Care Personnel Research Articles

A Cloud Infrastructure for Large Scale Health Monitoring in Older Adult Care Facilities

Technology development in the sub-field of older adult care has always been on the back-burner compared to other healthcare areas. But with increasing life expectancy, this is poised to change. With the increasing older adult population, the current older adult care facilities and personnel are struggling to keep up with demand. To address this matter, we proposed a distributed system infrastructure that will enable large-scale monitoring of vital signals and early detection of emergency situations in nursing homes and assisted living communities in this study. The system is mainly comprised of node devices and cloud infrastructure. The node device collects data from multiple users and forwards this data to the cloud service. Communication between the vital-sensing devices on the users and the node device is accomplished using Bluetooth Low-Energy (BLE). The Node device is implemented on a Raspberry Pi Model 3b+ which has built-in BLE capability. A cloud server consists of back-end and front-end components. The back-end handles all the data processing and logical decisions that drive the front-end. The front-end is the interface provided to the end-users, which can monitor all patients in nursing homes at the same time. We examined our system in terms of scalability, real-time operation, cost, and usability and then found that our system provides not only a smart remote monitoring solution that can provide a better aging experience for older adults and their families, but also increase automation in nursing homes leading to a reduction in running cost and an increase in capacity.

Abstract 13402: Continuous Rhythm Monitoring in Patients After Embolic Stroke of Undetermined Source Yields High Evaluation Burden

Introduction: Embolic stroke of undetermined source (ESUS) accounts for up to 20% of ischemic strokes. Undetected atrial fibrillation (AF) represents one important underlying cause. Once diagnosed, initiation of oral anticoagulation is recommended for secondary stroke prevention. Yet, detection of paroxysmal AF is tedious. Implantable loop recorders (ICM) have evolved as the diagnostic gold standard. Prior studies have indicated that ICM implantation and remote monitoring in particular result in a relevant financial and personnel burden in unselected patients. ESUS patients are considered at higher risk of an AF diagnosis. Hypothesis: We hypothesized that AF diagnosis by ICM and remote monitoring puts considerable strain on health care providers, even in patients at high risk for AF after ESUS. Methods: We investigated all patients of our hospital-based, prospective, single-center, observational ESUS cohort that were equipped with an ICM after ESUS between January 2018 and December 2019. Follow-up was performed through July 2020. Results: Overall, 179 patients were eligible for analysis. Of these, 38 patients (22,1%) were diagnosed with AF by ICM and remote monitoring. During the study period a total of 11,975 episodes were transmitted through remote monitoring, of which 3,766 were alarms for AF. Response to alarms resulted in 307 on site visits and 132 telephone calls to inquire about symptoms, to inform about the diagnosis of AF, and to initiate a change in antithrombotic regimen from antiplatelet therapy to oral anticoagulation. On average, a single ESUS patient generated 40.9 episodes per year for review, triggered one additional on-site visit, and every other patient required additional telephonic follow-up. The number needed to diagnose one ESUS patient with AF within one year was 5. Conclusions: ICM and remote monitoring can successfully diagnose AF in a high-risk cohort after ESUS. Yet, the number of alarms other than for AF, and alarms inappropriately suggesting AF by far exceed appropriate AF diagnoses. Even in a cohort at high risk for AF and with an immediate therapeutic consequence upon AF diagnosis, the resulting burden on personnel and health care resources is high. An optimization of diagnostic ICM algorithms is therefore desirable.

Infectious Diseases Society of America Guidelines on Infection Prevention for Healthcare Personnel Caring for Patients with Suspected or Known COVID-19.

