Extra Staff Research Articles

Perspectives Among Health Care Providers and People with HIV on the Implementation of Long-Acting Injectable Cabotegravir/Rilpivirine for Antiretroviral Therapy in Florida.

Long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) for antiretroviral therapy (ART) could benefit many people with HIV (PWH). However, its impact will largely be determined by providers' willingness to prescribe it and PWH's willingness to take it. This study explores the perceived barriers and facilitators of LAI CAB/RPV implementation among PWH and HIV care providers in Florida, a high prevalence setting. Semi-structured qualitative interviews were conducted in English with 16 PWH (50% non-Hispanic White, 50% cis men, and 94% on oral ART) and 11 providers (27% non-Hispanic Black, 27% Hispanic, 73% cis women, and 64% prescribed LAI CAB/RPV) throughout the state. Recruitment occurred between October 2022 and October 2023 from HIV clinics. Interviews were recorded, professionally transcribed, and then double coded using thematic analysis. The Consolidated Framework for Implementation Research guided the interview guide and coding. While PWH viewed LAI CAB/RPV as effective, predominant barriers included administration via injection, challenges of attending more clinic visits, and a feeling that this made HIV the center of one's life. Providers additionally expressed concerns about the development of integrase resistance. Barriers noted by PWH and providers outside of the clinic included transportation, stigma, access inequities, and payor issues. Within clinics, providers identified the need for extra staffing and the increased burden on existing staff as barriers. These barriers decreased the perceived need for LAI CAB/RPV among PWH and providers, especially with the high effectiveness of oral ART. Many of the identified barriers occur outside of the clinic and will likely apply to other novel long-acting ART options.

Factors influencing nurses' use of sedation interruptions in a critical care unit: a descriptive qualitative study.

This study examined critical care nurses', physicians', and allied health professionals' perceptions of factors that support, inhibit, or limit the use of sedation interruption (SI) to improve the use of this integral component of care for mechanically ventilated patients. We conducted a theory-based, descriptive qualitative study using semi-structured interviews with critical care registered nurses, respiratory therapists, a pharmacist, and a physician in a hospital in Ontario, Canada. The interview guide and analysis were informed by the Theoretical Domains Framework and transcripts were analyzed using content analysis. We identified 9 facilitators and 20 barriers to SI use by nurses. Facilitators included the innovation (importance of protocols) and potential adopters (comfort with the skill). The barriers were the potential adopters' (nurses) knowledge gaps regarding the performance and goal of SI and the practice environment (lack of time, availability of extra staff, and lack of multidisciplinary rounds). This study identified facilitators and barriers to SI for mechanically ventilated patients. Implementation efforts must address barriers associated with nurses, the environment, and contextual factors. A team-based approach is essential, as the absence of interprofessional rounds is a significant barrier to the appropriate use or non-use of SI. Future research can focus on the indications, contraindications, and goals of SI, emphasizing a shared appreciation for these factors across disciplines. Nursing capacity to manage a patient waking up from sedation is necessary for point-of-care adherence; future research should focus on the best ways to do so. Implementation study designs should use theory and evidence-based determinants of SI to bridge the evidence-to-practice gap. http://links.lww.com/IJEBH/A178.

Retrospective comparison between MRI examinations during radiographer-administered intranasal sedation or general anesthesia

