Acute Situations Research Articles

Sleep as a protective factor of children's executive functions: A study during COVID-19 confinement.

Confinements due to the COVID-19 outbreak affected sleep and mental health of adults, adolescents and children. Already preschool children experienced acutely worsened sleep, yet the possible resulting effects on executive functions remain unexplored. Longitudinally, sleep quality predicts later behavioral-cognitive outcomes. Accordingly, we propose children's sleep behavior as essential for healthy cognitive development. By using the COVID-19 confinement as an observational-experimental intervention, we tested whether worsened children's sleep affects executive functions outcomes 6 months downstream. We hypothesized that acutely increased night awakenings and sleep latency relate to reduced later executive functions. With an online survey during the acute confinement phase we analyzed sleep behavior in 45 children (36-72 months). A first survey referred to the (retrospective) time before and (acute) situation during confinement, and a follow-up survey assessed executive functions 6 months later (6 months retrospectively). Indeed, acutely increased nighttime awakenings related to reduced inhibition at FOLLOW-UP. Associations were specific to the confinement-induced sleep-change and not the sleep behavior before confinement. These findings highlight that specifically acute changes of children's nighttime sleep during sensitive periods are associated with behavioral outcome consequences. This aligns with observations in animals that inducing poor sleep during developmental periods affects later brain function.

The Phenomenological Method Applied to Acute Psychiatric Situations

The most accepted definition of urgency in psychiatry is that of a situation of acute and severe mental and behavioral suffering, which requires immediate treatment. Therefore, in the situation defined as “psychiatric urgency”, a descriptive and nosographic element (acute), a prognostic element (severity) and a therapeutic element (need for immediate treatment) coexists. In any case, it remains difficult and complex, sometimes enigmatic, to understand the acute episode within the course of a specific pathology. It is a matter of having to oscillate in front of the patient “between the madness of a moment and the madness of an existence” [1]. By the way, contribution from philosophical discourse may be helpful to clarify the psychopathological structure of acute psychiatric urgencies.

What Happens When you Ask for Feedback? Anticipating and Addressing Challenges Can Be Effective for Eliciting Parents' Views About Their Critically Ill Child's Retrieval to Paediatric Intensive Care.

User feedback is an important element of health-service evaluation and can be used to improve services but can be difficult to obtain, particularly in acute care situations. As part of a national study, we explored stakeholders' perspectives on paediatric critical care retrieval processes through questionnaires and interviews. Obtaining feedback in a highly charged, stressful and busy paediatric intensive care unit (PICU) environment is fraught with difficulties so we aimed to optimise each stage of data collection by being both proactive and reactive. Patient and public involvement occurred throughout and engagement with sites and supporting local research staff to approach and recruit families were prioritised. High-quality study materials were developed to reduce local staff burden and promote and maintain study awareness. We describe strategies used and what worked/did not work. We suggest approaches for optimising elicitation of parents' experiences in difficult circumstances, highlighting the importance of engagement and commitment of PICU staff.

Flood 2022 in Pakistan: Managing medical flood relief camps in a developing country.

Floods are the most common natural disasters in the world. Currently Pakistan is in an acute emergency situation due to the recent flood that occurred as a result of the monsoon rains in July-August 2022. Unfortunately, the country was already under an economic crisis and was just recovering from the COVID pandemic when this devastating calamity struck. Almost one-third of the country's land was affected, with millions of houses damaged and property lost. As the victims are displaced and local health units are flooded, their medical needs are being met through medical flood relief camps arranged by public and private sector welfare organizations. Due to a lack of disaster preparedness and policies, most of the healthcare workers are untrained to manage medical flood relief camps and are hence learning from experience rather than following any standardized policy guidelines. We did not find any guidelines for organization and management of a flood relief camp in previous literature. As natural disasters continue to cause mass destruction every few years, there is a need to devise policies and procedures for disaster preparedness and hazard reduction. This paper is thus an effort to provide the best possible delivery of acute health services in a developing country during and after a flood in the transit phase, while the government and other non-governmental organizations (NGOs) help communities rebuild their health system.

A Novel Experimental Rat Model for the In Vivo Assessment of Myocardial Ischemia Based on Single Photon Emission Computed Tomography.

