COVID-19 Wards Research Articles

Impact of Covid-19 Patients with Diabetes Mellitus and its Association with Clinical Outcomes

INTRODUCTION COVID-19 is a debilitating disorder affecting lungs with multiple organs. Diabetes mellitus is considered as a common co-mor- bidity whose impact has not been fully understood. There is a hypothesis that patients with diabetes are at increased risk of severe disease or death due to COVID-19. The main objective of the present study was to find the the association of COVID-19 diabetes mellitus (DM) and non-diabetes mellitus patients with the clinical outcomes. MATERIAL AND METHODS This cross-sectional study was conducted in hospitalized patients with COVID-19 at Universal College of Medical Sciences (UCMS), Bhairahawa. Total of 200 patients were enrolled in the study period from July 2021 to January 2022 whose clinical profile, socio-demographic and biochemical variables were assessed. The study variables taken were symptoms, random blood glucose (RBG), glycosylated hemoglobin (HbA1c) and their outcomes like High Dependency Unit/Intensive Care Unit (HDU/I- CU) or COVID ward admission, hospital stay and mortality. RESULTS A total of 40% of the patients require HDU/ICU hospitalization with 20% requiring ventilator support. The findings revealed a strong link between diabetes mellitus and fatigue (p=0.012) as well as mortality (p=0.032). The difference in hospital stay between ventilator and non-ventilator groups was substantial (p=0.001). The hospital stay in the mortality group was significantly shorter (p=0.026). Likewise, RBG and HbA1c are higher than in the non-mortality group (189 vs 167; 5.7 vs 5.6 %). CONCLUSION Hypertension and diabetes are the most common morbidities associated with COVID-19 individuals. Diabetes mellitus was found to have a substantial link to fatigue, but there was no link between HbA1c and the length of hospital stay or the method of ventilation.

Nurses’ Family Support System in Pandemic Covid-19

Background: The Covid-19 pandemic is being 2 years and the fluctuated cases made the nurses workload were increasing. The effects are stress, anxiety, and burnout. To decrease these sequences, need family support. Family support advantage to them for increasing their confidence and being valuable. Purpose: the major aim of the study is to know the difference between family support for nurses who work in Covid and non-Covid wards.Methods: Quantitative method were used in its study and used 149 nurses as a respondent. The inclusion criteria were working at hospital at least a year and lived with nuclear family. The questioner used Family Support Scale (FSS) with 19 sentences. It used Mann-Whitney test with SPSS 21 software.Results: Most of the respondent were nurses who work in Covid ward (64.4%) and majority is an associate nurse (84.9%). The p value was 0.077 (p0.05) which indicate that there were not differences of family support between nurses who work in Covid and non-Covid wards.Conclusion: There were not differences of family support between nurses who work in Covid and non-Covid wards.

Experiencing and witnessing disruptive behaviors toward nurses in COVID-19 teams, patient safety, and errors in care.

Nurse managers and team co-workers' disruptive behaviors (DBs) are negatively associated with a perceived safe climate. Moreover, DBs are a risk factor for patients' safety. Yet, it remains unknown whether and to what extent these effects were prevalent in COVID-19 wards and among witnesses of DBs. A cross-sectional study. A questionnaire was distributed on social networks and completed by nurses in various Israeli healthcare organizations using snowball sampling between October and December 2021. The questionnaire included seven previously published measures and a question checking whether the participants had worked in a COVID-19 ward. The minimal sample size for any analysis was 236. Hypotheses were tested with correlations and structural equation modeling. DBs of nurse managers and team co-workers toward nurses were higher in COVID-19 teams. As hypothesized, DBs were negatively correlated with a safe climate and positively with patient safety (fewer errors). The data were consistent with a model suggesting that a safe climate is related to fewer DBs and DBs largely mediate the effects of safe climate on errors. Surprisingly and importantly, the strongest predictor of errors, including preventable mortality, is witnessing DBs and not being a victim of DBs. DBs may impede open communication and collaboration among co-workers, particularly in COVID-19 teams. This study shows the links between nurse shaping of a safe climate, DBs toward nurses, and patient safety. Nurse managers who create a safe climate and show zero tolerance for DBs could reduce the risk of errors in care.

