Direct Patient Care Research Articles

Mental distress of intensive care staff in Germany during the COVID-19 pandemic. Results from the VOICE study

The coronavirus disease 2019 (COVID-19) pandemic posed major challenges to the healthcare system worldwide and led to particular stress among healthcare workers. The aim of this analysis was to investigate the level of global mental stress of direct healthcare workers in Germany during the COVID-19 pandemic. In this prospective cross-sectional study with four measurement points (T1: 4-5/2020, T2:11/2020-1/2021, 5-7/2021, 2-5/2022), psychological distress symptoms were recorded in an online survey with the Patient Health Questionnaire (PHQ-4) among hospital staff working in direct patient care (N = 5408 datasets). The total dataset was exploratively analyzed according to field of activity, gender, and professional group affiliation. Clinically relevant psychological distress (PHQ-4 ≥ 5) was present in 29.3% (n = 419/1429) of intensive care staff. Acomparison of the four cross-sectional surveys showed asignificant increase in the rate of clinically relevant mental distress in the first pandemic year (23.2% at T1 vs. 30.6% at T2; p < 0.01), which stabilized at ahigh level in the second pandemic year (33.6% at T3 and 32.0% at T4). Women did not differ from men in this respect (n = 280/919, 30.4% vs. n = 139/508, 27.4%; p = 0.74). Nursing staff were significantly more often psychologically stressed than physicians (n = 339/1105, 30.7% vs. n = 80/324, 24.7%; p = 0.03). Intensive care staff did not show significantly higher stress than staff working in nonintensive care areas (n = 419/1429, 29.3% vs. n = 1149/3979, 28.7%, p = 0.21). German healthcare workers reported high levels of mental distress during the pandemic, which increased during the course of the pandemic, but no significant difference was found between intensive care and nonintensive care staff in our sample. This may be due to the fact that the pandemic in Germany was comparatively moderate internationally and neither acollapse of the healthcare system in general nor acollapse of intensive care structures in particular took place.

Job satisfaction of nurses and the determinants of organizational climate: insights from hospitals in Lubelskie Voivodeship

Abstract Aim. Evaluation of nurses’ job satisfaction and the interconnectedness of the infl uence of dimensions of organizational climate. Material and methods. The study was conducted in 2022 among 300 nurses working in fi ve hospitals in Lublin Voivodeship. Methodology focused on outcomes was employed, highlighting the signifi cance of factors related to the organizational environment in shaping “job satisfaction”. The research tool was the Organizational Climate Questionnaire by L. Rosenstiel and R. Boegel, adapted from the Polish version by K. Durniat. Results. Most respondents report a high 121 (40.3%) or relatively high 142 (47.3%) level of satisfaction with their profession. Only 37 (12.4%) nurses reported a low level. Factors contributing to decreased satisfaction included negative relationships with management, diminished importance of organizational procedures implemented by supervisors, insufficient time for direct patient care, failure to meet patient and family expectations, and inadequate compensation. Conclusions. Nurses’ job satisfaction depended on the overall organizational climate in the hospital and its components: the overall image of the organization, employees’ perceptions of their superiors’ leadership style, and various aspects of the work organization process, ways of structuring, division of tasks and the degree of control over their implementation.

