Care Of Coronavirus Disease 2019 Patients Research Articles

Role and benefits of infectious diseases specialists in the COVID-19 pandemic: Multilevel analysis of care provision in German hospitals using data from the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS) cohort.

This study investigates the care provision and the role of infectious disease (ID) specialists during the coronavirus disease-2019 (COVID-19) pandemic. A survey was conducted at German study sites participating in the Lean European Open Survey on SARS-CoV-2 infected patients (LEOSS). Hospitals certified by the German Society of Infectious diseases (DGI) were identified as ID centers. We compared care provision and the involvement of ID specialists between ID and non-ID hospitals. Then we applied a multivariable regression model to analyse how clinical ID care influenced the mortality of COVID-19 patients in the LEOSS cohort. Of the 40 participating hospitals in the study, 35% (14/40) were identified as ID centers. Among those, clinical ID care structures were more commonly established, and ID specialists were always involved in pandemic management and the care of COVID-19 patients. Overall, 68% (27/40) of the hospitals involved ID specialists in the crisis management team, 78% (31/40) in normal inpatient care, and 80% (28/35) in intensive care. Multivariable analysis revealed that COVID-19 patients in ID centers had a lower mortality risk compared to those in non-ID centers (odds ratio: 0.61 (95% CI 0.40-0.93), p = 0.021). ID specialists played a crucial role in pandemic management and inpatient care.

The Effects of the COVID-19 Pandemic on Healthcare Providers' Mental Health: Experiences at Kenyatta National Hospital, Kenya.

In 2020, healthcare providers were expected to provide care to individuals with coronavirus disease 2019 (COVID-19), putting them at risk of acquiring COVID-19. The possibility of acquiring poorly understood infectious diseases while providing care may have an impact on the mental health of providers. We conducted a study to explore the effects of COVID-19 on the mental health of healthcare providers. Between April and August 2021, we conducted in-depth interviews with 60 healthcare providers in the infectious disease unit (IDU) and other units of the hospital (non-IDU). The healthcare providers completed an online self-administered survey form with demographic data (age, sex, average income, and known contact with a COVID-19 patient). We used semi-structured interview guides to understand the healthcare providers' lived experiences of stress, anxiety, depression, and their associated factors. We transcribed the interviews verbatim and coded and analyzed the transcripts to derive thematic concepts related to mental health experiences. The healthcare providers had a median age of 37 years [IQR 20.0-58.0], and 56.7% were female, 30.0% nurses, 18.3% medical doctors, and 11.7% laboratory technologists. The healthcare providers reported increased stress during the pandemic, attributed to the high demand for patient care, changes in social life, and fear of COVID-19 infection. They also reported experiences of anxiety and depression as a result of limited knowledge at the beginning of the pandemic and the perception that "COVID-19 resulted in death". Testing positive for COVID-19, high exposure to COVID-19 risks, and the death of patients and colleagues reportedly affected the healthcare providers' mental health. Additionally, the healthcare providers reported mental health support through debriefing meetings, peer-to-peer support, and psychological counseling, with privacy and confidentiality concerns. Healthcare providers faced mental health issues such as stress and anxiety while taking care of COVID-19 patients. An effective mental health response requires institutional practices that address context-specific challenges such as privacy and confidentiality.

Healthcare professionals' perceived stigmatization about direct care of COVID-19 Patients: development and validation of the discrimination about COVID-19 (DisCOV-19) instrument.

The novel coronavirus disease 2019 (COVID-19) is a public health concern worldwide. Healthcare professionals are among the most vulnerable groups in the fight against COVID-19 because they are directly involved in the care of at-risk persons and patients with Covid-19. This study aimed to measure the level to which healthcare workers feel that they can be discriminated due to their involvement in the direct care of COVID-19 patients. A cross-sectional online survey was conducted among healthcare professionals in Nigeria. A nineteen-item discrimination against COVID-19 (DisCOV-19) questionnaire was developed and validated for the study. Descriptive statistics and One-Way Analysis of Variance were used for data analysis. P<0.05 was considered statistically significant. Out of the 286 healthcare practitioners that participated in the study, 58.4% and 30.1% were pharmacists and physicians, respectively. The majority of the participants were at least "moderately concerned" about disability (60.9%), death (71.7%), unknown complications (65.1%), and risk of infecting family members and friends (83.2%) if asked to provide care for COVID-19 patients. The physicians had a significantly higher mean discrimination score compared to the pharmacists (p=0.041). Pharmacists had a significantly lower mean discrimination score than the nurses (p=0.011). Many of the healthcare professionals reported a certain level of concern and perceived that they could face some forms of discrimination for providing care to COVID-19 patients.