BackgroundSince its emergence in late 2019, SARS-CoV-2 continues to pose a risk to healthcare personnel (HCP) and patients in healthcare settings. Although all clinical interactions likely carry some risk of transmission, human actions like coughing and care activities like aerosol-generating procedures likely have a higher risk of transmission. The rapid emergence and global spread of SARS-CoV-2 continues to create significant challenges in healthcare facilities, particularly with shortages of personal protective equipment (PPE) used by HCP. Evidence-based recommendations for what PPE to use in conventional, contingency, and crisis standards of care continue to be needed. Where evidence is lacking, the development of specific research questions can help direct funders and investigators.ObjectiveDevelop evidence-based rapid guidelines intended to support HCP in their decisions about infection prevention when caring for patients with suspected or known COVID-19.MethodsIDSA formed a multidisciplinary guideline panel including frontline clinicians, infectious disease specialists, experts in infection control, and guideline methodologists with representation from the disciplines of public health, medical microbiology, pediatrics, critical care medicine and gastroenterology. The process followed a rapid recommendation checklist. The panel prioritized questions and outcomes. Then a systematic review of the peer-reviewed and grey literature was conducted. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to assess the certainty of evidence and make recommendations.ResultsThe IDSA guideline panel agreed on eight recommendations, including two updated recommendations and one new recommendation added since the first version of the guideline. Narrative summaries of other interventions undergoing evaluations are also included.ConclusionsUsing a combination of direct and indirect evidence, the panel was able to provide recommendations for eight specific questions on the use of PPE for HCP providing care for patients with suspected or known COVID-19. Where evidence was lacking, attempts were made to provide potential avenues for investigation. There remain significant gaps in the understanding of the transmission dynamics of SARS-CoV-2 and PPE recommendations may need to be modified in response to new evidence. These recommendations should serve as a minimum for PPE use in healthcare facilities and do not preclude decisions based on local risk assessments or requirements of local health jurisdictions or other regulatory bodies.

Epilepsy centers in China: Current status and ways forward

China has the largest population of patients with epilepsy worldwide, which imposes a heavy burden on the public and health care systems. Several epidemiological surveys on epilepsy have been performed in China. Although these surveys grossly describe the prevalence and gap in treatment of epilepsy, the status of epilepsy centers is unclear. The number of epilepsy centers has increased substantially in recent decades. Therefore, a nationwide investigation of the scale and distribution, personnel, equipment, and epilepsy care capacity of each epilepsy center is of great value. In 2017-2018, a multicenter cross-sectional survey was performed by the Commission on Standardized Development of Epilepsy Centers, China Association Against Epilepsy in 31 provinces, autonomous regions, and municipalities. The survey consisted of 74 questions divided into four sections: (1) overview, (2) personnel, (3) essential equipment and facilities, and (4) epilepsy care service capacity. The questions ranged from January 1, 2016 to December 31, 2016. The data were analyzed using descriptive statistics. There were 358 epilepsy centers for the 1.38 billion national population in 2016. Three quarters were in the eastern and western regions, and >90% were in tertiary hospitals. There were 9688 doctors engaged in epilepsy care, and 4.8% of doctors and electrophysiological physicians/technicians passed the national test for electroencephalography technical accreditation. A total of 9667 patients underwent resective surgeries in 2016. There were 888 vagus nerve stimulation procedures and 275 deep brain stimulation procedures. This study is the first unique survey of epilepsy centers in China. Despite their rapid development, epilepsy centers cannot meet patients' needs at this stage. The results provide data-based evidence for the formulation of policies related to epilepsy service planning.

Labor safety of medical personnel in medical organizations of stationary type

The aim of the research is to study the safety system of nursing personnel in medical institutions of the stationary type. Results. The most important conditions forthe effectivework of nursing personnel are: medical care of personnel, the availability of office equipment at the workplace, small mechanization for caring for patients with sufficient provision of personal protective equipment, tools, antiseptics and disinfectants. Conclusion. A harmful psychophysiological production factor in the professional activities of nursing personnel is also manifested in significant intellectual and emotional stress, which, over time, also cause the development of any somatic disease in specialists.

Evaluation of Capillary Blood Gases in Medical Personnel Caring for Patients Isolated Due to SARS-CoV-2 in Intensive Care Units before and after Using Enhanced Filtration Masks: A Prospective Cohort Study.