IntroductionIn order for young children to be able to undergo a Magnetic Resonance Imaging (MRI) examination, general anesthesia is often required. The aim of this study was to compare the image quality, times, and costs of the examinations of infant brains performed with MRI either during sedation with dexmedetomidine administered by radiographers or anesthesia with propofol administered by anesthesia staff. MethodsThis study was a quantitative retrospective study of 27 consecutive standard brain examinations performed under sedation or anesthesia, involving 15 children under sedation and 12 under anesthesia. The age of the children was from 0.5 to five years old. The image quality was evaluated by three radiologists experienced in pediatric MRI examinations. Information such as examination time and the expense of the examination was also collected. ResultsThere was no statistically significant difference in the general image quality, but one image series was assessed to have significantly better image quality under sedation than under anesthesia, but all images had very high quality. However, it emerged that children under anesthesia were at the hospital on average 55 min longer and the scanner room was occupied 20 min longer on average. The anesthesia examinations were three times more expensive. ConclusionThis study demonstrated equivalent image quality between sedation and anesthesia. In addition, sedation was less time-consuming and had a lower price, partly because no extra anesthetic staff were required. The use of intranasal sedation offers a possibility to expand the competence area for radiographers. Implications for practiceIf radiographers learn to perform intranasal sedation, examinations can be performed in less time, at a third of the staff costs while maintaining image quality.

Adoption and implementation of produce prescription programs for under-resourced populations: clinic staff perspectives.

Produce prescription programs represent a promising intervention strategy in the healthcare setting to address disparities in diet quality and diet-related chronic disease. The objective of this study was to understand adoption and implementation factors related to these programs that are common across contexts and those that are context-specific. In this qualitative case comparison study, we conducted qualitative interviews with eight clinic staff from five primary care "safety net" clinics, identified by a partnering non-profit organization that operated the programs, in April-July 2021. Across clinics, the ability to provide a tangible benefit to patients was a key factor in adoption. Flexibility in integrating into clinic workflows was a facilitator of implementation. Fit with usual operations varied across clinics. Common challenges were the need for changes to the workflow and extra staff time. Clinic staff were skeptical about the sustainability of both the benefits to patients and the ability to continue the program at their clinics. This study adds to a growing body of knowledge on the adoption and implementation of produce prescription programs. Future research will further this understanding, providing the evidence necessary to guide adopting clinics and to make informed policy decisions to best promote the growth and financial sustainability of these programs.

Supporting the “hallway residents”: a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care

BackgroundLong-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society’s most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia.MethodsUsing a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data.ResultsLTC staff (n = 46) emphasized the program’s ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers.ConclusionsLTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.

Retaining Healthcare Workers: A Systematic Review of Strategies for Sustaining Power in the Workplace

The shortage of healthcare workers is a growing concern. The COVID-19 pandemic and retirement wave have accelerated turnover rates. This systematic review aimed to identify and analyse the existing interventions for job retention of healthcare workers, in terms of nurses and physicians, in a hospital setting. A comprehensive search was conducted within three electronic databases, guided by the preferred reporting items for systematic review and meta-analyses (PRISMA) and synthesis without meta-analysis (SWiM) guidelines, this resulted in 55 records that met the inclusion criteria. The intervention outcomes are categorized into substantial themes: onboarding, transition program to a different unit, stress coping, social support, extra staffing, coping with the demands of patient care, work relationships, development opportunities and department resources, job environment, work organization, recruitment approach, and technological innovations. Considering the literature, onboarding programs and mentoring for nurses and physicians are recommended. Additionally, other interventions described in this review could positively affect the retention of nurses and physicians. When selecting an intervention for implementation, managers and human resources should consider the intervention that matches the determinant of intention to leave of their healthcare workers and the hospital’s mission, vision, and values. Sharing the success stories of implemented interventions may benefit healthcare organizations.

Pediatric intraoperative cardiopulmonary arrests: A survey to evaluate if Medical Emergency Teams are utilized in pediatric operating rooms.