Abstract We127: Infective Endocarditis in COVID-19 - An Unusual Suspect

Introduction: The COVID-19 pandemic globally overwhelmed healthcare systems and the complications associated with this illness have contributed to poor outcomes. The hypercoagulable state associated with COVID-19 is well recognized in the literature. Thromboembolic complications such as left ventricular thrombus (LVT), deep venous thrombosis (DVT) and pulmonary embolism (PE) have been increasingly reported. Dhakal et al. published an association between COVID-19 and cardiovascular disease, including possible complication by infective endocarditis (IE) which was confirmed by Amir et al. reporting the first case. Since then, there have been few reported cases. We present a case of COVID-19 in a patient who developed LVT, complicated by non-valvular IE by an underreported organism, Granulicatella adiacens. Case Presentation: A 55-year-old male with history of dental caries, provoked DVT/PE, NSTEMI x2 and STEMI in-stent restenosis requiring thrombectomy presented to the hospital with a 2-day history of shortness of breath, fatigue, cough, change in mentation and right-sided weakness. He tested positive for COVID-19 by NAAT. CXR revealed cardiomegaly and multiple bilateral infiltrates. CT head demonstrated acute ischemic stroke of the left occipital, parietal and posterior temporal lobes, also confirmed on MRI. CTA neck showed 30% stenosis of left ICA. Blood cultures x2 resulted positive for G. adiacens. Echocardiogram was obtained, demonstrating reduced EF of 35% and the presence of a large, 2.7 x 2.2cm mobile thrombus in the apical-septal region of the left ventricle, not visualized on previous echocardiogram 6 months earlier. Methods: Data was collected from direct patient care and electronic medical records. Discussion: G. adiacens is a fastidious gram-positive coccus, part of the nutritionally variant streptococci (NVS) species, and part of the normal oral and gastrointestinal flora. It is also found in dental plaques and endodontic abscesses. NVS account for less than 5% of cases of bacteremia and IE. G. adiacens account for even fewer cases. Two separate meta-analyses conducted by Quintero-Martinez et al. and George et al. failed to reveal any cases of IE attributable to G. adiacens in the setting of COVID-19 infection. In conclusion, we believe that the hypercoagulable state of COVID-19 infection led to endocardial damage and development of LVT, thereby creating a nidus for microorganism adherence from underlying dental carries resulting in thromboembolic stroke.

Pathology of the Salpinx: A Retrospective Literature Review.

The fallopian tubeis a common surgical specimen, yet there is limited research onthe histomorphologic findings. This study seeks to review the various abnormalities found in the fallopian tubeand establish the primary disease processes linked to it.These findings can provide valuable insights for future preventive healthcare measures. Utilizing PubMed, a search was conducted for articles published between 2009 and 2024 to investigate fallopian tube pathologies using case reports. The inclusion criteria focused on patients older than 18 years with confirmed or incidental fallopian tube pathology diagnoses. The study considered both common and uncommon presentations of fallopian tube pathologies, with a primary focus on identifying the presenting symptoms related to these conditions, such as primary infertility, severe abdominal pain, tachycardia, hypotension, and breathlessness (the last three could indicate a surgical emergency with ruptured ectopic pregnancy and subsequent hemoperitoneum). Fifteen studies were included in this review.The findings revealed three cases of genital tuberculosis, two cases of endometriosis, two cases of fallopian tubeprolapse, three cases of ovarian cancer, and four cases of ectopic pregnancy. To confirm the presence of these conditions, histopathological examination was performed using specimens obtained through salpingectomy/salpingostomy. This study effectively highlighted the occurrence of rare presentations associated with common fallopian tube pathologies. By identifying different pathologies present in the fallopian tube, healthcare professionals can expand the range of existing pathologies that may be considered as potential differential diagnoses. This knowledge is essential in directing patient care and has the potential to improve patient outcomes significantly.

Exploring Motivating Factors for Pursuing Radiation Oncology: A Comparative Analysis of Medical Students and Residents.

Purpose Increasing medical student (MS) interest in radiation oncology (RO) is important to meet the rising demand for radiation oncologists. Understanding the factors that drive MS to pursue RO is crucial. This study compares motivating factors between MS and RO residents to inform interventions to increase recruitment and sustained interest in the specialty. Methods Data from two similar studies investigating factors motivating MS and residents to pursue RO were analyzed. The first study surveyed Canadian RO residents to characterize enablers when applying for RO residency. The second study analyzed application essays from MS applying to an RO studentship. A mixed methods approach was used to compare themes ("career aspects,""prior exposure," and "personal experiences") between the datasets. Results Qualitative analysis demonstrated that both MS and residents identified "career aspects" as the most common theme facilitating interest in RO careers. "Multidisciplinary work" and "direct clinical contact and patient care" were prominent sub-themes. MS emphasized "serious illness and palliative care" and "advanced technology,"while residents prioritized RO as a "rewarding career.""Prior exposure,"particularly through shadowing/observerships, was more important for MS than residents who valued clinical experiences. Practical career considerations including "mentorship" and "career satisfaction and lifestyle" were significant motivators for residents. Conclusion MS value content-based aspects of RO and emphasize shadowing. In contrast, RO residents prioritize lifestyle-based considerations. These differences highlight the opportunity for intervention throughout medical training to sustain interest in RO and facilitate applications to RO residency programs.