The dynamically changing epidemiological situation caused by the SARS-CoV-2 virus is associated with the increased burden and fatigue of medical personnel. The aim of the study was to evaluate: (1) oxygen and carbon dioxide blood pressure and saturation levels in medical personnel caring for patients isolated due to SARS-CoV-2 in ICUs; (2) adverse symptoms reported by medical personnel after leaving the isolation zone. Design: A Prospective Cohort Study. Methods: The project was implemented in the first quarter of 2021. Medical personnel working with patients isolated due to SARS-CoV-2 in the ICU of three hospitals were eligible for the study. The participants of the study were subjected to two analyses of capillary blood by a laboratory diagnostician. Results: In the studied group of medical personnel (n = 110) using FFP2/FFP3 masks, no significant differences (p > 0.05) were found between the parameters of geometric examination performed before and after leaving the isolation ward of the hospital. After working in the isolation ward, nurses reported malaise (somnolence, fatigue, sweating, dizziness) more often than paramedics (44% vs. 9%; p = 0.00002). The risk of ill-being in nurses was approximately nine times higher than in paramedics (OR = 8.6; Cl 95%: 2.7 to 26.8) and increased with the age of the subjects (OR = 1.05; Cl 95%: 1.01 to 1.08). Conclusion: FFP2/FFP3 filter masks did not worsen blood oxygenation in medical staff caring for patients isolated due to SARS-CoV-2 in the ICU. The presence of subjective symptoms such as fatigue may be due to lack of adequate hydration.

Patient-reported outcome measures in pediatric palliative care\u2014a protocol for a scoping review

BackgroundIn pediatric palliative care (PPC), there is a need to involve the child’s voice in situations regarding their symptoms and care needs. Patient-reported outcome measures (PROMs) can be tools to systematically gather data reported from the child or a proxy if the child is not capable to self-report in order to provide the services they need. There has been a rapid development in PROM research the last decade, and there is a need for an overview of current knowledge and experiences in the field. Thus, we aim to explore and summarize what is known from the published research about PROMs in PPC.MethodsWe propose a scoping review following the framework by Arksey and O’Malley and the PRISMA Extension for Scoping Reviews checklist. A systematic search will be performed in the following databases: Medical Literature Analysis and Retrieval System Online (Medline), Excerpta Medica database (EMBASE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), American Psychological Association (APA) PsycInfo, Health and Psychosocial Instruments (HaPI), and Allied and Complementary Medicine Database (AMED). The search will be followed by snowballing to identify key papers and significant researchers for additional citations. Covidence will facilitate the independent review of eligible citations, and data will be extracted and presented descriptively, and thematically analyzed using NVivo.DiscussionThe scoping review suggested in this protocol will identify PROMs which have been proposed in PPC and clarify the experiences with their use. The findings of this review will be relevant for researchers and healthcare personnel caring for children and adolescents in PPC. In addition, by highlighting knowledge gaps about the use of PROMs in PPC, this review will point out future needs within this field of research, which is crucial for improving quality of care in PPC.Systematic review registrationhttps://osf.io/yfch2/.

An Evaluation of Post-Concussion Return to School Guidelines: A Survey of Massachusetts School Nurses.

Although all states have legislation pertaining to youth sports concussion, most of these laws focus on return-to-play procedures; only a few address return-to-learn (RTL) accommodations for students who have experienced a concussion. To address this gap in the legislation, some states and nongovernmental organizations have developed RTL guidelines to advise school personnel, parents, and health care providers on best practices for accommodating students' postconcussion reintegration into academic activity. In 2018, the Massachusetts Department of Public Health (MDPH) developed RTL guidelines which were disseminated to school nurses (SNs) at all public and nonpublic middle and high schools in the state. In 2020, the MDPH engaged the Injury Prevention Center at Boston Medical Center to survey Massachusetts SNs to assess the usefulness of the guidelines. The response rate was 63%; 92% found the booklet extremely useful or moderately useful; and 70% endorsed that the booklet fostered collaboration among stakeholders.