Negative and positive impacts on lives of resident doctors working in a dedicated COVID-19 hospital in Mumbai: A mixed-methods study

Background: The coronavirus disease 2019 (COVID-19) pandemic has resulted in inducting trainee resident doctors (RDs) in the care of COVID-19 patients. Limited research has been conducted to understand the impact of domains other than physical and emotional health on their lives. The focus has been to understand the negative consequences of COVID-19 duties, disregarding the possibility of any positive impact that could have emerged. Aim: This mixed-methods study (qualitative and quantitative) aims to explore the holistic and comprehensive impacts of COVID-19 duties on RD's lives. Materials and Methods: This is a mixed-methods convergent design study conducted in a 1400-bed multispecialty teaching hospital in a metropolitan city in India. A phenomenological approach was used for the qualitative part of the study, and the data were collected using focus group discussions (FGDs). For quantitative purposes, the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) questionnaire was administered. Results: Qualitative findings show themes of negative impact covering domains of physical, emotional, social, and professional life. Themes that reveal a positive impact have emerged in the social, professional, and personal domains of the RDs' lives. Quantitative and qualitative results were in agreement with all the questions covered in the WHOQOL-BREF scale; however, the qualitative data findings extend far beyond. Conclusion: In the course of the COVID-19 duties, the RD has suffered in multiple domains, yet it has allowed them to self-reflect and change. As a consequence, they have grown as individuals in many areas of their lives. Working in COVID-19 wards has had a holistic impact on the RDs and has transformed them into better doctors.

Stigma and inequality in the management of coronavirus disease-2019 (COVID-19)- patients among healthcare providers in Saudi Arabia and associated beliefs: A cross sectional study

BackgroundStigma and discrimination (SAD) can greatly impact the management of Coronavirus Disease-19 (COVID-19) patients. Studies examining SAD in managing COVID-19 patients in Saudi Arabia (SA) are limited. This study examined the discrimination and inequality in treating COVID-19 patients and the associated beliefs among healthcare workers (HCWs) during the pandemic. MethodsThis was a cross sectional study using an online self-administrated questionnaire by 414 HCWs from September 2022 to January 2023. ResultsOf the 414 participants, 53.4% aged 18–30 years, were males (53.4%), mostly Saudi (82.1%), and residents of western SA (90.8%). Almost one-third of the participants (32.1%) were physicians, and 23.7% were pharmacists. 53.1% of the HCWs had work experience < 5 years, 49.3% either had a current/previous COVID-19 infection and 10.1% (n = 42) reported treating ≥ 2000 COVID-19 patients. Most of the participants had not received training on avoiding discrimination against COVID-19 patients (n = 246; 59.4%) and denied receiving any incentives from their institution (n = 294; 71%) or community (n = 248; 59.9%) during the pandemic. Less than 20% of the HCWs had observed some sort of discrimination in providing care for COVID-19 patients. The responses significantly differed by nationality, educational level, specialty, workplace and COVID-19 infection status (P < 0.05). Approximately, 20% of the participants held negative beliefs about COVID-19 patients and these responses varied significantly by nationality, work experience, workplace, gender, and age (p < 0.05). Cross-tabulation and regression analyses showed some differences by gender, workplace, specialty and COVID-19 infection status. ConclusionsThere was a low prevalence of negative beliefs about COVID-19 patients and a low prevalence of discriminatory behaviors in providing care for these patients in SA. Training and governmental regulations could further lower the prevalence of SAD against COVID-19 patients.