Myocardial infarction, an acute medical situation with a high mortality rate worldwide, has been extensively studied in modern cardiovascular research, using different experimental models. However, a deep understanding of myocardial activity loss has not been fully investigated. We have developed a novel experimental rat model for noninvasive assessment of myocardial ischemia based on single photon emission computed tomography (SPECT/CT), in order to further understand and evaluate myocardial activity before and after surgical induction of myocardial ischemia. Thirty adult female Wistar rats underwent open thoracotomy with (n=20) or without (n=10) surgical ligation of the left anterior descending coronary artery (LAD). The myocardial ischemia was confirmed with ECG and myocardial viability was evaluated via SPECT/CT at 7 days before as well as at 7 and 14 days post-surgery, after which animals were sacrificed and myocardial ischemic injury was further assessed histologically. All animals were evaluated with anatomical and functional criteria based on the SPECT/CT imaging results. A successful surgical technique causing ischemia and loss of myocardial function in all animals undergoing a LAD ligation was established. Furthermore, evaluation of the viable myocardium with SPECT/CT confirmed the reduction of functional myocardial cells of the left ventricle post-infarction, which was also documented histologically. Using our technique, the validity of this animal model to induce and evaluate myocardial ischemia was demonstrated. Our choice to apply SPECT-CT qualitative and quantitative evaluation of myocardial function leads to a new approach in experimentation with an anticipated significant impact in the ongoing cardiovascular laboratory research.

Detecting postpartum anal sphincter injuries with three-dimensional endoanal ultrasound: a prospective diagnostic study

Occult obstetric anal sphincter injury (OASIS) is the subject of much debate. Three-dimensional endoanal ultrasound (3D-EAUS), regarded gold standard for anal sphincter evaluation in non-obstetric settings, is suggested to be a better tool for evaluation of OASIS than routine clinical examination. The aim of this study was to compare routine postpartum clinical examination with 3D-EAUS for detecting OASIS. This prospective diagnostic study included all primipara women with singleton vaginal delivery at Östersund hospital (Sweden) between 1st Jan 2016 and 31st Jan 2018. The routine postpartum clinical examination with inspection and vaginal and rectal palpation as well as 3D-EAUS recordings were performed directly after delivery. Maternal data were obtained from the medical records. The 3D-EAUS recordings were evaluated by an experienced colorectal surgeon specialized in proctology and 3D-EAUS and compared with the clinical findings. Of the 554 women with satisfactory 3D-EAUS recordings, 23 (4.2 %) had OASIS according to the clinical examination compared to 71 (12.8 %) with the 3D-EAUS. Among the 23 women clinically judged to have OASIS, only 7 could be confirmed with 3-D EAUS. No significant risk factors were found in the group with clinically detected OASIS. Episiotomy was the only risk factor for OASIS seen with 3D-EAUS. OASIS was more frequently detected with 3D-EAUS than with clinical evaluation. Furthermore, only one in three of the clinically observed OASIS cases was confirmed with 3D-EAUS. This indicates that 3D-EAUS is difficult to interpret in an acute obstetric situation and needs further improvement if it is to be a useful tool in detecting OASIS.

The Role of Prognostic Nutrition Index in Predicting Hospitalization of Patients With Heart Failure With Mildly Reduced Ejection Fraction.

Background The prognostic nutritional index (PNI), consisting of albumin and lymphocyte counts, has been associated with satisfactory predictive values ​​for in-hospital mortality or clinical follow-up outcomes in acute situations. In this study, we aimed to evaluate the use of PNI for the prediction of hospital admission in individuals withmildly reduced ejection fraction heart failure (HFmrEF). Methodology This retrospective study was conducted between January 2019 and May 2022 and included 200 patients with HFmrEF detected by transthoracic echocardiography.Data from hospitalized patients (group 1) and outpatients (group 2) were compared. Results In the multivariable regression analysis, brain natriuretic peptide (odds ratio (OR) = 1.001; 95% confidence interval (CI) = 1.000-1.001, p = 0.001) and PNI (OR = 0.783; 95% CI = 0.720-0.853; p < 0.001) were independent predictors of hospital admission in patients with HFmrEF. The PNI value was statistically significantly higher in group 2 (52.36 ± 5.36) than in group 1 (38.3 ± 8.63, p < 0.001). The PNI value <46.75 is a predictor of hospitalization in patients with HFmrEF, with 86% sensitivity and 88% specificity. Conclusions Lower PNI levels predict hospital admission in HFmrEF patients. This measure, which can be easily evaluated in daily cardiological practice, allows for quick and precise decisions for hospitalization.