Organization of the activities of mid-level medical staff in providing care to urological patients

In the last decade, the health care system has been suffering from an imbalance of medical personnel and low efficiency in the use of nursing personnel in practical health care, which significantly affects the quality of medical care. The article reveals the main goals and objectives of the activity of mid-level medical staff in the system of providing medical care to patients in a urological hospital. The need for nurses to comply with the formulated standards is a central link in the process of organizing their activities. The effectiveness of treatment and recovery of patients without reducing the further quality of their lives depends on timely measures for care, psychological assistance, tact and compliance with ethical standards by nurses. All these factors directly affect the prospects for the treatment and rehabilitation of patients with urological pathology, as well as the performance indicators of the urological hospital.

Home healthcare patient, caregiver and provider perspectives on use of unscheduled acute care and the usability and acceptability of on-demand telehealth solutions

Background/Objectives: Home health care (HHC) agencies provide an important role in helping to transition patients from acute care to independent residential living. Telehealth has the potential to transform care delivery in HHC, however the majority of studies in HHC have focused on the use of telemonitoring for patients with specific chronic conditions. The objective of this study was to examine reasons HHC patients use acute care services and assess the acceptability of on-demand telehealth services among HHC patients, caregivers and personnel to help alleviate the need for seeking in-person acute care.Design/Setting/Participants/Measures: This study was a secondary analysis of qualitative data from in-depth interviews of 30 HHC personnel, patients and caregivers from a Medicare-certified HHC agency affiliated with a large healthcare system from January through May 2020. A conventional content analysis approach was used to identify themes.Results: Themes associated with reasons for seeking acute care included: sense of urgency, behavioral and psychosocial factors, and access to care. Participants described their perceptions of the benefits, usability and acceptability and barriers to using telehealth. Patients and HHC personnel agreed that on-demand telehealth should not replace in-person visits but all identified roles that on-demand telehealth services could play in improving communication and access to care. The biggest barriers to use of telehealth identified by HHC personnel were cost, access and ability to use technology by HHC patients.Conclusion: This study identified reasons HHC patients seek unscheduled acute care and the usability and acceptability of on-demand telehealth services to increase access to care among HHC patients. These findings underscore the need to improve communication and coordination between patients, HHC personnel, and primary care providers and the role that on-demand telehealth services can have in transforming HHC.

Escala de ansiedad generalizada GAD-7 en profesionales médicos colombianos durante pandemia de COVID-19: validez de constructo y confiabilidad

IntroductionThe detection of anxiety symptoms among health workers who care for patients infected with COVID-19 is a current priority. Fast and valid instruments are required for this population group. The objective is to establish the construct validity and reliability of the Generalised Anxiety Disorder (GAD-7) scale in Colombian doctors during the COVID-19 lockdown. MethodsE-health study, in which cross-sectional data were collected online (n=1,030) from 610 COVID doctors and 420 non-COVID doctors, during the Colombian lockdown, between 20 April and 10 August 2020. Each subject was contacted, and they confirmed their participation, identity and professional role. ResultsA single factor factorial structure was found, made up of the 7 items of the instrument, which managed to explain 70% of the variance. The goodness of fit indices (RMSEA=0.080; CFI=0.995; SRMR=0.053; p <0.001) showed an “acceptable” unidimensionality and adequate factor loadings in each item of the GAD-7,>0.070. Finally, the internal consistency of the instrument was good, with a Cronbach's alpha of 0.920 (95%IC, 8.80-9.71). ConclusionsThe GAD-7 is an instrument that presents adequate indicators of validity and reliability. It is an excellent tool that is reliable and easy and fast to use for the detection of generalised anxiety symptoms in medical personnel caring (or not) for patients infected with COVID-19.