Psychological Conditions among Nurses in Caring for the COVID-19 Patients: A Study from Referral Hospitals of Aceh, Indonesia

Introduction: Nurses as frontline health care providers during the COVID-19 pandemic were at high risk and vulnerable to virus infection. Physical and mental conditions in caring for COVID-19 patients in hospitals may be associated with the exacerbation of the nurses experiencing depression, anxiety, and stress among the nurses. Objective: The study aimed to identify the psychological conditions (depression, anxiety, and stress) among nurses providing clinical assistance in caring for COVID-19 patients. Methods: This investigation employed a comparative study with a cross-sectional study design. The respondents were 109 nurses working in the COVID-19 wards in two referral hospitals offering care for COVID-19 patients. Data were collected using the standardized DASS-21 questionnaire and analyzed using the Mann-Whitney U-test. Results: The results showed psychological conditions among nurses caring for COVID-19 patients with depression (moderate) among 60.0% and 58.8%, anxiety (severe) at 60,0% and 58.8%, and stress levels (mild) at 56% and 52.9% for hospital A and B, respectively. The study also found no significant difference in depression (p=0.890), anxiety (p=0.846), and stress levels (p=0.806, α=0.05) between the nurses in the COVID-19 wards of the two hospitals. Conclusion: The demographic data of nurses, such as age, education level, working experience, hospital facilities, attended workshops/training on the use of personal protective equipment (PPE)/Hazmat, and management of COVID-19 patients might contribute to psychological conditions (depression, anxiety, and stress) among nurses in caring for the COVID-19 patients.

A cross-sectional study on knowledge, attitude, and practices of donning and doffing of personal protective equipment: an institutional survey on interns during the COVID-19 pandemic

Background: Personal protective equipment (PPE) is a physical barrier that healthcare workers (HCW) wear to stop the transmission of a pathogen from a pathologic specimen or a confirmed or suspected case. It prevents the spread of disease from patient to HCWs as well as the other way around. Eyewear, face shield, surgical mask, particulate respirators, glove, disposable gowns and boots, and head coverings are some examples of these physical barriers. The primary objective of the study is to assess the knowledge, attitude and practices (KAP) of interns towards appropriate use of PPE and secondary objective is to find the role of training on donning and doffing of PPE of interns towards appropriate use of PPE.Methods: This is an institutional based, analytical cross-sectional study. Data was collected from interns (n=130) posted in COVID-19 ward using a universal sampling method. A predesigned questionnaire was used for study. The data was analyzed using SPSS 26 trial versionResults: Interns were aware of the importance and criticality of donning and doffing procedure, overall level of KAP of donning and doffing of PPE were 96.90%, 73.10% and 86.20% respectively. We found that there was statistically significant mean difference between the KAP scores with respect to training of PPE.Conclusions: There were some gaps in KAP at institutional level among the interns with regards to donning and doffing of PPE during the beginning of this pandemic.

Factors Associated with Psychiatric Morbidity among Patients who tested Positive and Isolated for COVID-19

Objective: To look for the psychiatric morbidity and associated socio-demographic factors among patients who tested positive and isolated for COVID-19.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Combined Military Hospital, Malir Pakistan, from Mar to May 2020.
 Methodology: All patients who tested positive for COVID-19 and were admitted to the COVID-19 Ward without complications were included in the study. General Health Questionnaire-12 (GHQ-12) was administered to look for the presence of psychiatric morbidity.
 Results: Out of 61 patients included in the study, 45(73.7%) showed the presence of psychiatric morbidity, while 16(26.3%) did not show psychiatric morbidity when screened with GHQ-12. 43(70.4%) were male, while 18(29.6%) were female. The mean age of the patients was 35.21±2.355 years. The advanced age and female gender have a statistically significant relationship (pvalue<0.05) with the presence of psychiatric morbidity among patients of COVID-19.
 Conclusion: Many patients had psychiatric morbidity after being tested positive for COVID -19 and were isolated in the health facility. Female patients and patients aged more than 40 years were found to be more at risk of developing psychiatric morbidity among the patients admitted to COVID -19 ward.