Physicians’ perceptions of patient participation in the myocardial infarction pathway

Myocardial infarction is an acute, frightening and life-threatening condition for patients who are affected. They need plain and simple information about the disease and the treatment, yet patient participation might be challenging in acute situations. Previous studies have shown that patient participation leads to improved patient satisfaction, cooperation with healthcare professionals and better management of the disease. Physicians have a key role in facilitating patient participation in the healthcare services. This study explores physicians’ perceptions of patient participation in the myocardial infarction pathway. In 2018 we interviewed nine experienced physicians in Norway working in different phases of the pathway. Hermeneutics was chosen as the underpinning analytical framework. Four themes illustrated patient participation in the myocardial infarction pathway. Paternalism characterised the acute phase. During hospitalisation the physicians perceived a lack of continuity in physician–patient communication. In the discharge phase, the physicians focused on strengthening health literacy. In the rehabilitation phase, dialogue and shared decision making was central to achieving treatment adherence. We found variations in the level of patient participation along the different phases of the myocardial infarction pathway. Strengthening continuity to ensure patient participation and collaboration between healthcare professionals is essential. The physicians proposed introducing checklists for patient information to enhance interprofessional collaboration and strengthen patient participation.

Frustration in horses: Investigating expert opinion on behavioural indicators and causes using a delphi consultation

Frustration is a term often used to describe both a behavioural response to a situation and an emotional state experienced when goals or rewards are expected but not received. Literature on human and non-human animals provides an understanding into the mechanisms underlying frustration and the common behaviours expressed. Frustration is regarded as a negative affective state that could indicate a welfare concern. However, literature on horses lacks consistency regarding those behaviours believed to indicate frustration. The purpose of the current study was to ascertain expert opinion on the causes and behavioural indicators of frustration in horses via a Delphi Consultation process with 30 experts in the field of equine behaviour. Twenty-six statements were generated by experts in a two-round Delphi to describe potential causes of frustration, behavioural indicators of acute and chronic frustration and to enhance general understanding of the topic. The statements generated were agreed upon by > 70 % of participants. Mean level of agreement within demographic variables (researcher status (active or inactive), consultant status (active or inactive) and qualification level (<PhD or PhD holder) was analysed using Welch’s t-Test with no significant difference seen between any of the variables (t(21.55) = 1.11, p > 0.05; t(14.47) = −1.22, p > 0.05; t(15.31) = 2.10, p > 0.05 respectively). Consensus agreement suggests that horses are likely to exhibit frustration in similar ways to other species - in acute situations through increased locomotion, muscle tension, directed and redirected aggression, conflict or displacement behaviours; in chronic situations through the development of repetitive (stereotypic) behaviours and learned helplessness or shutdown behaviours. It was also suggested that certain management practices and human interactions are likely causes of most frustration-related behaviours. The majority of participants (85.7 %) agreed that frustration may present with similar behaviours to those generated by other affective states, indicating the need for caution when attributing the cause of observed behaviours solely to frustration.The study highlights the need for further exploration and empirical studies to validate behavioural indicators of frustration and to clarify differentiation of them from other affective states.

304: NOVEL CRITICAL CARE OUTREACH TEAM MODEL IMPROVING RAPID RESPONSE OUTCOMES

Introduction: The process and outcomes of a novel Critical Care Outreach Team (CCOT) staffed with dedicated critical-care advanced practice providers (APPs) collaborating virtually with an intensivist responding to rapid response team (RRT) activations is described. Methods: Upon RRT activation, the CCOT APP responds to the bedside to assess the patient and acute clinical situation while the CCOT intensivist reviews the electronic medical record for situational awareness of the patient’s hospital course. The CCOT APP and Intensivist in conjunction with the primary team develop a clinical care plan to manage the acute event. The CCOT APP remains with the patient until stabilization or escalation to the intensive care unit (ICU). The CCOT intensivist helps facilitate communication with primary and ICU teams, ensuring timely ICU transfers. CCOT interventions include medications, diagnostics, facilitating consults, transport, escalation of care, transitioning to comfort care, timely follow-up, and multidisciplinary communication. Results: CCOT evaluated 1,862 patients from July 2021 to June 2022 in a large, academic adult hospital. The average time spent on activations was 52 minutes with an average of seven interventions/patient. The ICU transfer rate decreased (37.0% from 46.6%) with no change in mortality (9.0% to 9.8%). Stepdown transfer increased from 3.7% to 9.3%. RRT documentation increased to 100% from 74%. Conclusions: A CCOT with dedicated APPs collaborating with a virtual intensivist can stabilize acutely deteriorating patients by remaining at the bedside, providing advanced interventions, improving communication with bedside providers, and decreasing the need for ICU transfers without increasing mortality. Improved documentation provided improved communication and billing for the institution.