Emergency Response: A Cross-sectional Study of Core Competencies for Nurses Regarding Major Infectious Disease Outbreaks

IntroductionThe core competencies of nursing personnel have been identified as a main factor affecting nursing effectiveness. This study examined core emergency response competencies of Chinese nursing personnel related to the outbreak of major infectious diseases. MethodsA survey was conducted among 960 nurses working in a tertiary hospital in Shanghai, China. Data were collected on core emergency response competencies of nursing personnel caring for patients with major infectious diseases, measuring overall competency as well as by dimensions of prevention ability, rescue ability, and preparation ability. A t-test and one-way analysis of variance were first analyzed for differences between groups, followed by multiple linear regression to analyze main influencing factors for core emergency response competencies. ResultsThe average score for core emergency response competencies of nursing personnel delivering care to patients with major infectious diseases was 128.05 (SD 22.23) (range 36–180 points); or 71%, which is equivalent to moderate performance. Multiple linear regression analysis demonstrated that the main influencing factors for these nursing personnel were before participation in emergency drills for infectious diseases, current educational background, and working experience in the realm of infectious disease nursing. The final model explained 8.4% of the variance in core emergency response competencies. DiscussionThese findings indicate that it is necessary to strengthen the training of nursing staff with educational background deficits or no prior work or drill experience related to infectious diseases to effectively improve the core emergency response competencies of nursing personnel relative to infectious diseases.

Everyday Life of Population of Siberian Province in Context of Peter’s I Reforms in First Quarter of 18&lt;sup&gt;th&lt;/sup&gt; Century

The article is devoted to the study of the evolution of the culture of everyday life of the Siberian province population in the first quarter of the 18th century, the characteristics of the development of traditional forms of material culture of Siberians, and new features of everyday life that arose under the influence of the implementation of Peter's reforms on the territory of Western Siberia. Changes in the material culture, leisure and life of the population of the Siberian province in the first quarter of the 18th century are considered, the traditions of building houses, making clothes, the level of medical care and health care, leisure activities of the population of Western Siberia in the first quarter of the 18th century are described. The study was carried out on the basis of an analysis of the complex of legislative and office-work sources of the State Archives in Tobolsk. Among them, an important place is occupied by decrees regulating the organization of medical care for the population, documents reflecting the actions of local authorities in relation to the occupation of Swedish prisoners of war in Tobolsk by distilling. The authors of the article show that Peter's modernization processes in the field of culture, customs and everyday life had little effect on the traditions of building houses, making clothes, and everyday activities of the majority of the peasant population of the Siberian province and local non-Russian peoples. It is concluded that the main changes affecting the area of everyday culture are associated with the implementation of the military and administrative reforms of Peter I, the appearance of captured Swedes on the territory of the province, the implementation of the provincial reform, a change in the local administration system, the emergence of medical professional personnel and health care institutions.

Сomparative epidemiological and demographic characteristics of TB and HIV infections among military personnel of the Russian Federation and USA armed forces and armed forces of National liberation army of people’s Republic of Сhina

More than 1,7 million people, 770 thousand people from HIV infection, died from tuberculosis worldwide in 2018. In accordance with the United Nations Sustainable Development Goals and the World Health Organization’s strategy to fight tuberculosis, all countries need to reduce the incidence of tuberculosis by 80% and reduce the death rate from tuberculosis by 90% by 2030. According to the Joint United Nations programme on HIV/AIDS (UNAIDS) goals of «90–90–90», countries should achieve the following indicators by 2020: «90% of people living with HIV infection should know their HIV status; 90% of those who know about their HIV infection should receive treatment, and 90% of those who are being treated should not have their viral load determined». Socially significant diseases are a serious problem for the Russian Federation (RF). The RF is one of 30 countries with a high incidence of tuberculosis and ranks 3rd place in multidrug-resistant tuberculosis and 6th place in the prevalence of HIV infection. Socially significant diseases present a serious problem for the Armed Forces of the RF. 150 new cases of tuberculosis, over 50 cases of HIV infection are diagnosed every year among military personnel of the RF Armed Forces.The purpose of the studyis to analyze the current epidemiological situation of tuberculosis and HIV infection in the armed forces of the Russian Federation and foreign armies, to generalize domestic and foreign experience in the organization of medical care for military personnel with these diseases.Data from reports of the medical service and a review of domestic Russian and foreign medical literature allowed us to assess TB and HIV sickness rate among military personnel in the RF and foreign states, as well as to characterize the current system of medical care for this category of patients.

