Breakthrough Covid-19 infections during periods of circulating Beta, Delta and Omicron variants of concern, among health care workers in the Sisonke Ad26.COV2.S vaccine trial, South Africa

Background: We report breakthrough infections (BTIs) during periods of circulating Beta, Delta and Omicron variants of concern, among health care workers (HCW) participating in the Sisonke phase 3B Ad26.COV2.S vaccine trial (ClinicalTrials.gov number, NCT04838795). Data were gathered between 17 February and 15 December 2021. Duration of each period in this study was 89 days for Beta, 180 days or Delta and 30 days for Omicron. Results: A total of 40 538 BTIs were observed, with 609 during Beta, 22 279 during Delta and 17 650 during Omicron. By 15 December, daily infections during Omicron were three times that seen during the peak observed during Delta. However, unlike the Delta period, with Omicron there was a clear and early de-coupling of hospitalisation from cases as a percentage of the Delta peak curves. Omicron significantly infected a greater proportion of HCW in the 18-30 year age-group, compared with the 55+ age group. There were 1 914 BTI-related hospitalisations - 77, 1 429 and 408 in the Beta (89 days), Delta (180 days) and Omicron (30 days) periods, respectively. During Omicron, 91% hospitalized HCWs required general ward care, 6% high care and 3% intensive care, compared with 89% general ward care, 4% high care and 7% intensive care, during Delta and 78% general care, 7% high care and 16% intensive care during Beta (p<0.001). During Beta and Beta 43% of hospitalized HCW needed supplementary oxygen and 7-8% needed ventilation, compared with 16% and 0.2% respectively during the Omicron period (p<0.001). Median length of hospitalization was significantly lower with Omicron compared with Beta and Delta (3 days compared with 5-6 days, p<0.001). Conclusions: We illustrate more BTIs but reassuringly less severe Covid-19 with Omicron. Re-infections and Omicron-driven primary infections were likely driven by high population SARS-CoV-2 seroprevalence, waning vaccine effectiveness over time, increased Omicron infectivity, Omicron immune evasion or a combination of these and need further investigation. Follow-up of this cohort will continue and reports will be updated, as time and infections accrue.

Trends in Acuity of Residents in Assisted Living

Assisted living serves as a substitute for nursing home residents with low care needs, especially in markets with a high proportion of dually eligible Medicare beneficiaries. This study examines trends in the acuity of residents in assisted living communities over time in comparison to nursing homes to characterize how substitution has affected the resident compositions of both settings. We also examine how trends in acuity are shaped by dual eligibility. Using Medicare claims data, we identify cross-sectional samples of beneficiaries in each setting from 2007-2017. The proportion of residents in assisted living with high care needs has increased 18% in assisted living communities compared to 8.7% in nursing homes. Acuity levels are higher among dually eligible assisted living residents compared to assisted living residents who are not dually eligible. Policy makers and administrators should examine whether assisted living is prepared to provide care for an increasingly acute population.

Findings From Implementation of the EIT-4-BPSD Trial

Behavioral and psychological symptoms of dementia (BPSD) include aggression, agitation, depression, anxiety, apathy and hallucinations and are exhibited by up to 90% of nursing home (NH) residents with dementia. BPSD result in negative health outcomes, functional decline, high care costs, increased risk for inappropriate use of antipsychotic medications and social isolation. Behavioral approaches are endorsed as the first line of treatment for BPSD. Despite regulatory requirements, less than 2% of nursing homes consistently implement these approaches. The EIT-4-BPSD Trial was done to test a novel implementation approach to assure that staff in nursing homes use non-pharmacologic, behavioral approaches for the management of BPSD. EIT-4-BPSD is a theoretically-based four-step approach that includes: 1. Assessment of the environment and policies; 2. Education of staff; 3. Establishing person-centered care plans; and 4. Mentoring and motivating staff. Implementation of the four-step approach was guided by the Evidence Integration Triangle (EIT). The EIT brings together evidence and key stakeholders from the NH and uses a participatory implementation processes, practical evidence-based interventions, and pragmatic measures of progress toward goals. A total of 55 nursing homes from two states and 553 residents were included in this study. Nursing homes were randomized to EIT-4-BPSD or education only. This symposium will describe the utility of the EIT as an implementation framework based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance model, report detailed effectiveness outcomes of EIT-4-BPSD at the setting and resident levels, and address recruitment and measurement challenges and future solutions to these challenges.

