Intensive Care Unit Physicians Research Articles

Association between ICU interruptions and physicians trainees’ electronic health records efficiency

ABSTRACT The intensive care unit (ICU) is a stressful and complex environment in due to its dynamic nature and severity of admitted patients. EHR interface design can be cumbersome and lead to prolonged times to complete tasks. This paper investigated the relationship between a prominent EHR interface design and interruptions with physician’s efficiency during patient chart review at ICU Pre-Rounds. We conducted a live observation of ICU physicians in a 30-bed MICU at a tertiary, southeastern medical center. Directly after the observation sessions, the physicians completed a modified System Usability Scale (SUS) survey. A total of 52 EHR patient chart reviews were observed at the MICU Pre-rounds. There was statistically significant positive correlation between time spent to review patient EHR with both number of scrolling(p-value<0.0001) across EHR interface; and with number of visited EHR screens (p-value=0.0444). There was positive correlation between number of interruptions with time spent to review patient EHR during ICU prerounds. EHR design and the occurrence of interruptions lead to reduced physician-EHR efficiency levels. We report that the number of scrolling and visited screens executed by physicians to gather the required information was associated with increased screen time and consequently decreased physician efficiency.

Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial

IntroductionThe technologies used to treat the millions who receive care in intensive care unit (ICUs) each year have steadily advanced. However, the quality of ICU-based communication has remained suboptimal, particularly concerning for Black patients and their family members. Therefore we developed a mobile app intervention for ICU clinicians and family members called ICUconnect that assists with delivering need-based care. ObjectiveTo describe the methods and early experiences of a clustered randomized clinical trial (RCT) being conducted to compare ICUconnect vs. usual care. Methods and analysisThe goal of this two-arm, parallel group clustered RCT is to determine the clinical impact of the ICUconnect intervention in improving outcomes overall and for each racial subgroup on reducing racial disparities in core palliative care outcomes over a 3-month follow up period. ICU attending physicians are randomized to either ICUconnect or usual care, with outcomes obtained from family members of ICU patients. The primary outcome is change in unmet palliative care needs measured by the NEST instrument between baseline and 3 days post-randomization. Secondary outcomes include goal concordance of care and interpersonal processes of care at 3 days post-randomization; length of stay; as well as symptoms of depression, anxiety, and post-traumatic stress disorder at 3 months post-randomization. We will use hierarchical linear models to compare outcomes between the ICUconnect and usual care arms within all participants and assess for differential intervention effects in Blacks and Whites by adding a patient-race interaction term. We hypothesize that both compared to usual care as well as among Blacks compared to Whites, ICUconnect will reduce unmet palliative care needs, psychological distress and healthcare resource utilization while improving goal concordance and interpersonal processes of care. In this manuscript, we also describe steps taken to adapt the ICUconnect intervention to the COVID-19 pandemic healthcare setting. Enrollment statusA total of 36 (90%) of 40 ICU physicians have been randomized and 83 (52%) of 160 patient-family dyads have been enrolled to date. Enrollment will continue until the end of 2021.

Non-readmission decisions in the intensive care unit: A qualitative study of physicians' experience in a multicentre French study.

PurposeDeciding not to re-admit a patient to the intensive care unit (ICU) poses an ethical dilemma for ICU physicians. We aimed to describe and understand the attitudes and perceptions of ICU physicians regarding non-readmission of patients to the ICU.Materials and methodsMulticenter, qualitative study using semi-directed interviews between January and May 2019. All medical staff working full-time in the ICU of five participating centres (two academic and three general, non-academic hospitals) were invited to participate. Participants were asked to describe how they experienced non-readmission decisions in the ICU, and to expand on the manner in which the decision was made, but also on the traceability and timing of the decision. Interviews were recorded, transcribed and analyzed using textual content analysis.ResultsIn total, 22 physicians participated. Interviews lasted on average 26±7 minutes. There were 14 men and 8 women, average age was 35±9 years, and average length of ICU experience was 7±5 years. The majority of respondents said that they regretted that the question of non-readmission was not addressed before the initial ICU admission. They acknowledged that the ICU stay did lead to more thorough contemplation of the overall goals of care. Multidisciplinary team meetings could help to anticipate the question of readmission within the patient’s care pathway. Participants reported that there is a culture of collegial decision-making in the ICU, although the involvement of patients, families and other healthcare professionals in this process is not systematic. The timing and traceability of non-readmission decisions are heterogeneous.ConclusionsNon-readmission decisions are a major issue that raises ethical questions surrounding the fact that there is no discussion of the patient’s goals of care in advance. Better anticipation, and better communication with the patients, families and other healthcare providers are suggested as areas that could be targeted for improvement.