Studies have shown that standardized code teams may improve outcomes following cardiac arrests. Pediatric intra-operative cardiac arrests are rare events and are associated with a mortality rate of 18%. There is limited data available regarding use Medical Emergency Team (MET) response to pediatric intra-operative cardiac arrest. The purpose of this study was to identify the use of MET in response to pediatric intraoperative cardiac arrest as an exploratory step in establishing evidence-based standardized practice across the hospital for training and management of this rare event. An anonymous electronic survey was created and sent to two populations: The Pediatric Anesthesia Leadership Council, a section of the Society for Pediatric Anesthesia, and the Pediatric Resuscitation Quality Collaborative, a multinational collaborative group, which works to improve resuscitation care in children. Standard summary and descriptive statistics were used for survey responses. The overall response rate was 41%. The majority of respondents worked in a university affiliated, free-standing children's hospital. Ninety-five percent of respondents had a dedicated pediatric MET at their hospital. In 60% of responses from Pediatric Resuscitation Quality Collaborative and 18% of Pediatric Anesthesia Leadership Council hospitals, the MET responds to pediatric intra-operative cardiac arrest; however, the majority of times MET involvement is requested rather than automatic. The MET was found to be activated intraoperatively for situations other than cardiac arrest such as, massive transfusion events, need for extra staff, and for specialty expertise. In 65% of institutions, simulation-based training for cardiac arrest is supported but lacking pediatric intra-operative focus. This survey revealed heterogeneity in the composition and response of the medical response teams responding to pediatric intra-operative cardiac arrests. Improved collaboration and cross training among MET, anesthesia, and operating room nursing may improve outcomes of pediatric intra-operative code events.

A Bayesian hierarchical assessment of night shift working for offshore wind farms

AbstractThis article presents a Bayesian data‐modelling approach to assessing operational efficiency at offshore wind farms. Input data are provided by an operational database provided by a large offshore wind farm which employs an advanced data management system. We explore the combination of datasets making up the database, using them to train a Bayesian hierarchical model which predicts weekly lost production from corrective maintenance and time‐based availability. The approach is used to investigate the effect of technician work shift patterns, specifically addressing a strategy involving night shifts for corrective maintenance which was employed at the site throughout the winter. It was found that, for this particular site, there is an approximate annual increase in time‐based technical availability of 0.64%. We explore the effect of modelling assumptions on cost savings; specifically, we explore variations in failure rate, price of electricity, number of technicians working night shift, extra staff wages, months of the year employing 24/7 working and extra vessel provision. Results vary quite significantly among the scenarios investigated, exemplifying the need to consider the question on a farm‐by‐farm basis.

Perception and attitude of emergency department and primary care physicians towards subarachnoid hemorrhage in Al-Hasa, Saudi Arabia: a cross-sectional study

Objective: This study examined the perception and attitude of emergency department (ED) and primary care physicians (PCPs) toward subarachnoid hemorrhage (SAH) in Al-Hasa, Saudi Arabia, and identified challenges in its management. Methods: A cross-sectional research design was employed in this study. A self-administered structured questionnaire with 17 validated questions was distributed electronically via email and social media to 103 eligible ED and PCPs residing in Al-Ahsa city, Saudi Arabia. The sample represented physicians from different settings. Results: Results showed physicians had moderate SAH knowledge, with age being the most important in determining patient prognosis. Limited access to specialized care and trained staff were the biggest management challenges. Additional staff training and increased specialized care access were suggested to improve SAH management. Conclusion: SAH is a potentially life-threatening condition requiring immediate attention. ED and PCPs play a crucial SAH management role, so understanding their perception and attitude is important. Providing extra staff training and specialized care access might improve SAH management.

Impact of antimicrobial stewardship on antibiogram, consumption and incidence of multi drug resistance