Factors associated with post-traumatic stress disorder in nurses after directly caring for COVID-19 patients: a cross-sectional study

BackgroundNurses are particularly at risk of suffering from post-traumatic stress disorder (PTSD) owing to their overwhelming workload, risk of infection, and lack of knowledge about the coronavirus disease 2019 (COVID-19). PTSD negatively affects an individual’s health, work performance, and patient safety. This study aims to assess factors related to PTSD among nurses after providing direct care to COVID-19 patients.MethodsThis study is a secondary analysis aimed at identifying factors influencing PTSD among nurses who provided direct care to COVID-19 patients. Data from 168 nurses, collected between October and November 2020, were analyzed. The independent variables were personal, interpersonal, and organizational and COVID-19-related factors (experience of quarantine and direct care of COVID-19 patients), and the dependent variables were PTSD symptoms evaluated based on the PTSD Checklist-5. The nurses’ experience of direct care for COVID-19 patients in the designated COVID-19 isolation wards during the first wave of the pandemic (February 2020 to May 2020) was included.ResultsAmong the nurses, 18.5% exhibited symptoms of PTSD. When providing direct care to a patient in the designated COVID-19 isolation ward, nurses witnessing the death of a patient (p = .001), low level of nurse staffing (p = .008), and inconvenience of electronic health records programs (p = .034) were associated with PTSD symptoms. The experience of quarantine owing to COVID-19 was also associated with PTSD symptoms (p = .034). Additionally, the higher the nurse managers’ ability, leadership, and support of nurses in the current ward, the higher the possibility of lowering nurses’ PTSD symptoms (p = .006).ConclusionsGovernments and hospitals should prepare and implement organizational intervention programs to improve nurse managers’ leadership, nurse staffing levels, and electronic health records programs. Additionally, because nurses who have witnessed the death of a COVID-19 patient or are self-isolating are vulnerable to PTSD, psychological support should be provided.

Prevalence and Factors Associated with Generalized Anxiety Disorder During Covid19 Pandemic among Healthcare Workers in a Tertiary Facility in Edo State, Nigeria

Background: The potential risk of the Coronavirus disease-2019 (COVID-19) pandemic and the psychological challenges that accompanied the pandemic posed a major threat and evoked high levels of anxiety among healthcare workers (HCWs) in Nigeria. Thus, this study aimed to assess healthcare workers' perceived threat of COVID-19, determine the prevalence of generalized anxiety disorder (GAD) among respondents and elucidate the factors associated with GAD.&#x0D; Methods: A cross-sectional study that used the 7-item Generalized Anxiety Disorder (GAD-7) Scale, 8-item Perceived Threat Scale, and a socio-demographic data collection sheet was used to obtain information from eligible healthcare workers who were selected using a convenience sampling technique. Data analysis was done using SPSS version 21, at a statistical significance level of p &lt;0.05.&#x0D; Results: Two hundred and thirteen HCWs participated in the study. COVID-19 posed moderatesevere threats to 57.3% of the participants, and the prevalence of GAD among respondents was 25.4%. Having a moderate-severe perception of threat by COVID-19 (p=0.039), being unmarried (p= .026), being previously suspected to have COVID-19 (p=0.018) and being directly involved in the care of COVID-19 patients (p=0.031) were significantly associated with anxiety disorder after adjusting for other variables.&#x0D; Conclusion: COVID-19 posed a substantial threat to HCWs and the prevalence of GAD among the study group was high. Government, public health institutions and non-governmental organizations have the responsibility to practically demonstrate concern for the mental well-being of HCWs by investing in mental health resources and providing adequate physical, material and psychological support for HCWs to guarantee their well-being.

Mental health complaints among healthcare workers engaged in the care of COVID-19 patients: A prospective cohort study from Japan.

Healthcare workers (HCWs) caring for patients with coronavirus disease-2019 (COVID-19) can experience physical and mental health burdens. It is imperative that hospitals reduce such burdens on frontline HCWs, protect them, and support their healthcare. This study aimed to investigate the association between occupation and the manifestation of physical or psychological symptoms among HCWs during the current COVID-19 pandemic. A twice-weekly survey using questionnaires targeting HCWs who care for COVID-19 patients was performed at Osaka Metropolitan University Hospital (tertiary hospital). The demographic characteristics of the participants, exposure level, and physical and psychological complaints were evaluated. Seventy-one HCWs participated in this study, of whom 27 (38.0%) were doctors, 25 (35.2%) were nurses, and 19 (26.8%) were technicians. Among the HCWs, the proportions of those who experienced any physical or psychological symptoms were 28.2% and 31.0%, respectively. The frequency of depression and anxiety was obviously higher among the nurses than that among the doctors (both p < 0.01). Multivariate analysis revealed that being a nurse (odds ratio 4.90; p = 0.04) and having physical complaints (odds ratio 4.66; p = 0.02) might be independent predictors of the manifestation of psychological symptoms. Our results indicate that the follow-up of HCWs experiencing physical symptoms, especially nurses engaged in the care of COVID-19 patients, may require more careful management to improve the psychological outcomes. We believe that this study is the first step toward establishing a psychological health management strategy for HCWs caring for COVID-19 patients.