Treatment Outcomes and Trajectories of Change in Patients Attributing Their Eating Disorder Onset to Anti-obesity Messaging.

Given the increased prevalence of eating disorders (EDs) among individuals higher on the weight spectrum, we aimed to 1) report the prevalence of ED patients in higher levels of care (residential, partial hospitalization, and intensive outpatient) attributing the onset of their ED to anti-obesity messaging, 2) report the most commonly recollected sources of those messages, and 3) determine if those attributing the onset of their ED to anti-obesity messaging a) enter, b) exit, and c) respond to treatment differently from peers who did not. This retrospective cohort study used data from 2901 patients receiving ED treatment in higher levels of care at a US-based center between 2015 and 2018. Multilevel models examined differences in ED symptoms and trajectories of change over time. NVivo was used to analyze the patients' comments about sources of messages. Eighteen percent attributed their ED onset to anti-obesity messaging, 45% did not, and 37% were unsure. Of those providing comments, the most common sources included the following: educational curriculum/school context (45.9%), media/Internet (24.7%), health care (10.4%), family (9%), and peer bullying (3.7%). At admission, patients attributing their ED onset to anti-obesity messaging had more severe ED symptoms than those who did not (γ = 0.463, standard error [SE] = 0.086, p < .001) and those who were unsure (γ = 0.288, SE = 0.089, p < .001); no differences were evident at discharge (p > .483). During phase 2 of treatment, patients attributing their ED onset to anti-obesity messaging improved faster than those who did not (γ = 0.003, SE = 0.001, p = .008) and those who were unsure (γ = 0.003, SE = 0.001, p = .014). Anti-obesity messaging may put vulnerable individuals at risk for EDs. We recommend increasing weight bias training for school personnel and health care professionals. To reduce health disparities, we also suggest the promotion of weight-neutral health-enhancing self-care practices in media and public health campaigns, legislative policies, and health care overall.

Infringement of the personal rights of a doctor and medical institution

Health and life constitute a special value for everyone. Therefore, parties involved in providing medical services are subject to exceptionally high expectations, and the activities of doctors and medical institutions are subject to social control. Such control is carried out with the participation of patients and journalists using mass media, particularly the Internet. Even though such control is allowed and freedom of speech and freedom of the press allow for public expression of opinions (including critical and negative ones), presenting one’s position – even on important social issues – does not entitle one to infringe upon the personal rights of medical personnel and health care institutions. Meantime, criticizing and defaming doctors has become increasingly common in recent years due to the growing popularity of internet portals evaluating doctors, social media disseminating information, as well as the social tensions related to the overburdened health service and limited access to some health services due to the COVID-19 pandemic. Furthermore, patients exposed to stress about the health or hospital treatment are more likely to manifest their emontions by verbal aggression (insults or slanders) towards the medical personnel [1]. In the case of a threat to or infringement of personal rights, civil and criminal remedies are available to the doctor and the medical establishment, which protect against the negative consequences of an infringement of reputation or good name in the personal, professional and social sphere.

The Mental Well-Being of Health Care Workers during the Peak of the COVID-19 Pandemic-A Nationwide Study in Poland.