Improving Patient Safety and Care Quality Through a "Speaking-Up" Climate: The Mediating Role of Situation Monitoring.

In healthcare settings, a climate that encourages speaking up among staff is believed to enhance patient safety and quality of care. However, the specific mechanisms of this relationship remain underexplored. Particularly, there is a need to understand how components of teamwork, such as situation monitoring, can be linked to the impact of a speaking-up climate on relevant outcomes. This study aimed to investigate the direct and indirect effects of a speaking-up climate on patient safety and quality of care using situation monitoring as a potential mediator. This cross-sectional study used survey data from 380 staff nurses who provided direct patient care at three Korean hospitals. Structural equation modeling was utilized to test a hypothesized mediation model using Mplus 7.0. Our data analysis confirmed the partial mediation model. As hypothesized, a speaking-up climate directly improved patient safety (β = 0.384, p < 0.001) and quality of care (β = 0.393, p < 0.001). Also, we found that indirect effects of a speaking-up climate on patient safety (β = 0.224, p < 0.001) and quality of care (β = 0.186, p = 0.005) through situation monitoring were significant. These results indicate that situation monitoring was found to significantly mediate the relationship between a speaking-up climate, patient safety, and quality of care. Our study demonstrates that the positive impact of a speaking-up climate extends beyond improving nurses' speaking up. Further, fostering a speaking-up climate can significantly improve patient safety and quality of care, and situation monitoring has a critical role in this relationship. These findings contribute to understanding how encouraging a speaking-up climate could benefit patient safety and care quality in healthcare organizations.

Community pharmacists’ roles during the closure stage of the COVID-19 pandemic in Newfoundland and Labrador, Canada: a qualitative case study

ObjectivesTo explore the experiences and perspectives of community pharmacists regarding their roles during the closure stage (ie, March to May 2020) of the COVID-19 pandemic in Newfoundland and Labrador (NL),...

Association between nurses' personal, professional and work characteristics, and engagement in hospital-based clinical research.

The purpose of this study was to assess the associations between demographic, professional and other personal nurse characteristics, social support factors and comfort in conducting research with nurses' level of active participation in clinical research. A prospective, cross-sectional, correlational design was used. Clinical nurses working in a multihospital healthcare system were recruited by email to complete an anonymous survey that used multiple valid and reliable scales to assess demographic and professional work characteristics, curiosity, grit, locus of control, perceived social support (for research activities), comfort in conducting research, and level of being research-active. Univariate and multivariable analyses were completed. Of 310 participants, 274 (88.4%) were female and mean (SD) age was 42.9 (13.1) years. After condensing 11 levels of research activity to four categories, 179 (57.7%) were not research-active, and 91 (29.4%), 26 (8.3%) and 14 (4.5%) were engaged at low, moderate, and high levels, respectively. Of 78 factors, 69 (88.5%) were associated with being research-active in univariate analyses. In multivariable analysis that adjusted for age, personal experience as a patient, years as a nurse and hours in direct patient care, professionalism characteristics, higher curiosity, internal locus of control, grit perseverance, support of a nurse scientist and nurse friends, and comfort in conducting research remained associated with higher levels of being research-active (all p < 0.01). Research-active nurses were more likely to be engaged professionally in hospital-based activities beyond their work roles and displayed higher levels of positive psychological characteristics and mentorship that supported research capacity. Research-active nurses were more likely to have internal factors and external resources that promoted higher levels of being research-active. A strong professional governance model may enhance clinical nurses research activities.

Impact of COVID-19 on Healthcare Professionals at a Midwestern Quaternary Academic Urban Health Center.