Medical Students’ Perspectives on Opportunities to Engage in the Clinical Care of COVID-19 Patients during the Pandemic

Recent disease modeling suggests that pandemics are likely to increase in frequency and severity. As such, medical educators must learn from their experiences with coronavirus disease 2019 (COVID-19) to develop systematic strategies for ensuring that medical students receive hands-on training in the management of emerging diseases. Here, we outline the process by which the Florida International University Herbert Wertheim College of Medicine developed and updated guidelines for student participation in the care of patients with COVID-19 and report on students' experiences. During the 2020-2021 academic year, Florida International University Herbert Wertheim College of Medicine students were not permitted to care for patients with COVID-19; however, academic year 2021-2022 guidelines did permit fourth-year students on subinternships or Emergency Medicine rotations to voluntarily care for patients with COVID-19. At the end of the 2021-2022 academic year, students completed an anonymous survey about their experience caring for patients with COVID-19. Likert-type and multiple-choice questions were analyzed using descriptive statistics and the short-answer responses were analyzed qualitatively. One hundred two students (84%) responded to the survey. Sixty-four percent of respondents opted to provide care for patients with COVID-19. Most students (63%) cared for patients with COVID-19 during their required Emergency Medicine Selective. Twenty-eight percent of students wished they had more COVID-19 patient care opportunities, and 29% did not feel prepared to care for patients with COVID-19 on their first day of residency. Many graduating students felt unprepared to care for patients with COVID-19 during residency and many wished they had had more opportunities to care for patients with COVID-19 during medical school. Curricular policies must evolve to allow students to gain competency in the care of patients with COVID-19 so that they are prepared for day one of residency.

Front-Line vs Second-Line Healthcare Workers: Susceptibility Prediction to COVID-19 Infection in a Tertiary Care Teaching Institute.

Background Since the beginning of the novel coronavirus disease in Wuhan city of China in 2019 and its spreading worldwide and taking the form of a pandemic, many healthcare workers (HCWs)were affected by coronavirus disease 2019 (COVID-19) infection. Though we have used many types of personal protective equipment(PPE) kitswhile taking care of COVID-19 patients, we have seen COVID-19 susceptibility in different working areas were different. The pattern of infection in different working areas depended on HCWsfollowing COVID-19 appropriate behavior. Therefore, we planned to estimate the susceptibility of front-line HCWs and second-line HCWs to getting COVID-19 infection. Aim To determine the risk of COVID-19 in front-line healthcare workers as compared to second-line healthcare workers. Method and materials We planned a retrospective cross-sectional analysis of COVID-19-positive healthcare workers from our institute within six months. Their nature of duty was analyzed and they were divided into two groups: 1) Front-line HCWs were defined as those who were working or who have worked in screening areas of the outpatient department (OPD)or COVID-19 isolation wards within the prior 14 days and provided direct care to patients with confirmed or suspected COVID-19. 2) Second-line HCWs were those who were working in the general OPD or non-COVID-19 areas of our hospital and did not have contact with COVID-19-positive patients. Results A total of 59 HCWs became COVID-19 positive during the study period, 23 as front-line and 36 as second-line HCWs. The mean (SD) duration of work as a front-line worker was 51 and as a second-line worker was 84.4 hours. Fever, cough, body ache, loss of taste, loose stools, palpitation, throat pain, vertigo, vomiting, lung disease, generalized weakness, breathing difficulty, loss of smell, headache, and running nose were present in 21 (35.6%), 15 (25.4%), 9 (15.3%), 10 (16.9%), 3 (5.1%), 5 (8.5%), 5 (8.5%), 1 (1.7%), 4 (6.8%), 2 (3.4%), 11 (18.6%), 4 (6.8%), 9 (15.3%), 6 (10.2%) and 3 (5.1%), respectively. To predict the risk of getting COVID-19 infection in HCWs, binary logistic regression with COVID-19 diagnosis as the output variable was modeled with hours of working in COVID-19 wards as front-line and second-line workers as independent variables. The results showed that there was a 1.18 times increased risk of acquiring the disease for every one-hour excess of working as a front-line worker, whereas, for second-line workers, it was slightly lower, with a 1.11 times increased risk for developing COVID-19 disease with every one hour increase in duty hours. Both these associations were statistically significant (p=0.001 for front-line and 0.006 for second-line HCWs). Conclusion COVID-19 has taught us the importance of COVID-19 appropriate behavior in preventing the spread of respiratory organisms. Our study has shown that both the front-line and second-line HCWs are at increased risk of getting the infection and proper use of a PPE kit or mask can decrease the spread of such respiratory pathogens.