IntroductionAntimicrobial stewardship programs are intended to improve patient outcomes, reduce side effects, bacterial resistance, and costs. Thus, it is important to assess their impact on an ongoing basis. We aimed to assess the impact of the antimicrobial stewardship program in two different hospitals which used different program approaches.MethodologyThis is a retrospective observational study in two private hospitals [4088 patient records] in Amman- Jordan. Antibiotic susceptibility using antibiogram results, consumption of antibiotics using Defined Daily Dose, and the incidence of Multi-Drug Resistance were recorded using patients’ records during 2018, 2019, and 2020.ResultsAntimicrobial stewardship program outcomes varied between the two hospitals. Bacterial susceptibility to antibiotics were improved in both hospitals. Moreover, the defined daily dose in Hospital “A” showed no significant change in Fluoroquinolones, Carbapenems, and Piperacillin- Tazobactam, Cephalosporins, and Colistin, while a significant change was observed among Anti-MRSA antibiotics. Finally, the incidence of Extended Spectrum Beta-lactamase [ESBL] E. coli, ESBL Klebsiella, and Vancomycin Resistant Enterococci [VRE] have decreased numerically over the study period, while Methicillin-Resistant Staphylococcus aureus [MRSA] showed an increase in incidence during the second year of the study.ConclusionThe study emphasizes the positive impact of the AMS program throughout the three years of the study. Plus, the need to enhance the program through recruiting extra staff and applying extra regulations like implementing educational programs for the hospital staff, designing local guidelines for common ID diseases, and monitoring the program’s outcomes which would eventually be more efficient, cost-effective, and safe.

Evaluating the effects of supplementing ward nurses on quality of newborn care in Kenyan neonatal units: protocol for a prospective workforce intervention study

BackgroundData from High Income Countries have now linked low nurse staff to patient ratios to poor quality patient care. Adequately staffing hospitals is however still a challenge in resource-constrained Low-middle income countries (LMICs) and poor staff-to-patient ratios are largely taken as a norm. This in part relates to limited evidence on the relationship between staffing and quality of patient care in these settings and also an absence of research on benefits that might occur from improving hospital staff numbers in LMICs. This study will determine the effect on the quality of patient care of prospectively adding extra nursing staff to newborn units in a resource constrained LMIC setting and describe the relationship between staffing and quality of care.MethodsThis prospective workforce intervention study will involve a multi-method approach. We will conduct a before and after study in newborn units of 4 intervention hospitals and a single time-point comparison in 4 non-intervention hospitals to determine if there is a change in the level of missed nursing care, a process measure of the quality of patient care. We will also determine the effect of our intervention on routinely collected quality indicators using interrupted time series analysis. Using three nurse staffing metrics (Total nursing hours, nursing hours per patient day and nursing hours per patient per shift), we will describe the relationship between staffing and the quality of patient care.DiscussionThere is an urgent need for the implementation of staffing policies in resource constrained LMICs that are guided by relevant contextual data. To the best of our knowledge, this is the first study to evaluate the prospective addition of nursing staff in resource-constrained care settings. Our findings are likely to provide the much-needed evidence for better staffing in these settings.Trial registrationThis study was retrospectively registered in the Pan African Clinical Trial Registry (https://pactr.samrc.ac.za/Default.aspx?Logout=True) database on the 10th of June 2022 with a unique identification number-PACTR202206477083141.

Collectibility Improvement In PT. Kaltim Prima Coal Receivables Management: A Framework Roadmap Proposal

Background : The Importance of efficient working capital management is indisputable given that a firm’s viability relies on the financial manager’s ability to effectively manage receivables, inventory, and payables. One of widely used measurement to calculate the effectiveness of working capital management is Cash Conversion Cycle. Purpose : Traditional Cash Conversion Cycle is calculated using items from Financial Statement. However, it is proofed to be overstated compare to the actual calculation. Based on a comparison with Cash Conversion Cycle of another company listed on Indonesian Stock Exchange, Cash Conversion Cycle of PT Kaltim Prima Coal seems to be superior with lower days it needs to convert inventory into cash and longer time to pay its payables. Method: This research uses a quantitative approach method. Results : The research found that based on the regression method, days of late payment and sales amounts of late payment have significant relationship with Profit. Days of late payment and sales amounts of late payment have significant relationship with ROA. And, Days of late payment and sales amounts of late payment also have significant relationship with NPM. Conclusion : PT. Kaltim Prima Coal are recommended to implement analysis of Risk Quadrant on periodic basis, to arrange Letter of Credit training to adopt Company Bank’s point of view in reviewing the Letter of Credit, to implement Letter of Credit checklist to reduce discrepancy rate, to arrange objective review of examining the extra staff requirement, and to develop Credit Policy.