Prior pandemic research has focused on physicians and nurses who provide direct patient care. Literature on the experiences of nonnurse/physician clinicians and nonclinical health care professionals is sparse. An observational, cross-sectional study was conducted over threetime points to examine the impact of COVID-19 on clinical and nonclinical healthcare professionals (n = 464). There were no significant differences in distress across survey waves, except for anger (p = .046). No significant differences in distress scores were found between job types. Multiple linear regression results varied. Both the threat and interrupted plans scores were significant predictors of distress. Resources available to healthcare providers (HCPs) were underutilized in all three waves. Healthcare professionals' distress increases with exposure. Integrating self-care resources for staff may mitigate the impact and maintain a healthy work environment. Occupational health providers should incorporate these findings when developing opportunities to address the needs of health care professionals in the workplace.

What Do We Mean by Sharing of Patient Data? DaSH - A Data Sharing Hierarchy of Privacy and Ethical Challenges.

Sharing of clinical data is common and necessary for patient care, research, public health, and innovation. The term "data sharing," however, is often ambiguous in its many facets and complexities-each of which involves ethical, legal, and social issues. To our knowledge there is no extant hierarchy of data sharing that assesses these issues. Develop a hierarchy explicating the risks and ethical complexities of data sharing with particular focus on patient data privacy. We surveyed the available peer-reviewed and gray literature, and with our combined extensive experience in bioethics and medical informatics, created this hierarchy. We present six ways data are shared and provide a tiered Data Sharing Hierarchy (DaSH) of risks, showing increasing threats to patients' privacy and to clinicians and organizations as one progresses up the hierarchy from data sharing for direct patient care, public health and safety, scientific research, commercial purposes, complex combinations of the preceding efforts, and among networked third parties. We offer recommendations to enhance benefits of data sharing while mitigating risks and protecting patients' interests by: improving consenting; developing better policies and procedures; clarifying, simplifying, and updating regulation to include all health-related data regardless of source; expanding the scope of bioethics for information technology; and increasing ongoing monitoring and research. Data sharing, while essential for patient care, is increasingly complex, opaque, and perhaps perilous for patients, clinicians and healthcare institutions. Risks increase with advances in technology and with more encompassing patient data from wearables and artificial intelligence database mining. Data sharing places responsibilities on all parties: patients, clinicians, researchers, educators, risk managers, attorneys, informaticists, bioethicists, institutions, and policy makers.

Human-robot interactions in autonomous hospital transports

The integration of robotics in nursing is a significant shift in healthcare, driven by the aging global population and the increasing demand for care. Robots in nursing can handle less technical tasks such as patient transport and rehabilitation activities. This support allows caregivers to focus on less strenuous nursing duties and more direct patient care. Human-Robot Interaction (HRI) plays an important role in this challenging context. In this research, we present an autonomous hospital transport system based on the ROS 2 framework, focusing on enhancing HRI in the healthcare environment. It encompasses the development of a control architecture for autonomous robot behavior, the implementation of machine learning for emergency detection, and the creation of a user-friendly interface for both patients and staff. The proposed concepts were validated in real-world scenarios in three different hospitals in Germany. This not only demonstrates the practical application of this system but also shares insights and methods, encouraging further advancement in the field of healthcare robotics.

Understanding Rewarding and Challenging Nursing Experiences During the Pandemic in Five Countries: Toward Strengthening the Workforce.

Nurses are now more likely to leave their current role in direct patient care than they were before the COVID-19 pandemic. Country culture and the organization of health care systems drive nurses' decisions to leave or stay in the profession. In a fall 2020 survey of nurse professional quality of life, a content analysis of responses to the open-ended question, "What has been challenging or rewarding during this pandemic experience?" was performed. Results were organized within Hofstede's Cultural Dimensions Theory. Six hundred and fifty-six nurses across five countries responded to the question; 526 comments were analyzed. Most (53.6%) respondents were staff bedside nurses. Themes, such as Distress and Fatigue and Building and Experiencing Social Capital were found and understood to reflect cultural values and dimensions such as Uncertainty Avoidance and Power Distance. Recommendations include strengthening culturally tailored leadership knowledge to inform and facilitate countries' nurse retention.

Identifying the facilitators and barriers to implementation of renal tumour biopsy in the diagnostic pathway for small renal masses.