From Message to Messenger: Should Politicians Lead-by-Example to Increase Compliance with Public Health Directives?

ABSTRACT This study proposes that in order to increase compliance with government directives during health crises, we should consider the message as well as the messenger. Prior research shows that highly instructional crisis communication increases compliance during acute crisis situations. Crisis communication literature provides no clear answers on how to address prolonged crises like the COVID-19 pandemic, however. We examined the impact of crisis communication on compliance with health directives in March – April 2021, during the third wave of the pandemic in Belgium. Two field experiments were conducted at two different points in time. Participants received an informational message from Belgian authorities, that was either highly instructional or not. Next, they watched a set of messages from traditional and social media, depicting Belgian politicians setting a good or a bad example in terms of adhering to public health directives. Instructional messages only proved to be effective in the first study. Leading-by-example had a stronger impact, especially in study two. During the third wave of COVID-19, Belgian people seemed more inclined to follow public health directives when politicians set the right example, due to an increase in trust in the government. Bad examples, however, decreased compliance.

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Personal Psychotherapy Prepares Trainees to Be Better Psychiatrists, Educators Say

Impact of a CBPR-informed physical activity intervention before and during COVID-19 among women from a disadvantaged neighborhood in Sweden.

Public health practitioners have been striving to reduce the social gradient and promote physical activity among citizens living in disadvantaged neighborhoods. The emergence of the COVID-19 pandemic, which has affected these citizens extensively, has posed a significant challenge to efforts to maintain a physically active lifestyle. Thus, the aim of this study was to explore the impact of a CBPR-informed physical activity intervention before and during the COVID-19 pandemic from the perspective of women from a socially disadvantaged neighborhood. A total of 34 women participated in a CBPR-informed physical activity intervention previously developed in collaboration with lay health promoters and other citizens from the same neighborhood. Focus group discussions were conducted at four time points, namely, at baseline prior to the intervention, post-intervention, 6 months after the intervention ended, and during the COVID-19 pandemic. The data were analyzed using qualitative content analysis following an inductive approach. In total, four themes emerged from the discussions: "Wavering between frustration and action," "Shifting from prioritizing family needs to taking control of self," "Between isolation and social support," and "Restricted access to health-related knowledge vs. utilizing internalized knowledge". The results of this study reveal that building on CBPR-informed health promotion initiatives has the potential to foster individual empowerment and assist during acute situations like the COVID-19 pandemic through mobilizing communities and their resources, which leads to increased community resilience and health. This study is regarded as unique in that it involves evaluation of a CBPR intervention that was initiated ahead of the pandemic and followed even during the pandemic.

AC-ABAC: Attribute-based access control for electronic medical records during acute care

Acute care demands fast response and procedures from the healthcare professionals involved in the emergency. The availability of electronic medical records (EMR) enables acute care teams to access patient data promptly, which is critical for proper treatment. The EMR contains sensitive data, so proper access control is a necessity. However, acute care situations entail the introduction of dynamic authorisation techniques that are able to swiftly grant access to the acute care teams during the treatment and that at the same time can revoke it as soon as the treatment is over. In this work, our contributions are threefold. First, we propose a step-by-step methodology that defines dynamic and fine-grained access control in acute care incidents. Then, we applied this methodology with the Amsterdam University Medical Center acute stroke care teams, resulting in a new model coined ’Acute Care Attribute-Based Access Control (AC-ABAC)’. AC-ABAC implements access control policies that take into account contextual attributes for dynamically sharing patient data with the appropriate healthcare professionals during the life cycle of acute care. Finally, we evaluate the performance and show the feasibility and correctness of AC-ABAC through a prototype implementation of the model and simulation of patient data requests in various scenarios. The results show that the most complex policy evaluation takes on average 194.89 ms, which is considered worthwhile when compared to the added value to the system’s security and the acute care process.