A descriptive study of demographics, triage allocations and patient outcomes at a private emergency centre in Pretoria

Background: Triage aims to detect critically ill patients and to prioritise those with time-sensitive needs, whilst contributing to the efficiency of an emergency centre (EC). International systems have been relatively well researched; however, little data exists on the use of the South African Triage Scale (SATS) in private healthcare settings in South Africa (SA).Methods: A retrospective descriptive study was undertaken. Data relating to demographics, application of triage, time in EC and disposition were collected on all patients presenting to the EC from 1st January to 31st December 2018.Results: A total of 29 055 patients’ data were included. The mean age was 41 years. Most patients were triaged yellow (73.5%); 17.4% were triaged as red and orange. Patients were seen by a doctor in a mean time of 28 min. Delays to be seen exceeded standards for red and orange patients at 8 min and 18 min, respectively. Most patients (76.1%) were discharged; 5.6% were admitted to intensive care unit (ICU)/high care, and 14.4% to general wards. Of patients triaged red and orange, 11.1% and 49.3% were discharged, respectively, whereas 81.7% of yellow patients were discharged home.Conclusion: This study found that most patients were triaged into low acuity categories and were discharged home. High acuity patients were usually admitted to ICU/high care; however, these patients experienced delays in receiving treatment. The causes of these issues, and the implications, remain unknown. Large numbers of high acuity patients were discharged home. Further studies are needed to understand the influence of triage accuracy on these patients’ outcomes.

Karakteristik Perawat Dan Kualitas Asuhan Raung Akut Psikiatri

Karakteristik ODGJ dengan ciri gangguan yang khas menyebabkan mereka membutuhkan penanganan yang khusus. Ruang PHCU atau Psychiatric High Care Unit merupakan ruang perawatan intensif psikiatri yang digunakan untuk merawat pasien dengan kondisi akut. Kualitas asuhan keperawatan di Ruang PHCU dipengaruhi oleh banyak faktor, salah satunya adalah karakteristik perawat. Penelitian ini merupakan penelitian deskriptif analitik dengan metode cross sectional. Populasi dari penelitian ini adalah perawat Ruang PHCU RSJ dr. H. Marzoeki Mahdi Bogor, adapun besar sampel yang diteliti ditentukan dengan metode total sampling. Pengambilan data dilakukan dengan menggunakan metode survey melalui penyebaran kuesioner dalam format digital. Uji statistik dilakukan untuk data univariat dan bivariat. Hasil penelitian pada analisis univariat diketahui bahwa perawat Ruang PHCU sebagian besar berusia ≥ 36 tahun, memiliki jenjang pendidikan non profesi dan memiliki masa kerja > 3 tahun. Gambaran kualitas asuhan berdasarkan determinan kualitas asuhan diketahui bahwa sebagian besar perawat mempunyai persepsi yang baik terkait pengembangan diri, pelaksanaan standar asuhan keperawatan, sarana dan prasarana serta ketersediaan anggaran untuk pemeliharaan sarana dan prasarana. Adapun persepsi yang kurang baik terjadi pada pengukuran determinan terkait ketersediaan anggaran untuk diklat dan anggaran untuk imbal jasa atau remunerasi. Pada analisis bivariat yang dilakukan dengan menggunakan uji chi-square dengan tingkat kemaknaan 95% dan nilai α ≤ 0,05, diketahui bahwa tidak ada hubungan antara usia, tingkat pendidikan dan masa kerja perawat dengan kualitas asuhan keperawatan.

