patients with limb paralysis, open airways and stroke, can be complicated by COVID-19, of which the prognosis is poor. Neurologists need to identify this situation early and pay attention to strengthening protection. Key words: Coronavirus disease 2019; Neurological diseases; Clinical characteristics

پژوهش حاضر، با هدف بررسی اثربخشی مشاوره و درمان سوگ با رویکرد دینی به شیوه گروهی، بر ارتقاء سطح کیفیت زندگی مادران داغدار فرزند، انجام شد. روش پژوهش شبه آزمایشی با طرح پیش آزمون- پس آزمون و گروه آزمایش و کنترل بود. ابزار مورد استفاده پرسشنامه کیفیت زندگی (SF- 36) بود. جامعه آماری پژوهش مادران داغدار فرزندی بودند که مدت سه ماه تا یکسال از مرگ فرزندانشان می گذشت و نمرات کیفیت زندگی آن ها پایین تر از یک انحراف معیار از میانگین جامعه بود. در این پژوهش 18 مادر داغدیده بوسیله نمونه گیری داوطلبانه تعیین شدند و به طور تصادفی در دو گروه آزمایش و کنترل قرار گرفتند. سپس مداخله درمانی طی 10 جلسه 90 دقیقه ای، بصورت یک جلسه در هفته، برای گروه آزمایش به اجرا در آمد. نتایج تحلیل واریانس داده ها نشان داد که تفاوت بین دو گروه آزمایش و کنترل در نمره کلی کیفیت زندگی معنادار بوده است و مداخله درمانی به طور معناداری موجب ارتقاء سطح کیفیت زندگی مادران داغدیده گردیده است. نتایج پژوهش حاضر نشان می دهد که مشاوره و درمان سوگ با رویکرد دینی، در ارتقاء سطح کیفیت زندگی مادران داغدیده موثر است.