Abstract 13075: Hemodynamic Estimation of Personalized Initial Target Heart Rate in Patients With Atrial Fibrillation With Rapid Ventricular Response

Introduction: Rate control in atrial fibrillation (AF) has played a pivot role in clinical setting even though recent advances in rhythm control. There are few evidences for target heart rate in either acute or chronic situations. Hypothesis: This study tried to estimate personalized initial target heart rate based on hemodynamic assessment in patient with AF with rapid ventricular response. Methods: A total of 72 patients with AF were included. From the equation between preceding RR interval and left ventricular peak ejection velocity adjusted by pre-preceding RR interval, the relationship between cardiac performance representing cardiac output and heart rate was calculated, and heart rate showing maximal cardiac performance (HRmax) was obtained (Left Figure). Results: Mean HRmax was 126±21.8/min (from 75/min to 188/min). Three-fourth patients had HRmax &gt;120/minute (Right Figure). The relationship between Vpe and preceding RR interval showed two types, biphasic or monophasic resulting in similar patterns between cardiac performance and heart rate (Left Figure). HRmax &lt;100/min was found in 7 patients in whom left ventricular dilatation, dysfunction, and/or aortic regurgitation were observed (Left Figure C). Lower HRmax was independently associated with larger aorta size (r=0.48, p&lt;0.001), the absence of mitral regurgitation (r=0.43, p&lt;0.005), prescription of angiotensin converting enzyme inhibitor or angiotensin receptor blocker (r=0.39, p=0.001), and a history of heart failure (r=0.21, p=0.019). Conclusions: In most AF patients, hemodynamic approach suggested that tachycardia of 120/min or more is tolerable. The method of this study may be useful to deliver individually designed management by identifying patient that strict rate control is mandatory. In other patients, management of underlying causes for tachycardia is enough without medications for mechanical heart rate control to avoid adverse effects without clinical benefits.

A Rare Case of Advanced Duodenal Cancer Infiltrating the Head of Pancreas and the Mesocolon of the Hepatic Flexure

Background Primary small bowel carcinoma is a very rare tumor, with non-specific symptoms that usually cause a delay in diagnosis and, consequently, a negative outcome. Duodenal carcinoma is on its own an uncommon tumor of the intestinal tract. Our case presented further local advancement with infiltration of the hepatic flexure mesocolon. En-block pancreaticoduodenectomy plus right hemicolectomy or Colo-Pancreatico- Duodenectomy (cPD) is feasible in highly selected patients if performed by experienced surgeons. Case presentation We are introducing the case of a 48 y/o male patient presenting with a dull pain of the lower abdomen and dark stools (melena) in the recent episodes of defecation; considerable weight loss; jaundice (total bilirubin level 10 mg/dL). In the radiologic investigations, IV contrast CT of the abdomen revealed the presence of a 7.7 cm x 8.5 cm mass of duodenum (D3) which infiltrates the head of pancreas as evidenced by homogeneous contrast enhancement. The pancreatic duct of Wirsung was dilated, 4.4 mm. Gastroduodenoscopy visualizes a non-circumferential ulcerative proliferation. Exploratory laparotomy was performed. Intraoperatively we encountered the presence of local progression of the primary duodenal lesion into head of the pancreas, the mesocolon of the hepatic flexure with infiltration of the right colic vessels. Colo-Pancreatico-Duodenectomy (cPD) and Whipple’s procedure was performed, with Blumgart type pancreatico-jejunal and ileo-colic anastomoses. Discussion En-block pancreaticoduodenectomy plus right hemicolectomy or Colo-Pancreatico-Duodenectomy (cPD) is feasible in highly selected patients if performed by experienced surgeons. The most common indication of cPD is locally advanced pancreatic head cancer that directly invades the colon or mesocolon, followed by locally invaded colon cancer at the duodenum and/or pancreatic head. The cPD procedure is rarely performed in gastrointestinal surgery. This is due to its complexity, difficulty, and high risks. In certain acute situations, cPD is the efficacious path forward. Conclusion Following a careful evaluation plan, along with necessary consults for accompanying disorders, the indications for colo-pancreatico-duodenectomy were clearly set for this patient with locally advanced duodenal adenocarcinoma infiltrating the pancreas head and hepatic flexure mesocolon. Our experience highlights the importance of meticulous and experienced perioperative care to minimize complications and mortality. Keywords: General surgery, Duodenal cancer, Whipple procedure, colo-pancreatico-duodenectomy, cPD, Blumgart pancreatico-jejunal anastomosis DOI: 10.7176/ALST/95-01 Publication date: November 30 th 2022

Arthroscopic Triple-Loaded Soft Anchor Technique in Medial Meniscal Root Repair: A Systematic, Step-by-Step Approach

The results of meniscal root repair (MRR) have shown that this repair is the best treatment option in the presence of an acute situation with no degenerative changes. The meniscal root could be restored, in addition to the meniscus's hoop stress function, which is a key component in preventing osteoarthritis progression in the future. Several MRR techniques have been developed, and both improved biomechanics and a lower incidence of failure repair are correlated with suture anchor techniques. Suture anchor techniques also have many ways in which they can be adapted until the disadvantages are eliminated, such as the risk of a major neurovascular problem in the posterior compartment and the difficulty of preparing the base of the meniscal footprint because visualization in the medial compartment of the knee is limited. My MRR technique can improve knee function and allow a return to normal activities without the development of osteoarthritis by relying on the concepts of biomechanics and the regeneration process.