Successful Implementation of Workflow-Embedded Clinical Pathways During the COVID 19 Pandemic.

Clinical pathways have been found effective for improving adherence to evidence-based guidelines, thus providing better patient outcomes. As coronavirus disease-2019 (COVID-19) clinical guidance changed rapidly and evolved, a large hospital system in Colorado established clinical pathways within the electronic health record to guide clinical practice and provide the most up-to-date information to frontline providers. On March 12, 2020, a system-wide multidisciplinary committee of specialists in emergency medicine, hospital medicine, surgery, intensive care, infectious disease, pharmacy, care management, virtual health, informatics, and primary care was recruited to develop clinical guidelines for COVID-19 patient care based on the limited available evidence and consensus. These guidelines were organized into novel noninterruptive digitally embedded pathways in the electronic health record (Epic Systems, Verona, Wisconsin) and made available to nurses and providers at all sites of care. Pathway utilization data were analyzed from March 14 to December 31, 2020. Retrospective pathway utilization was stratified by each care setting and compared with Colorado hospitalization rates. This project was designated as a quality improvement initiative. Nine unique pathways were developed, including emergency medicine, ambulatory, inpatient, and surgical care guidelines. Pathway data were analyzed from March 14 to December 31, 2020, and showed that COVID-19 clinical pathways were used 21 099 times. Eighty-one percent of pathway utilization occurred in the emergency department setting, and 92.4% applied embedded testing recommendations. A total of 3474 distinct providers employed these pathways for patient care. Noninterruptive digitally embedded clinical care pathways were broadly utilized during the early part of the COVID-19 pandemic in Colorado and influenced care across many care settings. This clinical guidance was most highly utilized in the emergency department setting. This shows an opportunity to leverage noninterruptive technology at the point of care to guide clinical decision-making and practice.

Successful Implementation of Yoga and Naturopathy Interventions for Coronavirus Disease 2019 Patients in Tamil Nadu

We read the article by Deepak and Rao on Yoga and Meditation presenting an adjunct interventional strategy for coronavirus disease 2019 (COVID-19) patients with great interest.[1] They have proposed a unique protocol for the management of COVID-19 with various practices of yoga and meditation techniques for patients with mild and moderate symptoms. Recent findings have stated that COVID-19 infection presents a wide range of complications from asymptomatic to multiorgan failure.[2] Many initiatives toward the pandemic control have been adopted by the Government of India with the inputs from the Ministry of AYUSH and recommended AYUSH therapies as a supportive and adjuvant treatment in COVID management. In Tamil Nadu, the Directorate of Indian Medicine and Homeopathy has specifically recommended yoga and naturopathy interventions along with conventional care for COVID-19 patients.[3] This advisory was prepared by experienced yoga and naturopathy doctors who recommended various yoga practices and naturopathy therapies (hydrotherapy, aromatherapy, self-acupressure, and sunbath). In addition to that, a natural immune booster drink was also recommended to the patients. Patients admitted to the COVID care centers received yoga and naturopathy interventions by a team of yoga and naturopathy doctors on daily basis. Videos regarding the same interventions were also shared for learning and self-practice. The main objective of these interventions was to promote the psychological wellbeing of the patients. A recent study on 100 COVID-19 patients (asymptomatic, mild, and moderate) with yoga and naturopathy interventions showed significant improvement in stress, anxiety, depression, and quality of sleep after 2 weeks.[4] Till date, more than 10 lakh patients have successfully undergone these interventions across 184 COVID care centers in Tamil Nadu. Out of which, ten dedicated centers have successfully treated more than 10,000 patients without any adverse events. In addition, these interventions were given to the patients in home isolation through teleconsultation under the scheme called “AMMA Covid-19 Homecare” and “E-Sanjeevani”. Under this scheme, dedicated yoga and naturopathy doctors rendered 24 × 7 service through telephonic conversation and guided more than 1,000 patients for better management. Patients who received our treatments revealed that these interventions were the best part of their hospital stay during their treatment period and recommended them along with a conventional approach to all the institutions.[5] Successful implementation of yoga and naturopathy interventions during COVID-19 would be not possible without the cooperation from the patients and dedicated yoga and naturopathy doctors.