Socio-demographic and clinical characteristics of SARS-CoV-2-positive psychiatric in-patients: A case-control study in the psychiatric wards of a Great Metropolitan Hospital in Milan

During the first Covid-19 outbreak, the Niguarda Hospital of Milan featured two Psychiatry wards, one for SARS-CoV-2 positive patient and one for patients requiring hospitalization and negative for SARS-CoV-2. The two groups of patients were compared and were similar in distribution of psychiatric diagnosis, duration of illness and previous hospitalizations. SARS-CoV-2 positive participants had a lower severity of symptoms both at admission and discharge, a lower frequency of psychotic symptoms and substance intoxication at admission. These findings suggest that patients admitted to the COVID ward were hospitalized not only for their mental health condition but also because of the infection.

The Effectiveness of NIV and CPAP Training on the Job in COVID-19 Acute Care Wards: A Nurses' Self-Assessment of Skills.

Background: Noninvasive ventilation (NIV) in COVID-19 patients outside of intensive care unit (ICU) settings was a feasible support during the pandemic outbreak. The aim of this study was to assess the effectiveness of an “on the job” NIV training program provided to 66 nurses working in 3 COVID-19 wards in an Italian university hospital. Methods: A quasi-experimental longitudinal before−after study was designed. The NIV Team education program, provided by expert ICU nurses, included: 3 h sessions of training on the job during work-shifts about the management of helmet-continuous positive airway pressure (CPAP) Venturi systems, and NIV with oronasal and full-face masks. An eleven-item “brief skills self-report tool” was administered before and after the program to explore the perception of NIV education program attendees about their level of skills. Results: In total, 59 nurses responded to the questionnaire. There was an improvement in the skill levels of the management of Helmet-CPAP (median before training 2, inter-quartile range (IQR) 0−6; median after training 8, IQR 3−9; p < 0.0001), and mask-NIV (median before training 2, IQR 0−6; median after training 8, IQR 3−9; p < 0.0001). Conclusions: Training on the job performed by expert ICU nurses can be a valuable and fast means to implement new Helmet-CPAP and mask-NIV skills outside of ICUs.

Personal protective equipment: Analysis of supply among midwives during the COVID-19 pandemic in Peru

ObjectiveTo report the details of provision of personal protective equipment to midwives during the COVID-19 pandemic in Peru MethodsThis is a non-experimental, descriptive, cross-sectional study. An online survey of 679 midwives working at public healthcare centres was conducted via questionnaires. The following aspects were outlined: method of supply and frequency of delivery of personal protective equipment, type of personal protective equipment provided by the institution, and self-purchase. Furthermore, features of the midwives’ workplace were described. For statistical analysis, absolute frequencies and relative proportions were used for categorical variables, and mean and standard deviation were used for numerical variables. Measurements and findingsThe most important finding of this study is that a large proportion of midwives (66.6%) did not receive new personal protective equipment for each shift; 41.9% of midwives who received personal protective equipment during each shift exclusively provided services in the COVID-19 ward, whereas 27.6% did not. The least received supplies were of N95 respirator masks (41.7%) and disposable isolation suit gown (50.5%). Only a certain proportion of midwives (38.6%) were trained by their own institutions on the use of personal protective equipment. Key conclusionsThe provision of personal protective equipment to midwives and training on personal protective equipment were insufficient at all workplaces. Therefore, measures must be taken to increase the supply of this material to midwives who are essential workers in reproductive health.

The relationship between spirituality and aggression in the workplace during the COVID-19 pandemic: A cross-sectional study among Iranian nurses.