Introduction: The current epidemiological situation has quickly led to several changes in the daily functioning of people around the world, especially among medical personnel, who in this difficult period were burdened with new professional duties, which significantly affects their mental health. Materials: This study aims to assess the mental health of health professionals at a critical point in their workload, to compare the results with those the general population, and to explore the potential determinants affecting it. The CAWI survey includes a sociodemographic section, work experience and a standardised psychometric tool (GHQ-28). Data were collected during the second wave of the COVID-19 pandemic in Poland (3–29 November 2020), which had the highest mortality rates and SARS-CoV-2 morbidity rates, as well as during the period of a significant increase in deaths, compared to the corresponding pre-pandemic period. Results: A total of 2150 surveys were eligible for analysis. Among them, 848 (39.4%) were active health professionals. In the analysis of the scores of the GHQ-28 scale and its sub-scales, evaluating anxiety/insomnia and somatic symptoms, medical workers scored significantly higher scores than non-medical professions (p < 0.001). Frontline medical workers (p < 0.001) and those who were forcibly seconded to work with COVID-19-infected patients (p = 0.011) achieved significantly higher GHQ-28 scores. Conclusions: The COVID-19 pandemic has had a significant impact on mental deterioration among health professionals, especially among those directly working with SARS-CoV-2-infected patients and those who were forcibly seconded to work with such patients. To mitigate the effects of the pandemic, appropriate psychological care for medical personnel needs to be implemented.

Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke

BackgroundSurgical occlusion of the left atrial appendage has been hypothesized to prevent ischemic stroke in patients with atrial fibrillation, but this has not been proved. The procedure can be performed during cardiac surgery undertaken for other reasons.MethodsWe conducted a multicenter, randomized trial involving participants with atrial fibrillation and a CHA2DS2-VASc score of at least 2 (on a scale from 0 to 9, with higher scores indicating greater risk of stroke) who were scheduled to undergo cardiac surgery for another indication. The participants were randomly assigned to undergo or not undergo occlusion of the left atrial appendage during surgery; all the participants were expected to receive usual care, including oral anticoagulation, during follow-up. The primary outcome was the occurrence of ischemic stroke (including transient ischemic attack with positive neuroimaging) or systemic embolism. The participants, research personnel, and primary care physicians (other than the surgeons) were unaware of the trial-group assignments.ResultsThe primary analysis population included 2379 participants in the occlusion group and 2391 in the no-occlusion group, with a mean age of 71 years and a mean CHA2DS2-VASc score of 4.2. The participants were followed for a mean of 3.8 years. A total of 92.1% of the participants received the assigned procedure, and at 3 years, 76.8% of the participants continued to receive oral anticoagulation. Stroke or systemic embolism occurred in 114 participants (4.8%) in the occlusion group and in 168 (7.0%) in the no-occlusion group (hazard ratio, 0.67; 95% confidence interval, 0.53 to 0.85; P=0.001). The incidence of perioperative bleeding, heart failure, or death did not differ significantly between the trial groups.ConclusionsAmong participants with atrial fibrillation who had undergone cardiac surgery, most of whom continued to receive ongoing antithrombotic therapy, the risk of ischemic stroke or systemic embolism was lower with concomitant left atrial appendage occlusion performed during the surgery than without it. (Funded by the Canadian Institutes of Health Research and others; LAAOS III ClinicalTrials.gov number, NCT01561651.)

Clinical Characteristics, Management, and Outcome of the First 19 Patients With Pneumonia Due to the 2019 Novel Coronavirus Disease Treated in an Intensive Care Unit in the Republic of Cyprus.

BackgroundThe widespread reach of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its consequences have severely affected the consistency of healthcare systems around the world and caused millions of deaths to date. Understanding the coronavirus disease 2019 (COVID-19) manifestation, progression, and management is crucial for the healthcare personnel caring for COVID-19 patients within the intensive care unit (ICU), as well as for the patients' health progression.MethodsA prospective observational study was used to investigate the progression of critically ill COVID-19 positive patients who were admitted to the ICU of Nicosia General Hospital from March 10 to May 1, 2020. All patients over the age of 18 were included in the study; their data were anonymously collected using the institution’s electronic medical record system and analyzed in Microsoft Excel (Microsoft Corporation, Redmond, WA). Pregnant women, children, and prisoners were excluded.ResultsDuring the study period, a total of 19 patients with a positive result on a reverse-transcriptase polymerase chain reaction (RT-PCR) were included in the study; 74% were men and their mean age was 64 years. Sixty-three percent of the patients were obese, 53% had a history of confirmed hypertension, 68% were admitted with severe respiratory failure, and all of them required invasive mechanical ventilation. Patients were categorized into four groups of ventilation based on the H or L ventilation phenotype in association with co-morbidities. Prone position in the first mechanical ventilation days was found to be more advantageous in L than H phenotype patients, 68% required vasopressor support, and 42% developed acute kidney injury (AKI) during their ICU stay. Diarrhea was with a median day of onset of eight days. Lactate levels above 2 mmol/L in the first four days of admission were correlated with a negative outcome. Nine patients (47%) were successfully discharged from the ICU while 10 (53%) died during their stay.ConclusionIn critically ill patients, male gender and obesity are significant risk factors for ICU admission due to COVID-19, and early prone position, mechanical ventilation, and low positive end-expiratory pressures (PEEP) values may be beneficial, especially in the L phenotype category patients. Patients' ventilation phenotype during ICU admission and hospitalization seemed to determine the outcome.Clinical improvement might have been higher and possibly ICU mortality lower if remdesivir was available. Hydroxychloroquine did not seem to improve patient outcomes, a consistent find, as suggested by other studies; on the contrary, it may have contributed to increased mortality rates.