At the nexus of music and medicine, some see treatments for disease

When physician Babar Khan started studying delirium seven years ago, he set out to find a drug that could sooth the agitation, inattention, and hallucinations that characterize the disorder. Delirium is common in the intensive care units (ICUs) where Khan works, most recently as an ICU physician at Indiana University School of Medicine and a researcher at Regenstrief Institute, both in Indianapolis. Some 70–80% of ventilated patients in the ICU experience episodes of delirium that not only prolong their stay in hospital but can also lead to long-term cognitive decline. Neurologists, cognitive neuroscientists, and clinicians are coming together to study the therapeutic potential of music. Image credit: Shutterstock/agsandrew. In the mid-2000s, Khan led two antipsychotic drug trials, neither of which worked for delirium. “So I started looking into more holistic interventions,” he says. He recalled seeing some evidence, drawn from assessments of anxiety and sedative exposure in hospital patients, suggesting that music can not only ease anxiety in the ICU but can help with pain management (1). The music-related findings would spur Khan to start investigating music as an alternative to pharmaceuticals. He recently co-led a 2020 pilot trial using music to alleviate delirium in mechanically ventilated ICU patients. Encouragingly, he found that relaxing, slow-tempo classical music reduced patients’ number of delirium days (2). That study is one of many new projects seeking evidence for music as a medical therapy. Cultures have used music in healing for centuries. Although the evidence is still limited, a growing body of research offers increasing promise for music’s health benefits. And the field is seeing a new injection of funding. Based on his pilot trial, Khan secured funding for a confirmatory trial through the Sound Health initiative, a partnership between the the National Institutes of Health (NIH) and the Washington, DC-based John F. …

Prevalence of burnout among intensivists in mainland China: a nationwide cross-sectional survey

BackgroundBurnout has gained increasing attention worldwide; however, there is a lack of relevant research in China. This study investigated the prevalence and factors associated with burnout in physicians of the intensive care unit (ICU) in mainland China.MethodsThis cross-sectional multicenter study included critical care physicians from all provinces in mainland China (except Tibet). A self-administered survey questionnaire was conducted. It included three parts: demographic information, lifestyle and work information, and the Maslach Burnout Inventory. The levels of burnout were calculated. The factors independently associated with burnout were analyzed by logistic regression.ResultsFinally, 1813 intensivists participated in the survey. The participation rate was 90.7%. The prevalence of burnout and severe burnout was 82.1% (1489/1813) and 38.8% (704/1813), respectively. According to the logistic regression analysis, “difficulty in making treatment decisions” was independently associated with burnout [OR = 1.365, CI (1.060, 1.757)]. “Higher number of children” [OR = 0.714, CI (0.519, 0.981)] and higher “income satisfaction” [OR = 0.771, CI (0.619, 0.959)] were independent protective factors against severe burnout.ConclusionsThe burnout rate in ICU physicians in China is high. Difficult treatment decisions, the number of children, and income satisfaction are independently associated with burnout rates among ICU physicians in China.Trial registration: Burnout syndrome of the Chinese personnel working in intensive care units: a survey in China, ChiCTR-EOC-17013044, registered October 19, 2017. http://www.chictr.org.cn/showproj.aspx?proj=22329.

Psychophysical impact of the covid-19 pandemic on healthcare workers in argentina. The imppacts-sac.20 survey

Background: The Coronavirus-2 (SARS-CoV-2) pandemic has generated negative psychological effects in the whole population. Our objective was to describe this impact on health care workers of Argentina. Methods: This was a cross-sectional, multicenter study evaluating anxiety, depression, burnout, and alterations in lifestyle and interpersonal relationships by means of an anonymous survey carried out from June to September 2020. Results: A total of 1221 healthcare workers, with median age 42 years (IQR 34.5-52) and 65% women were surveyed for the study. Among them, 77.2% lived in the Autonomous City of Buenos Aires and the Buenos Aires province;66.7% were specialist physicians or nurses, 41.1% were clinical specialists, 29.8% intensive care or coronary care unit physicians and 10.2% kinesiologists or nurses. In 51.8% of cases, healthcare workers reported that all biosafety recommendations were not met in their workplaces. Anxiety was detected in 40.5% of cases, major depression in 22.1% (4.5% referred frequent suicidal ideation), minor depression in10.9% and burnout in 38.7%. Smoking increased in 9.4% of healthcare workers and alcohol consumption in 22%;62.1% declared worse sleep quality, 50.2% reduced physical activity, 18.4% worsened their affective relationship and 40.4% suffered discrimination for being health workers. Conclusion: The Coronavirus pandemic has produced an increase in depression, anxiety, burnout and unhealthy lifestyle habits in healthcare workers surveyed in Argentina.