Collectibility Improvement In PT. Kaltim Prima Coal Receivables Management: A Framework Roadmap Proposal

Background : The Importance of efficient working capital management is indisputable given that a firm’s viability relies on the financial manager’s ability to effectively manage receivables, inventory, and payables. One of widely used measurement to calculate the effectiveness of working capital management is Cash Conversion Cycle. Purpose : Traditional Cash Conversion Cycle is calculated using items from Financial Statement. However, it is proofed to be overstated compare to the actual calculation. Based on a comparison with Cash Conversion Cycle of another company listed on Indonesian Stock Exchange, Cash Conversion Cycle of PT Kaltim Prima Coal seems to be superior with lower days it needs to convert inventory into cash and longer time to pay its payables. Method: This research uses a quantitative approach method. Results : The research found that based on the regression method, days of late payment and sales amounts of late payment have significant relationship with Profit. Days of late payment and sales amounts of late payment have significant relationship with ROA. And, Days of late payment and sales amounts of late payment also have significant relationship with NPM. Conclusion : PT. Kaltim Prima Coal are recommended to implement analysis of Risk Quadrant on periodic basis, to arrange Letter of Credit training to adopt Company Bank’s point of view in reviewing the Letter of Credit, to implement Letter of Credit checklist to reduce discrepancy rate, to arrange objective review of examining the extra staff requirement, and to develop Credit Policy.

Response to winter pressures in acute services: analysis from the Winter Society for Acute Medicine Benchmarking Audit

BackgroundThere is increased demand for urgent and acute services during the winter months, placing pressure on acute medicine services caring for emergency medical admissions. Hospital services adopt measures aiming to compensate for the effects of this increased pressure. This study aimed to describe the measures adopted by acute medicine services to address service pressures during winter.MethodsA survey of acute hospitals was conducted during the Society for Acute Medicine Benchmarking Audit, a national day-of-care audit, on 30th January 2020. Survey questions were derived from national guidance.Acute medicine services at 93 hospitals in the United Kingdom completed the survey, evaluating service measures implemented to mitigate increased demand, as well as markers of increased pressure on services.ResultsAll acute internal medicine services had undertaken measures to prepare for increased demand, however there was marked variation in the combination of measures adopted. 81.7% of hospitals had expanded the number of medical inpatient beds available. 80.4% had added extra clinical staff. The specialty of the physicians assigned to provide care for extra inpatient beds varied. A quarter of units had reduced beds available for providing Same Day Emergency Care on the day of the survey. Patients had been waiting in corridors within the emergency medicine department in 56.3% of units.ConclusionWinter pressure places considerable demand on acute services, and impacts the delivery of care. Although increased pressure on acute hospital services during winter is widely recognised, there is considerable variation in the approach to planning for these periods of increased demand.

Real-World Experience of mHealth Implementation in Clinical Practice (the Box): Design and Usability Study.