Aggression towards nurses in the workplace arises from various reasons, reportedly increasing during the COVID-19 pandemic. Where aggression can be maintained by spiritual well-being, as it is said that spirituality is a coping skill and psychological well-being maintainer-but there is little known, especially during the pandemic. Thus, this study explored the effect of spirituality on aggression among the nurses working in the COVID-19 wards. This cross-sectional data from 200 nurses involved in the COVID-19 patient treatment were collected using a random sampling method from four hospitals in East Mazandaran province, Iran. Responses were collected based on socio-demographics, Buss-Perry Aggression Questionnaire, and Paloutzian & Ellison Spiritual Well-being Scale. T-test, ANOVA, Pearson correlation coefficient, and multiple linear regression were applied for data analysis. The mean age of nurses was 31.49±6.88 (range: 21-48) years. Nurses working in the COVID-19 wards have a mean score of spiritual health of 67.21±12.84 (out of 120), whereas 51.77±10.96 (out of 116) was for aggression. The results showed a significant negative weak correlation between aggression and spiritual health (r = -.285, p<0.01). As per regression analysis, spiritual health [β = -.264], age [β = -.374], and working experience [β = 4.156] were the significant factors associated with aggression (p<0.05). It is evident that nurses who consider spirituality in their life actions are in a state of reduced negative emotions, such as aggression. Thus, policymakers and managers of the healthcare settings are suggested to promote spirituality among the nurses through spiritual care education, providing the ground for promoting spirituality and a positive attitude towards it.

Perbandingan Tingkat Kelelahan Kerja Perawat Antara yang Melayani Pasien COVID-19 dan Non COVID-19 di RSUP Dr Kariadi Semarang

Background: Health services during the COVID-19 pandemic trigger a high risk of fatigue among nurses in all inpatient rooms, especially the isolation rooms for patients with COVID-19. Fatigue can reduce the performance of nurses and health services. Objective: This study compares nurses' work fatigue levels between those who serve in the COVID-19 room and those who serve non-COVID-19 at RSUP Dr. Kariadi Semarang. Methods: A comparative study with consecutive sampling involving 96 nurses (46 COVID-19 ward nurses and 50 non-COVID-19 ward nurses). The survey was conducted by filling out a Subjective self-rating test questionnaire from the Industrial Fatigue Research Committee (IFRC) via a Google form. Analysis of fatigue differences was performed using the Chi-Square test. Result: The mean IFRC score of respondents was 47.19 ± 12.97, while most nurses experienced low levels of fatigue (67.71%, n=65). There was no significant difference in the level of nurse fatigue in the COVID-19 and non-COVID-19 isolation rooms (p = 0.169, x2 = 1.89). Uncomfortable work environment (t = -2.50, p = 0.014), anxiety feeling at work (F = 3.57, p = 0.032), and shift system (t = -2.34, p = 0.018) significantly correlated with the level of nurses' fatigue.Conclusion: The work environment, shift system, and feelings at work can affect nurses' fatigue levels. Therefore, hospital policies and regulations are necessary to reduce work fatigue for health workers