Telepharmacy during home isolation: drug-related problems and pharmaceutical care in COVID-19 patients receiving antiviral therapy in Thailand

BackgroundHome isolation has been proposed for coronavirus disease 2019 (COVID-19) patients with mild symptoms to avoid hospital overcrowding. This study aimed to describe the drug-related problems (DRPs) and the pharmaceutical care of home-isolating COVID-19 patients in Thailand.MethodsOur cross-sectional study was undertaken from July 1 to September 30, 2021, at the King Chulalongkorn Memorial Hospital, Thailand. Patients who were ≥ 18 years old, were diagnosed with mild COVID-19 by real-time polymerase chain reaction (RT-PCR), and were able to isolate at home while receiving an antiviral agent and standard symptomatic treatment were enrolled. Infectious disease pharmacists provided a telepharmacy service on days 1 and 3 after the COVID-19 diagnosis.ResultsA total of 197 patients met the study criteria. Their median age was 45 years, and their most common underlying disease was hypertension (44.29%). All patients exhibited excellent anti-COVID-19 drug adherence. We identified 125 DRPs, including adverse reactions (68%), and the unnecessary use of products (62.40%). Moreover, 91 patients (46.19%) reported the use of supplements or herbs, with vitamin C being the main supplement (37.36%). Pharmacists provided 36 recommendations and received 33 questions from COVID-19 patients.ConclusionsOur study demonstrates that telepharmacy is an essential service for detecting and preventing DRPs in home-isolating COVID-19 patients.

Potrebna lična zaštitna oprema za pružaoce prehospitalne zdravstvene zaštite u pandemiji kovida 19 - sistematski pregled

Aims. Coronavirus Disease 2019 (COVID-19) is a highly contagious disease, and a variety of personal protective equipment (PPE) has been recommended as preventive measures for prehospital emergency personnel, which has led to considerable challenges and a great confusion for the personnel. This review aims to identify different types of PPE required in the care of COVID-19 patients in prehospital emergency system. Material and methods. This study was carried out by searching through databases including: Pubmed, Proqust, Google Scholar, and Cinahl. All articles that recommended different types of PPE against COVID-19 and infectious diseases for prehospital emergency personnel were collected in a table. Results. After carrying out the initial search in the databases, 1,009 studies were obtained and then 16 articles were selected. The findings seem to suggest using equipment including: gloves, face shields (shield/goggles), protective clothes (medical jumpsuit/scrubs), surgical masks, N-95 masks, powered air purifying respirators (PAPR), hair covers, shoe covers and washing up the hands by the emergency medical service (EMS) personnel. Discussion. The scrutiny of the relevant studies showed that each of them advised the EMS personnel to use a number of PPE. The present study highlighted the fact that there are other components of the PPE which can be useful to them. Conclusion. This study identified the most appropriate PPE needed for prehospital emergency personnel against COVID-19, and it is believed that planning for adequate access to this equipment and training on how to use them can significantly help to reduce the infection among the personnel.

Effects of a Nursing Simulation Learning Module on Clinical Reasoning Competence, Clinical Competence, Performance Confidence, and Anxiety in COVID-19 Patient-Care for Nursing Students

This study aimed to develop a nursing simulation learning module for coronavirus disease 2019 (COVID-19) patient-care and examine its effects on clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient care for nursing students. A non-equivalent control group pre- and post-test design was employed. The study participants included 47 nursing students (23 in the experimental group and 24 in the control group) from G City. A simulation learning module for COVID-19 patient-care was developed based on the Jeffries simulation model. The module consisted of a briefing, simulation practice, and debriefing. The effects of the simulation module were measured using clinical reasoning competence, clinical competence, performance confidence, and anxiety in COVID-19 patient-care. Data were analyzed using χ²-test, Fisher's exact test, t-test, Wilcoxon signed-rank test, and Mann-Whitney U test. The levels of clinical reasoning competence, clinical competence, and performance confidence of the experimental group were significantly higher than that of the control group, and the level of anxiety was significantly low after simulation learning. The nursing simulation learning module for COVID-19 patient-care is more effective than the traditional method in terms of improving students' clinical reasoning competence, clinical competence, and performance confidence, and reducing their anxiety. The module is expected to be useful for educational and clinical environments as an effective teaching and learning strategy to empower nursing competency and contribute to nursing education and clinical changes.