To understand the facilitators and barriers to the implementation of renal tumour biopsy (RTB) in the diagnostic pathway for renal tumours in England. Participants consisted of patients who had a renal tumour diagnosed and/or treated at one of five tertiary centres in England, healthcare professionals involved in the direct care of patients diagnosed with renal tumours, and clinical service managers and commissioners. The study employed a mixed-methods research methodology consisting of individual interviews and an on-line survey that explored the types of facilitators and barriers individuals perceived and experienced and the frequency in which these were reported. A public dissemination event took place following the completion of data collection; to facilitate discussion of potential solutions to implementing RTB. There were 50 participant interviews (23 patients, 22 clinicians, and five health service commissioners/operations managers). The patient on-line survey received 52 responses, and the clinician survey received 22 responses. Patients most frequently reported influences in choosing whether to undergo RTB pertained to wanting to know the diagnosis of their kidney mass (40%), the advice or information provided by healthcare professionals (40%), and not wishing to delay treatment (23%). Clinicians most frequently reported barriers to recommending RTB related to their uncertainty of diagnostic accuracy (56%), availability of appointments or hospital beds (52%), concerns of risk of bleeding (44%), risk of seeding (41%), and delays in meeting national cancer pathway targets (41%). The dissemination event was attended by 18 participants (seven patients and 11 clinicians). Suggestions to improve implementation included reducing variation and promotion of standardisation of practice by a consensus statement, increasing the evidence base (clinicians) and improved communication by developing better patient aids such as videos and diagrams (patients and clinicians). Implementation of RTB may be dependent on the quality of information provided, its format and perceived reliability of the information. Increased utilisation of RTB may be improved by development of a consensus statement on the role of biopsy, with patients expressing a preference for alternative information aids such as patient videos.

Data Lake, Data Warehouse, Datamart, and Feature Store: Their Contributions to the Complete Data Reuse Pipeline.

The growing adoption and use of health information technology has generated a wealth of clinical data in electronic format, offering opportunities for data reuse beyond direct patient care. However, as data are distributed across multiple software, it becomes challenging to cross-reference information between sources due to differences in formats, vocabularies, and technologies and the absence of common identifiers among software. To address these challenges, hospitals have adopted data warehouses to consolidate and standardize these data for research. Additionally, as a complement or alternative, data lakes store both source data and metadata in a detailed and unprocessed format, empowering exploration, manipulation, and adaptation of the data to meet specific analytical needs. Subsequently, datamarts are used to further refine data into usable information tailored to specific research questions. However, for efficient analysis, a feature store is essential to pivot and denormalize the data, simplifying queries. In conclusion, while data warehouses are crucial, data lakes, datamarts, and feature stores play essential and complementary roles in facilitating data reuse for research and analysis in health care.

Multispecialty resident physicians’ perceived preparedness for mass casualty events (MCEs) at an urban level I trauma center prior to the coronavirus disease 2019 (COVID-19) era

PurposeCoronavirus disease 2019 (COVID-19) has underscored how ill-prepared healthcare systems are for mass casualty events (MCEs,) especially as MCEs increase worldwide. We hypothesized that resident physicians (RPs) across multiple specialties are underprepared for MCE.MethodsTwo similar surveys were conducted to assess awareness of disaster plans (DPs) and individual’s roles and responsibilities therein. Initially, we surveyed exclusively trainees who are trauma team members (TTMs,) including physician assistants (PAs), residents from emergency medicine (EMRs) and general surgery (GSRs.) Subsequently, we surveyed multi-specialty RPs, except GSRs and EMRs, and their program directors/associate program directors (PDs/APDs.) RPs’ awareness, knowledge of, and confidence in hospital MCE response plans were assessed, and barriers encountered were queried. Data were consolidated except with respect to PDs/APDs, who were queried only in the second survey. The Fisher exact test for multiple-group comparisons was used. Alpha = 0.05.ResultsFor the first survey, the response rate was 74% (123/166), whereas 34% (129/380) responded to the second survey. Combined, the response rate was 46% (252/546.) Considering the RPs only for the two surveys combined, 103 (53%) respondents reported no awareness of institutional MCE response plans, 73% (n = 143) did not know/were unsure whether they were expected to contact someone, and 68% (n = 134) reported no formal MCE/disaster management (DM) training over the prior year. Additionally, the median response reported for level of knowledge of the MCE response plan among all RPs was “not at all,” with a significant difference observed between those aware of the plan and those who were not (p < 0.001). The median response reported for confidence level of RPs in MCE/DM training, excluding GSRs and EMRs (TTMs,) was “not at all,” with significant differences between surgical and non-surgical specialty RPs (p = 0.031), and between junior and senior RPs (p = 0.027). PDs/APDs (n = 12) reported “time” as the main barrier to implementation.ConclusionsRPs across all surveyed specialties reported low levels of knowledge and minimal training regarding MCE/DM. Incorporation of MCE/DM preparedness into residency training in all specialties involving direct patient care is essential. Curricular restructuring will be required for meaningful participation of RPs in MCEs.