Spiritual care in the intensive care unit.

The aim of the present paper is to describe the real possibilities of providing spiritual care in intensive care units (ICUs) in Poland. Faced with suffering and death, critically ill patients and their families need asource of comfort and hope. Spiritual care is intended to bring relief to them by responding to their spiritual needs. The literature review indicates the positive effects of providing spiritual care in ICUs. Spiritual care improves the quality of life of patients, satisfaction with medical care and even prevents or alleviates the negative psychological consequences of hospitalization. Moreover, it is beneficial to the ICU personnel, to their motivation, work efficiency, well-being and reduces the risk of burnout. Basic spiritual care that can be provided by any ICU physician on adaily basis is nothing more than the way of behaving towards apatient: seeing an individual who has his/her dignity, history, personality, beliefs, fears and hopes. Whenever disease-associated stress has led to an existential crisis, the ICU staff may request ahospital chaplain's visit. The physician can support the conscious patient by establishing arelationship with him: by showing concern, compassion and solicituide. According to some researchers, each patient admitted to the ICU should be asked questions about spiritual issues. If faith is important to the patient, it is necessary to allow him/her to use religious resources, which requires cooperation with ahospital chaplain. The paper discusses the ways the hospital chaplaincy operates in Poland and worldwide. Furthermore, the education of chaplains abroad and the scope of their tasks and activities are described.

Impact of nonclinical factors on intensive care unit admission decisions: a vignette-based randomized trial (V-TRIAGE).

ObjectiveTo assess the impact of intensive care unit bed availability, distractors and choice framing on intensive care unit admission decisions.MethodsThis study was a randomized factorial trial using patient-based vignettes. The vignettes were deemed archetypical for intensive care unit admission or refusal, as judged by a group of experts. Intensive care unit physicians were randomized to 1) an increased distraction (intervention) or a control group, 2) an intensive care unit bed scarcity or nonscarcity (availability) setting, and 3) a multiple-choice or omission (status quo) vignette scenario. The primary outcome was the proportion of appropriate intensive care unit allocations, defined as concordance with the allocation decision made by the group of experts.ResultsWe analyzed 125 physicians. Overall, distractors had no impact on the outcome; however, there was a differential drop-out rate, with fewer physicians in the intervention arm completing the questionnaire. Intensive care unit bed availability was associated with an inappropriate allocation of vignettes deemed inappropriate for intensive care unit admission (OR = 2.47; 95%CI 1.19 - 5.11) but not of vignettes appropriate for intensive care unit admission. There was a significant interaction with the presence of distractors (p = 0.007), with intensive care unit bed availability being associated with increased intensive care unit admission of vignettes inappropriate for intensive care unit admission in the distractor (intervention) arm (OR = 9.82; 95%CI 2.68 - 25.93) but not in the control group (OR = 1.02; 95%CI 0.38 - 2.72). Multiple choices were associated with increased inappropriate allocation in comparison to the omission group (OR = 5.18; 95%CI 1.37 - 19.61).ConclusionIntensive care unit bed availability and cognitive biases were associated with inappropriate intensive care unit allocation decisions. These findings may have implications for intensive care unit admission policies.