Impact of Post-acute COVID-19 Syndrome on Mental Health of Healthcare Professionals: A Cross-sectional Study

Introduction: Anxiety, depression, and poor sleep quality are the most common mental health issues in post-acute Coronavirus Disease-2019 (COVID-19) syndrome. Healthcare professionals (HCPs) were overburdened and unable to focus on their own health issues. Previous epidemic diseases, such as Severe Acute Respiratory Syndrome (SARS) in 2003, also accompanied psychiatric issues in HCPs. In light of this, the purpose of this study was to identify the symptoms of COVID19 that continue to affect HCPs and their associations with fatigue, poor sleep, anxiety, depression, and activity levels, in order to provide better care and treatment for them. Aim: To analyse the impact of post-acute COVID-19 syndrome on the mental health of HCPs and compare the results with non COVID-19 infected participants. Materials and Methods: A cross-sectional study was conducted at PGIMS, Rohtak in Haryana, India from October 2021 to September 2022. A total of 280 participants between 25-45 years of age, including doctors, nurses, and dentists involved in direct COVID-19 patient care, were included in the survey. They were divided equally into a non COVID-19 infected group and a post-acute COVID-19 syndrome group, with atleast three months having passed since infection. The survey included scales addressing anxiety, depression, and sleep quality, including the Zung Self-rating Anxiety Scale (SAS), Zung Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). The mean scores were compared between both groups using an Independent sample t-test. Results: The data of 240 participants were analysed and compared between both groups. The mean age was 32.41 years in the post-acute COVID-19 syndrome group and 31.24 years in the non COVID-19 infected group. The post-acute COVID-19 syndrome group consisted of a large proportion of doctors (60, 42.9%) and nurses (53, 37.9%), whereas the non COVID-19 infected group included doctors (47, 33.5%) and nurses (56, 40%). The results showed statistically significant differences for anxiety (p-value=0.001) and sleep quality (p-value =0.001), while no significant differences were found for depression (p-value&gt;0.05). Conclusion: Anxiety and poorer sleep quality occur in healthcare workers suffering from post-acute COVID-19 syndrome. Creating multidisciplinary rehabilitation health teams in hospitals with clinician psychologists, physiotherapists, nurses, and psychiatrists is essential to address mental health issues in the post-COVID-19 population.

1053. Comorbidities Associated with All-Cause Readmission to the Same Hospital after Index COVID-19 Hospitalization: A Retrospective Cohort Study of 232155 Patients in the United States

Abstract Background Understanding comorbidities that drive all-cause readmission in patients hospitalized with Coronavirus disease 2019 (COVID-19) can inform healthcare system capacity planning and improve post-discharge care. Methods This was a retrospective cohort study of patients hospitalized for COVID-19 between April 2020-December 2020 (index cohort) across 760 hospitals in the Premier Healthcare Database. Patients who died or left against medical advice were excluded from the index cohort. Surviving patients in the index cohort were followed until May 2021. First readmission to the same hospital as the COVID-19 index admission was considered all-cause readmission. The all-cause 14-month risk (95% confidence interval) of readmission was calculated using the Kaplan-Meier approach. A multivariable Cox proportional hazards model adjusted for demographic variables, hospital characteristics, co-existing comorbidities, and COVID-19 severity was built to study the association between Elixhauser comorbidities and readmission. Results Among 232155 unique patients in the index cohort, 36680 were readmitted to the same hospital at least once, followed through May 2021. The 14-month risk of readmission was 16.2% (95% CI:16.1% - 16.4%). The most frequent primary diagnosis on readmission was infectious disease (14240, 38.8%), of which 8754 (24%) were for COVID-19. With each additional comorbidity, the readmission hazard increased by 19% (HR, 1.19; 95% CI:1.18 - 1.19). In the multivariable Cox proportional hazards model, many comorbidity categories were associated with an increased risk of readmission. Metastatic cancer (HR, 1.74; 95% CI:1.60 –1.89), lymphoma (HR, 1.61; 95% CI:1.47 – 1.77), drug abuse (HR, 1.51; 95% CI:1.41 – 1.62), congestive heart failure (HR, 1.47; 95% CI:1.44– 1.51), and alcohol abuse (HR, 1.46; 95% CI:1.36– 1.56) were associated with the highest hazard for readmission. Conclusion COVID-19 patients have a high risk of all-cause readmission and are frequently readmitted for COVID-19. With the continued emergence of COVID-19 variants, this study provides valuable insights into developing more informed discharge plans and improving post-discharge care for COVID-19 patients with existing comorbidities to prevent readmission. Disclosures Lyndsay M. O'Hara, PhD, MPH, PDI: Grant/Research Support.