Rational Redesign of an Introductory Pharmacy Practice Experience Curriculum

ObjectiveTo utilize a process to identify strengths and weaknesses of an introductory pharmacy practice experience (IPPE) curriculum from stakeholder perspectives and undergo IPPE curricular revision. MethodsAn IPPE curriculum redesign taskforce was created, and a 5-step systematic quality improvement process was developed and applied to redesign an IPPE curriculum. The steps were to identify existing curriculum challenges and strengths, determine potential solutions to challenges, redesign IPPE curricular structure, obtain stakeholder input and support, and redesign IPPE content. Throughout these steps, surveys were administered, and feedback was solicited from stakeholder groups through focus groups and meetings. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using inductive content analysis and peer debriefing to identify themes. ResultsStudent survey and focus group results identified desires to limit student-preceptor negotiations when scheduling hours, decrease conflict between IPPE hours and scheduled classes, and increase direct patient care opportunities. Structural revisions included transition of IPPE hours from the first and second year of the program into the third year, revising course schedule grids to allow third-year students 1 day per week to complete hours, and aligning rotation dates during class-free times. Curricular content was strengthened through curricular mapping, threading, and course coordinator collaborations. ConclusionA 5-step IPPE redesign systematic quality improvement process utilizing solicitation, analysis, and incorporation of stakeholder feedback was used to revise an IPPE curriculum to maintain framework and content strengths and address weaknesses. Other pharmacy programs could utilize this process to redesign their IPPE curriculum.

TrachGPT: Appraisal of tracheostomy care recommendations from an artificial intelligent Chatbot.

Safe home tracheostomy care requires engagement and troubleshooting by patients, who may turn to online, AI-generated information sources. This study assessed the quality of ChatGPT responses to such queries. In this cross-sectional study, ChatGPT was prompted with 10 hypothetical tracheostomy care questions in three domains (complication management, self-care advice, and lifestyle adjustment). Responses were graded by four otolaryngologists for appropriateness, accuracy, and overall score. The readability of responses was evaluated using the Flesch Reading Ease (FRE) and Flesch-Kincaid Reading Grade Level (FKRGL). Descriptive statistics and ANOVA testing were performed with statistical significance set to p < .05. On a scale of 1-5, with 5 representing the greatest appropriateness or overall score and a 4-point scale with 4 representing the highest accuracy, the responses exhibited moderately high appropriateness (mean = 4.10, SD = 0.90), high accuracy (mean = 3.55, SD = 0.50), and moderately high overall scores (mean = 4.02, SD = 0.86). Scoring between response categories (self-care recommendations, complication recommendations, lifestyle adjustments, and special device considerations) revealed no significant scoring differences. Suboptimal responses lacked nuance and contained incorrect information and recommendations. Readability indicated college and advanced levels for FRE (Mean = 39.5, SD = 7.17) and FKRGL (Mean = 13.1, SD = 1.47), higher than the sixth-grade level recommended for patient-targeted resources by the NIH. While ChatGPT-generated tracheostomy care responses may exhibit acceptable appropriateness, incomplete or misleading information may have dire clinical consequences. Further, inappropriately high reading levels may limit patient comprehension and accessibility. At this point in its technological infancy, AI-generated information should not be solely relied upon as a direct patient care resource.

"Alexa, Cycle The Blood Pressure": A Voice Control Interface Method for Anesthesia Monitoring.