BackgroundMobile health (mHealth) is an emerging field of scientific interest worldwide. Potential benefits include increased patient engagement, improved clinical outcomes, and reduced health care costs. However, mHealth is often studied in projects or trials, and structural implantation in clinical practice is less common.ObjectiveThe purpose of this paper is to outline the design of the Box and its implementation and use in an outpatient clinic setting. The impact on logistical outcomes and patient and provider satisfaction is discussed.MethodsIn 2016, an mHealth care track including smartphone-compatible devices, named the Box, was implemented in the cardiology department of a tertiary medical center in the Netherlands. Patients with myocardial infarction, rhythm disorders, cardiac surgery, heart failure, and congenital heart disease received devices to measure daily weight, blood pressure, heart rate, temperature, and oxygen saturation. In addition, professional and patient user comments on the experience with the care track were obtained via structured interviews.ResultsFrom 2016 to April 2020, a total of 1140 patients were connected to the mHealth care track. On average, a Box cost €350 (US $375), not including extra staff costs. The median patient age was 60.8 (IQR 52.9-69.3) years, and 73.59% (839/1140) were male. A median of 260 (IQR 105-641) measurements was taken on a median of 189 (IQR 98-372) days. Patients praised the ease of use of the devices and felt more involved with their illness and care. Professionals reported more productive outpatient consultations as well as improved insight into health parameters such as blood pressure and weight. A feedback loop from the hospital to patient to focus on measurements was commented as an important improvement by both patients and professionals.ConclusionsIn this study, the design and implementation of an mHealth care track for outpatient follow-up of patients with various cardiovascular diseases is described. Data from these 4 years indicate that mHealth is feasible to incorporate in outpatient management and is generally well-accepted by patients and providers. Limitations include the need for manual measurement data checks and the risk of data overload. Moreover, the tertiary care setting in which the Box was introduced may limit the external validity of logistical and financial end points to other medical centers. More evidence is needed to show the effects of mHealth on clinical outcomes and on cost-effectiveness.

Evaluation of the outcomes of adjunctive awake-proning as a novel approach to the management of COVID-19 pneumonitis in a level 1 hospital ward setting

In response to pressure on United Kingdom healthcare services due to the COVID-19 pandemic, a decision was made to pre-emptively awake-prone hypoxic patients with COVID-19 pneumonitis in a non intensive care unit (ICU) setting, with the aim of improving oxygenation and patient outcomes. This approach was trialled over 30 days from 30th March 2020, awake-proning patients for up to 15 hours a day in the first 72 hours of commencement. This case series was retrospectively analysed to characterise patients who tolerated the intensive regime (group A) versus those who ceased awake-proning early (group B). Additionally, length of stay in days was evaluated in the two groups. In total, 36 patients were proned – with an average of 2% point increase in oxygen saturations. Of these, 21 patients tolerated the intensive regime (average 1878 minutes/72 hours). Of the 15 people who ceased early (971 minutes/72 hours), only 4 were due to intolerable side effects. There were no major significant differences in baseline clinical characteristics between the two groups. Length of stay was significantly reduced in group A over group B even when adjusted for confounding of ICU stay (7.2 compared to 15.2 days p = 0.049). In conclusion awake-proning was successfully delivered in a level 1 setting, requiring the addition of 2 extra physiotherapy staff only. Further exploration is needed to explore the association of intensive regimes with reduced length of stay.

Perspectives of Nurses About Factors Affecting Quality of Care at the Solomon Islands National Referral Hospital During the 2016-2017 Dengue Outbreak: A Qualitative Study

During the 2016-2017 Solomon Islands dengue outbreak, the National Referral Hospital (NRH) in Honiara was the epicenter for the national response. High-quality nursing care is critical for successful management and this study investigated the factors affecting the quality of nursing care for patients admitted to NRH with dengue. Data were collected using two methods: ( a) Focus group discussions with nurses who cared for dengue patients and ( b) a self-administered questionnaire completed by a senior manager. Analysis of qualitative data using a thematic technique found two key factors affected care: ( a) training on protocols and guidelines for clinical management and ( b) planning and preparedness of NRH. Quality of care was influenced by lack of basic equipment, transport provided for nursing staff to attend shifts, and confusion between allowances for regular salaried staff and extra staff assisting with the outbreak. Specific attention is needed in future outbreaks to ensure staff understand protocols, follow guidelines, and that adequate equipment is provided.

Bold Frogs or Shy Toads? How Did the COVID-19 Closure of Zoological Organisations Affect Amphibian Activity?