Magnesium

Dear Editor, There is a constant emphasis on identifying possible supportive therapies to ameliorate the morbidity and mortality associated with the enigmatic COVID-19 pandemic which continues to bewilder the medical fraternity at large. In this context, Tang et al. recently proposed that a judicious magnesium supplementation can benefit the COVID-19 cohort like hypertensives, obstetrics, and those with cardiovascular morbidities and airway hyper-reactivity, given its anti-inflammatory, anti-oxidative, bronchial smooth-muscle relaxative role (heralding the beneficial impact on lung and airway related pathologies), as supported by clinical and pre-clinical research.[1] As an extension of their proposition, the membrane stabilizing properties of magnesium can be particularly useful to an intensive care unit (ICU) physician in attenuating the risk of torsades de pointes with concomitant pro-arrhythmogenic therapies such as hydroxycholoroquine and macrolides, etc. While the drug is also effective against the majority of the other arrhythmias described with an underlying severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the attributes like analgesia-potentiation and seizure-threshold elevation can equally contribute to the welfare of ICU-admitted COVID-19 patients.[2] In addition, magnesium has been suggested to have a role in staging the innate and adaptive immune-responses instrumental in combating the viral infection.[2] Moreover, the COVID-19 subset described to be vulnerable to a severe form of disease, such as the elderly cardiac patients are peculiarly prone to magnesium deficiency given the dietary insufficiency alongside the commonplace diuretic therapy. While magnesium deficiency is understandably frequent in critically ill with co-existing electrolyte disturbances, the lack of account of magnesium homeostasis in studies depicting hypokalemia in substantial percentage of COVID-19 patients mandates elucidation.[1] This elucidation becomes all the more relevant in the context of an ongoing COVID-related systemic inflammatory process being potentially compounded by an accompanying magnesium deficiency.[1] The description of a significant inverse-relationship between the dietary magnesium and the serum C-reactive protein (CRP) bears testimony to the aforementioned.[3] Furthermore, a systematic review and meta-analysis by Simental-Mendia et al. revealed a reduction of CRP levels attributable to magnesium supplementation in diverse inflammatory settings.[4] Remarkably, the depiction of an attenuated lipopolysaccharide-inflicted acute lung injury in mice treated with magnesium sulfate adds to the contextual significance amidst the pandemic.[5] Hypomagnesemia can be an important underemphasized factor that might propel the severity progression of COVID-19. Therefore, serum magnesium merits meticulous attention wherein subsequent closely monitored supplementation can be pivotal in assisting the management of high-risk SARS-CoV-2 patients. Nevertheless, while administering this versatile drug, caution needs to be exercised in critically ill patients with altered renal clearance and those on concomitant neuromuscular blockers. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience

Background:The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region.Methods:We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors.Results:A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin.Conclusion:We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.

Importance of empathy level and communication skills of intensive care unit physicians in kidney transplantation

Importance of empathy level and communication skills of intensive care unit physicians in kidney transplantation

Safe Rehabilitation Practices For COVID-19 Patients on Mechanical Ventilators in the Intensive Care Units

A new type of coronavirus called Severe Acute Respiratory Syndrome (SARS-Cov-2) emerged in the city of Wuhan of China in December 2019. Due to its highly infectious nature, the new coronavirus (COVID-19) has spread over to more than 200 countries in the world and continues to infect more and more people worldwide. According to the World Health Organization, 5% of COVID-19 patients require the use of mechanical ventilators. Due to the fragility of the COVID-19 patients, it is of utmost importance that safe exercises that are supported with evidence are applied to these patients. Whole-body vibration, cycle ergometer, and electrical muscle stimulation were all investigated in this review and evaluated in terms of their safety, feasibility, practicality, and the quality of evidence presented. According to the current evidence in the literature, they were all deemed safe and feasible alternatives to active exercises that could put the patients’ health in jeopardy. Physiotherapists are recommended to work with the intensive care unit physicians regarding the implementation of these exercise programs and determine whether the patients with COVID-19 are suitable for the program. This review concluded that whole-body vibration, cycle ergometer, and electrical muscle stimulation modalities may serve as the safe rehabilitation practices for the physiotherapists worldwide to improve functional outcomes in patients with COVID-19, prevent muscle wasting, delirium, and decrease respiratory complications of COVID-19.

Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study.