214 THE IMPACT OF ARRHYTHMIA ON PROGNOSIS IN HOSPITALIZED COVID-19 PATIENTS. A CARDIAC TELEMETRIC MONITORING STUDY

Abstract Background Cardiovascular abnormalities have been largely reported in patients with COVID-19. Among these, myocardial injury and rhythm disorders represent one of the most important complications in patients affected by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Moreover, a poorer prognosis has been documented in COVID-19 patients when complicated by arrhythmias, independently by age and sex. Objectives The aims of the present study were to identify some of non-cardiac and cardiac comorbidities and some myocardial electrical features (including QT dispersion) associated with arrhythmia in hospitalized COVID-19 patients. Moreover, another objective was to contribute in analyzing the impact of arrhythmias on outcome in this setting of patients. Methods At admission, each patient underwent cardiac telemetry monitoring through entire hospitalization period. In all the subjects, laboratory analyses, standard 12-lead electrocardiogram (both at admission and on discharge), and lung imaging examination (by means of both ultrasound scans and computed tomography) were performed. Patients exhibiting arrhythmia during in-hospital period were divided into three groups: i, with brady-arrhythmias; ii, with tachy-arrhythmias; and, iii, with tachy- and brady-arrhythmias. Results Two-hundred patients completed the study (males, 123; mean age, 70.1 years); of these, 80 patients (40%) exhibited rhythm disorders on cardiac telemetry. Patients with arrhythmia resulted to be older (p&amp;lt;0.0001) than patients without arrhythmia. Moreover, patients with arrhythmia showed: i, greater number of comorbidities (p&amp;lt;0.0001); ii, higher values of creatinine (p=0.007), B-type natriuretic peptide (p&amp;lt;0.0001), troponin (p&amp;lt;0.0001), c-reactive protein (p=0.01), ferritin (p=0.001), d-dimer (p&amp;lt;0.0001), and procalcitonin (p=0.0008); iii, QT interval (p=0.002), QTc interval (p=0.04), and QTc dispersion (p=0.01); and, iiii, lower values of sodium (p=0.03), magnesium (p=0.04), glomerular filtration rate (p&amp;lt;0.0001), and hemoglobin (p=0.008) as compared to patients without arrhythmia. By comparing the three subgroups of patients, no significant differences were found. Multivariate analysis showed that age (OR=1.14 [95% CI: 1.07-1.22]; p=0.0004), coronary artery disease (OR=12.7 [95% CI: 2.38-68.01]; p=0.005), and circulating troponin (OR=1.05 [95% CI: 1.003-1.10]; p=0.04) represented risk factors independently associated with arrhythmia. By analyzing all-cause in-hospital mortality, it resulted a ∼forty-fold higher among patients with arrhythmia (OR=39.66 [95% CI: 5.20-302.51]; p=0.0004) when compared to patients without rhythm disorders. Conclusion In the present study, arrhythmias have been to be associated with ageing, coronary artery disease, subtle myocardial injury, hyperinflammatory status, coagulative unbalance, and abnormalities in myocardial electrical impulse propagation in patients affected by SARS-CoV-2 infection. In alignment with previous reports, the presence of arrhythmia seems to be associated with a worse in-hospital prognosis. Given its usefulness, routinary use of cardiac telemetric monitoring should be encouraged in COVID wards.

1921. Leveraging Bluetooth Low-Energy Technology to Improve Contact Tracing in Healthcare Settings during the COVID-19 Pandemic

Abstract Background COVID-19 rapidly evolved into a global pandemic. Contact tracing with isolation and quarantine contribute to epidemic control but they are time consuming, costly and may be incomplete. We set out to assess the usability and performance characteristics of Bluetooth Low-Energy (BLE) wireless technology for indoor localization applied to contact tracing in healthcare settings. Methods Consented healthcare workers (HCW) from 2 designated COVID-19 wards (one intensive care unit (ICU) and one medical ward) were equipped with coin-sized BLE- emitting beacons. The signal was captured by small embedded computers (anchors) placed at designated locations, time-stamped and transmitted to an edge server via secure Wi-Fi where data were stored and real time contact algorithms were run (Fig.1). We developed experiments mimicking clinical scenarios and tested indoor localization during observed clinical activity for 6 months. We constructed our algorithms based on room structure (e.g. open spaces vs computer rooms) and activity characteristics (e.g. rounding in a large group vs 2 healthcare workers sitting together). We used 1) radio fingerprint localization where an initial virtual radio map was developed, 2) semantic localization which carries additional information such as proximity to a computer to define indirect transmission via fomites, and 3) clustering contact tracing to identify individuals rounding together. Close contact was defined as per the CDC guidelines. Fig. 1System configuration Results Consent rate was 43.3% with 187 HCW enrolled in the study. Consent rate was higher in the ICU and among attendings. All participants were compliant with wearing the beacons for the duration of the study. The performance characteristics for contact tracing using fingerprinting methods were AUROC 0.93, AUPRC 0.96, sensitivity 0.9, specificity 0.77 with F1 score of 0.89 and overall accuracy of 0.85. The clustering contact tracing registered a sensitivity of 0.86, specificity 0.89, F1 score 0.91 and accuracy 0.87. Computation time necessary to generate a list of close contacts as per specified criteria was less than 30 minutes. Conclusion We have developed and tested a reliable and accurate, low-cost and easily deployable system based on BLE technology to improve contact tracing among healthcare workers. Disclosures M Cristina Vazquez Guillamet, MD, AUPH: Stocks/Bonds|BNGO: Stocks/Bonds|OCGN: Stocks/Bonds|SESN: Stocks/Bonds.

Evaluation of Cardiovascular Activity and Emotional Experience in Healthcare Workers (HCWs) Operating in COVID-19 Wards.