AB0879-HPR MOTIVATION OF HEALTHCARE PROVIDERS DURING COVID19 PANDEMIC OUTBREAK

Background:Since the beginning of 2020, the medical staff caring for patients with rheumatic disorders has been exposed to considerable emotional and physical stress due to the COVID19 pandemic outbreak. Newly-designed circuits were imposed to better manage chronic patient admissions.Objectives:To assess the level of motivation in healthcare personnel caring for patients with rheumatic disorders and identify determinants that lead to dissatisfaction during the COVID19 spread.Methods:A 15-item questionnaire was distributed among medical and paramedical staff looking after chronic rheumatic patients. Motivation factors were included in questions having five preset answers, ranging from “not al all”, “to a small extent”, “moderately”, “to a large extent” and “to a very large extent”. The final item was an open-type question, favoring personal suggestions and potential changes in local management.Results:Out of a total of a 124 responders, 82 were doctors with various degrees in training (fellow trainees, specialists in Rheumatology, Head of Department), 37 medical assistants, 3 nurses, a physical therapist, one clinical psychologist. Mean age in the group was 38.3 years old with a strikingly female dominance (87.6%). Within the responders, the financial factor represented by monthly salary or bonuses had no or little impact on work motivation during the pandemic since more than 70% answered with “not al all / to a small extent / moderately”. Regarding motivation through working hours, 26.7% responded either “not at all” or “to a small extent”, 32.4% were moderately motivated while only 12.4% were more enthusiastic. More than half (53.4%) of the staff stated that motivation was not entirely affected by working conditions in the hospital. Answers were relatively equally divided referring to motivation by safety at their workplace (almost 20% for each statement), and 40.9% suffered some extent of demotivation due to risk of contamination while caring for COVID19 positive patients. 42% of the staff was only moderately motivated by hospital’s measure to limit the spread of COVID throughout the personnel. Almost 75% of the healthcare workers were not motivated by news media. Around 54% said that personal motivation was not influenced by a larger work volume and 43% were very much motivated by work relationships with colleagues. 41% of the staff is only moderately satisfied with their work during the COVID outbreak while 18% are not at all satisfied. Finally, the last open-question confirmed that for some the pandemic period was a time to bring healthcare professionals together to a stronger bond. Other responders felt that chronic rheumatic patients were left aside, while caring mostly for COVID19 patients and only limited admissions for life-threatening conditions. Moreover, medical staff suggested that the lack of a more frequent testing throughout the personnel to avoid contamination was demotivating, while still living with families or relatives.Conclusion:Motivation of the personnel is a process with great economic and social impact. This study challenged the level of healthcare staff in difficult times caused by medical crisis. Results of the enquiry showed that financial benefits had no impact on motivation. Harsher working conditions or larger volume did not negatively impact motivation of staff, but the fear of contamination was considerable. Apparently the media influence was not a motivator for medical staff during the outbreak. Medical teams should find their stamina until the end of pandemia.