Post-Intensive Care Syndrome in Survivors from Critical Illness including COVID-19 Patients: A Narrative Review

Current achievements in medical science and technological advancements in intensive care medicine have allowed better support of critically ill patients in intensive care units (ICUs) and have increased survival probability. Post-intensive care syndrome (PICS) is a relatively new term introduced almost 10 years ago, defined as “new or worsening impairments in physical, cognitive, or mental health status arising after critical illness and persisting beyond acute care hospitalization”. A significant percentage of critically ill patients suffer from PICS for a prolonged period of time, with physical problems being the most common. The exact prevalence of PICS is unknown, and many risk factors have been described well. Coronavirus disease 2019 (COVID-19) survivors seem to be at especially high risk for developing PICS. The families of ICU survivors can also be affected as a response to the stress suffered during the critical illness of their kin. This separate entity is described as PICS family (PICS-F). A multidisciplinary approach is warranted for the treatment of PICS, involving healthcare professionals, clinicians, and scientists from different areas. Improving outcomes is both challenging and imperative for the critical care community. The review of the relevant literature and the study of the physical, cognitive, and mental sequelae could lead to the prevention and timely management of PICS and the subsequent improvement of the quality of life for ICU survivors.

Thromboelastography after Cardiopulmonary Bypass: Does it Save Blood Products?

Introduction. This study aimed to determine if thromboelastography (TEG) is associated with reduced blood product use and surgical re-intervention following cardiopulmonary bypass (CPB) compared to traditional coagulation tests. Methods. A retrospective review was conducted of 698 patients who underwent CPB at a tertiary-care, community-based, university-affiliated hospital from February 16, 2014 – February 16, 2015 (Period I) and May 16, 2015 - May 16, 2016 (Period II). Traditional coagulation tests guided transfusion during Period I and TEG guided transfusion during Period II. Intraoperative and postoperative administration blood products (red blood cells, fresh frozen plasma, platelets, and cryoprecipitate), reoperation for hemorrhage or graft occlusion, duration of mechanical ventilation, hospital length of stay and mortality were recorded. Results. Use of a TEG-directed algorithm was associated with a 13.5% absolute reduction in percentage of patients requiring blood products intraoperatively (48.2% vs. 34.7%, p <0.001). TEG resulted in a 64.3% and 43.1% reduction in proportion of patients receiving FFP and platelets, respectively, with a 50% reduction in volume of FFP administered (0.3 vs. 0.6 units, p < 0.001). Use of TEG was not observed to significantly decrease postoperative blood product usage or mortality. The median length of hospital stay was reduced by 1 day after TEG guided transfusion was implemented (nine days vs. eight days, p = 0.01). Conclusions. Use of TEG-directed transfusion of blood products following CPB appears to decrease the need for intraoperative transfusions, but the effect on clinical outcomes has yet to be clearly determined.

The Implementation of AIDS Care Community (ACC) Work Program as an Efforts for Handling HIV / AIDS Cases in Poncol Community Health Center Work Area

Introduction: Semarang City has the highest number of HIV / AIDS cases in Central Java. Several attempts to control HIV / AIDS cases, such as the organization for AIDS that is named after AIDS Care Community (ACC) in every village scope. The purpose of this study is to describe the implementation of the ACC program in Poncol Community Health Center.Methods: This is a descriptive research, uses qualitative methods using in-depth interview for data collection techniques. There are 9 informants who are selected by using purposive sampling method. Data is analyzed using descriptive method. The process of data analysis begins with collecting data, and then reducing the data that has been generated. After that, the data are presented and concluded.Results: The results show that the implementation of ACC program in the work area of Poncol Community Health Center is assisted by Poncol Puskesmas. There is 1 ACC out of 9 ACC that is actively implementing the ACC program while the others are not running well. It is found that low capacity of ACC members, lack of funds, low of support from the local government (village), low community support, inadequate facilities and infrastructure that affect the implementation of ACC programs. Therefore, the output is not achieved optimally.Conclusions: The implementation of the of the ACC program in Poncol Community Health Center work area has not been running optimally. Support from all parties is needed, including from the members of the ACC, local government, AIDS commission, and the community in order to achieve the ACC goals.

Analysing student achievement of advanced pharmacy practice experience learning outcomes

Objectives: To assess the learning outcome achievement of the required Advanced Pharmacy Practice Experiences (APPE) for the purposes of accreditation, quality improvement, and practice readiness. Methods: At the end of each APPE rotation, students were evaluated on 11 professionalism criteria and 25 skills criteria via a rubric. For the four required rotations (ambulatory patient care, community pharmacy, inpatient general medicine patient care and hospital/health system pharmacy), professionalism and skills outcomes data for the class of 2020 were analysed. Results: A total of 6,293/6,303 (99.84%) of the professionalism ratings met expectations (received a score > 2). The median professionalism rating was 3. A total of 14,286/14,325 (99.7%) of the skills ratings met expectations (received a score > 3). The median skills rating was 4. Conclusion: Calculating and analysing APPE student achievement of learning outcomes supports accreditation standards, can be used for quality improvement and measures practice readiness.