The new 2019 coronavirus or SARS-CoV-2 has been the first biological agent to generate, in this millennium, such a global health emergency as to determine the adoption of public health measures. During this sanitary emergency, the emotional experience of healthcare workers (HCWs) has been hugely tested by several factors. In fact, HCWs have been exposed to greatly tiring physical, psychological and social conditions. The authors investigated the cardiocirculatory activity of a group of HCWs as well as how they perceived stress while working in COVID-19 wards. In particular, every HCW underwent a medical check, an electrocardiographic base exam, systolic and diastolic pressure measurement, and cardio frequency measurement. Furthermore, each HCW was provided with a cardiac Holter device (HoC) and a pressure Holter (Hop). Some psychological factors were considered in order to quantify the stress perceived by each HCW while at work through the administration of two questionnaires: the "Social Stigma towards Patients due to COVID Scale (SSPCS)" and the "Professional Quality of Life Scale (ProQOL)". The HoC and HoP analysis results for HCWs working in COVID-19 OU wards showed significant variations in cardiocirculatory activity. From the analysis of the SSPCS questionnaire answers, it is clear that all of them showed a sense of duty towards their patients. The analysis of the ProQOL questionnaire answers showed that the prevailing attitude is fear; however, HCWs did not absolutely discriminate against those who had COVID-19 nor did they refuse to help those in need. Continuous monitoring of these employees, also carried out through occupational medicine surveillance, allows for the detection of critical conditions and the implementation of actions aimed at preventing chronic processes.

Management of pediatric oncohematology patients during the COVID‐19 pandemic: Reopening a pediatric oncohematology COVID ward

Management of pediatric oncohematology patients during the COVID‐19 pandemic: Reopening a pediatric oncohematology COVID ward

Scope of treatment and clinical-decision making in the older patient with COVID-19 infection, a European perspective.

Older patients were particularly vulnerable to severe COVID-19 disease resulting in high in-hospital mortality rates during the two first waves. The aims of this study were to better characterize the management of older people presenting with COVID-19 in European hospitals and to identify national guidelines on hospital admission and ICU admission for this population. Online survey based on a vignette of a frail older patient with Covid-19 distributed by e-mail to all members of the European Geriatric Medicine Society. The survey contained questions regarding the treatment of the vignette patient as well as general questions regarding available services. Additionally, questions on national policies and differences between the first and second wave of the pandemic were asked. Survey of 282 respondents from 28 different countries was analyzed. Responses on treatment of the patient in the vignette were similar from respondents across the 28 countries. 247 respondents (87%) would admit the patient to the hospital, in most cases to a geriatric COVID-19 ward (78%). Cardiopulmonary resuscitation was found medically inappropriate by 85% of respondents, intubation and mechanical ventilation by 91% of respondents, admission to the ICU by 82%, and ExtraCorpular Membrane Oxygenation (ECMO) by 93%. Sixty percent of respondents indicated they would consult with a palliative care specialist, 56% would seek the help of a spiritual counsellor. National guidelines on admission criteria of geriatric patients to the hospital existed in 22 different European countries. This pandemic has fostered the collaboration between geriatricians and palliative care specialists to improve the care for older patients with a severe disease and often an uncertain prognosis.

Post-Traumatic Stress Disorder (PTSD) Among Healthcare Workers of Tertiary Care Hospitals of Rawalpindi; Amid the COVID-19 Pandemic