Factors Influencing the Educational Needs and Nursing Intention Regarding COVID-19 Patient Care among Undergraduate Nursing Students.

This study examines final-year undergraduate nursing students to determine the educational needs for Coronavirus disease 2019 (COVID-19), knowledge of COVID-19, attitude toward COVID-19 patient care, and nursing intention toward COVID-19 patients. A structured questionnaire was used to collect data from 21 April to 6 May 2022. The participants included 144 final-year (4th year) undergraduate nursing students in Gangwon-do, Daegu-si, and Chungcheong-do. The SPSS/WIN 21.0 program was used to analyze the data; Pearson's correlation coefficients and multiple regression were further performed. The attitude toward COVID-19 patient care (β = 0.38, p = 0.001), a cohabitant formerly infected with COVID-19, and the intention to study COVID-19 patient care (β = 0.16, p = 0.018) were found to influence nursing intention toward COVID-19 patients. These variables had a 27% explanatory power for nursing intention (F = 14.23, p < 0.001). To foster undergraduate nursing students' nursing intention toward patients with emerging infectious diseases (EIDs), a program focused on cultivating a positive attitude toward EID patient care should be developed and implemented. The curriculum should further include education on EID patient care.

Augmentation of a Hospital Incident Command System to Support Continued Waves of the COVID-19 Pandemic.

Stamford Hospital (SH) is a 305 bed Level II Trauma center located in Fairfield County, the epicenter of the coronavirus disease 2019 (COVID-19) pandemic in Connecticut. The COVID-19 pandemic was a fast paced, rapidly evolving crisis, presenting our leadership team with unique challenges related to resource availability, patient care, and staff safety. The existing Hospital Incident Command System (HICS) was activated in March 2020 to coordinate our operational emergency management planning, response, and recovery capability for this unplanned event. Although HICS lays the groundwork for hospital preparations and protocol implementation, it is not designed to withstand prolonged crisis circumstances. Given the conditions that the COVID-19 pandemic presented, the possibility for future waves became an impending reality, prompting the need for a long-term solution. To establish guidelines that promoted balance between necessary preparations in the case of additional surges of the pandemic and concurrent resumption then maintenance of routine hospital operations, the SH COVID-19 Playbook was created. The Playbook, presented here, is arranged in accordance with the evidence-based 4 S's (Space, Staff, Systems, and Stuff) strategic critical care planning framework, to address surge capacity management within our hospital's four main patient care areas and additional supportive services. Through feedback from frontline caregivers and leaders within SH, the Playbook captures our experience, best practices, and insight acquired during the first wave of the pandemic. Established with the intentions of equipping leadership and staff globally, guidelines are presented to aid in the navigation of future pandemic surges and successfully care for COVID-19 patients, ensure staff safety, allow for normal services to operate, and provide optimal communication and support for the community, patients, and staff.

The distribution of acquired peripheral nerve injuries associated with severe COVID-19 implicate a mechanism of entrapment neuropathy: a multicenter case series and clinical feasibility study of a wearable, wireless pressure sensor

We diagnosed 66 peripheral nerve injuries in 34 patients who survived severe coronavirus disease 2019 (COVID-19). We combine this new data with published case series re-analyzed here (117 nerve injuries; 58 patients) to provide a comprehensive accounting of lesion sites. The most common are ulnar (25.1%), common fibular (15.8%), sciatic (13.1%), median (9.8%), brachial plexus (8.7%) and radial (8.2%) nerves at sites known to be vulnerable to mechanical loading. Protection of peripheral nerves should be prioritized in the care of COVID-19 patients. To this end, we report proof of concept data of the feasibility for a wearable, wireless pressure sensor to provide real time monitoring in the intensive care unit setting.