Simple SummaryThe visitor effect describes how zoo animals respond to the presence of visitors to their enclosures in a positive, negative or neutral manner. The period of enforced closure of zoos due to the COVID-19 pandemic in March 2020 (and subsequent reopening later that year) allowed for the effect of visitor presence to be evaluated on several species of amphibian. Results have shown that amphibian visibility (i.e., likelihood to be on show in their enclosure) is potentially influenced by the presence of people, and therefore, enclosure layout, collection planning and amphibian husbandry should consider how to minimize any negative influences of the viewing public.Amphibians are an understudied group in the zoo-focussed literature. Whilst commonly housed in specialist exhibits and of real conservation value due to the global extinction crisis, amphibian welfare is not often investigated empirically in zoo settings. The limited research that is available suggests that enclosure design (structure, planting and naturalistic theming) has a positive impact on the time that amphibians will be on show to visitors. However, the categorisation of any “visitor effect” (i.e., influences of visitor presence on amphibian activity and time on display) is hard to find. The COVID-19 pandemic forced the closure of zoological organisations in the UK for several months from March 2020, with gradual re-openings from the summer into autumn and winter. This event provided a unique opportunity to study the effect of the lack of visitors, the presence of essential zoo staff only, the wider return of organisational staff, and then the return of visitors over a prolonged period. This project at WWT Slimbridge Wetlands Centre assessed the number of individuals of six species of amphibian—common toad (Bufo bufo), common frog (Rana temporaria), smooth newt (Lissotriton vulgaris), pool frog (Pelophylax lessonae), golden mantella (Mantella aurantiaca) and golden poison dart frog (Phyllobates terribilis)—visible to observers under different conditions. All amphibians were housed in a purpose-built indoor exhibit of individual enclosures and were recorded when visible (as a proportion of the total population of the enclosure) during closure, the return of extra centre staff and visitor periods. The results showed species-specific differences in visibility, with some species of amphibian being more likely to be on view when the presence of people at their enclosure was less likely or in smaller numbers. Such differences are likely related to the specific camouflage or anti-predation tactics in these focal species. Further study to quantify amphibian sensitivity to, and perception of, environmental change caused by public presence (e.g., light levels and sound) would be useful welfare-themed research extensions. Our results can help inform husbandry, collection planning and amphibian enclosure design to reduce any noticeable visitor effects, and provide a useful benchmark for further, more complex, welfare assessment measures.

The impact of corona pandemic on critical care medicine

A pandemic is defined as an epidemic of an infectious etiology that crosses the international boundaries and infects a large number of people. This has happened several times in the human history; influenza, smallpox, bubonic plaque and cholera being some of the examples. Smallpox alone has resulted in death of 300—500 million people. As a frontline healthcare professional fighting against the COVID–19 pandemic, the author has experienced its socio–economic and psychological consequences. In addition, critical care units faced ethical challenges to meet with the bed requirement. Dedicated and modified COVID–19 critical care services were started in both the public and private sectors. Because of high workload and lack of trained medical and nursing staff, extra staff ha to be recruited on temporary basis. Some commonly performed procedures were modified to decrease the risk of infection spread. ICUs faced shortage of personal protective equipment and ventilators. Training programs were developed to help improve the understanding of novel COVID–19 infection. ICU staff was probably at lower risk of acquiring this infection as compared to other hospital staff. Key words: COVID–19, Implications, Critical Care Medicine Citation: Mansoor F. The impact of corona pandemic on critical care medicine. Anaesth. pain intensive care 2021;25(4):420-423. DOI: 10.35975/apic.v25i4.1561 Received: June 4, 2021, Reviewed & Accepted: July 8, 2021

Pharmacy-led COVID-19 vaccination sites offered part of £20m fund for extra staff

Community pharmacy-led COVID-19 vaccination sites in England will receive part of a £20m government pot to pay for additional workforce, NHS England has said. In a letter sent on 10 June 2021, NHS England said sustainability and transformation partnerships (STPs) and integrated care systems (ICSs) would receive a total of £20m to boost staff numbers […]