Objective: To determine the prevalence of PTSD symptoms and its severity among HCWs, amid the COVID pandemic in a tertiary care setting.&#x0D; Study Design: Cross sectional analytic study.&#x0D; Place and Duration of Study: Pakistan Emirates Military Hospital, Rawalpindi Pakistan, from May to Aug 22. &#x0D; Methodology: The study was conducted on 173 healthcare workers of a tertiary care hospital. The sample size was calculated using the Rao-soft calculator. Validated questionnaires such as the Impact of Event Scale-Revised (IES-R) and PTSD Checklist Civilian Version (PCL-C) were used to collect the data. Data was entered and analyzed by using Statistical Package for Social Sciences (SPSS) version 26.&#x0D; Results: Out of 173 participants, majority of participants 90(52%) were male and single 103(63%). Mean age of the participating HCWs was 27(SD= 2.3). HCWs performing duties the in COVID-19 ward for one year were 66(38.2%) and majority were from Emergency medicine 61(35.3). Almost 150(86.71%) of HCWs did not experiencing any PTSD symptoms and those exhibiting a higher severity of symptoms were only 5(2.9%). There was no statistically significant difference in total and sub scales mean scores of IES-R among males and females (p= 0.28). &#x0D; Conclusions: Our study concluded that prevalence of symptoms of PTSD was significantly low in Health Care Workers despite of the fact, majority of doctor participants were working in COVID-19 ward for one year. The symptoms were evident among healthcare professionals, however there was modest severity.

Hospital Outcomes in Non COVID Wards at a Northern Italy Hospital during COVID 19 Pandemic

Hospital Outcomes in Non COVID Wards at a Northern Italy Hospital during COVID 19 Pandemic

The impact of working in COVID-19 hospital on indonesian nurses’ mental health and wellbeing: a qualitative study

BackgroundThe outbreak of coronavirus disease (COVID-19) has impacted the lives of more than 580 million people and killed more than six million people globally. Nurses are one of the most impacted groups as they are at the frontline to fight against the virus and to try to save the lives of everyone affected. The present study aimed to explore the impact of working in COVID-19 wards on the mental health and wellbeing of nurses in the early stage of the pandemic in a hospital in East Nusa Tenggara, Indonesia.MethodsA qualitative study was conducted with 22 nurses, recruited using purposive sampling. Data collection was conducted from April to May 2022 and data analysis was guided by qualitative framework analysis.ResultsThe findings show that nurses experienced a range of mental health impacts including fear of being infected and infecting loved ones; fear of early death; psychological distress related to the conflict between the lack of personal protective equipment (PPE) and both professionalism and moral responsibility for patients; stress due to long waiting period to know the result of the COVID-19 tests; stress and worry due to public indifference and lack of role models; the negative impact of community doubt and distrust around COVID-19; and distress due to stigma and discrimination towards nurses caring for COVID-19 patients and their families.ConclusionsThe current findings indicate further psychological intervention programs to support nurses, especially the ones in resource poor settings and enhance their psychological resilience.

A mid-term follow-up with a lung ultrasonographic score correlates with the severity of COVID-19 acute phase.

Lung ultrasound (LUS) has rapidly emerged in COVID-19 diagnosis and for the follow-up during the acute phase. LUS is not yet used routinely in lung damage follow-up after COVID-19 infection. We investigated the correlation between LUS score, and clinical and laboratory parameters of severity of SARS-COV-2 damage during hospitalization and at follow-up visit. Observational retrospective study including all the patients discharged from the COVID-19 wards, who attended the post-COVID outpatient clinic of the IRCCS Policlinico San Matteo in April-June 2020. 115 patients were enrolled. Follow-up visits with LUS score measurements were at a median of 38days (IQR 28-48) after discharge. LUS scores were associated with the length of hospitalization (p < 0.001), patients' age (p = 0.036), use of non-invasive ventilation (CPAP p < 0.001 or HFNC p = 0.018), administration of corticosteroids therapy (p = 0.030), and laboratory parameters during the acute phase (WBC p < 0.001, LDH p < 0.001, CRP p < 0.001, D-dimer p = 0.008, IL-6 p = 0.045), and inversely correlated with lymphocyte count (p = 0.007). We found correlation between LUS score and both LDH (p = 0.001) and the antibody anti-SARS-CoV-2 titers (p value = 0.008). Most of these finding were confirmed by dichothomizing the LUS score (≤ 9 or > 9 points). We found a significantly higher LUS score at the follow-up in the patients with persistent dyspnea (7.00, IQR 3.00-11.00) when compared to eupnoeic patients (3.00, IQR 0-7.00 p < 0.001). LUS score at follow-up visit correlates with more severe lung disease. These findings support the hypothesis that ultrasound could be a valid tool in the follow-up medium-term COVID-19 lung damage.