Effectiveness of complete primary vaccination against COVID-19 at primary care and community level during predominant Delta circulation in Europe: multicentre study analysis by age-group, vaccine brand and time since vaccination, I-MOVE-COVID-19 and ECDC networks, July–August 2021

IntroductionIn July and August 2021, the SARS-CoV-2 Delta variant dominated in Europe. We measured COVID-19 vaccine effectiveness (VE) against symptomatic infection, using a multicentre test-negative study at primary care/community level in Europe.MethodsPatients presenting with COVID-19/ARI symptoms at primary care/community level in 10 countries were tested for SARS-CoV-2. We measured complete primary course overall VE among those aged 30–44, 45–59, 60–74 and ≥75 years, and among those 30–59 and ≥60 years by vaccine brand and by time since vaccination.ResultsOverall VE was 74% (95%CI: 69–79), 76% (95%CI: 71–80), 63% (95%CI: 48–75), 63% (95%CI: 16–83) among those aged 30–44, 45–59, 60–74 and ≥75 years, respectively. VE among those aged 30–59 years was 78% (95%CI: 75–81), 66% (95%CI: 58–73), 91% (95%CI: 87–94) and 52% (95%CI: 40–61), for Comirnaty, Vaxzevria, Spikevax and COVID-19 Vaccine Janssen, respectively. VE among those aged ≥60 years was 67% (95%CI: 52–77), 65% (95%CI: 48–76), 83% (95%CI: 64–92) for Comirnaty, Vaxzevria and Spikevax, respectively. Comirnaty VE among those aged 30–59 years was 87% (95%CI: 83–89) and 65% (95%CI: 56–71%) at 14–29 days and ≥90 days between vaccination and onset of symptoms, respectively.ConclusionsVE against the symptomatic SARS-CoV-2 Delta variant infection varied among brands, ranging from 52–91%. While some waning of the vaccine effect may be present (sample size limited this analysis to only Comirnaty), protection was 65% ≥90 days between vaccination and onset.

Experiences and Disease Self-Management in Individuals Living With Chronic Kidney Disease: Qualitative Analysis of the National Kidney Foundation's Online Community

Background: Self-management of chronic kidney disease (CKD) is one of the keys in improving CKD outcomes and quality of life. There has been an increased use of online health communities to share the experiences of those living with CKD. By analyzing the CKD online forum data, this study aims to: 1) understand the experiences and challenges of individuals living with CKD, and 2) explore how online communities may help CKD patients in improving CKD self-management. Methods: Publicly available posts of peer interactions on the National Kidney Foundation's online community for people affected by CKD were extracted in April 2021 using computer programming. A total of 20,436 posts were collected, of which 400 posts were analyzed using inductive thematic analysis, and saturation was reached. Two researchers coded each post independently, and discrepancies were discussed to reach consensus. Results: The analysis identified seven themes: 1) Dynamics of CKD status, 2) CKD comorbidities, 3) Managing CKD and symptoms, 4) Life participation and outlook; 5) Navigating healthcare and clinical needs, 6) Medical tests and results; and 7) Support on the forum. The results revealed that comorbidities were common in CKD patients and early-stage CKD was not communicated in a timely manner to patients by the health care community; living with CKD challenged both CKD and caregivers; some common challenges included but were not limited to the management of a diet for CKD and co-morbidities (especially co-morbid diabetes), CKD dynamics and symptoms, and fear of/ways to prevent progression. Individuals living with CKD primarily used the online forum to share and seek information and emotional support for managing CKD (including co-morbidities). Conclusions: Challenges of living with CKD were found not only in those with advanced kidney disease and those on dialysis, but also in those with early and middle stages. Information and emotional support from the online forum serves as a platform to empower CKD patients with the knowledge, skills and confidence for CKD self-management. Proactive and innovative strategies with a combination of virtual and real settings to improve self-management for individuals with all-stage CKD needs to be explored and tailored.

Psychological Distress and Coping Strategies among Nurses during the COVID-19 Pandemic: A Cross-Sectional Online Survey

Background: The emergence of COVID-19 has a significant impact on nurse’s overall health. The severity and magnitude of the COVID-19 pandemic means it is extremely likely that health-care professionals will experience psychological distress as a result of their direct contact with patients who have contracted the infection. Objectives: This study aimed to evaluate levels of psychological distress among nurses during the COVID-19 pandemic, determine the associated factors, and identify nurses’ coping strategies. Methods: This study is a cross-sectional design. Overall, 130 nurses answered online questionnaires. The questionnaires measured sociodemographic characteristics, Fear of COVID-19 Scale, the Depression, Anxiety, and Stress Scale, and the Brief Coping Inventory. Results: Nurses have a moderate level of fear (mean score: 24.34 ± 13.43) and depression (43.8% of the sample), and severe anxiety (73.8%) and stress (45.4%). Anxiety and fear were positively correlated (r = .675, p < .001). Independent t-tests revealed that female nurses had higher psychological distress and fear than male nurses (p = 0.015 and p = 0.038, respectively). Nurses who cared for patients who had tested positive for coronavirus disease 2019 and those who had a friend or family member who had tested positive had higher fear and psychological distress than their respective counterparts (p < .001 and p = .010, respectively). Working more hours was moderately correlated with fear and anxiety (p = 0.016). Nurses were found to generally adopt maladaptive coping styles. Conclusion: Through careful study of the factors determined through this research to be associated with psychological distress among nurses, the health-care community can better prepare to mitigate nurses’ emotional and psychological toll in future pandemic situations. Working with patients who have tested positive for COVID-2019 causes psychological distress for nurses.