Background: The outbreak of coronavirus disease 2019 (COVID-19) has led to a large and increasing number of patients requiring prolonged mechanical ventilation and tracheostomy. The indication and optimal timing of tracheostomy in COVID-19 patients are still unclear, and the outcomes about tracheostomy have not been extensively reported. We aimed to describe the clinical characteristics and outcomes of patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia who underwent elective tracheostomies.Methods: The multi-center, retrospective, observational study investigated all the COVID-19 patients who underwent elective tracheostomies in intensive care units (ICUs) of 23 hospitals in Hubei province, China, from January 8, 2020 to March 25, 2020. Demographic information, clinical characteristics, treatment, details of the tracheostomy procedure, successful weaning after tracheostomy, and living status were collected and analyzed. Data were compared between early tracheostomy patients (tracheostomy performed within 14 days of intubation) and late tracheostomy patients (tracheostomy performed after 14 days).Results: A total of 80 patients were included. The median duration from endotracheal intubation to tracheostomy was 17.5 [IQR 11.3–27.0] days. Most tracheotomies were performed by ICU physician [62 (77.5%)], and using percutaneous techniques [63 (78.8%)] at the ICU bedside [76 (95.0%)]. The most common complication was tracheostoma bleeding [14 (17.5%)], and major bleeding occurred in 4 (5.0%) patients. At 60 days after intubation, 31 (38.8%) patients experienced successful weaning from ventilator, 17 (21.2%) patients discharged from ICU, and 43 (53.8%) patients had died. Higher 60 day mortality [22 (73.3%) vs. 21 (42.0%)] were identified in patients who underwent early tracheostomy.Conclusions: In patients with SARS-CoV-2 pneumonia, tracheostomies were feasible to conduct by ICU physician at bedside with few major complications. Compared with tracheostomies conducted after 14 days of intubation, tracheostomies within 14 days were associated with an increased mortality rate.

Perceptions of Hyperoxemia and Conservative Oxygen Therapy in the Management of Acute Respiratory Failure.

Rationale: Mechanically ventilated patients in the intensive care unit (ICU) are often managed to maximize oxygenation, yet hyperoxemia may be deleterious to some. Little is known about how ICU providers weigh tradeoffs between hypoxemia and hyperoxemia when managing acute respiratory failure. Objectives: To define ICU providers' mental models for managing oxygenation for patients with acute respiratory failure and identify barriers and facilitators to conservative oxygen therapy. Methods: In two large U.S. tertiary care hospitals, we performed semistructured interviews with a purposive sample of ICU nurses, respiratory therapists, and physicians. We assessed perceptions of oxygenation management, hyperoxemia, and conservative oxygen therapies through interviews, which we audio recorded and transcribed verbatim. We analyzed transcripts for representative themes using an iterative thematic-analysis approach. Results: We interviewed 10 nurses, 10 respiratory therapists, 4 fellows, and 5 attending physicians before reaching thematic saturation. Major themes included perceptions of hyperoxemia, attitudes toward conservative oxygen therapy, and aspects of titrated-oxygen-therapy implementation. Many providers did not recognize the term "hyperoxemia," whereas others described a poor understanding; several stated they never encounter hyperoxemia clinically. Concerns about hyperoxemia varied: some providers believed that typical ventilation strategies emphasizing progressive lowering of the fraction of inspired oxygen mitigated worries about excess oxygen administration, whereas others maintained that hyperoxemia is harmful only to patients with chronic lung disease. Almost all interviewees expressed familiarity with lower oxygen saturations in chronic obstructive pulmonary disease. Cited barriers to conservative oxygen therapy included concerns about hypoxemia, particularly among nurses and respiratory therapists; perceptions that hyperoxemia is not harmful; and a lack of clear evidence supporting conservative oxygen therapy. Interviewees suggested that interprofessional education and convincing clinical trial evidence could facilitate uptake of conservative oxygenation. Conclusions: This study describes attitudes toward hyperoxemia and conservative oxygen therapy. These preferences and uncertain benefits and risks of conservative oxygen therapy should be considered during future implementation efforts. Successful oxygen therapy implementation most likely will require 1) improving awareness of hyperoxemia's effects, 2) normalizing lower saturations in patients without chronic lung disease, 3) addressing ingrained beliefs regarding oxygen management and oxygen's safety, and 4) using interprofessional education to obtain buy-in across providers and inform the ICU team.

Elucidating the pivotal role of convalescent plasma therapy in critically ill COVID-19 patients: A review.