Factors affecting missed nursing care in hospitalized frail older adults in the medical wards: a qualitative study

Background Frail older adults who are hospitalized, are more likely to experience missed nursing care (MNC) due to high care needs, communication problems, and complexity of nursing care. We conducted a qualitative study to examine the factors affecting MNC among hospitalized frail older adults in the medical units. Methods This qualitative study was carried using the conventional content analysis approach in three teaching hospitals. Semi-structured interviews were conducted with 17 nurses through purposive and snowball sampling. The inclusion criteria for the nurses were: at least two years of clinical work experience on a medical ward, caring for frail older people in hospital and willingness to participate. Data were analyzed in accordance with the process described by Graneheim and Lundman. In addition, trustworthiness of the study was assessed using the criteria proposed by Lincoln and Guba. Results In general, 20 interviews were conducted with nurses. A total of 1320 primary codes were extracted, which were classified into two main categories: MNC aggravating and moderating factors. Factors such as “age-unfriendly structure,” “inefficient care,” and “frailty of older adults” could increase the risk of MNC. In addition, factors such as “support capabilities” and “ethical and legal requirements” will moderate MNC. Conclusions Hospitalized frail older adults are more at risk of MNC due to high care needs, communication problems, and nursing care complexity. Nursing managers can take practical steps to improve the quality of care by addressing the aggravating and moderating factors of MNC. In addition, nurses with a humanistic perspective who understand the multidimensional problems of frail older adults and pay attention to their weakness in expressing needs, can create a better experience for them in the hospital and improve patient safety.

Association between care burden, depression and personality traits in Alzheimer’s caregiver: A pilot study

Introduction In this study correlations between care burden, depression, and personality at intrapsychic level in caregivers of Alzheimer’s disease patients were evaluated. Materials and methods Caregivers: n.40. Tests: Social-schedule; CBI; BDI; SASB-Structural-Analysis of Social Behaviours- Form-A- intrapsychic behaviours (8 Cluster); ECOG. Patients:MMSE. Statistical analysis: Chi-squared test; Anova one way F test; Pearson’s R coefficient. Results Correlations: CBI-total and NPI(p < .001); CBI-total—ECOG (p = .042); CBI-total—BDI(p< .001); CBI- total-SASB-Cl7(p = .014); SASB-CL8(p<0.000); BDI and SASB-Cl 2 (p = .018), SASB-Cl 3 (p = .004), SASB-Cl7(p < .000), SASB-CL8 (p < .000). High CBI is correlated with high depression, neuropsychiatry symptoms, low cognitive patient’s functions. Caregivers have the following intrapsychic behaviors: poor self-care, poor ability to take care of themselves; they exercise control over themselves and do not consider and/or ignore their basic needs at emotional and physical levels. These intrapsychic behaviours are indicators of depression (SASB Model) and are correlated with high care burden–CBI and high depression-CDQ. Discussion Care burden is closely related to the depression and individual personality (intrapsychic experience) of the caregiver. This may reveal a source of strength and may suggest areas of multidimensional and psychotherapeutic interventions.

Delivering Bad News: Should Physicians Express their Emotions?

The traditionally assumed medical dictum is that a physician who expresses his or her emotions in font of patients or their families is almost deemed unprofessional. This feeling may be common place, particularly among traditional physicians who still hold the belief that professionalism is endangered if physicians deliver bad news laced with their true emotions. Discussion of this important topic surfaces now and then and are then hidden away without definite answers possibly due to lack of attention by physician's fraternity to dispense with this out-of-date dictum. Though we understand the protection of professionalism is the basis for this practice, the topic is rarely revisited because the community of physicians remains distant from this sensitive issue, in spite of its importance in achieving high care satisfaction from patients and their families. In view of the increased emphasis on enhancing patients’ hospital experiences and satisfaction, the demonstration of sensitivity on the part of physicians in some form as a component of their compassionate care may require renewed attention.