Anesthesia monitors and devices are usually controlled with some combination of dials, keypads, a keyboard, or a touch screen. Thus, anesthesiologists can operate their monitors only when they are physically close to them, and not otherwise task-loaded with sterile procedures such as line or block placement. Voice recognition technology has become commonplace and may offer advantages in anesthesia practice such as reducing surface contamination rates and allowing anesthesiologists to effect changes in monitoring and therapy when they would otherwise presently be unable to do so. We hypothesized that this technology is practicable and that anesthesiologists would consider it useful. A novel voice-driven prototype controller was designed for the GE Solar 8000M anesthesia patient monitor. The apparatus was implemented using a Raspberry Pi 4 single-board computer, an external conference audio device, a Google Cloud Speech-to-Text platform, and a modified Solar controller to effect commands. Fifty anesthesia providers tested the prototype. Evaluations and surveys were completed in a nonclinical environment to avoid any ethical or safety concerns regarding the use of the device in direct patient care. All anesthesiologists sampled were fluent English speakers; many with inflections from their first language or national origin, reflecting diversity in the population of practicing anesthesiologists. The prototype was uniformly well-received by anesthesiologists. Ease-of-use, usefulness, and effectiveness were assessed on a Likert scale with means of 9.96, 7.22, and 8.48 of 10, respectively. No population cofactors were associated with these results. Advancing level of training (eg, nonattending versus attending) was not correlated with any preference. Accent of country or region was not correlated with any preference. Vocal pitch register did not correlate with any preference. Statistical analyses were performed with analysis of variance and the unpaired t -test. The use of voice recognition to control operating room monitors was well-received anesthesia providers. Additional commands are easily implemented on the prototype controller. No adverse relationship was found between acceptability and level of anesthesia experience, pitch of voice, or presence of accent. Voice recognition is a promising method of controlling anesthesia monitors and devices that could potentially increase usability and situational awareness in circumstances where the anesthesiologist is otherwise out-of-position or task-loaded.

Functional status related to post-COVID 19 Syndrome in the nursing staff of a Second Level Hospital in Quito-Ecuador

Introduction: Nurses are on the front line fighting against the COVID-19 and are at high risk of infection by direct patient care. Multiple factors determine the severity of this disease and along with persistent symptoms due to subsequent infection, affect the functional status of the infected nurses. General Objective: To determine the functional status related to the post-COVID-19 in direct patient care nurses at Hospital General Docente de Calderón during 2022. Method: The research has a quantitative approach with a descriptive, observational and cross-sectional design which determined the functional status related to the post-COVID 19 syndrome in 142 respondents. For this purpose it was used the Spanish version of Post COVID 19 Functional Status Scale, previously validated. Results: The average age of the participants was 36.8 years, 110 women and 32 men. Regarding functional limitations, 54.9% had no limitations, 16.9% had minimal limitations, 5.6% had mild limitations, 12.7% had moderate limitations and 9.9% had severe limitations. By exploring possible associations between variables, a significant relationship (p&lt;0.005) was found between functional status with age and the number of infections. Conclusions: Although the largest percentage does not present functional limitations, it is worth noting that the 45.1% of nurses and auxiliary nurses, with minimal or severe functional limitations, continue to work in areas of medium or greater complexity. It constitutes an important input for the improvement of occupational health.

Navigating competing tensions: A qualitative study of experiences and perceptions of leadership among emergency medicine doctors.

Emergency medicine (EM) doctors are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. The objective of the present study was to explore the research question: 'What are the experiences and perceptions of leadership by EM doctors?' This single-site qualitative study was undertaken using semi-structured in-depth individual interviews to collect data. Interviews were audio recorded, transcribed and de-identified. Reflexive thematic analysis was performed by the research team with the aid of DelveTool software. Our sample included nine participants incorporating consultants and registrars. Three major themes were identified: (i) situational tensions, (ii) relational tensions and (iii) leadership style tensions. Each of these was further explored with subthemes discussed separately. Leadership within the ED is complex and multifaceted, with doctors required to navigate many competing tensions. The present study highlighted key areas for future leadership development, including situational awareness, emotional intelligence and a fluid approach to leadership styles. The present study provides an important step towards enhancing the development of targeted leadership training for EM doctors.