World Health Organization (WHO) declared coronavirus disease (COVID-19) a pandemic in March 2020. Currently almost every country in the world has reported cases with moderate to high mortality rates. The European Union (EU), the United States of America (USA) and the United Kingdom (UK) are the severely affected countries. Nevertheless, the WHO is very much concern about countries with weak health systems. The clinical characteristics of COVID-19 varies extensively, ranging from asymptomatic infections to severe as well as critical pneumonia with high mortality rates in the elderly and patients with co-morbid medical illness. Convalescent Plasma Therapy (CPT) has been successfully used in treating various viral disease outbreaks such as 1918 influenza pneumonia pandemic, poliomyelitis, measles, mumps, Machupo virus, Junin virus, Lassa virus, Ebola etc. High-titer specific antibodies maybe capable of binding to Coronavirus- 19 (CoV-19) and neutralize the viral particles, inhibit entry to uninfected cells, and trigger potent effector mechanisms such as complement activation as well as phagocytosis. Therefore, in most countries with very weak health systems with no Intensive Care Units (ICUs) or trained ICU physicians, early initiation of CPT for severely COVID- 19 patients may be rewarding. Therefore, solidarity control trials on CPT for COVID- 19 patients involving large number of patients are urgently needed.

Impact of a web-based module on trainees\u2019 ability to interpret neonatal cranial ultrasound

BackgroundAccurate interpretations of neonatal cranial ultrasound (CUS) studies are essential skills for physicians in neonatal intensive care units (NICUs) in order to properly diagnose and manage brain injury. However, these skills are not formally taught to pediatric and neonatal-perinatal medicine (NPM) trainees in Canada. Therefore, our study describes the design, implementation, and evaluation of a new web-based learning (WBL) module that focuses on teaching these skills.MethodsTrainees’ needs assessment survey, sent to all NPM and pediatrics trainees (n = 62), concluded that most of them feel uncomfortable with their ability to interpret CUS, highlighting the need for a new educational intervention. The needs assessment informed the development of the WBL module, which we evaluated using questionnaires and pre-and post-testing methods to measure participants’ satisfaction, knowledge gain, skills development, and behaviour changes. Only trainees rotating through the NICU over 6 months (n = 23) were invited to participate in all the evaluation steps. We used the ADDIE instructional design model as a framework for this project.ResultsRespondents were very satisfied with the module, and their baseline knowledge increased significantly after studying and engaging with the module. The post-test score was 76% (p < 0.001) compared to the pre-test mean score of 42%. Tests for CUS interpretation skills assessment showed that 49% of pre-test answers were incorrect compared to 8% in the post-test (p < 0.001). Seventy-eight percent of trainees (n = 18) responded to a survey conducted a year after implementation, and 78% of the respondents (n = 14) reported that they still used these skills and shared this knowledge with junior trainees.ConclusionA WBL module for teaching neonatal CUS interpretation considerably improved trainees’ knowledge and enhanced their skills in interpreting neonatal CUS.

The Psychological Impact of COVID-19 Disease is more Severe on Intensive Care Unit Healthcare Providers: A Cross-sectional Study.

ObjectiveFear, anxiety, depression and sleep deprivation are common mental health disorders in COVID-19 disease. We aimed to analyse the risk for healthcare providers during COVID-19 pandemic in a university hospital.MethodsAnesthesiologists, nurses and nurse anesthetists were invited to fill out the survey. The survey was consist of questions from ‘’The Fear of COVID-19 Scale’’, ‘’Patient Health Questionnaire’’ and ‘’Pittsburgh Sleep Quality Index’’ (PSQI). Each question was worth a point.ResultsThe data of 208 participants were analyzed. Mean age was 29 ± 7.748 years, 72.1% were male, 67.3% were nurses, 62% were working in intensive care units, 38% were in hospital wards, 62% of all participants were living alone. Moderate depression was the most frequently detected outcome (n = 90, 43.3%). Mean The Fear of COVID-19 Scale for all participants was 18.56 ± 7.731. The mean PSQI of patients was 6.18 ± 4.356 with a 45.7% rate of poor sleep quality. PSQI was found significantly higher in nurses (7.1 ± 4.7, p = 0.000). Nurses were the group with the highest deterioration in sleep quality (53.6%, p = 0.003). The rate of moderate-to-severe depressive symptoms was significantly higher in intensive care unit nurses and physicians (p = 0.018). PSQI score was found significantly higher in intensive care unit nurses and physicians than hospital ward co-workers (7.02 ± 4.59 vs. 4.81 ± 3.57 respectively, p = 0.001). A significant positive correlation was observed between PSQI and The Fear of COVID-19 Scale total score in all patients (p < 0.005).ConclusionDepression, anxiety, fear and sleep disorders may occur in healthcare workers during COVID-19 outbreak. Intensive care unit nurses were at highest risk.