Changing pattern of water supply system in Jaipur metropolitan (Rajasthan, India)

Jaipur is the capital and largest city of the Rajasthan state with a growing population of 4.008 million in 2021. Jaipur metropolitan is a fast-growing city that attracts the population to migrate from all over the state. Jaipur city is a well-known tourist center and the tourist footfall around the world is very high. The city is developing rapidly (in terms of industrial) and so the population is. This results in the lack of some of the basic necessities to cater to the demands of the population residing here. The major problem nowadays is water scarcity and the crisis that threatens drinking water sources. Due to scorching heat and semi-arid climatic conditions, the surface water sources of dams are drying up resulting in depleting water table. There is no perennial source of surface groundwater in the city. Initially, the Ramgarh dam was the source of drinking water for the city population. In the late 1980s/early 1990s, the major part of Ramgarh dam remained dried and till 2012 the river bed was completely dried. Jaipur city suffered in an acute situation in getting drinking water. Hence, a new source of water was investigated and constructed in 1990 i.e., Bisalpur dam located in Tonk district of Rajasthan over 120 km away from Jaipur, providing water to Tonk, Ajmer and Jaipur. The supply of water from Bisalpur Dam to Jaipur began in 2009. Due to the shortage of water supply from the Bisalpur dam, the government has planned and investigated a detailed feasibility report to link the Bisalpur dam to Chambal and Brahmini Rivers to make Bisalpur dam a sustainable water resource for utilizing excess water off the Brahmini River project. To combat such situation, it is very important for the government to find sustainable solutions. Besides this, public participation is also very significant to attain the solution.

Nurses' experiences of the phenomenon 'isolation communication'.

Communication with patients and relatives can be a challenge in the intensive care unit (ICU) setting because of the acute and critical situation. However, when caring for patients with infectious diseases like COVID-19, nurses' communication is challenged further due to the required use of personal protective equipment (PPE) and mandatory isolation regimes. To explore nurses' experiences of communicating while wearing PPE during COVID-19 isolation precautions in the ICU. A qualitative study within the phenomenological-hermeneutic tradition. Data were collected via 12 interviews with nurses working in a Danish ICU from September to November 2020. Data were analysed using a Ricoeur-inspired text interpretation method. Three themes emerged during the analysis: (1) communication was limited and distanced and nurses had to compromise; (2) the nurses' senses were reduced, and verbal and nonverbal communication practises changed; and (3) patients' and relatives' communicative vulnerability were exposed in an extraordinary situation. The analysis revealed a phenomenon that can be described as 'isolation communication'. The isolation precautions and use of PPE had a profound impact on the nurses' caring and communicative practices, which were limited in this situation. The nurses found themselves physically, emotionally and socially distanced from the patients, relatives and their colleagues. However, to prevent the spread of the virus, isolation communication is something that the nurses have to endure. As our findings show that the nurses' communicative practises had to change during isolation communication, it is important for clinical practise and education to focus on implementing communication methods that optimise message transmission between ICU clinicians, patients and relatives in conditions requiring PPE and isolation. We should also focus on how to optimise interdisciplinary health communication in this situation.

Sexual violence: evaluation of cases and care for women in specialized and non-specialized health services.

The objective was to characterize the cases of sexual violence (SV) against women in Minas Gerais state, associating the care provided in cases of rape with the type of health service that provided the care (specialized or not). The Notifiable Diseases Information System was used for data referring to the notification of SV among women (age ≥10 years old), which occurred in 2017, and the National Registry of Health Facilities for information on the type of health service. The SV occurred mainly among women under 29 years old (77.1%), blacks (61.1%), singles (69.7%), and with low education (42.4%). Rape was the most frequent SV (73.5%), with the majority being notified within 72 hours of the occurrence. For all the procedures recommended for acute situations of SV, there was an association between attendance at a specialized service and a greater chance of carrying out the planned procedures. The only exception was abortion permitted by law. The results demonstrated the importance of continuing investment in the qualification and expansion of the SV care network and the importance of a better territorial distribution of reference services in Minas Gerais.