The impact of caring for dying patients in intensive care units on a physician\u2019s personhood: a systematic scoping review

BackgroundSupporting physicians in Intensive Care Units (ICU)s as they face dying patients at unprecedented levels due to the COVID-19 pandemic is critical. Amidst a dearth of such data and guided by evidence that nurses in ICUs experience personal, professional and existential issues in similar conditions, a systematic scoping review (SSR) is proposed to evaluate prevailing accounts of physicians facing dying patients in ICUs through the lens of Personhood. Such data would enhance understanding and guide the provision of better support for ICU physicians.MethodsAn SSR adopts the Systematic Evidenced Based Approach (SEBA) to map prevailing accounts of caring for dying patients in ICUs. To enhance the transparency and reproducibility of this process, concurrent and independent use of tabulated summaries, thematic analysis and directed content analysis (Split Approach) is adopted.ResultsEight thousand three hundred fifty-eight abstracts were reviewed from four databases, 474 full-text articles were evaluated, 58 articles were included, and the Split Approach revealed six categories/themes centered around the Innate, Individual, Relational and Societal Rings of Personhood, conflicts in providing end of life care and coping mechanisms employed.ConclusionThis SSR suggests that caring for dying patients in ICU impacts how physicians view their personhood. To resolve conflicts within individual concepts of personhood, physicians use prioritization, reframing and rely on accessible, personalized support from colleagues to steer coping strategies. An adapted form of the Ring Theory of Personhood is proposed to direct timely personalized, appropriate and holistic support.

Mental health status of Chinese physicians working in intensive care unit.

Physicians working in intensive care unit (ICU) are prone to suffer from mental health problems, but there are still very limited data of mental health status of ICU physicians in China. Therefore, this study was to investigate their psychological status. ICU physicians were contacted electronically and asked to complete the Symptom Check-list 90 (SCL-90) for Chinese from December 13 to December 14 in 2018. A total of 1749 valid questionnaires were collected. Fifteen potential relevant factors that could affect the mental health status of ICU physicians were also analyzed by multivariate logistic regression. The total mean score of SCL-90 for surveyed subjects was 175.49±65.79. Near half of the respondents were identified with psychological symptoms. The pooled estimates of all the nine factors, including somatization, obsession-compulsion, interpersonal-sensitivity, depression, anxiety, hostility, phobic anxiety, and paranoid ideation among ICU physicians, were significantly higher than those in the general population (P<0.001). Multivariate analysis revealed that education, title, working hours per week, frequency of night shift were risk factors for psychological symptoms. The situation of psychological health of ICU physicians in China is worrying, and it is urgent to take some effective measures to improve their mental health.

Triage or Randomization – Who Receives a Chance of Survival in the COVID-19 Pandemic Crisis?

The COVID-19 pandemic has proven to be exceptionally challenging for health care worldwide. Media and politicians currently pay attention to the ethical dilemma of distributing a prospective and potentially scarce COVID-19 vaccine. Meanwhile, physicians in intensive care units that are running out of equipment and qualified staff face vital ethical dilemmas already today. The specific course of the COVID-19 virus leads to situations in which physicians are aware that they make a pivotal decision over the life or death of one patient, for the direct benefit or disadvantage of others. Until now, these decisions are left to the individual physician without legal backing. While guidelines by professional medical associations provide orientation, the law often stands idly by. The guidelines themselves are ethically and legally controversial. We draw on literature in the behavioral sciences to outline which pitfalls the current juridical situation may entail. We argue that polity has to decide whether there are criteria for duly justified cases in which the medical system has to prioritize patients, and the procedure to do so, to overcome the intolerable present legal situation. This will provide due justification and relief for physicians. We show how informative research on ethical dilemmas in autonomous driving can inform policymakers which triage criteria may find acceptance in society if dilemmatic resource shortages occur. If policymakers refuse to lay down criteria for triage, by which they would deliberately impose harm on some in order to avoid greater harm for others, every patient must be given an equal chance of treatment, irrespectively of age or condition. We argue that this would imply that ventilators and other vital medical resources have to be allocated randomly. Furthermore, we provide empirical evidence for the acceptance of randomization in emergencies during the COVID-19 pandemic. Polity has to provide legal certainty for physicians, who face ethical dilemmas induced by resource shortages. It has to define legally binding triage criteria, or else deliberately refuse to do so and rely on a random allocation of scarce resources among the needy, to explicitly exclude any kind of discrimination.